Confidentiality Of Patient Information Research Articles

Comparison of All-Cause Mortality in England With European Countries and the USA: January 2020 Through to February 2021: A Secondary Analysis of Routine Administrative Data

Background: Assessments of mortality continue to inform public health strategies and policy making during the COVID-19 pandemic. All-cause excess mortality is a robust measure of the impact of the pandemic. Our study assesses the relative burden of excess mortality in England during the pandemic compared with 28 European countries and the USA. Methods: Weekly deaths and population estimates were obtained from Eurostat or directly from national statistical and public health agencies. Contextual information on COVID-19 case rates and population-level risk factors were obtained from open-source databases. Weekly directly age-standardised mortality rates (ASMRs) during week 1 2020 to week 7 2021 were calculated and summed cumulatively. These were compared with weekly sums of mean ASMRs observed between 2015 and 2019 and presented relative to the mean cumulative 2015-2019 ASMR averaged over an equivalent period. Findings: By February 2021, England had an overall relative excess mortality of 10·05%. This was the fifth highest out of 29 countries, the USA (14·82%) being the highest. Five countries showed below average mortality, with Norway the lowest (-6·76%). The same statistic for deaths under 65 years showed substantial international variation, with England having the second highest excess of 11·46%. Cumulative COVID-19 case rates explained about half of the international variation in relative excess mortality. Interpretation: England has experienced comparably high all-cause excess mortality during the COVID-19 pandemic. Factors contributing to England’s relative position should be further explored, particularly the association of health inequalities and wider determinants of health on the mortality risk of younger age groups. Funding Information: This study was carried out as part of the PHE’s work during the pandemic and therefore funded by PHE. Declaration of Interests: All authors declare no conflicts of interest. Ethics Approval Statement: This study was carried out as part of the PHE responsibility to manage the COVID-19 pandemic. PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002 to process confidential patient information (http://www.legislation.gov.uk/uksi/2002/1438/regulation/3/made) under Sections 3(i) (a) to (c), 3(i)(d) (i) and (ii) and 3(3) as part of its outbreak response activities. As such this work falls outside the remit for ethical review. The study was subject to an internal review by the PHE Research Ethics and Governance Group and was found to be fully compliant with all regulatory requirements. As a full ethical review is not a requirement for this type of study and as no ethical or regulatory issues had been identified the study was approved.

COVID-19 Outbreaks in Nurseries During Rapid Spread of the B.1.1.7 Variant of SARS-CoV-2 in England: Cross-Sectional National Surveillance, November 2020 – January 2021

Background: The reopening of schools during the COVID-19 pandemic has raised concerns about widespread infection and transmission of SARS-CoV-2 in educational settings. In June 2020, Public Health England (PHE) initiated prospective national surveillance of SARS-CoV-2 in primary schools across England (sKIDs). We used this opportunity to assess the feasibility and agreeability of large-scale surveillance and testing for SARS-CoV-2 infections in school among staff, parents and students.Methods: Staff and students in 131 primary schools were asked to complete a questionnaire at recruitment and provide weekly nasal swabs for SARS-CoV-2 RT-PCR testing (n=86) or swabs with blood samples for antibody testing (n=45) at the beginning and end the summer half-term. In six blood sampling schools, students were asked to complete a pictorial questionnaire before and after their investigations.Results: In total, 134 children aged 4-7 years (n=40) or 8-11 years (n=95) completed the pictorial questionnaire fully or partially. Prior to sampling, oral fluid sampling was the most acceptable test (107/132, 81%) followed by throat swabs (80/134, 59%), nose swabs (77/132, 58%), and blood tests (48/130, 37%). Younger students were more nervous about all tests than older students but, after completing their tests, most children reported a “better than expected” experience with all the investigations. Students were more likely to agree to additional testing for nose swabs (93/113, 82%) and oral fluid (93/114, 82%), followed by throat swabs (85/113, 75%) and blood tests (72/108, 67%). Parents (n=3,994) and staff (n=2,580) selected a preference for weekly testing with nose swabs, throat swabs or oral fluid sampling, although staff were more flexible about testing frequency. Conclusions: Primary school staff and parents were supportive of regular tests for SARS-CoV-2 and selected a preference for weekly testing. Children preferred nose swabs and oral fluids over throat swabs or blood sampling.Funding Statement: This surveillance was internally funded by PHE and did not receive any specific grant funding from agencies in the public, commercial or not-for-profit sectors.Declaration of Interests: None.Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases and as such, individual patient consent is not required.

The Impact of the COVID-19 Pandemic on Invasive Pneumococcal Disease and the Risk of Pneumococcal Coinfection with SARS-CoV-2: Prospective National Cohort Surveillance, England

Background: Streptococcus pneumoniae coinfection with seasonal and pandemic influenza results in synergistic lethality, but there are limited data on pneumococcal coinfection with SARS-CoV-2 during the current COVID-19 pandemic.Methods: Public Health England conducts invasive pneumococcal disease (IPD) and COVID-19 surveillance in England. IPD trends from 2000/01 to 2019/20 were analysed and cases between 01 February and 30 June 2020 were linked with laboratory-confirmed SARS-CoV-2 infections.Findings: IPD incidence in 2019/20 (7.6/100,000; 3,964 cases) was 30% (IRR 0.70, 95%CI, 0.18-2.67) lower compared to 2018/19 (10.9/100,000, 3,964 cases) with large reductions observed across all age-groups during March-June 2020. The serotypes responsible for IPD during 2019/20 were similar to previous years. There were 160,886 SARS-CoV-2 infections and 1,159 IPD cases between February and June 2020, including 40 IPD/SARS-CoV-2 coinfections (0.025% [95%CI, 0.018-0.034] of SARS-CoV-2 infections; 3.5% [95%CI, 2.5-4.8] of IPD cases), 21 with COVID-19 diagnosed 3-28 days after IPD and 27 who developed COVID-19 >28 days after IPD. Case fatality was 63.2% (25/40) in the coinfection group compared to 47.6% (10/21) in those who developed COVID-19 3-14 days after IPD, and 33.3% (9/27) in patients who developed IPD and COVID-19 more than 28 days apart (pInterpretation: The COVID-19 pandemic and the consequent lockdown was associated with large declines in IPD across all age groups. IPD/SARS-CoV-2 confections were rare but associated with high case-fatality, mainly in older adults. The rarity, age distribution and serotype distribution of IPD/SARS-CoV-2 coinfections does not support wider extension of pneumococcal vaccination during the COVID-19 pandemicFunding: PHEDeclaration of Interests: SNL performs contract research for vaccine manufacturers (including GSK, Pfizer, and Sanofi Pasteur) on behalf of St George’s University of London and Public Health England but receives no personal remuneration. The Immunisation and Countermeasures Division at PHE has provided pharmaceutical companies with post-marketing surveillance reports on vaccine-preventable infections, which the companies are required to submit to the UK Licensing Authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. All other authors declare no competing interests.Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases. This includes PHE’s responsibility to monitor the safety and effectiveness of vaccines, and as such, individual patient consent is not required.

ECG steganography based on tunable Q‐factor wavelet transform and singular value decomposition

AbstractThe article presents a novel ECG steganography scheme based on the tunable Q‐factor wavelet transformation (TQWT) and also singular value decomposition (SVD) techniques that ensure better safety and confidentiality of patient information. Initial parameters such as Q, r, and J are used to decompose the cover signal into individual frequency sub‐bands with the tunable Q‐factor wavelet transform (TQWT). The singular value decomposition (SVD) technique is used to further decompose high‐frequency sub‐band coefficients into singular values. The watermark information is then embedded with high‐frequency sub‐band coefficients by involving the quantization process. The performance of this proposed system is successfully evaluated by considering various metrics, such as peak signal to noise ratio (PSNR), structural similarity index (SSIM), percentage residual difference (PRD), and bit error rate (BER). The simulation results of the proposed scheme are observed to be better than other traditional algorithms.

Investigation of SARS-CoV-2 Outbreaks in Six Care Homes in London, April 2020: The London Care Home Investigation

Background: Care homes are experiencing large outbreaks of coronavirus disease 2019 (COVID-19) associated with high case-fatality. We conducted detailed investigations in six London care homes reporting suspected COVID-19 outbreaks during April 2020. Methods: Residents and staff had nasal swabs taken for SARS CoV-2 testing using RT-PCR and were followed-up for 14 days. They were categorized as symptomatic, post-symptomatic or pre-symptomatic if they had symptoms at the time of testing, in the two weeks before or two weeks after testing, respectively, or asymptomatic throughout. Virus isolation and whole genome sequencing (WGS) was also performed. Findings: Across the six care homes, 107/268 (39.9%) residents were SARS CoV-2 positive, including 29 (27.1%) symptomatic, 9 (8.4%) post-symptomatic, 21 (19.6%) pre-symptomatic and 48 (44.9%) who remained asymptomatic. Case-fatality was highest among symptomatic SARS-CoV-2 positive residents (10/29, 34.5%) compared to asymptomatic (2/48, 4.2%), post-symptomatic (2/9, 22.2%) or pre-symptomatic (3/21,14.3%) residents. Among staff, 51/250 (20.4%) were SARS CoV-2 positive and 29/51 (56.9%) remained asymptomatic. RT-PCR cycle threshold s and live virus recovery were similar between symptomatic/asymptomatic residents/staff. WGS identified multiple introductions of different SARS-CoV-2 strains into individual care homes. SARS-CoV-2 strains from residents and staff had identical sequences, as did strains from fatal and non-fatal cases. Interpretation: In care homes reporting a COVID-19 outbreak, a high rate of SARS-CoV-2 positivity was found among residents and staff, half of whom were asymptomatic and are potential reservoirs for on-going transmission. Symptomatic SARS-CoV-2 residents had high case-fatality, while asymptomatic infection was rarely fatal. Symptom-based screening alone is not sufficient for outbreak control.Funding Statement: This study did not receive any funding. The authors are all employed by Public Health England, the study funder, which is a public body — an executive agency of the Department of Health. Declaration of Interests: None.Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases and as such, individual patient consent is not required.

Guidelines for the use of WhatsApp groups in clinical settings in South Africa.

In everyday clinical practice, healthcare professionals (HCPs) are exposed to large quantities of confidential patient information, and many use WhatsApp groups to share this information. WhatsApp groups provide efficient mechanisms for clinical management advice, decision-making support and peer review. However, most HCPs do not fully understand the legal and ethical implications of sharing content in a WhatsApp group setting, which is often thought to be hosted on a secure platform and therefore removed from public scrutiny. In our paper, we unpack the legal and ethical issues that arise when information is shared in WhatsApp groups. We demonstrate that sharing content in this forum is tantamount to the publication of content; in other words, those who share content are subject to the same legal ramifications as a journalist would be. We also examine the role of the WhatsApp group administrator, who bears an additional legal burden by default, often unknowingly so. We consider the recommendations made by the Health Professions Council of South Africa in their guidelines for the use of social media, and highlight some areas where we feel the guidelines may not adequately protect HCPs from the legal repercussions of sharing content in a WhatsApp group. Finally, we provide a set of guidelines for WhatsApp group users that should be regularly posted onto the group by the relevant group administrator to mitigate some of the legal liabilities that may arise. We also provide guidelines for group administrators.

Implementation of Open Visitation in an Adult Intensive Care Unit: An Evidence-Based Practice Quality Improvement Project.

Implementation of Open Visitation in an Adult Intensive Care Unit: An Evidence-Based Practice Quality Improvement Project.

SAT-489 AUDIT OF A WHATSAPP BASED CONTINUING EDUCATION PLATFORM TO FACILITATE ON THE JOB FORMAL LEARNING TO IMPROVE QUALITY OF CARE DELIVERED AMONG HAEMODIALYSIS NURSES

WhatsApp messaging is a common internet based communication tool among smart phones users across East Africa. Medical and nursing communities have reported successful educative initiatives via this messaging platform. Continuing nephrology education (CNE) was provided on a single WhatsApp group to the hemodialysis nurses of the organization across Rwanda and Tanzania since January 2019. This tool was used as a CNE channel for informal learning via group chats, enabling the sharing of large data files (e.g. photos, videos, short voice messages, documents in powerpoint, word or in portable document formats) at no added costs on a common platform. In this study, the contents of this WhatsApp group was audited to determine content of interest and provided formats to incentivise frequent access and use for learning especially when employed in a busy and shift based work schedule in hemodialysis units. All communication within the organization occurs across multiple WhatsApp groups. Seventy nursing and physician staff of AHN, who had access to a smart phone, were introduced and added to these groups of the CNE WhatsApp channels upon appointment. Group administrators were gate-keepers for the quality of material inserted with no forwards or confidential patient information permitted into the CNE group without appropriate checks and validation. While those without smart phone access missed out on the WhatsApp communication, they occasionally received materials via e-mail. The permitted content included reporting of weekly topic discussions from each center, case discussions, 1-2 page short simplified topic inserts for relaxed reading, internally prepared or external videos, text books and notes, and messages as educative instructions for processes, protocols and operations within the unit. Between January and October 2019, 1,662 WhatsApp messages were analyzed for content and popularity of format from across our dialysis centers. These included 179 weekly topic discussion reports, 40 practical case discussions, 97 educative pages, 4 internal and 15 external video messages, 11 messages including textbooks and notes and 42 messages as educative instructions. Practical case discussions on day-to-day hemodialysis patient management found the most uptake. Simple and short educative pages were well received by clinicians due to time constraints related to work. Short educative videos (e.g. on infection control), either prepared internally or externally, were also very popular. Finally, WhatsApp reporting of mandatory once weekly academic topic discussionsenabled comprehensive monitoring and allowed for clarification, answering questions and peer-to-peer interactions across the board garnering interest and learning within the group. The use of WhatsApp to provide CNE among our hemodialysis nurses created an excellent method for informal education. Simple and effective renal education message content, tailored to suit busy schedules and practical to the workplace, can improve quality of care and patient outcomes.

COVID-19 in Patients with Hepatobiliary and Pancreatic Diseases in East London: A Single-Centre Cohort Study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing COVID-19 in patients with pre-existing hepatobiliary and pancreatic (HPB) conditions is not clearly understood. Methods: In a single-centre retrospective cohort study (Barts Health NHS Trust, East London), linked primary, secondary and tertiary care electronic health records for patients diagnosed newly or with pre-existing HPB diseases since 2008 till March 6, 2020 were interrogated to identify COVID-19 cases between February 12 and June 12, 2020. We conducted risk analyses to identify the effect of demographics, comorbidities and associated medication use, and lifestyle factors and with appropriate adjustment for gender, ethnicity, age group and HPB diagnoses on COVID-19 incidence and mortality. Findings: Some 212 (1·4%) of 15586 patients with existing HPB conditions had confirmed diagnosis of COVID-19, with an increased risk for men (Relative Risk (RR)=1.59 [95% CI 1·21–2·09]) and Black ethnicity (RR= 2·2 [1·5–3·18]) amongst demographic features. The increased risk for South Asian ethnicity, patients with pre-existing non-malignant pancreatic or liver conditions, and age>70 years seemed to be due to underlying comorbidities in these particular groups. Each additional comorbidity increased the risk of infection by 60%. Both current and past substance mis-users were at more risk of COVID-19 (RR= 2·5 [1·58–4·05] and 3.65 [1·81–7], respectively). The high risk associated with past smokers was largely associated with co-existing respiratory or cardiovascular diseases; surprisingly current smokers were associated with a lower risk of infection (RR=0·58 [0·35–0·93]). HPB patients on current or past Vitamin D treatment were at increased risk of COVID-19 (RR= 2·26 [1·6–3·12] and 2·55[1·55–3·95], respectively). Black ethnicity was at increased mortality risk (RR=2.4 [1·35–3·48]). COVID-19 patients with a pre-existing kidney condition had a higher risk of death (RR=2·13 [1·16–3·55]), particularly when accompanied with an acute episode of renal complications (RR=2·74 [1·32–5·13]). Interpretation: In a large multi-ethnic population-based study of HPB patients, male gender, Black ethnicity, medical co-morbidities, and substance mis-use independently posed a higher risk of acquiring COVID-19. Particular attention should be paid to patients with a pre-existing kidney disease to further renal insult to prevent fatality. Funding: The study is conducted under an umbrella study, focusing on the epidemiology of pancreatic and other hepatobiliary cancers in East London, funded by Medical Research Council UK as a UKRI/Rutherford Fellowship to ADU. No additional funding has been received for this study.Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: The EL-PaC-Epidem study was approved by the East of England - Essex Research Ethics Committee (19/EE/0163; May 17, 2019) and supported by the NHS Confidentiality Advisory Group for collecting and processing confidential patient information without consent (19/CAG/0219; January 17, 2020).

SARS-CoV-2 Infection and Transmission in Educational Settings: Cross-Sectional Analysis of Clusters and Outbreaks in England

Background: There are limited data on SARS-CoV-2 infection and transmission in educational settings. This information is critical for policy makers and practitioners to ensure the safety of staff, students and the wider community during the COVID-19 pandemic.Methods: Public Health England initiated enhanced national surveillance following the reopening of educational settings during the summer mini-term on 01 June 2020. COVID-19 related situations in educational settings across England were reviewed daily and followed-up until 31 July 2020. SARS-CoV-2 infection and outbreak rates were calculated for staff and students attending early year settings, primary and secondary schools during June 2020. Findings: There were 67 single confirmed cases, 4 co-primary cases and 30 COVID-19 outbreaks during June 2020, with a strong correlation between number of outbreaks and regional COVID-19 incidence (0.51 outbreaks for each SARS-CoV-2 infection per 100,000 in the community; p=0.001). Overall, SARS-CoV-2 infections and outbreaks were uncommon across all educational settings. Staff members had an increased risk of SARS-CoV-2 infections compared to students in any educational setting, and the majority of cases linked to outbreaks were in staff. The probable transmission direction for the 30 confirmed outbreaks was: staff-to-staff (n=15), staff-to-student (n=7), student-to-staff (n=6) and student-to-student (n=2).Interpretation: SARS-CoV2 infections and outbreaks were uncommon in educational settings during the first month after the easing of national lockdown in England. The strong correlation with regional SARS-CoV-2 incidence emphasises the importance of controlling community transmission to protect educational settings. Additional interventions should focus on reducing transmission in and among staff members.Funding: NoneDeclaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases and as such, individual patient consent is not required.

Design and Development of Dentistry Ethical Codes: Proposed for National Implementation in Iran

Objectives: The dental profession has a special place of trust in the society, and dental clinicians must adhere to ethical standards in all dental procedures. Ethical conduct is one of the main expectations of individuals from this profession. The aim of this study was to design and develop dental ethical codes for national implementation in Iran.
 Materials and Methods: This qualitative study was performed using directed content analysis method and purposive sampling. Data were collected until saturation through 15 semi-structured face-to-face individual interviews and two expert panels with academic staffs from dental faculties in Tehran, Iran.
 Results: Data were classified into five principles and 90 codes. The principles included consideration of patients’ interest as a priority, respect for human dignity and patient autonomy, confidentiality of patient information, the excellence of knowledge and skills, and building trust.
 Conclusion: The ethical codes for Iranian dentists were drafted considering Islamic teachings and the prevailing culture. Some codes were exclusively developed for the cultural atmosphere of Iran especially on topics such as interaction with patients previously treated by other dentists. Some codes addressed the principles of consultation and continuing the therapeutic communication with such patients. Some items have not been considered in codes released by other associations, such as religious considerations in Islamic cover and alcohol consumption that were taken into consideration in this draft. These codes can serve as a guide for professional practice of dentists. It seems that these sets can help us reach the standardized code.

Research on E-healthcare Security Evaluation in Cloud-Based System

As healthcare adopts electronic methods of storing patient health records, cloud technology allows mining and analyzing this data and accessing the general public health information. Patient’s privacy and security of personal information is crucial when considering using electronic health records in the healthcare industry (E-Healthcare). The need of the hour is to be able to store and recover patient’s data efficiently. However, moving patient’s medical information to the Cloud involves major security risks and destructs robust data privacy of health records. The threat of data breaches and the need to manage huge amounts of data are issues that have affected the healthcare industry for years. The privacy issues and threats faced by E-healthcare systems include network attacks and threats to hosts and unsanctioned access to EHR records. The major EHR system functions such as appointment scheduling, dietary planning, admission and discharge, transfer radiology/lab orders and prescription order entry are vulnerable to security threats. Security issues need to be assessed thoroughly in order for hospitals and other such medical institutions to shift to electronic standards of maintaining patient's data. Before moving to a cloud-based architecture, health organizations should perform a risk assessment. This will help to identify the security measures required to mitigate these risks. This approach provides a valid assessment of the security risk management procedure approved by field experts. It not only identifies threats to E-healthcare but also allows for a structured flow in risk management. The risk management process is documented and reported in an efficient and easy way for concerned stakeholders of the E-healthcare to understand. It will compare existing solutions on how to protect the confidentiality of patient information. Some of these methods include implementation of a Role-Based Access Control (RBAC) model, digital encryption and signature for cloud security and EHR service continuity management. Moreover, it will consider security matters that CSP’s should look into while storing patient’s record. Ultimately, it will come up with the most suitable solution to make E-Healthcare systems more secure. In this paper, the focus will be on identifying security encounters that E-health systems face by discussing means in which these systems are susceptible to attacks.

Invasive Pneumococcal Disease in People with HIV in England, 1999-2017

Background: The 7-valent and 13-valent pneumococcal conjugate vaccines (PCVs) were introduced into the United Kingdom childhood immunisation programme in 2006 and 2010 respectively, with high effectiveness and resulting in both direct and indirect protection. We describe the epidemiology of invasive pneumococcal disease (IPD) in adults with HIV in England following the introduction of both PCVs. Methods: Data on a national cohort of people with HIV were linked to confirmed IPD cases in adults aged ≥15 years during 1999-2017. Date of HIV infection was estimated using a CD4 slope decline algorithm. Findings: Among 133,994 adults with HIV, 1,453 developed IPD during 1999-2017, with 70% (1,016/1,453) developing IPD ≥3 months after their HIV diagnosis. IPD and HIV were co-diagnosed within 90 days in 345 (24%) individuals. A missed opportunity for earlier HIV diagnosis was identified in 6% (89/1,453), mostly in earlier years. IPD incidence in people with HIV increased from 147/100,000 in 1999 to 284/100,000 in 2007 before declining and stabilising between 92-113/100,000 during 2014-2017. Mean annual IPD incidence was lower among those receiving ART during 2014-17 (720 vs. 68/100,000; IRR 9.3; 95%CI, 7.3-11.8; P<0.001) and was markedly lower in those with a suppressed viral load (523 vs. 50/100,000; IRR 10.4; 95%CI, 7.6-14.1; P<0.001). The latter group still had 4.5-fold higher (95%CI, 3.8-5.3; P<0.001) IPD incidence compared to the general population (11.2/100,000). Interpretation: IPD incidence among people with HIV reduced after PCV13 introduction and has remained stable. Adults presenting with IPD should continue to be tested for HIV infection. Funding Statement: The authors are employed by PHE. There was no additional funding for this study. Declaration of Interests: PDK, ZAC, SEC, CS, NF and VCD declare no conflicts of interest. SNL performs contract research on behalf of St. George’s University of London (SGUL) and Public Health England (PHE) for vaccine manufacturers but receives no personal remuneration. The Immunisation Department has provided vaccine manufacturers with post-marketing surveillance reports on pneumococcal and meningococcal infection which the companies are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. Ethics Approval Statement: PHE has legal permission, provided by Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002, to process patient confidential information for national surveillance of communicable diseases (http://www.legislation.gov.uk/uksi/2002/1438/regulation/3/made). This includes PHE’s responsibility to monitor the safety and effectiveness of vaccines.

Disclosure of confidential information by mental health nurses, of patients they assess to be a risk of harm to self or others: An integrative review.

There is a duty of confidentiality on the part of mental health nurses when they handle confidential patient information. Nonetheless, it may be necessary to disclose confidential information of a patient if the patient is assessed as being a risk to self or others, to protect the patient or others from harm. However, disclosing information inappropriately may constitute a breach of confidentiality. There is a paucity of information on how mental health nurses understand the rules of confidentiality when deciding to withhold or disclose confidential information in these circumstances. An integrative review of the literature was undertaken to explore the disclosure of confidential information by mental health nurses when they assess a patient as being a risk of harm. The findings indicate the rules of confidentiality are not well understood, or are not adhered to by mental health nurses. Risk assessments were found to underpin deliberations to withhold or disclose confidential information of a patient, despite risk being difficult to predict with any certainty. For risk assessment, mental health nurses were noted to prefer their unstructured clinical judgement over actuarial methods; and defer to their clinical intuition over scores of a structured risk assessment instrument, when making structured clinical judgement-backed decisions in this area of their practice. Gaps in the literature that may be addressed by future empirical research were revealed during this integrative review.

RETRACTED ARTICLE: Optimal users based secure data transmission on the internet of healthcare things (IoHT) with lightweight block ciphers

The ever-growing advancement in communication innovation of modern smart objects carries with it a new era of improvement for the Internet of Things (IoT) based networks. The health care system is the best approach to store the patient’s health data online with high privacy. Ensuring the privacy and confidentiality of patient information in the cloud is of utmost importance; here, the enhanced security model of healthcare data gives rise to trust. For the secure communication, the healthcare data sensed by the IoT sensor network is encrypted by Lightweight SIMON block cipher. For improving the privacy of healthcare data among individuals, we implemented the share generation model. Then, share creation model, i.e., Chinese Remainder Theorem (CRT) is developed to generate the copy of every ciphertext based on the selected number of users and the data is shared among the optimal number of users. The selection of the users in IoHT is made by the metaheuristic algorithm called Hybrid Teaching and Learning Based Optimization (HTLBO). Then, we present healthcare service providers for giving the full scope of medical services to people enrolled in IoHT. The performance of Secure Data is approved through simulations in terms of energy cost, computation time, etc., of the proposed algorithms and the outcomes demonstrate that Secure Data can be efficient while applying for ensuring security chances in IoT-based healthcare systems.

The right to medical assistance for seafarers. Ethical and practical consequences of the introduction of telemedicine to improve healthcare on board ships

Quality and easy access to healthcare is considered a Fundamental Right in most countries. While access to care has progressed, the ethical challenges related with medical error, confidentiality of patient information and risk of technology over-riding human judgement have become important to address. In the case of seafarers, the challenges are compounded by the fact that they spend a significant amount of time on the high seas with no direct access to medical care. With the introduction of Tele-medicine, quality and access to care has improved. However due to the fact that there is no direct patient – doctor contact, ethical issues related to consent and care are important to review to safegaurds the interest both the doctor and patient. The gradual introduction of advanced technologies present improved medical assistance to seafarers onboard.

Reasonable Expectations of Privacy and Disclosure of Health Data.

The law of confidence allows for a range of defined circumstances in which confidential patient information (CPI) can be disclosed without breach of confidence—including statutory gateway and overriding public interest. Outside such circumstances, current guidance to health professionals (the ‘standard account’) assumes that CPI can only be lawfully disclosed with patient consent. This article argues that the standard account has not yet caught up with judgments, post the Human Rights Act 1998 coming into force, which have reinterpreted the law of confidence in the light of Article 8 of the European Convention on Human Rights. In particular, the article explains the significance of the concept of a ‘reasonable expectation of privacy’ to an action for breach of confidence and thus to legal liability for disclosure of health data. It argues that conformity with a reasonable expectation of privacy provides an alternative account for the lawful disclosure of CPI, and may provide a more sustainable and authentic approach to meeting obligations under the law of confidence than the standard account. The article concludes with recommendations for an evolution of the standard account in a way that could allow restatement of associated concepts (such as consent) free from particular pressure to bend them out of shape. The evolution proposed continues to bring to the fore the patient perspective and allows protection of their ‘reasonable expectations’ regarding uses of data collected about them rather than those of the profession.

Information Governance Program: A Review of Applications in Healthcare

Context: The healthcare in different countries faces challenges in enhancing the quality of services and reducing the costs. Information governance provides a tool for effective and efficient management of information, the use of which contributes to improved productivity, and effectiveness of services and reduced costs. Identifying the applications and benefits of using this tool paves the way for its accurate and effective deployment in a variety of healthcare organizations. This study was conducted to identify and classify the applications of information governance program within healthcare systems. Evidence Acquisition: The study reviewed English studies related to the information governance applications in healthcare published during 2000 and 2017. The publications were identified by searching the Pub Med, Google Scholar, ProQuest, Scopus and Science Direct databases. The key words included, but not restricted to, information governance, health information governance, information governance program and impacts of information governance in health care. Having completed the search, 128 studies were retrieved, of which 23 were reviewed. Results: The Information Governance program applications were categorized into five general groups, including improving healthcare and patient safety, reducing the costs, enhancing the quality of data and information healthcare, enhancing the security and confidentiality of patient information, improving the management of information and healthcare organizations. Conclusion: Through developing and implementing of Health Information Governance programs, updating information and upgrading information technologies, healthcare organizations could improve the quality of healthcare services and reduce the subsequent costs to achieve competitive advantages.

Development and validation of a Dignity in Care Scale for Nurses.

Maintaining patient dignity is an important aspect of nursing care. No instrument is currently available to measure nurses' behaviours for maintaining patient dignity in clinical care. To develop and test an instrument to measure activities nurses perform to maintain patient dignity in clinical care settings, guided by the literature and face-to-face interviews. A quantitative cross-sectional descriptive survey collected data from the developed scale, which was analysed by descriptive statistics and factor analysis. Convenience samples of nurses participated in the interviews (n = 40) and examined face validity of the scale (n = 20). A purposive sample of 610 nurses was recruited from four regional hospitals in the northern, southern and eastern areas of Taiwan to test the developed scale. Research was approved by the Institutional Review Board of the study hospital. Information about the study was provided to nurses and those willing to participate provided written informed consent prior to data collection. The 36-item Dignity in Care Scale for Nurses had acceptable content and face validity. Factor analysis identified six factors necessary for maintaining dignity of patient care: communication skills, confidentiality of patient information, prompt response to patient needs, respect for patient's autonomy, providing a safe environment and protecting the patient's well-being. The reliability coefficient for the total scale was 0.93; alpha coefficients for the subscales ranged from 0.70 to 0.94. The Dignity in Care Scale for Nurses was demonstrated to be a reliable and valid tool for assessing how nurses maintain dignity in care for patients in the clinical setting. The questionnaire can be used to provide feedback to nurses regarding patient dignity. Data gained from this instrument could be used to design nursing education programmes to help nurses enhance their abilities for maintaining patient dignity in clinical practice.

Design and Development of Dentistry Ethical Codes: Proposed for National Implementation in Iran.

Objectives:The dental profession has a special place of trust in the society, and dental clinicians must adhere to ethical standards in all dental procedures. Ethical conduct is one of the main expectations of individuals from this profession. The aim of this study was to design and develop dental ethical codes for national implementation in Iran.Materials and Methods:This qualitative study was performed using directed content analysis method and purposive sampling. Data were collected until saturation through 15 semi-structured face-to-face individual interviews and two expert panels with academic staffs from dental faculties in Tehran, Iran.Results:Data were classified into five principles and 90 codes. The principles included consideration of patients’ interest as a priority, respect for human dignity and patient autonomy, confidentiality of patient information, the excellence of knowledge and skills, and building trust.Conclusion:The ethical codes for Iranian dentists were drafted considering Islamic teachings and the prevailing culture. Some codes were exclusively developed for the cultural atmosphere of Iran especially on topics such as interaction with patients previously treated by other dentists. Some codes addressed the principles of consultation and continuing the therapeutic communication with such patients. Some items have not been considered in codes released by other associations, such as religious considerations in Islamic cover and alcohol consumption that were taken into consideration in this draft. These codes can serve as a guide for professional practice of dentists. It seems that these sets can help us reach the standardized code.