A Blockchain-Enabled Framework for mHealth Systems

Bridging Gaps in Telemedicine Education in Romania to Support Future Health Care: Scoping Review

Background

Telemedicine is a key element of modern health care, providing remote medical consultations and bridging the gap between patients and health care providers. Despite legislative advancements and pilot programs, the integration of telemedicine education in Romania remains limited. Addressing these educational gaps is essential for preparing current and future medical professionals to effectively use telemedicine technologies.

Objective

This study aimed to evaluate the current state of telemedicine education for medical professionals in Romania, focusing on the integration of diagnostic and therapeutic capabilities into medical curricula, identifying the challenges and opportunities, and providing recommendations for improving telemedicine education.

Methods

A scoping review was conducted following Arksey and O'Malley's framework. Peer-reviewed articles from 2019 to 2023 were identified using databases such as PubMed and Scopus. Additional gray literature was reviewed to provide a comprehensive understanding of telemedicine education in Romania. Data were thematically analyzed to extract key findings and recommendations.

Results

The review identified significant progress in the legislative and infrastructural aspects of telemedicine in Romania, but highlighted gaps in integrating telemedicine education into curricula for medical professionals and other health care practitioners directly involved in telemedicine practices. While some universities have included telemedicine components, dedicated telemedicine courses and hands-on training remain insufficient. Barriers include a lack of infrastructure, digital literacy, and practical exposure to telemedicine technologies.

Conclusions

For telemedicine to be effectively integrated into Romania's health care system, medical education must be adapted to include comprehensive telemedicine training. Recommendations include enhancing digital literacy, fostering public-private partnerships, and incorporating telemedicine into undergraduate and continuous professional education programs. These efforts are essential for improving healthcare access and quality through telemedicine.

Factors driving the use of mobile health app: insights from a survey

Background

Mobile health (mHealth) offers easy accessibility to healthcare information and services, promoting positive behaviour change. However, user engagement to mHealth diminishes over time, resulting in significant dropout rates. This study aims to investigate the factors contributing to the discontinuation of mHealth use and examine how persuasive elements influence users' intention to continue using mHealth. It also seeks to identify the key motivators and barriers affecting mHealth engagement.

Methods

A survey was conducted to assess persuasive elements, motivators, and barriers related to mHealth usage. The survey included measures to evaluate users' perceived persuasiveness of mHealth, the factors influencing their intention to continue using it, and both the motivators and barriers to its sustained use.

Results

The analysis revealed that unobtrusiveness had the strongest positive correlation with the intention to continue using mHealth. Additionally, a positive association was found between users' perception of mHealth's persuasiveness and their intention to continue using it. The study also identified key motivators that encourage mHealth adoption and several barriers that hinder long-term engagement.

Conclusions

These findings highlight the importance of developing strategies to enhance the long-term adoption of mHealth solutions and reduce dropout rates. Future research is needed to explore effective interventions for sustaining mHealth usage and addressing the barriers that lead to disengagement.

Smart Contracts and Shared Platforms in Sustainable Health Care: Systematic Review

BACKGROUND

The benefits of smart contracts (SCs) for sustainable health care are a relatively recent topic that has gathered attention given its relationship with trust and the advantages of decentralization, immutability, and traceability introduced in health care. Nevertheless, more studies need to explore the role of SCs in this sector based on the frameworks propounded in the literature that reflect business logic that has been customized, automatized, and prioritized, as well as system trust. This study addressed this lacuna.

OBJECTIVE

This study aimed to provide a comprehensive understanding of SCs in health care based on reviewing the frameworks propounded in the literature.

METHODS

A structured literature review was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) principles. One database-Web of Science (WoS)-was selected to avoid bias generated by database differences and data wrangling. A quantitative assessment of the studies based on machine learning and data reduction methodologies was complemented with a qualitative, in-depth, detailed review of the frameworks propounded in the literature.

RESULTS

A total of 70 studies, which constituted 18.7% (70/374) of the studies on this subject, met the selection criteria and were analyzed. A multiple correspondence analysis-with 74.44% of the inertia-produced 3 factors describing the advances in the topic. Two of them referred to the leading roles of SCs: (1) health care process enhancement and (2) assurance of patients' privacy protection. The first role included 6 themes, and the second one included 3 themes. The third factor encompassed the technical features that improve system efficiency. The in-depth review of these 3 factors and the identification of stakeholders allowed us to characterize the system trust in health care SCs. We assessed the risk of coverage bias, and good percentages of overlap were obtained-66% (49/74) of PubMed articles were also in WoS, and 88.3% (181/205) of WoS articles also appeared in Scopus.

CONCLUSIONS

This comprehensive review allows us to understand the relevance of SCs and the potentiality of their use in patient-centric health care that considers more than technical aspects. It also provides insights for further research based on specific stakeholders, locations, and behaviors.

A framework for sharing of clinical and genetic data for precision medicine applications

Precision medicine has the potential to provide more accurate diagnosis, appropriate treatment and timely prevention strategies by considering patients' biological makeup. However, this cannot be realized without integrating clinical and omics data in a data-sharing framework that achieves large sample sizes. Systems that integrate clinical and genetic data from multiple sources are scarce due to their distinct data types, interoperability, security and data ownership issues. Here we present a secure framework that allows immutable storage, querying and analysis of clinical and genetic data using blockchain technology. Our platform allows clinical and genetic data to be harmonized by combining them under a unified framework. It supports combined genotype-phenotype queries and analysis, gives institutions control of their data and provides immutable user access logs, improving transparency into how and when health information is used. We demonstrate the value of our framework for precision medicine by creating genotype-phenotype cohorts and examining relationships within them. We show that combining data across institutions using our secure platform increases statistical power for rare disease analysis. By offering an integrated, secure and decentralized framework, we aim to enhance reproducibility and encourage broader participation from communities and patients in data sharing.

Trustworthy and ethical AI-enabled cardiovascular care: a rapid review

BACKGROUND

Artificial intelligence (AI) is increasingly used for prevention, diagnosis, monitoring, and treatment of cardiovascular diseases. Despite the potential for AI to improve care, ethical concerns and mistrust in AI-enabled healthcare exist among the public and medical community. Given the rapid and transformative recent growth of AI in cardiovascular care, to inform practice guidelines and regulatory policies that facilitate ethical and trustworthy use of AI in medicine, we conducted a literature review to identify key ethical and trust barriers and facilitators from patients' and healthcare providers' perspectives when using AI in cardiovascular care.

METHODS

In this rapid literature review, we searched six bibliographic databases to identify publications discussing transparency, trust, or ethical concerns (outcomes of interest) associated with AI-based medical devices (interventions of interest) in the context of cardiovascular care from patients', caregivers', or healthcare providers' perspectives. The search was completed on May 24, 2022 and was not limited by date or study design.

RESULTS

After reviewing 7,925 papers from six databases and 3,603 papers identified through citation chasing, 145 articles were included. Key ethical concerns included privacy, security, or confidentiality issues (n = 59, 40.7%); risk of healthcare inequity or disparity (n = 36, 24.8%); risk of patient harm (n = 24, 16.6%); accountability and responsibility concerns (n = 19, 13.1%); problematic informed consent and potential loss of patient autonomy (n = 17, 11.7%); and issues related to data ownership (n = 11, 7.6%). Major trust barriers included data privacy and security concerns, potential risk of patient harm, perceived lack of transparency about AI-enabled medical devices, concerns about AI replacing human aspects of care, concerns about prioritizing profits over patients' interests, and lack of robust evidence related to the accuracy and limitations of AI-based medical devices. Ethical and trust facilitators included ensuring data privacy and data validation, conducting clinical trials in diverse cohorts, providing appropriate training and resources to patients and healthcare providers and improving their engagement in different phases of AI implementation, and establishing further regulatory oversights.

CONCLUSION

This review revealed key ethical concerns and barriers and facilitators of trust in AI-enabled medical devices from patients' and healthcare providers' perspectives. Successful integration of AI into cardiovascular care necessitates implementation of mitigation strategies. These strategies should focus on enhanced regulatory oversight on the use of patient data and promoting transparency around the use of AI in patient care.

[Mobile health in primary care. New challenges in the development of solutions to promote physical activity and well-being]

The use of smart devices such as mobile phones (smartphones) or smart watches (smartwatch) to promote physical activity and well-being has increased in recent years among patients and professionals in primary care. This change is driven by the access of patients and professionals to a large catalog of health applications, which can complement the provision of services and promote the empowerment of patients in their own health and lifestyles. These applications are beginning to be integrated with areas such as Artificial Intelligence (AI), the Internet of Medical Things (IoMT) and data storage in the cloud, among other emerging technological systems, offering a new complementary approach to clinical practice known so far. Despite the great potential, there are numerous limitations and major challenges for its full implementation in clinical practice.

Sensing Data Concealment in NFTs: A Steganographic Model for Confidential Cross-Border Information Exchange

In an era dominated by rapid digitalization of sensed data, the secure exchange of sensitive information poses a critical challenge across various sectors. Established techniques, particularly in emerging technologies like the Internet of Things (IoT), grapple with inherent risks in ensuring data confidentiality, integrity, and vulnerabilities to evolving cyber threats. Blockchain technology, known for its decentralized and tamper-resistant characteristics, stands as a reliable solution for secure data exchange. However, the persistent challenge lies in protecting sensitive information amidst evolving digital landscapes. Among the burgeoning applications of blockchain technology, non-fungible tokens (NFTs) have emerged as digital certificates of ownership, securely recording various types of data on a distributed ledger. Unlike traditional data storage methods, NFTs offer several advantages for secure information exchange. Firstly, their tamperproof nature guarantees the authenticity and integrity of the data. Secondly, NFTs can hold both immutable and mutable data within the same token, simplifying management and access control. Moving beyond their conventional association with art and collectibles, this paper presents a novel approach that utilizes NFTs as dynamic carriers for sensitive information. Our solution leverages the immutable NFT data to serve as a secure data pointer, while the mutable NFT data holds sensitive information protected by steganography. Steganography embeds the data within the NFT, making them invisible to unauthorized eyes, while facilitating portability. This dual approach ensures both data integrity and authorized access, even in the face of evolving digital threats. A performance analysis confirms the approach's effectiveness, demonstrating its reliability, robustness, and resilience against attacks on hidden data. This paves the way for secure data transmission across diverse industries.

Securing Optical Networks Using Quantum-Secured Blockchain: An Overview

The deployment of optical network infrastructure and development of new network services are growing rapidly for beyond 5/6G networks. However, optical networks are vulnerable to several types of security threats, such as single-point failure, wormhole attacks, and Sybil attacks. Since the uptake of e-commerce and e-services has seen an unprecedented surge in recent years, especially during the COVID-19 pandemic, the security of these transactions is essential. Blockchain is one of the most promising solutions because of its decentralized and distributed ledger technology, and has been employed to protect these transactions against such attacks. However, the security of blockchain relies on the computational complexity of certain mathematical functions, and because of the evolution of quantum computers, its security may be breached in real-time in the near future. Therefore, researchers are focusing on combining quantum key distribution (QKD) with blockchain to enhance blockchain network security. This new technology is known as quantum-secured blockchain. This article describes different attacks in optical networks and provides a solution to protect networks against security attacks by employing quantum-secured blockchain in optical networks. It provides a brief overview of blockchain technology with its security loopholes, and focuses on QKD, which makes blockchain technology more robust against quantum attacks. Next, the article provides a broad view of quantum-secured blockchain technology. It presents the network architecture for the future research and development of secure and trusted optical networks using quantum-secured blockchain. The article also highlights some research challenges and opportunities.

Blockchain technology applications in the health domain: a multivocal literature review

Blockchain technology has been changing the nature of several businesses, from supply chain management to electronic record management systems and copyright management to healthcare applications. It provides a resilient and secure platform for modifications due to its distributed and shared nature and cryptographic functions. Each new technology, however, comes with its challenges alongside its opportunities. Previously, we performed a systematic literature review (SLR) to explore how blockchain technology potentially benefits health domain applications. The previous SLR included 27 formal literature papers from 2016 to 2020. Noticing that blockchain technology is rapidly growing, we extended the previous SLR with a multivocal literature review (MLR) approach to present the state of the art in this study. We focused on understanding to what degree blockchain could answer the challenges inherited in the health domain and whether blockchain technology may bring new challenges to health applications. The MLR consists of 78 sources of formal literature and 23 sources of gray literature from 2016 to 2021. As a result of this study, we specified 17 health domain challenges that can be categorized into four groups: (i) meeting regulatory requirements and public health surveillance, (ii) ensuring security and privacy, (iii) ensuring interoperability, and (iv) preventing waste of resources. The analysis shows that blockchain makes significant contributions to the solutions of these challenges. However, 10 new pitfalls come with adopting the technology in the health domain: the inability to delete sensitive data once it is added to a chain, limited ability to keep large-scale data in a blockchain, and performance issues. The data we extracted during the MLR is available in a publicly accessible online repository.

A Review of Blockchain Technology Applications in Ambient Assisted Living

The adoption of remote assisted care was accelerated by the COVID-19 pandemic. This type of system acquires data from various sensors, runs analytics to understand people’s activities, behavior, and living problems, and disseminates information with healthcare stakeholders to support timely follow-up and intervention. Blockchain technology may offer good technical solutions for tackling Internet of Things monitoring, data management, interventions, and privacy concerns in ambient assisted living applications. Even though the integration of blockchain technology with assisted care is still at the beginning, it has the potential to change the health and care processes through a secure transfer of patient data, better integration of care services, or by increasing coordination and awareness across the continuum of care. The motivation of this paper is to systematically review and organize these elements according to the main problems addressed. To the best of our knowledge, there are no studies conducted that address the solutions for integrating blockchain technology with ambient assisted living systems. To conduct the review, we have followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology with clear criteria for including and excluding papers, allowing the reader to effortlessly gain insights into the current state-of-the-art research in the field. The results highlight the advantages and open issues that would require increased attention from the research community in the coming years. As for directions for further research, we have identified data sharing and integration of care paths with blockchain, storage, and transactional costs, personalization of data disclosure paths, interoperability with legacy care systems, legal issues, and digital rights management.

A Survey of Human Gait-Based Artificial Intelligence Applications

We performed an electronic database search of published works from 2012 to mid-2021 that focus on human gait studies and apply machine learning techniques. We identified six key applications of machine learning using gait data: 1) Gait analysis where analyzing techniques and certain biomechanical analysis factors are improved by utilizing artificial intelligence algorithms, 2) Health and Wellness, with applications in gait monitoring for abnormal gait detection, recognition of human activities, fall detection and sports performance, 3) Human Pose Tracking using one-person or multi-person tracking and localization systems such as OpenPose, Simultaneous Localization and Mapping (SLAM), etc., 4) Gait-based biometrics with applications in person identification, authentication, and re-identification as well as gender and age recognition 5) “Smart gait” applications ranging from smart socks, shoes, and other wearables to smart homes and smart retail stores that incorporate continuous monitoring and control systems and 6) Animation that reconstructs human motion utilizing gait data, simulation and machine learning techniques. Our goal is to provide a single broad-based survey of the applications of machine learning technology in gait analysis and identify future areas of potential study and growth. We discuss the machine learning techniques that have been used with a focus on the tasks they perform, the problems they attempt to solve, and the trade-offs they navigate.