MedHypChain: A patient-centered interoperability hyperledger-based medical healthcare system: Regulation in COVID-19 pandemic

Recently, an infectious disease, coronavirus disease 2019 (COVID-19), has been reported in Wuhan, China, and spread worldwide within a couple of months. There have been seen an outbreak of COVID-19 in many countries, where the infected patients' rate overwhelmed the inadequate medical services. The push of patient-centered interoperability (PCI) from medical institution-centered interoperability may defeat the current and post resultant disease of the COVID-19 pandemic. This paper proposes a state-of-the-art privacy-preserving medical data sharing system based on Hyperledger Fabric (MedHypChain), where each transaction is secured via an Identity-based broadcast group signcryption scheme. We proved that MedHypChain achieves confidentiality, anonymity, traceability, and unforgeability. Besides, we regularize the MedHypChain to implement the PCI healthcare system, where the patient manages its health-related information in the blockchain that can be accessible to the authorized entity. We also use the Hyperledger caliber as a benchmark tool to analyze the performance of MedHypChain in three metrics (latency time, execution time, and throughput) for up to 20 permissioned nodes. Finally, we compare MedHypChain with related blockchain-based healthcare systems and found that the proposed scheme needs the least computation cost and communication cost and achieves all security features, such as authenticity, scalability, and access control.

Asthma-specific health-related quality of life of people in Great Britain: A national survey

BACKGROUND

Although the ultimate goal of asthma treatment is to improve asthma-specific Health-Related Quality-Of-Life (HRQOL), in the UK population this is insufficiently studied. National asthma-specific HRQOL data is needed to inform strategies to address this condition.

AIMS AND OBJECTIVES

To benchmark asthma-specific HRQOL in a national survey of adults with asthma, and explore differences in this measure within subsections of the population.

METHODS

We analysed answers to the Marks Asthma Quality-of-Life Questionnaire (AQLQ-M) from a representative sample of 658 adults with asthma. Respondents answered asthma-specific questions to assess control, previous hospital admissions, asthma attacks and an indicator of severity. Higher scores indicate poorer HRQOL (maximum = 60). The highest quintile formed a subgroup 'Poor HRQOL'. Data were weighted to correct for any biases caused by differential non-response. Chi-square analyses were used to determine differences between good and poor quality of life and regression analyses performed to determine what factors are associated with poor HRQOL.

RESULTS

The response rate was 49%. AQLQ-M median (IQR) scores were 5 (2-13) for the total sample (poor HRQOL = 21, good HRQOL = 3). Significant differences between good and poor HRQOL were observed in smoking status, SES, employment status and co-morbidities, but no differences were found between age groups. Those with poorly controlled asthma were significantly more likely to have poor HRQOL, ≥1 breathing related hospital admission or ≥1 asthma attack.

CONCLUSIONS

This article provides benchmarking data on asthma-specific HRQOL. Improved strategies are needed to target interventions towards people experiencing poor HRQOL.

Comparison of the effects of tulobuterol patch and salmeterol in moderate to severe asthma

1. Although the clinical effects of the tulobuterol patch have been reported to include an increase in morning peak expiratory flow (PEF) values and a decrease of symptoms and the frequency of the rescue use of inhaled short-acting beta2-adrenoceptor agonists, no trials comparing the efficacy of the tulobuterol patch to other standard inhaled long-acting beta2-adrenoceptor agonists have yet been conducted. The aim of the present study was to compare the clinical effects of the patch formulation of tulobuterol with those of inhaled salmeterol in moderate to severe asthma. 2. Fifty-four patients with moderate to severe asthma, whose conditions were suboptimally controlled despite receiving inhaled corticosteroids, were recruited. The study was a prospective, randomized trial of cross-over design comparing the effects of 4 weeks treatment with tulobuterol patch, 2 mg once daily, and salmeterol, 50 mg twice daily. The mean prebronchodilator morning PEF during the last 14 days of each treatment period and health-related quality of life (HRQoL) were the primary outcome variables. The HRQoL was assessed using the St George's Respiratory Questionnaire. 3. Forty-four patients (81.5%) completed the trial and were included in the analysis. The mean morning PEF and HRQoL score were significantly improved in both the salmeterol (P < 0.0001 and P < 0.05, respectively) and the tulobuterol patch (P < 0.01 and P < 0.05, respectively) treatment periods compared with the run-in period. Although the mean morning PEF was significantly higher in the salmeterol-treated group than in the tulobuterol-treated group (P < 0.001), the HRQoL scores were comparable. 4. The tulobuterol patch may be useful as a controller medication in addition to inhaled corticosteroids in moderate to severe asthma.