The elephant in the room: cybersecurity in healthcare.

Cybersecurity has seen an increasing frequency and impact of cyberattacks and exposure of Protected Health Information (PHI). The uptake of an Electronic Medical Record (EMR), the exponential adoption of Internet of Things (IoT) devices, and the impact of the COVID-19 pandemic has increased the threat surface presented for cyberattack by the healthcare sector. Within healthcare generally and, more specifically, within anaesthesia and Intensive Care, there has been an explosion in wired and wireless devices used daily in the care of almost every patient-the Internet of Medical Things (IoMT); ventilators, anaesthetic machines, infusion pumps, pacing devices, organ support and a plethora of monitoring modalities. All of these devices, once connected to a hospital network, present another opportunity for a malevolent party to access the hospital systems, either to gain PHI for financial, political or other gain or to attack the systems directly to cause erroneous monitoring, altered settings of any device and even to access the EMR via this IoMT window. This exponential increase in the IoMT and the increasing wireless connectivity of anaesthesia and ICU devices as well as implantable devices presents a real and present danger to patient safety. There has, at the same time, been a chronic underfunding of cybersecurity in healthcare. This lack of cybersecurity investment has left the sector exposed, and with the monetisation of PHI, the introduction of technically unsecure IoT devices for monitoring and direct patient care, the healthcare sector is presenting itself for further devastating cyberattacks or breaches of PHI. Coupled with the immense strain that the COVID-19 pandemic has placed on healthcare and the changes in working patterns of many caregivers, this has further amplified the exposure of the sector to cyberattacks.

Radiology and Te Whatu Ora - Health New Zealand in 2022. Why we should all care.

Radiology is a key enabler of clinical activity and has been shown to be highly cost effective. Demand and activity have increased over time, with demand for computed tomography (CT), magnetic resource imaging (MRI) and ultrasound (US) growing faster than population growth. Complexity has also increased over time. Resources in the public sector have not kept up with demand, exacerbated by the COVID-19 pandemic. A reliance on an overseas trained workforce has resulted in critical shortages. Waiting times for CT, MRI and US across Aotearoa New Zealand remain well below targets and have not improved over 10 years. Robust links between clinical activity and radiology resourcing are needed to address the deficits and thereby maintain clinical safety.

Inhaled antibodies: Quality and performance considerations.

The use of antibodies in the treatment of lung diseases is of increasing interest especially as the search for COVID-19 therapies has unfolded. Historically, the use of antibody therapy was based on multiple targets including receptors involved in local hyper-reactivity in asthma, viruses and micro-organisms involved in a variety of pulmonary infectious disease. Generally, protein therapeutics pose challenges with respect to formulation and delivery to retain activity and assure therapy. The specificity of antibodies amplifies the need for attention to molecular integrity not only in formulation but also during aerosol delivery for pulmonary administration. Drug product development can be viewed from considerations of route of administration, dosage form, quality, and performance measures. Nebulizers and dry powder inhalers have been used to deliver protein therapeutics and each has its advantages that should be matched to the needs of the drug and the disease. This review offers insight into quality and performance barriers and the opportunities that arise from meeting them effectively.

COVID-19 and adult congenital heart disease services: impact on support and advice from nurse specialists.

Although the focus on service provision in response to the COVID-19 pandemic has mainly been on acute and particularly intensive care, it is important to consider other services that are still needed. This is especially the case for vulnerable patients with long-term conditions, such as those under the care of an adult congenital heart disease (ACHD) service. The authors conducted a survey of ACHD nurse specialists in centres across the UK to acertain what they were planning in terms of the redeployment of nurse specialists. The results showed a range of plans with an average of half of nurses per centre being moved, but with 65% of the workforce planned to be redeployed to deal with the pandemic. The telephone advice service at the authors' own level 1 centre showed a significant increase in patients seeking advice when compared with the previous year, with large peaks following major Government announcements. Access to specialist advice for patients with complex conditions is of vital interest, for those in a wide range of specialities.