Developing an infrastructure for secure patient summary exchange in the EU context: Lessons learned from the KONFIDO project.

BACKGROUND: The increase of healthcare digitalization comes along with potential information security risks. Thus, the EU H2020 KONFIDO project aimed to provide a toolkit supporting secure cross-border health data exchange. METHODS: KONFIDO focused on the so-called "User Goals", while also identifying barriers and facilitators regarding eHealth acceptance. Key user scenarios were elaborated both in terms of threat analysis and legal challenges. Moreover, KONFIDO developed a toolkit aiming to enhance the security of OpenNCP, the reference implementation framework. RESULTS: The main project outcomes are highlighted and the "Lessons Learned," the technical challenges and the EU context are detailed. CONCLUSIONS: The main "Lessons Learned" are summarized and a set of recommendations is provided, presenting the position of the KONFIDO consortium toward a robust EU-wide health data exchange infrastructure. To this end, the lack of infrastructure and technical capacity is highlighted, legal and policy challenges are identified and the need to focus on usability and semantic interoperability is emphasized. Regarding technical issues, an emphasis on transparent and standards-based development processes is recommended, especially for landmark software projects. Finally, promoting mentality change and knowledge dissemination is also identified as key step toward the development of secure cross-border health data exchange services.

Long-term outcomes of corneal cross-linking for keratoconus in pediatric patients.

PURPOSE: To report the long-term outcomes of corneal cross-linking (CXL) in pediatric patients with bilateral progressive keratoconus. METHODS: The medical records of consecutive pediatric patients with bilateral progressive keratoconus who underwent CXL at a single institution from June 2007to December 2009 were reviewed. All eyes underwent CXL treatment in accordance with the original Dresden protocol. Pre- and post-operative (at 1 year and >5 years after CXL) examinations included, corneal thickness (CT) at the thinnest point, corneal topographic evaluation (flat, steep meridian keratometry and maximum keratometry), with manifest refraction and corrected distance visual acuity. RESULTS: A total of 20 eyes of 10 patients were included. Mean age at time of CXL was 14.34 ± 2.14 years (range, 10.49-17.09 years). Mean follow-up was 7.63 ± 1.31 years (range, 5.41-9.34 years). No intra- or postoperative complications were observed. Stabilization of all topographic indices (steep K, flat K, Kmax, and topographic cylinder) was demonstrated throughout the follow-up period (compared to preoperative topographic indices [P < 0.05]). Mean corrected distance visual acuity improved to 0.14 ± 0.16 logMAR at final follow-up from the preoperative values 0.28 ± 0.17 logMAR (P > 0.05); none of the eyes lost corrected distance visual acuity lines. Manifest refraction and mean corneal pachymetry at the thinnest point remained stable throughout the follow-up (P < 0.05). CONCLUSIONS: In this case series CXL (Dresden protocol) for pediatric keratoconus halted disease progression and offered improved visual function up to 7.5 years after treatment.

Corneal collagen cross-linking for progressive keratoconus in pediatric patients: a feasibility study.

PURPOSE: To evaluate the outcomes of corneal collagen cross-linking (CXL) in pediatric patients with bilateral progressive keratoconus. METHODS: This retrospective case series included four pediatric patients (eight eyes) with progressive keratoconus aged 14.0±2.2 years (range: 11 to 16 years). All eyes underwent CXL in accordance with the standard Dresden protocol. Pre- and 1-, 12-, 24-, and 36-month postoperative examinations included corneal thickness at the thinnest point (using a topographic system), corneal topographic evaluation (flat and steep meridian keratometry [K1 and K2]), refraction, and visual acuity. RESULTS: All patients completed 36-month follow-up. No intra- or postoperative complications were observed. Stabilization of K1 and K2 was demonstrated in all cases throughout follow-up (from the first postoperative interval), while visual acuity improved in six eyes and remained stable in the remaining two eyes. Manifest refraction remained stable, and corneal thickness decreased at the first postoperative month with gradual return to preoperative values during follow-up. CONCLUSIONS: Preliminary data of four pediatric patients with moderate keratoconus show feasibility of treatment by CXL in these select patients with no intra- or postoperative complications over 3-year follow-up.