Securing patient data in the healthcare industry: A blockchain-driven protocol with advanced encryption.

BACKGROUND: Ensuring the security and privacy of patient data is a critical concern in the healthcare industry. The growing utilization of electronic data transmission and storage in medical records has amplified apprehensions about data security. However, due to varying stakeholder interests, not all data can be freely shared, necessitating the development of secure protocols. MATERIALS AND METHODS: This study presents a highly secure protocol that integrates blockchain technology, patient biometric information, and robust cryptographic algorithms (elliptic curve cryptography (ECC) and advanced encryption algorithm (AEC)) to facilitate data encryption and decryption. The protocol encompasses secure login, secure key sharing, and data sharing mechanisms among miners, offering comprehensive security measures. To validate the effectiveness of the proposed protocol, both informal and formal security analyses are conducted. The security protocol description language in Scyther is utilized to evaluate the protocol's resilience against attacks. RESULTS: The culmination of this research is a secure protocol that leverages blockchain technology and ECC for the secure storage and sharing of medical records. The protocol covers all stages, including system setup, user registration, login mechanisms, key exchange between users and blockchain, communication between blockchains, and interaction with other miners, with a steadfast emphasis on security. Furthermore, the protocol's communication and computation costs are assessed, with a comparison to existing blockchain-based schemes. Informal proofs establish the protocol's security against common attacks faced by medical institutions. Formal simulation of the protocol using the Scyther tool provides definitive evidence of its resistance to attacks. CONCLUSIONS: As a result, this protocol presents a viable real-time implementation solution for safeguarding patient data within the healthcare domain, representing a significant contribution to data security.

Comparative Outcomes of Cap Assisted Endoscopic Resection and Endoscopic Submucosal Dissection in Dysplastic Barrett's Esophagus.

BACKGROUND & AIMS: Endoscopic resection is an important component of the endoscopic treatment of Barrett's esophagus (BE) with dysplasia and intramucosal adenocarcinoma. Endoscopic resection can be performed by cap-assisted endoscopic mucosal resection (cEMR) or endoscopic submucosal dissection (ESD). We compared the histologic outcomes of ESD vs cEMR, followed by ablation. METHODS: We queried a prospectively maintained database of all patients undergoing cEMR and ESD followed by ablation at our institution from January 2006 to March 2020 and abstracted relevant demographic and clinical data. Our primary outcomes included the rate of complete remission of dysplasia (CRD): absence of dysplasia on surveillance histology, and complete remission of intestinal metaplasia (CRIM): absence of intestinal metaplasia. Our secondary outcome included complication rates. RESULTS: We included 537 patients in the study: 456 underwent cEMR and 81 underwent ESD. The cumulative probabilities of CRD at 2 years were 75.8% and 85.6% in the cEMR and ESD groups, respectively (P < .01). Independent predictors of CRD were as follows: ESD (hazard ratio [HR], 2.38; P < .01) and shorter BE segment length (HR, 1.11; P < .01). The cumulative probabilities of CRIM at 2 years were 59.3% and 50.6% in the cEMR and ESD groups, respectively (P > .05). The only independent predictor of CRIM was a shorter BE segment (HR, 1.16; P < .01). CONCLUSIONS: BE patients with dysplasia or intramucosal adenocarcinoma undergoing ESD reach CRD at higher rates than those treated with cEMR, although CRIM rates at 2 years and complication rates were similar between the 2 groups.

Neoplasia Detection Rate in Barrett's Esophagus and Its Impact on Missed Dysplasia: Results from a Large Population-Based Database.

BACKGROUND & AIMS: It is a challenge to detect dysplasia in Barrett's esophagus (BE) and esophageal adenocarcinomas (EACs) are missed in 25%-33% of cases. The neoplasia detection rate (NDR), defined as the rate of high-grade dysplasia (HGD) or EAC detection during initial surveillance endoscopy, has been proposed as a quality metric for endoscopic evaluation of patients with BE. However, current estimates are from referral center cohorts, which might overestimate NDR. Effects on rates of missed dysplasia are also unknown. We analyzed data from a large cohort of patients with BE to estimate the NDR and factors associated with it, and assess the effects of the NDR on the rate of missed dysplasia. METHODS: We analyzed data from 1066 patients in the Rochester Epidemiology Project-linked medical record system, a population-based cohort of patients with BE (confirmed by review of the endoscopic and histologic reports) from 11 southeastern Minnesota counties from 1991 through 2019. Biopsies reported to contain dysplasia were confirmed by expert gastrointestinal pathologists. The NDR was calculated as the rate of HGD or EAC detected by histologic analyses of biopsies collected during the first surveillance endoscopy. Patients without HGD or EAC at their initial endoscopy (n = 391) underwent repeat endoscopy within 12 months; HGD or EAC detected at the repeat endoscopy were considered to be missed on index endoscopy. Factors associated with NDR and missed dysplasia were identified using univariate and multivariate logistic regression models. RESULTS: The NDR was 4.9% (95% CI, 3.8-6.4); 3.1% of patients had HGD, 1.8% had EAC, and 10.6% had low-grade dysplasia. Factors associated with higher rates of detection of neoplasia included older age, male sex, smoking, increasing length of BE, and surveillance endoscopies by gastroenterologists. This NDR was associated with a substantially lower rate of missed dysplasia (13%). CONCLUSIONS: In an analysis of 1066 patients with BE in a population-based cohort, we found a lower NDR and lower rate of missed dysplasia than previously reported. NDR may have value as a quality metric in BE surveillance if validated in other cohorts.

Axial length, anterior chamber depth-a study in different age groups and refractive errors.

INTRODUCTION: Axial length and anterior chamber depth play an important role in refractive status of the eye in different age groups. MATERIAL AND METHODS: The present study has been done on 240 patients (480 eyes) who attended eye OPD of Department of Ophthalmology at NIMS Medical College & Hospital Jaipur, Rajasthan, India. The patients attending eye OPD between July 2011 to December 2012 of different ages groups were without significant history of any ocular disease. The axial length and anterior chamber depth were measured and compared. CONCLUSION: Hypermetropic eyes have shallow anterior chamber depth and shorter axial length as compared to myopic and emmtropic eyes.