Health Tech Insider - Maiden Edition June 2022

What is in this issue?

3. CEO’s Message

4. Healthcare transformation - leveraging integrated care systems for better patient & clinical outcome

8. Tech & Innovation in Healthcare

14. World blood donor day

18. Genesys: The Rise and Rebirth

20. The application of blockchain in managing patient records

22. World Environment Day

24. NFT : The Future Of Information Exchange

30. Healthcare Cybersecurity: The rise of ransomware

32. Leveraging technology in affordability of accessing health care- the roadblocks limiting technology

36. Webinar Highlight- Healthcare Cybersecurity: Protecting patient information

41. Good food - the best medicine

42. International Nurses Day - Nursing in the digital world

44. Pain Modulations

50. References

CEO’S Message

Hello readers, I want to welcome you as we return “to the world as we know it”. With the removal of restrictions on public gatherings, the lifting of the nationwide curfews, relaxed face mask restrictions and the relaxed domestic and international travel guidelines, it’s safe to say corona season is over! As we strive to forge ahead as a collective and build on the ruins of the pandemic, let’s endeavour to get the complete course of vaccination and keep up with public health guidelines and safety advisory. I am also super excited and proud to welcome you to the maiden edition of our newsletter. This is something we’ve had in the works for a while. Rest assured, this is the first of many series, as we intend to make quarterly releases. As our premier subscriber, a gift is hidden somewhere in this letter, but you would need to read along to find it.

The recent past years have been challenging since the sudden onset of the covid-19 pandemic, disrupting life as we know it, and its crippling economic effects were felt by businesses across the globe on either spectrum of revenue scale, be you a Fortune 500 corporation or MSME, no surprise we weren’t insulated from these effects. Well, as the popular

saying goes, the darkest hour is just before dawn. Over the years, our story has been one of resilience, invention and innovation. Being a brainchild of two industry leaders (our parent companies) we consolidated on our advantage of industry knowledge and insights and at this particular dawn, we emerged as a lean and agile health tech startup. To get the inside scoop, look out for our feature story –Genesys: The rise and rebirth

Following our rebirth, we have been able to streamline our products, introducing three new variants; GeneSys Lite, GeneSys Midi & GeneSys ERP. The Lite & Midi are EMR variants geared towards primary and secondary care, while the ERP is our bespoke enterprise offering. It is a custom-built Hospital Management Information System. We are barely weeks away from introducing our revolutionary GeneSys v2 release. This is a culmination of nearly a decade of industry experience, insights and feedback, layered on modern technologies and software design principles. It has taken about 3-years to develop, however, I am pleased to announce that it would be available to the market before Q3 2022.

This newsletter is intended to

be a compendium of topics across the spectrum of health and tech and features a recap of our Twitter space event from the previous quarter, titled – Regulating the health tech Space and our just concluded webinar titled Healthcare Cybersecurity: Protecting patient information. We have meticulously and thoughtfully curated a lineup of trending health and techrelated topics that would be sure to pique your curiosity and keep you engaged, so sit back, put your feet up, relax and enjoy the read .

If you’ve gotten this far, then you deserve the gift. We have limited advertisement slots, which we would be giving out for free within the next issue of our publication. To be eligible, simply send an email with your product offering to editorial@ genesys-health.com with the subject, free advert.

All the best,

Ayo-Olagunju Muna CEO Genesys Health

Healthcare Transformation Leveraging Integrated Care Systems for Better Patient and Clinical Outcome

By Fiyinfoluwa Adeoti

There is a prevalent level of deteriorated provision and access to healthcare services for the neediest population across Nigeria. Hence, they are subjected to the risk of combating serious medical issues. How far spread is this problem? The organizational structure of the Nigerian health care system today suffers decentralization in terms of operations, management of the patient records, and patient safety. And now more than ever, there is a need to push for a shift in the healthcare system leveraging integrated care systems.

Although change usually comes slowly, the Covid-19 pandemic has demonstrated that it is possible to rapidly reorient our systems if there is a strong enough stimulus. The healthcare system has been described as “deeply fragmented, with only a small fraction of the healthcare coming from a unified and organized center. ” According to the World Health Organization 2017, Integrated Care Systems are ‘’the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results, and provide value for money.’ Provider-centered models of care and to reorient many based on principles of integration to ensure everybody has access to a continuum of care that is responsive, coordinated, and in line with people’s needs throughout their life. Successful integration also ensures that health care services throughout this continuum of care are of acceptable quality, i.e. effective, safe and people-centered. Integrated care contributes to improved access to services, fewer unnecessary hospitalizations and readmissions, better adherence to treatment, increased patient satisfaction, health literacy and self-care, greater job satisfaction for health workers, and overall improved health outcomes.

Integrated healthcare systems are built on three layers: infrastructure, intelligence, and engagement. The infrastructure layer is foundational, composed of effective data capture, curation, management, storage, and interoperability to create a common data set

upon which the ecosystem can operate. Built on top of the infrastructure layer is the intelligence layer, which converts data elements to consumable and actionable insights. Finally, bringing an ecosystem to life also requires a robust engagement layer, enabled by the infrastructure and intelligence layers, to effectively curate an end-to-end experience for suppliers who provide services and offerings to patients. Components of these layers can be built, bought, partnered, or vended by ecosystem curators and participants.

Data liquidity—the ability to access, ingest, and manipulate standardized data sets—is required for the infrastructure layer to serve as the foundation for all insights and decisions made in the ecosystem. This data liquidity enables the ecosystem to create value and removes silos by allowing stakeholders to operate off the same data sets with increased coordination.

In this article, the emphasis would be laid on how the engagement layer of ensuring integrated healthcare systems can improve patient and clinical outcomes. The engagement layer of the ecosystem is where end-users interact with services that are in turn supported by underlying data sets from the infrastructure layer and insights from the intelligence layer. The engagement layer requires a shared digital platform where end users can access, through one principal channel, the curated set of services and offerings. In healthcare, these engagement offerings might include appointment scheduling, transportation assistance, daily health

monitoring, and financial assistance. In this layer, data liquidity and infrastructure will support advanced digital therapeutics and coordinated care across traditional and innovative care models that rely on up-to-date and comprehensive patient information. So, to fully take advantage of this model in healthcare, industry behaviors will need to change. For example, provider practice changes include using the layer of intelligence to inform care decisions, leveraging innovative care delivery models and working across a care team at distributed sites, and capturing data from all relevant healthcare-related encounters. These changes will require payment model innovation to align provider and healthcare stakeholder incentives to change provider, payer, and patient behaviors.

In conclusion, how can healthcare stakeholders prepare for and act within healthcare ecosystems? Strategically, stakeholders need to decide whether they will act as curators or participants across the ecosystems that they touch. Stakeholders who wish to curate an ecosystem will need to ensure meaningful improvement in outcomes for a specific set of patients. This approach will require being clear on which industry-agnostic services they leverage and how they augment those services with healthcare-specific capabilities to create a differentiated ecosystem. Other stakeholders who want to provide point solutions will need to ensure their value proposition is both competitively distinctive and compatible with a variety of ecosystems.

Tech & Innovation in Healthcare

By Faderera Adekunle

On January 22, 2022, a man in California has his Apple Watch to thank for saving his life after he fell off his electric bike, The device, which he was wearing around his wrist, initiated an emergency 911 call after the rider fell unconscious...

In 2020, the health sector was awakened or rather forced to step up their game through the rise of the COVID pandemic and the limited number of hands in the Nigerian healthcare sector.

Prior to this our healthcare resources were backwards and outdated but with the help of technology and innovation, healthcare is improving every day. From ground-breaking new treatments to revolutionary software systems and hightech machinery, healthcare is rapidly transforming into a digital industry. It is safe to say that COVID-19 was the big push we all needed in healthcare development.

As we press on into the future it’s critical to remain mindful of the trends driving healthcare technology in 2022. There are numerous health technologies and innovations in healthcare

that can be used to advance clinical process and medical devices which can significantly improve patient satisfaction.

At the forefront of this growth is Nigeria’s health tech industry. Many of the health tech startups have taken advantage of this opportunity and have further plunge themselves into building technologies that are revolutionizing the health space.

Not only are we advancing in the health tech industry but also the innovation sector isn’t lacking behind from wearable technology to ECG machines, digital glucometers, and automated blood pressure apparatus form part of the numerous advances in health tech. These innovations have significantly improved standards across the board for care providers and patients alike — from surgery to radiation treatment

AI In Diagnosis & Drug Development

and everything in between... AI is incredibly helpful for improving efficiency with information processing and decision making. In the healthcare industry, machine learning is extremely helpful for the development of new pharmaceuticals and the efficiency of diagnosis processes.

For those being treated for the effects of COVID-19, AI is helping analyze Chest CT scans and Chest X-ray Images to detect pneumonia due to Covid 19. Microsoft uses Project Inner Eye, a a research project from Microsoft Research Cambridge that uses state of the art machine learning technology to build innovative tools for the automatic, quantitative analysis of three-dimensional medical images.

The goal of Project InnerEye is to democratize AI for medical image analysis and empower researchers, hospitals, life science organizations, and healthcare providers to build medical imaging AI models using Microsoft Azure. The project - InnerEye Deep Learning Toolkit is open source on GitHub.

Project Hanover is another Microsoft AI system meant to advance the state of the art of machine reading for accelerating CaaS in precision medicine.

In the Tech and innovation in healthcare Nigeria is not found lacking, we have built a very innovative idea like Ubenwa, Omomi, Drugstoc and many more. Ubenwa is a start-up that is using signal processing and machine learning to improve the diagnosis of birth asphyxia in low-resource setting. Currently deployed as an embedded model on an Android app, Ubenwa, which means baby’s cry, helps parents and caregivers detect asphyxia

earlier, without having to wait on doctors. According to the founders, the AI solution has achieved over 95% prediction accuracy in trials with nearly 1,400 pre-recorded baby cries.

Birth asphyxia is the third highest cause of under-five child deaths and is responsible for almost one million neonatal deaths annually, according to WHO. It has also been linked to 1.1 million intrapartum stillbirths, long-term neurological disability and impairment.

Charles Onu, Ubenwa’s founder and principal innovator, explained that the startup’s machine learning system takes an infant’s cry as input, analyses the amplitude and frequency patterns of the cry and provides instant diagnosis of birth asphyxia. Although the condition is detectable, Onu said few public hospitals in the country had the equipment due to its excessive cost, poor electricity service and an unrealistic routine application for every child.

Also, we have Omomi, a web, and mobile-based childcare service developed to help improve the health of younger children by providing parents with ample opportunity to monitor their children’s health easily. With this unique app, parents can easily track the immunization status of their kids, manage diarrhoea at home via a responsive and interactive DIY platform a chat with doctor and lots of other cool features And, Drugstoc is a health tech startup established in 2015 by Adham Yehia and Chibuzo Opara to help licensed hospitals, pharmacies, and medical experts obtain authentic pharmaceutical and health care products directly from certified distributors nationwide. When it comes to healthcare technology,

IoT and Wearables in Healthcare

there are many advances that are being made in Nigeria. One of the most notable advancements is wearable health tech and IoT. IoT (Internet of Things) has revolutionized how we interact with our environment through sensors and connected devices that monitor our health and transmit data via the internet.

Wearable health tech refers to any device that can be worn on or around the body and used to monitor or improve health. Wearable devices have become very popular thanks to their convenience and comfortability. They can be used anywhere and at any time, making them very useful in addition to being fashionable and stylish.

On January 22, 2022, a man in California has his Apple Watch to thank for saving his life after he fell off his electric bike. The device, which he was wearing around his wrist, initiated an emergency 911 call after the rider fell unconscious in Hermosa Beach, California. Apple’s Fall Detection feature initiates a call to emergency services after 60 seconds if no movement has been detected.

With wearable technology, wearers can track their healthy decisions and set goals with numerous benefits such as improved productivity at work or school because they know exactly how much exercise they need each day to maintain a healthy lifestyle. In some cases, it helps them avoid medical emergencies by sending emergency alerts when needed instead of having traditional medical practitioners contact them directly when something goes wrong such as heart attack. It has many benefits: they help keep track

of healthy habits and set goals; they allow patients to receive medical care remotely; they enable doctors to monitor patients’ health remotely; they can also be used as security systems for homeowners. They are also useful in emergency situations when you need immediate assistance from your doctor or nurse.

Other examples include smart watches with ECG trackers, female urinary device monitors, pain relief devices, stress measurement trackers, body building health devices, Tyto home remote examination kits and so on. These devices connect to smartphones via Bluetooth or Wi-Fi.

Telemedicine And The Evolution Of Remote Care

Telemedicine has been a game-changer in the world of healthcare for a number of years now, with many countries around the globe using it to improve access to health care. Nigeria is no exception. The country has seen an increase in telemedicine usage over the past few years, and there are several reasons for this growth:

First, Nigeria’s population is growing at a rapid rate, which means that more people are requiring access to healthcare services.

Second, Nigeria is made up of many different ethnic groups who have their own native languages and customs, which makes it difficult for providers of traditional medical services to communicate effectively with patients.

Third, Nigeria’s climate varies greatly from region to region—it can be hot

Health tech companies have rose to the channels and have created solutions to help solve this problem. The likes of iWello is bridging this gap by provide telemedicine to people that survive on less than $1.

and humid in some places, while it may be cold or rainy in others. The conditions under which people live can affect their ability to receive proper medical care.

Finally, there is a large gap between wealthy Nigerians and poor ones when it comes to access to healthcare services—many people do not have insurance or any other way of paying for these services; therefore, they must rely on public resources like hospitals or clinics. Health tech companies have rose to the channels and have created solutions to help solve this problem the likes of iWello is bridging this gap by provide telemedicine to people that survive on less than $1. iWello is a telemedicine platform that allows anyone, regardless of income level, to gain access to healthcare for as little as $1 and surgery funding while also ensuring the wellbeing of doctors and healthcare workers.

Telemedicine is growing at a rapid pace because it allows doctors from various locations access medical records remotely through secure networks such as HIPAA compliant VPNs (Virtual Private Networks). Doctors can diagnose patients without being physically present by using video conferencing tools like Skype or Zoom video calls.

World Blood Donor Day

By Adeyinka Adenikinju

Amedu said “When you are asked, requested or coerced to donate blood to someone you know, it means you are saving someone you know, but voluntary unpaid donors are committed to saving the lives of unseen and unknown persons, and for that, we appreciate them for what they are doing.”

June 14, 2022, was designated and celebrated in countries around the world as the World Blood Donor Day (WBDD) with the theme: Donating blood is an act of solidarity. Join the effort and save lives

According to the World health organisation, this event’s several goals which include: raise global awareness of the need for safe blood and blood products for transfusion; highlight the critical contribution voluntary, unpaid blood donors make to national health systems; support national blood transfusion services, blood donor organisations, and other non-governmental organisations in strengthening and expanding their voluntary blood donor programmes by reinforcing national and local campaigns (WHO, 2022).

The global theme of World Blood Donor Day changes each year with the criteria being to recognize selfless individuals who donate their blood to people unknown to them. Safe blood and blood products transfusion in sufficient quantity

is the pivotal part of an effective health system.

A country is always chosen to host global celebration events each year, and this year was held in Mexico City, Mexico through its National Blood Centre.

The day also provides an opportunity to call to action governments and national health authorities to provide adequate resources to increase the collection of blood from voluntary, unpaid blood donors and to manage access to blood and the transfusion of those who require it.

The specific objectives of this year’s campaign were to: thank blood donors in the world and create wider public awareness of the need for regular, unpaid blood donation; highlight the need for committed, year-round blood donation, to maintain adequate supplies and achieve universal and timely access to safe blood transfusion; recognize and promote the values of voluntary unpaid blood

donation in enhancing community solidarity and social cohesion; raise awareness of the need for increased investment from governments to build a sustainable and resilient national blood system and increase collection from voluntary non-remunerated blood donors (WHO, 2022). As planned and encouraged, this year world Blood Donor Day saw countries in the world implement the dissemination to various media outlets; stories of people whose lives have been saved through blood donation as a way of motivating regular blood donors to continue giving blood, and to motivate people in good health

who have never given blood to begin doing so.

Other activities that were implemented to keep the slogan of this year’s World Blood Donor Day include; donor appreciation ceremonies, social networking campaigns, special media broadcasts, social media posts featuring individual blood donors with the slogan, meetings and workshops, musical and artistic events to thank blood donors and celebrate solidarity, and colouring iconic monuments red. In Africa, access for everyone who needs blood is universal with demand regularly surpassing supply, negatively impacting timely access

for all patients who need safe and quality-assured blood to save their lives. A noticeable drop in voluntary unpaid blood donations can be attributed as one of the consequences of the COVID-19 pandemic, Malawi, for example, registered a 46% decrease in donations. The situation remains challenging, and it is exacerbated by issues such as staff shortages and limited funding from governments and partner organizations for effective blood donor education, recruitment, and retention (Moeti, 2022). Despite these situations, countries in Africa have strived to improve blood donation frequency, and the situation is showing signs of stabilizing with blood transfusion services in many countries reaching out to blood donors through public awareness campaigns, transporting donors from and to their homes, using digital platforms and establishing call centres (Moeti, 2022). In Nigeria, to mark World Blood Donor Day 2022, the Institute of Human Virology Nigeria (IHVN) has joined the National Blood Service Commission (NBSC) and other stakeholders participated in a road walk

to sensitize the public on the importance of blood donation. The road walk was within the Abuja metropolis from Berger roundabout to the NBSC Wuse Zone 3 office (IHVN, 2022).

The Acting Director-General of the National Blood Service Commission (NBSC), Dr Omale Amedu, urged Nigerians to regularly donate blood to improve their health and be able to have children during his interview with newsmen in Abuja ahead of the World Blood Donor Day 2022. According to him, regular blood donation not only saves lives but also enables the donor to obtain good health and a renewed system.

Amedu said “when you are asked, requested or coerced to donate blood to someone you know, it means you are saving someone you know, “but voluntary unpaid donors are committed to saving the lives of unseen and unknown persons, and for that, we appreciate them for what they are doing.

“Our target is to ensure blood units collected will increase from the present 25,000 to one million by 2023 and three million by 2030,” he said (Muanya, 2022).

In Nigeria, an expert and Consultant Haematologist, Dr Peter Ogundeji (who works at the University College Hospital), has called for the establishment of a national haemovigilance system to ensure quality and safety in blood transfusion due to the high number of quackery ongoing in the medical profession with unqualified doctors causing all manner of consequences. This legislation would coordinate, regulate and ensure the provision of safe, quality blood transfusion services on a countrywide basis within the national health plan. Ogundeji noted that the National Blood Service Commission Law signed by President Muhammadu Buhari in 2021 regulated blood transfusion services in Nigeria, and He appealed for the domestication of the law by more states and the implementation of the regulation to improve blood transfusion service in the country (Muanya, 2022).

Other organisations and parastatals engaged in various activities to mark the World Blood Donor Day 2022; Media houses dedicated special programs to this cause. We commerorated this year’s edition across our social media channels and educated our staff on the importance of blood donation.

As a reminder the World Health Organisation (WHO) specifies that Blood and blood products are essential resources for effective management of women suffering from bleeding associated with pregnancy and childbirth; children suffering from severe anaemia due to malaria and malnutrition; patients with blood and bone marrow disorders inherited disorders of haemoglobin and immune deficiency conditions; victims of trauma, emergencies, disasters and accidents; as well as patients undergoing advanced medical and surgical procedures (WHO, 2022).

So do find the goodwill to donate blood voluntarily with the stack reminder that blood shortages are particularly acute in low- and middle-income countries including Nigeria and by doing so you will be partaking in this act of solidarity.

Genesys: The Rise and Rebirth

By Ayo-Olagunju Muna

The year was 2012, and what the world would later come to know as GeneSys was at least 2-years earlier than its time and at best a figment of one individual’s very vivid and lifelike imaginations. Perhaps, this was the first undocumented trip into the metaverse. Having returned from the UK fresh out of business school and with a background in medicine and dentistry, Olamide was fueled with passion and a burning desire, having completed his master’s thesis on hospital management information systems to practically apply this in addressing the challenges in our healthcare system.

Fueled with this passion, and equipped with domain expertise, Pheonix solution came into existence. This was the first iteration of our EMR. As with life, you often have to crawl before you walk. Pheonix wasn’t exactly market-ready, but it served its purpose. It had validated someone’s imagination and convictions, yielding a prototype in the least and a proof of concept at best. Paradoxical to the fabled phoenix, which emerges from the ruins of its previous self, this phoenix birthed the product GeneSys.

In the true sense, GeneSys emerged in 2014, from what initially could be termed a relationship of convenience, that organically grew into a concrete partnership between two organisations, Realms healthcare services consulting limited and

Vatebra technology limited, emerging as their brainchild. On one hand, was a solely health-inclined startup that was gradually paving a way for itself in the health sector and on the other hand, a wholly indigenous technology company with over a decade of crosssector experience building customized software solutions and had positioned itself as the technology backbone in Africa. Perhaps, the true birthplace of our indigenous health tech industry can be traced back to this synergy right here. The relationship was a formidable duo, yielding several positive fruits.

Innovation was at the core of what we did and we sought to make a difference through this; by introducing a click-based system of text entry, an international disease coding system and a custombuilt solution incorporating the hospital’s unique processes. We commenced a pilot implementation in 2014, at R-Jolad & R-Jolad plus hospitals simultaneously. It was an industry milestone as this was the first commercial full-scale implementation of a wholly indigenous bespoke hospital management information system. Riding on this feat and the success of the pilot, we were, within 2 years, able to attract reputable top-tier facilities like; Reddington, Premier, St. Nicholas, Isalu, which ultimately culminated in a National Health Excellency Award for GeneSys as the healthcare technology provider of the year. We occupied the market niche as the leading providers of customized HMIS and ERM solutions and progressed to other successful deployments. In the midst of all these, we had a fundamental problem, there was a dichotomy of corporate identity. We traded using either identity of Realms or Vatbera. A whole lot of water passed under the bridge and In 2018, Genesys Health Information Systems Limited was established, bearing a similar identity to our product GeneSys

for which we had gained prominence.

As an early-stage organization, the pandemic posed an especially difficult year for us. However, it wasn’t all doom and gloom as it provided a watershed in our corporate existence. Over the years, our story has been one of resilience, invention and innovation. Following our 2021 strategic intent, we consolidated on our advantage of industry knowledge and insights, into venturing out as a lean and agile health tech start-up, adequately positioned towards the rapid-paced growing health tech industry. We have created systems to better understand and improve clients’ needs and satisfaction and strengthened our operational efficiency through the formulation and orientation of policies and procedures. We have been able to build a structure that addresses all areas of our immediate and near-term future business needs across; technology, service delivery and management, strategy and growth, towards positioning us to better serve our immediate and growing clientele.

Over the years, we’ve built a network of over 200 healthcare workers, 500,000+ patients and over 1,000,000 clinical encounters, with a presence across 4 of the 6 geo-political zones in Nigeria. We enjoin you to journey with us towards our next phase of growth as we shape the future of health tech.

The Application Of Blockchain In Managing Patient Records

By Dr. Dare Godiya Ishaya.

Ablockchain is essentially a digital ledger of transactions that is duplicated and distributed across the entire network of computer systems on the blockchain. Each block in the chain contains several transactions, and every time a new transaction occurs on the blockchain, a record of that transaction is added to every participant’s ledger.1-2

Although the identity of the founder remains a mystery, the blockchain concept was brought to light by the infamous Satoshi Nakamoto in 2008, and quickly took the form of the decentralized currency –‘Bitcoin’. It helps to eliminate the need for intermediaries, such as banks, while at the same time making it difficult or impossible to change, hack, or cheat the system.1,3

Blockchain has also found application in the medical industry in various ways, such as in transactions such as purchase and shipping transactions in the supply

chains of medical equipment and pharmaceuticals; however the greatest prospects have been in the aspect of patient record keeping.4

The Healthcare sector throughout the world generates a copious amount of data every day in the form of clinical trials, patient medical records, medical research and more. This massive amount of data is neither standardized nor organized, thereby making it burdensome to access the appropriate and relevant information when needed.1

Even though, recently, there has been a transition by most health institutions from manual to electronic health records (EHR), with opportunities for cost savings and reduced medical errors, there are still enormous challenges.

One of such is the burnout associated with the use of EHRs. Many practitioners have expressed the feeling that EHRs cause far too much of their time ultimately be spent on data entry. This takes away from other important aspects of

tending to clients and can even eat into the physician’s time. There are also issues such as poor quality documentation due to template-based reporting, and incompatibilities between different systems have further caused headaches and increased inefficiencies.1,3,5

These challenges are addressed by Blockchain-based electronic health records. It gives doctors and nurses control over the flow of information from a single, trusted platform. Everyone would be able to see the same data, and all updates would be visible to the whole network almost immediately. This means that medical teams can trust that what they learn about a patient is both accurate and up to date.1,6

All the data can be shared with any hospital at any time, ensuring process integrity and a simpler ecosystem based on disintermediation and a trustless exchange. Blockchain technology also gives more power to patients such that they can choose which data to share, whom to share their

healthcare data with and how much of it.6

Even though it has numerous advantages, this technology also has drawbacks. Some of them include. The technology is still in its nascent stage hence even large corporations are struggling to integrate it into their core systems.6

Also, the high buy-in for the technology coupled with the huge amount of processing power required to keep it up is proving to be a deterrent. Another drawback is the fact that, although it can handle personal data like IDs and certificates, large data like CT scans will be difficult to store in blockchains.6

In conclusion, Blockchain technology is here to stay and flourish, especially, at a time when the medical system has never been more strained or more critical and its vulnerabilities exposed. It opens the door to an overall better healthcare system.

World Environment Day

By Faderera Adekunle

World Environment Day (WED) aims to raise worldwide awareness of the need to help protect the planet’s environment and the theme for this year’s ‘World Environment Day’ is ‘Only One Earth’. A message which we can all relate to as it speaks to each and every one of us.

What does it mean? In a galaxy where there are billions of planets, there’s only one earth, the only earth in which our feet are currently standing upon. And, we may have noticed or heard from the news that the world is in crisis and getting worse as the days roll by.

Did you know that we are using the equivalent of 1.6 of Earth to maintain our current way of life, and ecosystems cannot keep up with our demands. The climate is worsening faster than man can adapt to it and nature is in its emergency mode.

According to the UN to keep global warming below 1.5°C

In a galaxy where there are billions of planets, there’s only one earth, the only earth in which our feet are currently standing upon.

in this century, we must halve annual greenhouse gas emissions by 2030. Without any urgent action to address these pressing issues, exposure to air pollution beyond safe guidelines will increase by 50 percent within the decade and plastic waste flowing into the aquatic ecosystem to triple by 2040.

It is evident that we need to step up and start making better daily decisions. The louder we raise our voice the faster change will come. The UN highlighted that we could do this by making suitable living the default option and focusing on living in sustainable harmony with nature.

We only have one earth! Let’s be the change it needs and make it habitable! What changes are you going to make to our environment today?

Save the world and take the first step to embracing change by going paperless and embracingEMRinyourorganisation.

NFT: The Future Of Health Information Exchange?

By Ayo-Olagunju Muna

NFT – buzzword? Cool-kids lingo? Tech-jargon? Attention grabber? Ooops…busted! Perhaps that’s what was just needed to get your attention. Well, since you’re here, you might as well just read along. NFT is not an entirely novel concept as its origin can be traced back to a 2012 concept paper by Meni Rosenfield titled “Colored coins” putting it at almost a decade old (Hamilton, 2022). The creation of the first actual NFT, “Quantum” is attributed to Kevin Mccoy and Anil Dash in 2014. It was a video created by Kevin’s wife Jennifer, he registered it on the Namecoin blockchain, eventually selling it to Dash for $4 (Wikipedia Contributors, 2022). Now let’s

come back to the present, imagine selling your tweet for $ 2,900,000 (Zlatev, 2022) (well, that probably wouldn’t happen unless you’re Twitter’s former CEO, Jack Dorsey), or selling the picture of this Ape above, which you can easily download of the internet, that is if it’s not already your wallpaper, for $ 3,408,000 (Tahelyani, 2022) or this digital collage for a staggering $ 69,000,000 (Zlatev, 2022). From a financial context, from its humble beginnings, it is quite easy to see why the world is buzzing about ‘something’ that within so short a period has grown to a $ 41 Billion industry as of 2021(Conti, 2022). It is so ubiquitous on the internet, that it is now impossible to ignore.

NFT is not an entirely novel concept as its origin can be traced back to a 2012 concept paper by Meni Rosenfield titled “Colored coins” putting it at almost a decade old (Hamilton, 2022).

Figure 1 : Bored Ape Yacht Club #8817

NFT is short for Non-Fungible Token. According to the Merriam-Webster online dictionary, something is said to be fungible if it is of such a nature that one part or quantity may be replaced by another equal part or quantity (Merriam-Webster Dictionary, 2022). A non-fungible item would essentially mean such an item is unique and can’t be replaced with anything else.

NFT is a unique unit of data on a blockchain that can be linked to a digital or physical object, to provide immutable proof of ownership (Creighton & Summers, 2022).

NFT turns your digital asset into one of kind, by creating a unique digital signature, which defines the ownership of your asset, making it unique. It is built using the same type of technologies as cryptocurrencies, such as; Bitcoin and Ethereum, but that is about the similarity between NFT and cryptocurrencies.

In stark contrast, cryptocurrencies, similar to fiat currencies are fungible. For instance, a =N=500 bill is equal and can be exchanged for five =N=100 bills, as they are equal in value. Similarly, 1BTC is equal to a given amount of Dollar value. However, 1 NFT is not equal to and cannot be exchanged for another NFT. NFTs majorly exist on the Ethereum blockchain network. Blockchain technology is the underlying foundation of NFT and understanding how it

works, is crucial to understanding the workings of NFT.

Let’s take a crash course into what a blockchain is. A blockchain, as the name suggests is a chain of blocks that contains information (Simply Explained, 2017). This technique, first described in 1991 was intended for use in time-stamping documents, pretty much like a notary. It remained largely unused and was brought into prominence in 2009 by Satoshi Nakamoto who is regarded as the father of the cryptocurrency Bitcoin.

A blockchain is an immutable distributed ledger used to hold information. A block typically contains data, a cryptographic hash (which can be likened to a fingerprint, since it is unique), and a link/address to a previous block (which is equally a hash). The block type is dependent on the nature of data that is contained within it. A cryptocurrency block would typically contain information about the transaction attributes like; sender, receiver and amount.

Once a block is created, changing something inside would automatically change the hash, likewise tampering with a block within the chain, meaning it is no longer the same block, thus preserving its property of immutability. Now that you have a high-level overview of blockchain and its technical plumbings, being the underlying technology of NFT, it would help in driving home some key concepts associated with NFTs.

Figure 2: Jack Dorsey’s first tweet

NFTs’ rise to prominence can be largely attributed to creatives. They are digital tokens that live on a blockchain and represent ownership of unique items. Well, how is this helpful you may ask? Tracking a digital item can get a bit tricky, as it can be copied and distributed effortlessly, so how do you ascertain the true ownership, when everyone has an identical copy of the file? For illustration, if you create digital artworks, you can mint an NFT to represent this ownership. The token would typically contain A unique fingerprint (hash), token name, token symbol & optionally a link to the file posted on IPFS (InterPlanetary FileSystem). This token is stored on a blockchain and you, as the artist becomes the owner. You can sell this token by

token owner owns the artwork, the creator maintains the copy and production rights.

Coming from the article opener up to this point, I bet you’re asking yourself, still, why would anyone want to pay almost 3 Million Dollars to own a tweet? At what point does it make sense exactly? Well, NFTs can be likened to securities like stocks, which are similarly intangible and somewhat speculative in nature. The value ascribed to an NFT is speculative, it is the premium someone is willing to place on it, which is usually sentimental. A practical example would be the case of Dorsey’s NFT Tweet, which was purchased for almost $3 Million, and has plummeted in value by almost 99%, being able to garner a bid of only $280 on bid

creating a transaction on the blockchain, which keeps track of the current owner of the token, the amount it was sold for and the buyer. The immutable property of the blockchain preserves the integrity of the information contained within it. It is important to note that the digital artwork itself is not stored within the NFT nor the blockchain, only its attributes. Where it gets interesting is that when you purchase an NFT that represents an artwork, you do not get a physical copy of it. The NFT represents ownership and it is stored in a blockchain, making it tamper-proof. They merely earn you digital bragging rights as you don’t own the actual physical copy. While the

day and plateauing at its current present value of circa $10,000 (Winters, 2022).

If you’ve been following the article, you Wwould very easily see the applications of NFTs in the creative industry. At its core, NFTs are best suited for trading digital art, which includes, but is not limited to; visual art, and digital records. As an artist, you can purchase an NFT to make your digital asset unique, this creates a unique digital signature (a hash) which defines ownership of the asset, making them distinct and easily identifiable. You can then proceed to participate in online auctions without the threat of forgery or

Figure 4: Blockchain Illustration

Mike Winkelmann, better known as Beeple, is a South Carolina graphic designer and motion artist who has famously been creating a picture every single day for the last 13 years - not missing a single day for 5,000 straight days. These works, better known as Everydays, have formed one of the most celebrated bodies of work in the history of digital art.

Figure 3: Beeple, Everydays – The First 5000 Days 2021.

counterfeiting. Beyond the rudiments of buying and selling, they can be tied to smart contracts which can be used to factor in seamless royalty payments for subsequent re-sell of the item. Essentially, they can be applied across various sectors to validate anything that is unique and requires proof of ownership. Having examined its most basic use case, let’s begin to explore its other real-world applications

The ticketing industry can apply NFT in ticket sales. According to a poll by CNBC, about 12% of people who purchase online tickets get scammed (Leonhardt, 2018). NFTs can help with this as it makes it easier to verify ownership, authenticity and ownership transfer, transparently, with an option to make these tickets non-transferable. A company called GUTS is already ahead with this.

Document verification can be more seamless and fraud-free. Recruiters and hiring managers can easily verify academic credentials. It is additionally possible to verify the authenticity and integrity of documents such as; passports, certifications, licenses, birth certificates, etc. In the not-toodistant future, issuing these hard copy documents would be a thing of the past, making way for their NFT equivalents. Blockcerts is already ahead with this implementation, leveraging the blockchain, though they are yet to incorporate NFT. They can be used to verify the ownership of real-world assets such as; cars, houses, lands, bonds, etc. They can help greatly reduce the occurrence of fraud stemming from identity theft.

The supply chain and logistics industry can make use of it to track the

timestamp and metadata of an item, along each stage of the chain to uniquely identify an item. The tamper-proof nature of NFT would guarantee the authenticity of the item and promote transparency within the supply chain. IBM Food Trust is an example of a blockchain-based supply chain solution, its underlying technology supports the use of NFT.

They equally have applications in voting processes, owing to their outstanding attribute of being immutable and unique. NFT denoting voter registration can be issued to individuals, this goes without saying, it would store sensitive registration data pertinent to the individual, which is tamperproof and transparent (owing to the decentralized nature of the blockchain) and would certainly improve the integrity of any electioneering process. This is not just a concept idea, as a 12-year-old Philippine already

implemented this in 2021, during the lockdown. Interestingly, it was all done in the span of a month (Lay, 2021)

Lastly, the elephant in the room. Having found various use cases in other sectors, you might wonder what use it would be to the health sector, especially with an emphasis on health information exchange. Its strong distinguishing properties of uniqueness and immutability which have earned its stake in other sectors, make it shine brightest in the health sector, where privacy and security are its ethea.

With big data, AI and machine learning moving to the forefront of clinical research and development, Personal Health Information (PHI) has become more sacrosanct (Gold, 2022). The health data marketplace is already an established Billion-dollar industry, with several actors usually ranging from big pharma, hospitals, health

tech companies and other commercial entities. The patients, who generate the raw material for this industry are often marginalized, being reduced to spectators in the entire process. NFTs however would go a long way in changing this narrative. It would democratise and bring transparency to how PHI is exchanged, with a possible incentive of monetization for the patients can now take full control and responsibility of the PHI, deciding what data is shared, with whom and under what conditions. Patients’ can use this degree of control to monetize their PHI, which would be beneficial to them, rather than it being solely beneficial to the corporations, which is the case right now. NFTs through smart contracts can be programmed in such a way that the Patient earns future royalties for the use of their PHI. Asides from its commercial benefits to patients’ the decentralized nature of the NFT blockchain would go a long way in securing and preserving the integrity of medical information exchange.

NFTs are still in their infancy and there is only as much data to back their stability as a financial instrument, as is available on cryptocurrencies. However, it is barely starting its journey of use-case discovery, having fast found several practical applications in various sectors, with other limitless possibilities that extend well beyond bridging the gap between the digital and real-world as value carriers and a medium of ownership rights.

Healthcare cybersecurity: The rise of ransomware

By Gbolabo Awelewa

Cybersecurity Awareness is spreading across the world with the rapid advancement of technology and the need to protect the data which they store and services provided. Cybersecurity is no stranger to both the public and private sectors such as Education, Oil and Gas, Transportation and especially Healthcare as long as technology and data is involved.

“CyberMed” a term coined to relate cybersecurity and the healthcare within the same ecosystem. The Healthcare sector has been a major target for malicious threat actors due to the data held by the healthcare sector and lack of implementing best security practice. The value of data healthcare organizations controls and maintain is of tremendous value to threat actors, from personal information, payment card data, healthcare insurance number and sensitive health information.

The monetary rewards are great with these bad parties. Unfortunately, data isn’t the only goal for a cybercriminal,

operations in the healthcare is of major importance as this could hinder saving the life of a patient. Threat actors can brutely crumble the operations of healthcare organization by causing a denial of service, denying access to Hospital Management System (HMS), inventory systems and data retrieving application. Operations in the healthcare sector is technology and application driven for time management.

These operations are needed to identify, process, allocate patients in the everyday operations in the healthcare sector. Imagine being denied access to test results generated from test laboratory application, operations trickle down to every aspect of the healthcare sector.

Cyber criminals use a popular attack to achieve disruption of operational service in the healthcare sector as well as making needed data inaccessible. Ransomware attack is most common attack used by malicious actors against the healthcare sector. Threat actors deliver this malware into their target’s environment via

several means with the aim to encrypt all the files, demanding for a ransom to restore access to the files while in the process disrupting business operation.

Reports from Kaspersky identified Nigeria to have experienced the most cyberattacks with majority being ransomware and phishing in the year 2021 alongside Ethiopia for the highest cyberattacks post-covid year.

The Ryuk ransomware was a popularly known ransomware which targeted the healthcare sector globally in 2020, ever since there have been outbreaks of other variants of the ransomware as well as newly developed malwares modernized to bypass basic security measures. This is currently the half of the year 2022 and there are already two breakout exploits such as “Folina” which affected a lot of organizations in every sector.

In Nigeria, the CyberMed industry is known to have a large attack surface area for cybercriminals to exploit and take advantage off especially with the use of ransomware. This is due to the lack of applying the right security processes (and Controls) and aligning to a global and national cyber security standard for data protection.

Many healthcare organizations have been breached via business email compromise, phishing, malicious email attachments and vulnerable application. With the implementation of security practices such as endpoint security which is the use of Endpoint Detection and Response (EDR) solution or Extended Detection and Response (XDR) solutions, healthcare organizations can reduce their exposed attack surface as well as the use of other security technology such as firewall and email security gateways.

Nigerian Data Protection Regulation (NDPR) was introduced 2019 by National Information Technology Development Agency (NITDA) to aid safeguard, regulate and protect against personal data breaches and ensure all Nigerian

businesses in all sectors including the healthcare operate without business disruption caused from a cyber breach.

This regulation applies to all kind of transactions, healthcare organizations are subject to this regulation as it gives impetus to Section 24 of the National Health Act, 2014, which states “All information concerning a user including information relating to his or her health status, treatment or stay in a health establishment is confidential”.

As at May 2021, Vanguard news reported the Lagos State Ministry of Health is adopting NDPR and push for healthcare organizations within Lagos to adopt as this will ensure trust of data privacy and protection as well as ensure organizations are implementing the right security practice to prevent and respond to a data breach from a malicious threat actor.

With the evident rise of cyberattacks especially ransomware in the healthcare sector, it is important healthcare organizations adopt NDPR and are compliant which in turn will ensure implementation of global security practice to secure their environment such as cybersecurity awareness training, the use of firewalls for perimeter protection of their external facing networks, EDR, XDR and proactive Monitoring solutions to close security gaps.

Also, the operationalization of standard cybersecurity policies and processes are very cost-effective measure to prevent against a Cyber or Ransomware attack. This will reduce the attack surface area exposed to threat actors which inline would reduce breaches and cyber incidents in the Healthcare sector.

Leveraging Technology In

Affordability of Accessing Health Care- The Roadblocks Limiting Technology

By Adeyinka Adenikinju

According to the WHO’s Global strategy on digital Health “Health systems and delivery of care across all countries have been challenged by the rise of noncommunicable diseases, shortage of the health workforce, aging population, unplanned emergencies, and infectious disease outbreaks”.

To paint a clearer picture of the situation as of 2020, “at least half the world’s population still lacks access to essential health services” (WHO and World bank). This concern resonated during our maiden twitter space as Genesys Health, where a listener asked a pertinent question; how can technology be used to create affordable access to health care for the populace who are below the living standard.

He seemed not to be the only one with this same question or objective, as the World Health Assembly (WHA) which met in Geneva in May 2019, while addressing the implementation of the health-related goals of the 2030 Agenda for Sustainable Development, focused singularly on how to make universal health coverage (UHC) a reality (Jong, 2019). Earlier that same year, the World Health Organization (WHO) published its draft Global Strategy on Digital Health, which

puts digital health initiatives and greater use of technology and health information systems at the heart of achieving affordable and universal access to care.

It must be mentioned that though the WHA’s focus was on the role of the public sector in achieving this, it will take a combination of government bodies, NGOs or companies alone can solve the challenges that stand in the way of achieving universal health coverage. Attempting to find a panacea to this question is the proposition that “achieving UHC by 2030 will only be possible if we create a collaborative ecosystem consisting of private sector and governments as a major part of the digital transformation”.

The potential use of digital technologies has been explored to address some of these challenges by several countries. After the first wave of initiatives on eHealth applications in the late 1990s and early 2000s, the need for a synergetic approach to the application of information and communication technologies (ICT) to health care delivery and patient care was identified as necessary (Jong, 2019).

The aim was to integrate eHealth services to use resources more efficiently, avoid fragmentation, and facilitate information sharing for better and faster decision-making. This effort led to the creation of national and regional eHealth policies and strategies.

In response to countries´ emerging eHealth initiatives, organizations such as the WHO, the International Organization for Standardization (ISO), and the International Telecommunication Union (ITU), adopted the role of disseminating knowledge, facilitating collaboration, sponsoring discussion forums, and developing tools and other guiding documents that would help policymakers and public servants (Jong, 2019).

Interoperability: Lowering administrative expenditure

Integrating health systems with the use of technology to create a unified system that now gives access to a combined the data from theadifferent health systems can help in quicker diagnosis and treatment, this has beneficial effects on caregivers enabling them to understand the exact needs of patients, share data between systems and the cloud, and drive efficient analysis that can lead to better and affordable patient care.

Smart Technology: Streamline claims processing

Another major contributor to skyrocketing healthcare costs is the insurance claims process – which is time-consuming and also labor-intensive – for stakeholders in the healthcare sector. The complexity in processing and managing claims, and slow response times which greatly affect patient experience are the culprits of rising costs in this case (Siddhartha., 2019).

Using smart technology like Hospital Management information systems can streamline claims processing, cut costs by a large margin, and significantly improve turnaround times. This technology automates the hospital processes; data collection and communication processes while proving the events that lead to a claim. The major outcome is reduced healthcare costs as well as a better customer experience. The automation of the processes allows both healthcare providers and insurances companies the possibility of further improving payment efficiency which then drives significant savings in overhead costs and repayment turnaround times.

With the many benefits of technology and data in the health tech sector, governments and other stakeholders now have a higher chance of accelerating the deployment of connectivity and technology to deliver real impact and scale in their health systems.

Many of today’s doctors, and certainly the next generation of medical practitioners, will be working in the hospitals of the future. These hospitals will be built largely around technology, with Artificial Intelligence (AI), telehealth, and connected care being the norm, advanced automation and algorithms enhancing the efficiency of routine tasks will thus lead to an improved outcome of both the quality and affordability of care.

Healthcare wearables: Cutting down the need for specialists

Healthcare wearables have become a major part of our gadgets and a tool for caregivers, these tools now play an immensely positive impact on healthcare delivery, when you consider the cost of patients accessing care; the patients will be required to visit the health facility physically (logistics costs) and clearly articulate their condition (communication stress) doctors to diagnose symptoms and provide precise treatment (false vitals due to fear of the garment, additional cost for delayed testing where investigations are needed multiple times and logistic cost if the patient has to visit a different location for his or her test to be carried out).

The overuse of specialists for diagnosis and treatment and the ever-increasing doctor fees makes healthcare very expensive. Technology can be leveraged here using the wearables which can provide an array of benefits, they can automatically gather necessary information from patients, and send critical healthcare data to a unified system, which in turn allows doctors to get real-time alerts when conditions go beyond normal – thus drastically bringing costs down (Siddhartha., 2019).

Remote patient monitoring: Eliminating hospital room expenses

As earlier established a patient incurs more costs in a traditional healthcare setting which arises from patients’ travel costs in getting to the healthcare organization (commonly some patients have to travel to other countries to access specialized care) to get any kind of treatment. The cost incurred not only includes doctor fees, costs of treatment, lab fees, and medication costs, but also insurance costs and the cost of traveling –especially for patients living in remote areas (Siddhartha., 2019).

Smart technology like remote patient monitoring can be used to keep healthcare costs in check even as healthcare spending per person keeps increasing.

The advent of the Internet of Medical Things has brought accessibility and affordability to healthcare costs considering how primary telemedicine tools are becoming widespread. The use of advanced tools, allows healthcare to remotely monitor patients in real-time and adjust treatment plans accordingly –thereby eliminating travel costs, hospital room expenses, and exorbitant doctor fees (Siddhartha., 2019).

Webinar Highlight: Healthcare Cybersecurity: Protecting Patient Information

By Ayo-Olagunju Muna

Our just-concluded webinar was graced by a seasoned panellist of industry experts and savants across the intersection of Cybersecurity and health law in the persons of; Rotimi Akinyele, a renowned cybersecurity expert, and the first Offensive Security Certified Professional/Expert (OSCP) out of Nigeria. Yomi Ajibade, a thoroughbred legal professional with a master in law, focused on the intersection between law and tech and lastly, an erudite legal scholar, who is equally a health law consultant, and a recipient of the 2021 Nigerian prize for literature award, in the person of Prof. Cheluchi Onyemelukwe.

Rotimi opened by pointing toward a KPMG survey that spoke to the fact that 80% of healthcare execs say they haven’t fallen victims to cyber security attacks, which is not entirely an indicator of progress. Instead, it poses a red flag, as most times victims of cyber attacks are often oblivious to these attacks. He stated that the attacks could vary in complexity from a simple attack on a corporate Facebook page, as reported here, to a threat on a class III medical device as posited here by Barnaby Jack or the more critical instance of the Wannacry ransomware attack in 2017 on the UK NHS, which resulted to 19,000 cancelled appointments, GPs being locked out of medical devices, patients records being inaccessible, emergency patients being diverted to other hospitals and ultimately costing £92 Million. He stated that healthcare cyberattacks are becoming predominant and would continuously be on

the increase, due to the heavy adoption of technology and digitisation within the sector and the gradual shift toward paperless, which has provided enablement coupled with the sensitivity of the data within the sector, making it very attractive. We were introduced to the most common attack vectors for the healthcare industry, which include, the use of dated technologies and legacy systems, limited security awareness amongst staff, unrestricted access to computers (multiple users sharing a single login), lack of appropriate security controls on Wi-Fis (especially through guest WiFis) and insecure asset disposal techniques. Rotimi provided a quick glimpse into some sections and sub-sections within the Cybercrimes (Prohibition and Prevention) Act 2015, which designates the health sector as a National Critical Information Infrastructure, which means that similar controls currently in place to safeguard critical national information and assets are equally applicable to the health sector. These policies and frameworks are merely a high-level guide on what should be obtainable. In the practical context of how health care providers can protect patient information against cyber attacks, he advised the following; conduct risk assessments, conduct technical security controls, promote security awareness and culture shift, take frequent and routine data backups, update digital assets and enforce strong and secure authentications.

Yomi took over the baton, doing further

justice to the discourse, focusing on data protection from a legal purview. On a global scale, the audience was introduced to the EU GDPR which ascribes certain obligations to entities that operate not only within Europe, but companies that operate within other jurisdictions, but process data of European Nationals. Domestically, the NDPR addresses this, which is mirrored after the GDPR, similarly affecting and relating to data subjects of Nigerian descent. Some high-level insights were provided on how to protect data across all sectors and meet compliance needs which were; knowing your data protection goals, knowing your data - what do you have in your system and how do you collect what you have? Educate/train your employees and lastly, initiate eternal oversights, internal controls and enforcement measures. In summary, Yomi implored the audience to keep up with global best practices, by holding their organization accountable to the highest level of standards, that way, one is certain to meet the obligations of less stringent data protection guidelines, citing the GDPR as the gold standard in that regards.

The erudite professor, Cheluchi took the virtual podium, being the closing panellist, coming from a legal background, she brought in the legal/regulatory perspective from the local context. She shone a light on legislative and regulative provisions that govern data protection, privacy, cyber security and patient rights, ranging from the; Consitution of the Federal Republic of Nigeria 1999, National Health Act 2014, Cybercrimes (Prohibition and Prevention) Act, National Health Insurance Scheme Act (NHIS Act), Freedom of Information Act (FOI Act), National Data Protection Regulation (NDPR) 2019 and Patients Bill of Rights (PBoR). Each of these pieces of legislation is geared toward protecting upholding and protecting the patients’ right to confidentiality, especially for Personally Identifiable Information (PII) which is information that can uniquely identify an individual. These provisions create an allowance for scenarios and preconditions

that permit the ethical and safe disclosure of patients’ information, some of which include; when the patient’s consent is sought, if a court order or any appropriate law requires such disclosure, if non-disclosure poses a serious threat to public health, if the disclosure is necessary for a legitimate purpose and especially if it is in the best interest of the patient and in the case of a person who is otherwise unable to grant consent upon the request of a guardian or representative. She wrapped up by providing some practical recommendations that healthcare organizations can adopt for protecting data; developing an information governance framework, developing/ reviewing information governance policies, reviewing agreements with EHR vendors, developing tailored privacy policies and appointing a data privacy officer.

The webinar wrapped up with a Q&A session. Prof. Cheluchi, in response to a question on data ownership between a patient, healthcare provider and EMR company, asserted that in the context of patient medical information, despite the patient being the data subject, the other actors in the value chain within this context can equally intellectually contribute to the said data. The best way she retorted, which the NDPR equally makes provision for is to seek appropriate consent before the data is being used, as most times it is the use of data that occassions the debate of ownership. Rotimi respond to the question from the opener, on how a patient can know their data has been compromised, by saying it would be near impossible without adequate proof.

The panellists dropped their social handles, which are contained within their picture inset. If you enjoyed this highlight and are looking forward to our next edition, use these links, to keep up to date with us; Facebook, Instagram, Twitter, LinkedIn

GOOD FOOD: THE BEST MEDICINE

By Owolabi Peter

I can’t quite forget this soon, as I regularly remember an excerpt from the Inaugural Lecture of Professor Ramota Karim, a Professor of Food Science, University of Ilorin. She said, “ Mr Vice Chancellor Sir, Ladies and Gentlemen, To eat is a necessity, but to eat intelligently is an art”. Impacted through that, I couldn’t help but think that I need to start eating intelligently, as thoughts kept coming through, I stumbled on another popular adage that says “you are what you eat”.

However, from ages long gone, the prebasic necessity of life which is feeding or Nutrition according to biological terms, has been ensured reasonably well. But as time passed by, some factors such as increase in chemical application, oil spillage and others rendering the nutritional values of human food lower than by-gone ages, humans then have to augment their meals with drugs, that were chemically prepared to suppress or eliminate diseases brought about by the nutritionally devalued foods.

To say that wasn’t enough, diseases grew even with the advent of drugs while foods are still grown inorganically (usage of fertilizers and other chemicals), because foods does much more than simply provide you with fuel. It is capable of promoting or worsening health, depending on what you eat. Furthermore, in the wakeW of these events, scientific research have

proved that organically grown foods are more nutritive than the inorganic ones, as evidence does suggest that foods grown organically may be more nutritious as they contain low nitrate which reduces cancer as high nitrate levels are associated with an increased risk of certain types of cancer. Organic foods also release low pollution to the soil, as they preserve the water

and air condition of the soils. In addition, a research published by the NCBI in 2017 stated that, organic crops have higher antioxidant activity and between 18 and 69% higher concentrations of a range of individual antioxidants; increased intakes of polyphenolics and antioxidants has been linked to a reduced risk of certain chronic diseases such as cardiovascular and neurodegenerative diseases and certain cancers.

Organically grown foods may be expensive as well as scarce, but they are definitely worth it. So I conclude with the words of Hippocrates “Let thy food be thy medicine and medicine be thy food’, as it emphasizes the importance of nutrition to prevent or cure diseases.

INTERNATIONAL NURSING DAY 2022: Nursing In The Digital World

By Amilo Precious

It is no news that we are in the digital age and the world is now a global one, where Technology is the order of the day. Most professions have been fine tuned to adjust to the new normal, and nursing is not left.

Nursing is the act of caring for the sick. It encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people.

The Nursing Profession is very important to the health care sector and the world at large. Nurses are caregivers, advocate, life savers, teachers, in-fact the list is endless. Incorporating technology into nursing has helped to reduce the workload on nurses, make the job easier, improves efficiency and ensure a lot of people have access to this healthcare.

The just concluded nurse’s week was themed “A voice to Lead- invest in nursing and respect rights to secure global health” . Nurses are very important to the health sector because they are the first line of contact with the patients/clients and apart from being the first contact they

are also the ones the patient spends the most time with. They work tirelessly to walk the sick through and out of their sick and weak state. This year’s nurse’s week theme emphasized on the fact that Nursing is a profession to be invested in, it should be respected and protected at all costs if we want to secure optimum health for everyone.

As upcoming nurses who have passion to help individuals obtain optimum health and complete wellbeing, we hope to deliver our very best and reach a wide range of persons with the help of technology.

Technology has no doubt breached the communication gap between nurses and other health care professionals, also nurses and patients.

Life is much better with the advent of Technology.

Cheers to our nurses in tech!

PAIN MODULATIONS

What is pain?

Pain is an ache or bodily suffering resulting from a derangement of functions, disease, or injuries. It is an uncomfortable feeling that tells you something may be wrong. It can be steady, throbbing, stabbing, aching, pinching, or described in many other ways. (John Hopkins medicine).

THE BODY’S NATURAL MECHANISM FOR THE MODULATION OF PAIN.

Accumulating evidence suggests that endogenous pain inhibition depends on activation of the prefrontal cortex, periaqueductal gray and rostral ventral medulla. Nociceptive signals that are transmitted from the periphery to the brain require integration and processing within the spinal cord, brainstem and brain. Increased pain sensitivity, a characteristic of chronic pain, may develop either through peripheral mechanisms (peripheral sensitization) or as a consequence of neuroplastic changes in the CNS (central sensitization). Pain modulatory signals from the PAG can reach dorsal horn neurons of the spinal cord either directly or indirectly via the rostroventral medulla. Compelling evidence suggests that spinal input to the PAG can elicit pain inhibition through a spinal–supraspinal–spinal loop.

Endogenous pathways for the modulation of pain include;

• The Endogenous Opioid system

• Pain Gate Theory

• Muscle Guarding

Opioid System: The body possess an opioid system (pain modulating), which soften the blow of pain once the brain receives that information. The body then sends signals to the hypothalamus and pituitary gland, which in turn, release ENDORPHINS, which are the body’s natural painkillers. The name of these hormones comes from the term “endogenous morphine.” “Endogenous” because they’re produced in our bodies. Once the signal from the ascending pathway reaches the somatosensory cortex, it triggers the descending pain modulation pathway. The balance between inhibition and facilitation is dynamic, and can be altered in different behavioral, emotional, psychological and pathological states. Descending pain control pathways plays a critical role in determining the experience of both acute and chronic pain. The goal of this pathway is to allow the organism to function enough to respond to the pain source by reducing the pain signal through neuronal inhibition.

It begins in the periaqueductal gray (PAG), a region of the midbrain that process nociceptive information and relays it to the rostral ventral medulla (RVM). These neurons in the RVM then send a signal down the spinal cord to re-

lease endogenous opioids at neuronal synapses at multiple points in the peripheral nervous system to prevent these pain signaling neurons from sending action potentials.

Additionally, these endogenous opioids are released in parts of the dorsal horn of the spinal cord to further block ascending pain transmission signals.

Hormone as a body’s natural pain modulation mechanism. Hormones are chemical messengers that are secreted from endocrine glands in the body directly into the blood, which carries them to organs and tissues of the body to exert their functions.

Severe pain, (either acute or chronic) is a severe stressor which activates the hypothalamic–pituitary–adrenal–thyroid–gonadal (HPATG) system. The HPATG system. is the major stress control mechanism of the body.

The biologic Importance of this system is to produce additional hormones in the thyroid, adrenals and gonads, and secrete them into the serum as they are needed by the body to perform pain-control functions, they also perform functions which include:protection and regeneration of injured tissue, immunologic activity, and metabolic control.

Serotonin (5-HT) and norepinephrine are involved in endogenous pain modulation, they are released through descending pain pathways to modulate painful signaling in the spinal cord. Serotonin performs both pain facilitatory and inhibitory functions. Norepinephrine inhibits pain through 2 adrenoceptors.

The goal of the descending pain pathways is to allow the organism to function enough to respond to the pain source by reducing the pain signal through neuronal inhibition.

PAIN GATE THEORY:

This theory was postulated by Melzacks and wall’s . This Gate Control Theory of Pain is a mechanism, in the spinal cord, in which pain signals can be sent up to the brain to be processed to accentuate the possible perceived pain, or attenuate it at the spinal cord itself. The ‘gate’ is the mechanism where pain signals can be let through or restricted. One of two things can happen, the gate can be ‘open’ or the gate can be ‘closed’.

If the gate is opened, pain signals can pass through and will be sent to the brain to perceive the pain.

If the gate is closed, pain signals will be restricted from travelling up to the brain, and the sensation of pain won’t be perceived.

CLOSED GATE.

If someone experiences a painful (noxious) stimulus, the application of a non-noxious stimulus (soothing or light rubbing) for example, ice, heat,massage etc can help activate the gate control mechanism, and reduce the pain.

According to this theory, pain stimulation is carried by small, slow fibers that enter the dorsal horn of the spinal cord; then other cells transmit the impulses from the spinal cord up to the brain. These fibers are called T-cells.

The T-cells can be located in a specific area of the spinal cord, known as the substantial gelatinosa. These fibers can have an impact on the smaller fibers that carry the pain stimulation. In some cases they can inhibit the communication of stimulation, while in other cases they can allow stimulation to be communicated into the central nervous system.

OPENED GATE

For example, large fibers can prohibit the impulses from the small fibers from ever communicating with the brain. In this way, the large fibers create a hypothetical “gate” that can open or close the

system to pain stimulation.

According to the theory, the gate can sometimes be overwhelmed by a large number of small activated fibers.There are 3 factors which influence the ‘opening and closing’ of the gate these include:

• The amount of activity in the pain fibers. Activity in these fibers tends to open the gate. The stronger the noxious stimulation, the more active the pain fibers.

• The amount of activity in other peripheral fibers— that is, those fibers that carry information about harmless stimuli or mild irritation, such as touching, rubbing, or lightly scratching the skin. These are large-diameter fibers called A-beta fibers. Activity in A-beta fibers tends to close the gate, inhibiting the perception of pain when noxious stimulation exists. This would explain why gently massaging or applying heat to sore muscles decreases the pain.

present. Our body typically responds to this signal through the use of muscle guarding (a protective mechanism) to prevent further injury. Muscle spasms range in intensity from mild, uncomfortable twitches to significant discomfort to intense, severe pain. Spasms typically last from seconds to 15 minutes or longer, and may recur multiple times before going away. Thermotherapy : comprises a number of physical agents that use superficial heat to increase soft tissue extensibility, reduce pain, improve circulation, and accelerate healing. Thermal therapy is believed to accomplish these goals by increasing blood flow (vasodilation), reducing alpha motor neurone firing rate, increasing pain threshold (gating effect; reduced ischemia), and increasing metabolic activity (increasing the availability of oxygen to tissue).

temperature of the skin/ soft tissue, the blood flow decreases by vasoconstriction. It will be followed by a vasodilatation which will prevent against hypoxic damage (hunting reflex: If the cold pack is left on the skin for more than 10 minutes, the blood vessels will dilate). The tissue metabolism will decrease just like the neuronal excitability, inflammation, conduction rate and tissue extensibility. At joint temperatures of 30°C or lower, the activity of cartilage degrading enzymes, including collagenase, elastase, hyaluronidase, and protease, is inhibited. the decreased metabolic rate limits further injury and aids the tissue in surviving the cellular hypoxia that occurs after injury.

Muscle guarding (spasm) is the body’s first response when the pain occurs because it is the brain’s reflexogenic attempt to prevent further injury to injured tissues. Pain, aside from being an unpleasant sensation, acts as a signal for the body that an injury Is

Heat: By increasing the temperature of the skin/ soft tissue, the blood flow increases by vasodilatation. The metabolic rate and the tissue extensibility will also increase. Heat increases oxygen uptake and accelerates tissue healing, it also increases the activity of destructive enzymes, such as collagenase, and increases the catabolic rate.

Cold

By decreasing the

Deep heating is thought to lessen nerve sensitivity, increase blood flow, increase tissue metabolism, decrease muscle spindle sensitivity to stretch, cause muscle relaxation, and increase flexibility. Heat stimulates the cutaneous thermoreceptors that are connected to the cutaneous blood vessels, causing the release of bradykinin which relaxes the smooth muscle walls resulting in vasodilation. Muscle relaxation occurs as a result of a decreased firing rate of the gamma efferents, thus lowering the threshold of the muscle spindles and increasing afferent activity. There is also a decrease in firing of

the alpha motor neuron to the extrafusal muscle fibre, resulting in muscle relaxation and decrease in muscle tone. All these promote pain reduction.

Ice Therapy

Ice is great for easing damaged superficial tissue that is hot, red, inflamed, or swollen. The inflammatory process is a natural process; however, it can be painful. Ice is a mild way to dull the pain and reduce swelling.

How Physiotherapy Uses Hydrotherapy to Relieve Pain.

Hydrotherapy (also known as aquatherapy) is any activity performed in water to assist in rehabilitation and recovery from hard training or serious injury. It is a form of exercise in warm water and it is a popular treatment for patients with neurologic and musculoskeletal conditions. The goals of this therapy are muscle relaxation, improving joint motion and reducing pain. Hydrotherapy involves the patient being in a heated pool of water, carrying out specific exercises. The water is usually heated at between 33 and 36 degrees Celsius. The sensation of being in the heated water helps to interrupt pain signals and therefore also help to relieve pain. This study

explains, “Sensory-motor hyper stimulation exerted by the hydrostatic pressure, viscosity, and water temperature increases the triggers of thermal receptors and mechanoreceptors while blocking nociceptors.”

During the hydrotherapy session the warmth and the calming setting promotes relaxation. It’s been proven that during hydrotherapy, levels of stress hormones (such as cortisol and norepinephrine) are reduced. Reducing stress can in turn reduce pain levels.

Some Physiotherapy Modalities that Facilitate the Release of Pain Modulating Hormones

Exercise therapy, Manual therapy {Massage} are useful in inducing relaxation and reducing stress levels in the body by reducing cortisol levels. Among the primary paincontrol functions of these hormones are immune and anti-inflammatory actions, cellular protection, tissue regeneration, glucose control, and modulation of CNS receptors, the blood–brain barrier, and nerve conduction. Given the CNS effects of certain hormones, analgesics such as antidepressants, neuropathic agents and opioids, may not achieve maximal analgesic

responses without hormone homeostasis.

Ultrasound exert its antiinflammatory effects by down-regulating proinflammatory genes and up-regulating antiinflammatory genes.

A transcutaneous electrical nerve stimulator (TENS) sends electrical pulses through the skin to start your body’s own pain killers. The electrical pulses can release endorphins and other substances to stop pain signals in the brain. TENS can reduce pain.

TENS effects on Hypothalamic-PituitaryOvarian axis. It is suggest that normal E2level is very important in regulation behavioral and physiological events essential for successful procreation.

Manual Therapy In Pain Modulation

Three Paradigms for Manual Therapy

Therapeutic Effects

• Physiological: positive placebo response

• Bio-mechanical

• Physical: facilitates repair and tissue modeling

Psychological: pain relief via- stimulates gating mechanism;

muscle inhibition; reduction of nociceptive activity; reduced intraarticular or periarticular pressure

Techniques that primarily target muscles and other soft tissues, such as massage, use mechanical pressure. This pressure is hypothesized to increase tissue extensibility with resulting increases in joint motion. Pressure to the tissues will also help to increase blood flow and therefore promote healing and reduce pain. Manual Therapy- Hands-on manual therapies such as soft tissue and joint mobilization help to combat inflammation by gaining movement while reducing pain and encouraging blood flow.

Examples of manual Therapy Techniques include; Massage, Trigger Point Therapy, Active Release Technique ,Assisted Active Range of Motion, Passive Range Of motion, Stretches, Lymphatic Drainage, Joint Mobilization , Thrust Manipulation..

Role of Exercise Therapy in Pain Modulation

Exercise is any bodily activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic skills, weight loss or maintenance, improve health, or simply for enjoyment.

EXERCISE-BASED MODULATION OF PAIN.

Exercise is a key component of a healthy lifestyle as it helps maintain a healthy body weight and reduces the risk of various morbidities and co-morbidities. Exercise is an acute physiological stress that initiates a multitude

of processes that attempt to restore physiological homeostasis and promote adaptation. A component of the stress response to exercise is the rapid release of hormones from the adrenal gland including glucocorticoids, the catecholamines and aldosterone. While each hormone targets several tissues throughout the body, skeletal muscle is of interest as it is central to physical function and various metabolic processes. Indeed, adrenal stress hormones have been shown to elicit specific performance benefits on the muscle.

Exercise can reduce pain sensitivity in painfree participants, also known as exerciseinduced hypoalgesia (EIH). Hypoalgesia is a reduced sensitivity to pain. Physical activity and exercise reduces excitability of central neurons, measured by phosphorylation of the NR1 subunit of the NMDA receptor, alters neuroimmune signaling in the central nervous system, and increases release of endogenous opioids and serotonin in the brainstem pain inhibitory pathways.

Regular physical activity can keep the muscles around affected joints strong, decrease bone loss and may help control joint swelling and pain. Regular activity replenishes lubrication to the cartilage of the joint and reduces stiffness and pain. Exercise reduces levels of the body’s stress hormones, such as adrenaline and cortisol. It also stimulates the production of endorphins, chemicals in the brain that are the body’s natural painkillers and mood elevators. Exercise pumps up your endorphins. Physical activity may help

By Woke-Bankole .O. Ifeloluwa Okunoye Mercy

Shah B, Shah N, Shakhla S, Sawant V. Remodeling the healthcare industry by employing blockchain technology. In2018 international conference on circuits and systems in digital enterprise technology (ICCSDET) 2018 Dec 21 (pp. 1-5). IEEE.

Quasim MT, Khan MA, Algarni F, Alharthy A, Alshmrani GM. Blockchain Frameworks. InDecentralised internet of things 2020 (pp. 75-89). Springer, Cham.

Monrat AA, Schelén O, Andersson K. A survey of blockchain from the perspectives of applications, challenges, and opportunities. IEEE Access. 2019 Aug 19;7:117134-51.

Abu-Elezz I, Hassan A, Nazeemudeen A, Househ M, Abd-Alrazaq A. The benefits and threats of blockchain technology in healthcare: A scoping review. Int J Med Inform. 2020 Oct;142:104246. doi: 10.1016/j.ijmedinf.2020.104246.

Sadiku MN, Eze KG, Musa SM, Perry RG. Block chain Technology in Healthcare. International Journal of Advances in Scientific Research and Engineering (ijasre) 2018; 4 (5): 154-9

Zarour M, Ansari MT, Alenezi M, Sarkar AK, Faizan M, Agrawal A, Kumar R, Khan RA. Evaluating the impact of blockchain models for secure and trustworthy electronic healthcare records. IEEE Access. 2020 Aug 27;8:157959-73. Conti, R. (2022, June 13). What Is An NFT? Non-Fungible Tokens Explained. Forbes. https://www.forbes.com/advisor/investing/cryptocurrency/nft-non-fungibletoken/

Creighton, J., & Summers, S. (2022, May 25). NFTs Explained: A Must-Read Guide to Everything Non-Fungible. Nft Now; 351Studios. https://nftnow.com/guides/ what-is-nft-meaning/

Future Business Tech. (2021). The Future of NFTs: 7 INNOVATIVE Use Cases [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=H6dsrYFVC30

Gold, L. (2022). Could NFTs change personal health information management? Integrativepractitioner.com. https://www.integrativepractitioner.com/practicemanagement/news/2022-02-24-could-nfts-change-personal-healthinformation-management

References

Hamilton, A. (2022, March 3). The Beginning Of NFTs - A Brief History Of NFT Art. Zeno Fine Art; Zeno Fine Art. https://www.zenofineart.com/blogs/news/the-beginningof-nfts-a-brief-history-of-nft-art#:~:text=2012%2D2016%20%2D%20The%20 Early%20History%20Of%20NFTs,-Long%20before%20Ethereum&text=On%20May%20 3rd%2C%202014%2C%20digital,manner%20reminiscent%20of%20an%20octopus.

Lay, R. (2021, November 18). How a 12-year-old boy developed an NFT voting platform. Forkast; forkast.news. https://forkast.news/12-year-old-boy-nft-votingplatform-for-philippines/

Leonhardt, M. (2018, September 14). About 12 percent of people buying concert tickets get scammed. CNBC; CNBC. https://www.cnbc.com/2018/09/13/about-12percent-of-people-buying-concert-ticketsget-scammed-.html

Merriam-Webster Dictionary. (2022). Merriam-Webster.com. https://www. merriam-webster.com/dictionary/fungible

Simply Explained. (2017). How does a blockchain work - Simply Explained [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=SSo_EIwHSd4

Tahelyani, R. (2022, March 30). Top 11 Most Expensive Bored Ape Yacht Club NFTsThe Crypto Times. The Crypto Times. https://www.cryptotimes.io/most-expensivebored-ape-yacht-club-nfts/

Thapa, S. (2021, April 8). 20 Most Expensive NFTs Sold (So Far) | ScreenRant. ScreenRant; Screen Rant. https://screenrant.com/expensive-nfts-sold-so-far/

MAKERSPLACE. (n.d.). Beeple: Everydays - First 5000 Days | MakersPlace. Makersplace.com. https://makersplace.com/beeple/5000-days/

Wikipedia Contributors. (2022, June 17). Non-fungible token. Wikipedia; Wikimedia Foundation. https://en.wikipedia.org/wiki/Non-fungible_token#:~:text=A%20 non%2Dfungible%20token%20(NFT,a%20form%20of%20distributed%20ledger.

Winters, M. (2022, April 14). An NFT of Twitter co-founder Jack Dorsey’s first tweet has lost almost all of its $2.9 million value. CNBC; CNBC. https://www.cnbc. com/2022/04/14/2point9-million-dollar-nft-of-jack-dorseys-first-ever-tweetplunges-in-value.html

References

Zlatev, D. (2022, April 14). NFT of Jack Dorsey’s first tweet put for US$48 million sale, attracts laughable bids. Notebookcheck; Notebookcheck. https://www. notebookcheck.net/NFT-of-Jack-Dorsey-s-first-tweet-put-for-US-48-millionsale-attracts-laughable-bids.613829.0.html

Sharif-Naeini R, Basbaum AI. Targeting pain where it resides … in the brain. Sci Transl Med. 2011;3(65):65ps1. [PubMed] [Google Scholar]

Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009

Kroenke K, Krebs EE, Bair MJ. Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. Gen Hosp Psychiatry. 2009;

Naugle KM, Ohlman T, Naugle KE, Riley ZA, Keith NR. Physical activity behavior predicts endogenous pain modulation in older adults. Pain. 2017

Holden JE, Jeong Y, Forrest JM. The endogenous opioid system and clinical pain management. AACN Advanced Critical Care. 2005

Carolyn Middleton Nurs Times,. 2003 Sep 16., 6Heinricher MM, Tavares I, Leith JL, Lumb BM. Descending control of nociception: specificity, recruitment and plasticity. Brain research reviews. 2009

medlineplus.gov, esearchgate.net, bioninja, Sciencedirect.com

health.harvard.edu.ng, Original Editor - Kirianne Vander Velden

Lead Editors - Bianca Geeroms, Anja Vanroelen, Charles Senay, Kirianne Vander Velden, Admin, Ella Rubbens, Kim Jackson, Oyemi Sillo, WikiSysop, Laura Ritchie, Evan Thomas, Scott Buxton, Claire Knott, Chelsea Mclene and Aminat Abolade

https://www.integrityphysio.com.au/blog/how-to-use-ice-andheat-therapy-for-sports-injuries/, https://www.physio-pedia.com/ Theories_of_Pain. https://www.physio-pedia.com/Gate_Control_Theory_ of_Pain?utm_source=physiopedia&utm_medium=related_articles&utm_ campaign=ongoing_internal, https://www.physio-pedia.com/Transcutaneous_ Electrical_Nerve_Stimulation_(TENS), https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4186747/#:~:text=TENS%20activates%20a%20complex%20 neuronal,inhibitory%20systems%20to%20reduce%20hyperalgesia., https://www. ncbi.nlm.nih.gov/pmc/articles/PMC3795936/

Http://www.vet.ed.ac.uk/animalpain/Pages/physiology.ht. https://pharmaceuticaljournal.com/article/ld/thermotherapy-and-cryotherapy .

Andersen RE, Blair SN, Cheskin LJ, Bartlett SJ. Encouraging patients to become more physically active: The physician’s role. Ann Int Med127, Minor MA. Exercise in the treatment of osteoarthritis. Rheum Dis Clin North Am 25

Ytterberg SR, Mahowald ML, Krug HE. Exercise for arthritis. Baillieres Clin Rheumatol 8:161-189, 1994.

Lewis BS & Lynch WD. The effect of physician advice on exercise behaviour. Preventive Medicine.

Mónica Ambriz-Tututi 1 , Héctor I Rocha-González, Silvia L Cruz, Vinicio GranadosSoto.

Xueyin Chen, Jinyuan Zhang, Xiangrui Wang, Department of Pain Management, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

Glynn CJ, Lloyd JW. Biochemical changes associated with intractable pain. Br Med J. 1978; [PMC free article] [PubMed]

Mellor DJ, Stafford KJ, Todd SE, et al. A comparison of catecholamine and cortisol responses of young lambs and calves to painful husbandry procedures. Aust Vet J. 2002;. [PubMed] [CrossRef] [Google Scholar], Moore RA, Evans PJ, Smith RF, et al. Increased cortisol excretion in chronic pain. Anesthesia

Nakagawa H, Hosokawa R. Study of the stress response to acute pain in the awake human. Pain Clin. 1994. [Google Scholar], Laura Frey Law, PT, PhD and Kathleen A. Sluka, PT, PhD, FAPTA

Neeck G, Crofford LJ. Neuroendocrine perturbations in fibromyalgia and chronic fatigue syndrome. Rheum Dis Clin North Am. 2000 [PubMed] [CrossRef] [Google Scholar]

Goh Yamamoto, Yoshinori Kamiya, Mika Sasaki, Miho Ikoma, Hiroshi Baba, Tatsuro Kohno, Tatsuro Kohno

ICN(2022).international nurses day.international council. https://www.icn.ch

References

ICN(2022).nursing definitions.international council. https://www.icn.ch

IHVN. (2022, June 16). IHVN Marks World Blood Donor Day 2022. IHV NIGERIA.org. https://ihvnigeria.org/ihvn-commemorates-world-blood-donor-day-2022/?utm_ source=rss&utm_medium=rss&utm_campaign=ihvn-commemorates-worldblood-donor-day-2022

Moeti, M. (2022, June 14). World Blood Donor Day 2022. WHO | Regional Office for Africa. https://www.afro.who.int/regional-director/speeches-messages/worldblood-donor-day-2022

Muanya, C. (2022, June 14). WHO decries acute blood shortage in Nigeria, other low-income countries. The Guardian Nigeria News - Nigeria and World News; The Guardian Nigeria News - Nigeria and World News. https://guardian.ng/news/worldblood-donor-day-who-decries-acute-blood-shortage-in-nigeria-other-lowincome-countries/

WHO. (2022, June 14). World Blood Donor Day 2022: Donating blood is an act of solidarity. Join the effort and save lives. www.who.int. https://www.who.int/newsroom/events/detail/2022/06/14/default-calendar/world-blood-donor-day-2022

Jong. (2019, May 21). How technology can help us achieve universal healthcare. World Economic Forum. https://www.weforum.org/agenda/2019/05/universalhealth-coverage-technology/

Siddhartha. (2019, December 16). How Smart Technology Can Help Reduce Healthcare Costs. Https://www.hatiintl.com/blog/how-smart-technology-canhelp-reduce-healthcare-costs

Van Houten, F. (2020). Here’s how to improve access to healthcare around the world. World Economic Forum. https://www.weforum.org/agenda/2020/01/tacklinghealthcare-access-constraints/

References

W.H.O. (2019). Global Strategy on Digital Health 20202024 Draft 26 March 2019. In World Health Organization https://extranet.who.int/dataform/upload/ surveys/183439/files/Draft%20Global%20Strategy%20on%20Digital%20Health.pdf

Elebeke, E. (2021, May 20). NITDA seeks full implementation of NDPR in Lagos. Vanguard News. https://www.vanguardngr.com/2021/05/nitda-seeks-fullimplementation-of-ndpr-in-lagos/

Cash-Gibson, L. (2018). Integrating health services brief (pp. 2–3). World Health Organization. https://www.who.int/docs/default-source/primary-health-careconference/linkages.pdf

J.W(OCSD.1), P., & Kilo, Ms. M. (2002). Nigeria - Health Systems Development Project (Health IV). Projectsportal.afdb.org. https://projectsportal.afdb.org/dataportal/ VProject/show/P-NG-IB0-006

Reyes, J. (2017). Integrated Health Systems: Definition & Types | Study.com. Study. com. https://study.com/academy/lesson/integrated-health-systems-definitiontypes.html

Singhal, S., Kayyali, B., Levin, R., & Greenberg, Z. (2020, June 23). The next wave of healthcare innovation | McKinsey. Www.mckinsey.com. https://www.mckinsey. com/industries/healthcare-systems-and-services/our-insights/the-next-waveof-healthcare-innovation-the-evolution-of-ecosystems

Zimlichman, MD, MSc, E., Nicklin, BN, MSc(A), W., Aggarwal, MD, PhD, FRCS, FACS, I., Rajesh, & Bates, MD, MSc, D. W. (2020). NEJM Catalyst - Home - Practical Innovations in Health Care Delivery. Nejm.org. https://catalyst.nejm.org

Microsoft. (n.d.). Project InnerEye - Democratizing Medical Imaging AI. Microsoft Research. https://www.microsoft.com/en-us/research/project/medical-imageanalysis/