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  • 1. Albrecht, E. C.
    et al.
    Kaelin, Vera C.
    Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
    Rigau, B. L.
    Dooling-Litfin, J. K.
    Scully, E. A.
    Murphy, N. J.
    McManus, B. M.
    Khetani, M. A.
    Pilot implementation of an electronic patient-reported outcome measure for planning and monitoring participation-focused care in early intervention2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 199Article in journal (Refereed)
    Abstract [en]

    Background: Family-centered care is a valued approach to improving child and family outcomes in early intervention (EI), yet there is need to implement interventions that support information exchange for shared decision-making when planning and monitoring EI care. This study aims at estimating the feasibility, acceptability, and value of implementing the Young Children’s Participation and Environment Measure (YC-PEM), a valid electronic patient-reported outcome (e-PRO) that is designed to support family engagement when planning care and monitoring outcomes of care.

    Methods: Data were gathered from caregivers (N = 139) that were enrolled in a Phase 1 trial of the YC-PEM e-PRO as implemented within 1 month of their child’s next EI evaluation of progress. YC-PEM e-PRO feasibility was estimated according to enrollment and completion rates, and mean completion time. Chi-square tests were used to examine parent perceptions of YC-PEM e-PRO acceptability by caregiver education and family income. Caregiver feedback via open-ended responses were content coded to inform intervention and protocol optimizations. YC-PEM e-PRO value was estimated via composite and item-level scores to capture the extent of participation difficulty in home and community activities, and common areas of need regarding caregivers desired change in their child’s participation.

    Results: Feasibility of implementing the YC-PEM e-PRO in routine EI care was mixed, as evidenced by low enrollment rates (21.0–29.2%), a high completion rate (85.3%), and limited missing data (80.6% of completed cases contained no missing data). More than half of the participants reported that the completion of the YC-PEM e-PRO was at least somewhat helpful, regardless of family income or caregiver education, providing support for its acceptability. As for its value, the YC-PEM e-PRO results were viewed by 64% of caregivers, whose desire for change most often pertained to the child’s participation in non-discretionary activities at home and structured activities in the community.

    Conclusions: Results may support the implementation of YC-PEM e-PRO as a feasible, acceptable, and valued option for engaging families in planning the child’s EI care. Results also inform select intervention and protocol optimizations prior to undertaking a multi-site pragmatic trial of its effectiveness on family engagement and shared decision-making within an EI clinical workflow.

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  • 2.
    Andersson Hagiwara, Magnus
    et al.
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Andersson-Gare, Boel
    Sjöqvist, Bengt-Arne
    Henricson, Maria
    Jonsson, Anders
    University of Borås, School of Health Science.
    The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study2014In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 14, no 70Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST).METHODS:In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression.RESULTS:In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST.CONCLUSIONS:The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

  • 3. Backlund, L
    et al.
    Skånér, Y
    Montgomery, H
    Bring, J
    Strender, L-E
    GPs' decisions on drug treatment for patients with high cholesterol values: A think-aloud study2004In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 4, no 23Article in journal (Other academic)
    Abstract [en]

    Background The purpose was to examine how General Practitioners (GPs) use clinical information and rules from guidelines in their decisions on drug treatment for high cholesterol values. Methods Twenty GPs were presented with six case vignettes and were instructed to think aloud while successively more information about a case was presented, and finally to decide if a drug should be prescribed or not. The statements were coded for the clinical information to which they referred and for favouring or not favouring prescription. Results The evaluation of clinical information was compatible with decision-making as a search for reasons or arguments. Lifestyle-related information like smoking and overweight seemed to be evaluated from different perspectives. A patient's smoking favoured treatment for some GPs and disfavoured treatment for others. Conclusions The method promised to be useful for understanding why doctors differ in their decisions on the same patient descriptions and why rules from the guidelines are not followed strictly.

  • 4. Bagattini, Francesco
    et al.
    Karlsson, Isak
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Rebane, Jonathan
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Papapetrou, Panagiotis
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    A classification framework for exploiting sparse multi-variate temporal features with application to adverse drug event detection in medical records2019In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 19, article id 7Article in journal (Refereed)
    Abstract [en]

    Background: Adverse drug events (ADEs) as well as other preventable adverse events in the hospital setting incur a yearly monetary cost of approximately $3.5 billion, in the United States alone. Therefore, it is of paramount importance to reduce the impact and prevalence of ADEs within the healthcare sector, not only since it will result in reducing human suffering, but also as a means to substantially reduce economical strains on the healthcare system. One approach to mitigate this problem is to employ predictive models. While existing methods have been focusing on the exploitation of static features, limited attention has been given to temporal features.

    Methods: In this paper, we present a novel classification framework for detecting ADEs in complex Electronic health records (EHRs) by exploiting the temporality and sparsity of the underlying features. The proposed framework consists of three phases for transforming sparse and multi-variate time series features into a single-valued feature representation, which can then be used by any classifier. Moreover, we propose and evaluate three different strategies for leveraging feature sparsity by incorporating it into the new representation.

    Results: A large-scale evaluation on 15 ADE datasets extracted from a real-world EHR system shows that the proposed framework achieves significantly improved predictive performance compared to state-of-the-art. Moreover, our framework can reveal features that are clinically consistent with medical findings on ADE detection.

    Conclusions: Our study and experimental findings demonstrate that temporal multi-variate features of variable length and with high sparsity can be effectively utilized to predict ADEs from EHRs. Two key advantages of our framework are that it is method agnostic, i.e., versatile, and of low computational cost, i.e., fast; hence providing an important building block for future exploitation within the domain of machine learning from EHRs.

  • 5.
    Bakidou, Anna
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden.
    Caragounis, Eva-Corina
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 15, 413 45, Gothenburg, Sweden.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Jonsson, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Sjöqvist, Bengt Arne
    Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden.
    Candefjord, Stefan
    Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden.
    On Scene Injury Severity Prediction (OSISP) model for trauma developed using the Swedish Trauma Registry2023In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 23, article id 206Article in journal (Refereed)
    Abstract [en]

    Background

    Providing optimal care for trauma, the leading cause of death for young adults, remains a challenge e.g., due to field triage limitations in assessing a patient’s condition and deciding on transport destination. Data-driven On Scene Injury Severity Prediction (OSISP) models for motor vehicle crashes have shown potential for providing real-time decision support. The objective of this study is therefore to evaluate if an Artificial Intelligence (AI) based clinical decision support system can identify severely injured trauma patients in the prehospital setting.

    Methods

    The Swedish Trauma Registry was used to train and validate five models – Logistic Regression, Random Forest, XGBoost, Support Vector Machine and Artificial Neural Network – in a stratified 10-fold cross validation setting and hold-out analysis. The models performed binary classification of the New Injury Severity Score and were evaluated using accuracy metrics, area under the receiver operating characteristic curve (AUC) and Precision-Recall curve (AUCPR), and under- and overtriage rates.

    Results

    There were 75,602 registrations between 2013–2020 and 47,357 (62.6%) remained after eligibility criteria were applied. Models were based on 21 predictors, including injury location. From the clinical outcome, about 40% of patients were undertriaged and 46% were overtriaged. Models demonstrated potential for improved triaging and yielded AUC between 0.80–0.89 and AUCPR between 0.43–0.62.

    Conclusions

    AI based OSISP models have potential to provide support during assessment of injury severity. The findings may be used for developing tools to complement field triage protocols, with potential to improve prehospital trauma care and thereby reduce morbidity and mortality for a large patient population.

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  • 6.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment2018In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 18, article id 106Article in journal (Refereed)
    Abstract [en]

    Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.

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  • 7.
    Berglund, Malin
    et al.
    Department of Otorhinolaryngology, NU Hospital Group, Trollhättan, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Olaison, Sara
    Örebro University, School of Medical Sciences. Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden.
    Westman, Eva
    Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Site Sundsvall, Umeå, Sweden.
    Eriksson, P. O.
    Medical Unit of Ear, Nose and Throat, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden; Department of Surgical Sciences, Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden.
    Steger, Lena
    Department of Otorhinolaryngology, Gävle Hospital, Gävle, Sweden.
    Bonnard, Åsa
    Medical Unit of Ear, Nose and Throat, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden; Division of CLINTEC, Department of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden.
    Validation of the Swedish Quality Register for Ear Surgery - SwedEar2023In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 23, no 1, article id 240Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Swedish Quality Register for Ear Surgery (SwedEar) is a national register monitoring surgical procedures and outcomes of ear surgery to facilitate quality improvement. The value of the register is dependent on the quality of its data. SwedEar has never been validated regarding data quality or missing entries. Therefor, the purpose of this study was to assess coverage, completeness and response rate in the register and validate the physicians' reported data accuracy.

    METHODS: In this validation study, the completeness, response rate and missing registrations were analysed. Data in SwedEar were compared with the yearly collected statistics of otosurgical procedures in The Swedish Otosurgical Society and the comparison of rates between groups was calculated with Fisher's exact test. Validation of registered data accuracy was performed on every 20th registered case during a five-year period. Data were reabstracted from medical records and compared with the original registration. Interrater agreement, reliability measures, Cohen's kappa, Gwet's AC1 and positive predictive value were calculated.

    RESULTS: SwedEar has a coverage of 100%. The completeness of registered cases was 84% and the response rate was 74%. The validation of data accuracy assessed 13 530 variables, including audiograms. Less than 3% of incorrect or missing variables were identified. For most of the pre- and postoperative variables the Kappa and Gwet´s AC1 results show an almost perfect agreement (> 0.80). For audiogram data the ICC shows an excellent reliability (> 0.9) for all but one value.

    CONCLUSION: This validation shows that SwedEar has excellent coverage, high completeness, and that the data in the register have almost perfect reliability. The data are suitable for both clinical and research purposes. Further efforts to improve completeness are warranted.

  • 8.
    Berglund, Malin
    et al.
    Department of Otorhinolaryngology, NU Hospital Group, Trollhättan, Sweden; Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Olaison, Sara
    Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden; Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Westman, Eva
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Eriksson, P.O.
    Medical Unit of Ear, Nose and Throat, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden; Department of Surgical Sciences, Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden.
    Steger, Lena
    Department of Otorhinolaryngology, Gävle Hospital, Gävle, Sweden.
    Bonnard, Åsa
    Medical Unit of Ear, Nose and Throat, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden; Division of CLINTEC, Department of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden.
    Validation of the Swedish Quality Register for Ear Surgery – SwedEar2023In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 23, no 1, article id 240Article in journal (Refereed)
    Abstract [en]

    Background: The Swedish Quality Register for Ear Surgery (SwedEar) is a national register monitoring surgical procedures and outcomes of ear surgery to facilitate quality improvement. The value of the register is dependent on the quality of its data. SwedEar has never been validated regarding data quality or missing entries. Therefor, the purpose of this study was to assess coverage, completeness and response rate in the register and validate the physicians’ reported data accuracy.

    Methods: In this validation study, the completeness, response rate and missing registrations were analysed. Data in SwedEar were compared with the yearly collected statistics of otosurgical procedures in The Swedish Otosurgical Society and the comparison of rates between groups was calculated with Fisher’s exact test. Validation of registered data accuracy was performed on every 20th registered case during a five-year period. Data were reabstracted from medical records and compared with the original registration. Interrater agreement, reliability measures, Cohen’s kappa, Gwet’s AC1 and positive predictive value were calculated.

    Results: SwedEar has a coverage of 100%. The completeness of registered cases was 84% and the response rate was 74%. The validation of data accuracy assessed 13 530 variables, including audiograms. Less than 3% of incorrect or missing variables were identified. For most of the pre- and postoperative variables the Kappa and Gwet´s AC1 results show an almost perfect agreement (> 0.80). For audiogram data the ICC shows an excellent reliability (> 0.9) for all but one value.

    Conclusion: This validation shows that SwedEar has excellent coverage, high completeness, and that the data in the register have almost perfect reliability. The data are suitable for both clinical and research purposes. Further efforts to improve completeness are warranted.

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  • 9.
    Blomqvist, Andreas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Usability and feasibility analysis of an mHealth-tool for supporting physical activity in people with heart failure2024In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 24, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    BackgroundPhysical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial.MethodsA mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively.ResultsTen people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. Feasibility: Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves.ConclusionsIt was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial.Trial registrationClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.

  • 10.
    Cakici, Baki
    et al.
    KTH.
    Hebing, Kenneth
    Swedish Institute for Infectious Control (SMI).
    Grünewald, Maria
    Swedish Institute for Infectious Control (SMI).
    Saretok, Paul
    Swedish Institute for Infectious Control (SMI).
    Hulth, Anette
    Swedish Institute for Infectious Control (SMI).
    CASE: A Framework for Computer Supported Outbreak Detection2010In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 10, no 14Article in journal (Refereed)
    Abstract [en]

    Background: In computer supported outbreak detection, a statistical method is applied to a collection of cases to detect any excess cases for a particular disease. Whether a detected aberration is a true outbreak is decided by a human expert. We present a technical framework designed and implemented at the Swedish Institute for Infectious Disease Control for computer supported outbreak detection, where a database of case reports for a large number of infectious diseases can be processed using one or more statistical methods selected by the user.

    Results: Based on case information, such as diagnosis and date, different statistical algorithms for detecting outbreaks can be applied, both on the disease level and the subtype level. The parameter settings for the algorithms can be configured independently for different diagnoses using the provided graphical interface. Input generators and output parsers are also provided for all supported algorithms. If an outbreak signal is detected, an email notification is sent to the persons listed as receivers for that particular disease.

    Conclusions: The framework is available as open source software, licensed under GNU General Public License Version 3. By making the code open source, we wish to encourage others to contribute to the future development of computer supported outbreak detection systems, and in particular to the development of the CASE framework.

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    cakici2010
  • 11.
    Cakici, Baki
    et al.
    KTH, School of Information and Communication Technology (ICT), Communication: Services and Infrastucture, Software and Computer Systems, SCS.
    Hebing, Kenneth
    Swedish Institute for Infectious Control (SMI), Solna, Sweden.
    Grünewald, Maria
    Swedish Institute for Infectious Control (SMI), Solna, Sweden.
    Saretok, Paul
    Swedish Institute for Infectious Control (SMI), Solna, Sweden.
    Hulth, Anette
    Swedish Institute for Infectious Control (SMI), Solna, Sweden.
    CASE: a framework for computer supported outbreak detection2010In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 10, p. 14-Article in journal (Refereed)
    Abstract [en]

    Background: In computer supported outbreak detection, a statistical method is applied to a collection of cases to detect any excess cases for a particular disease. Whether a detected aberration is a true outbreak is decided by a human expert. We present a technical framework designed and implemented at the Swedish Institute for Infectious Disease Control for computer supported outbreak detection, where a database of case reports for a large number of infectious diseases can be processed using one or more statistical methods selected by the user. Results: Based on case information, such as diagnosis and date, different statistical algorithms for detecting outbreaks can be applied, both on the disease level and the subtype level. The parameter settings for the algorithms can be configured independently for different diagnoses using the provided graphical interface. Input generators and output parsers are also provided for all supported algorithms. If an outbreak signal is detected, an email notification is sent to the persons listed as receivers for that particular disease. Conclusions: The framework is available as open source software, licensed under GNU General Public License Version 3. By making the code open source, we wish to encourage others to contribute to the future development of computer supported outbreak detection systems, and in particular to the development of the CASE framework.

  • 12.
    Cao, Yang
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Bass, G. A.
    Örebro University, School of Medical Sciences. Faculty of Medicine and Health, School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden; Department of Surgery, Tallaght University Hospital, Dublin, Ireland.
    Ahl, Rebecka
    Örebro University, School of Medical Sciences. Faculty of Medicine and Health, School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden; Department of General Surgery, Karolinska University Hospital, Stockholm, Sweden.
    Pourlotfi, Arvid
    Örebro University, School of Medical Sciences. Department of General Surgery, Örebro University Hospital, Örebro, Sweden.
    Geijer, Håkan
    Örebro University, School of Medical Sciences. Department of Radiology.
    Montgomery, Scott
    Örebro University, School of Medical Sciences. Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK..
    Mohseni, Shahin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of General Surgery, Örebro University Hospital, Örebro, Sweden.
    The statistical importance of P-POSSUM scores for predicting mortality after emergency laparotomy in geriatric patients2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 86Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Geriatric patients frequently undergo emergency general surgery and accrue a greater risk of postoperative complications and fatal outcomes than the general population. It is highly relevant to develop the most appropriate care measures and to guide patient-centered decision-making around end-of-life care. Portsmouth - Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) has been used to predict mortality in patients undergoing different types of surgery. In the present study, we aimed to evaluate the relative importance of the P-POSSUM score for predicting 90-day mortality in the elderly subjected to emergency laparotomy from statistical aspects.

    METHODS: One hundred and fifty-seven geriatric patients aged ≥65 years undergoing emergency laparotomy between January 1st, 2015 and December 31st, 2016 were included in the study. Mortality and 27 other patient characteristics were retrieved from the computerized records of Örebro University Hospital in Örebro, Sweden. Two supervised classification machine methods (logistic regression and random forest) were used to predict the 90-day mortality risk. Three scalers (Standard scaler, Robust scaler and Min-Max scaler) were used for variable engineering. The performance of the models was evaluated using accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Importance of the predictors were evaluated using permutation variable importance and Gini importance.

    RESULTS: The mean age of the included patients was 75.4 years (standard deviation =7.3 years) and the 90-day mortality rate was 29.3%. The most common indication for surgery was bowel obstruction occurring in 92 (58.6%) patients. Types of post-operative complications ranged between 7.0-36.9% with infection being the most common type. Both the logistic regression and random forest models showed satisfactory performance for predicting 90-day mortality risk in geriatric patients after emergency laparotomy, with AUCs of 0.88 and 0.93, respectively. Both models had an accuracy > 0.8 and a specificity ≥0.9. P-POSSUM had the greatest relative importance for predicting 90-day mortality in the logistic regression model and was the fifth important predictor in the random forest model. No notable change was found in sensitivity analysis using different variable engineering methods with P-POSSUM being among the five most accurate variables for mortality prediction.

    CONCLUSION: P-POSSUM is important for predicting 90-day mortality after emergency laparotomy in geriatric patients. The logistic regression model and random forest model may have an accuracy of > 0.8 and an AUC around 0.9 for predicting 90-day mortality. Further validation of the variables' importance and the models' robustness is needed by use of larger dataset.

  • 13.
    Chen, Rong
    et al.
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Enberg, G.
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Klein, Gunnar O.
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden + Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Julius - a template based supplementary electronic health record system2007In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 7, no 10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: EHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. Our objective was to provide a more flexible solution enabling the clinicians to define which data to be recorded and shared for both routine documentation and clinical studies. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data. Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems.

    METHODS: We have designed and developed a template based system (called Julius) that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely web-based, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database.

    RESULTS: The Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems.

    CONCLUSION: The approach of the template system in combination with various local EHR systems can facilitate the sharing and reuse of validated clinical information from different health care units. However, future system developments for these purposes should consider using the openEHR/CEN models with shareable archetypes.

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    Julius - a template based supplementary electronic health record system
  • 14.
    Chen, Rong
    et al.
    Karolinska Institutet.
    Enberg, Gösta
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Klein, Gunnar
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Julius--a template based supplementary electronic health record system2007In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 7, no 10Article in journal (Refereed)
    Abstract [en]

    Background: EHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. Our objective was to provide a more flexible solution enabling the clinicians to define which data to be recorded and shared for both routine documentation and clinical studies. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data. Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems.

    Methods: We have designed and developed a template based system (called Julius) that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely webbased, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database.

    Results: The Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems.

    Conclusion: The approach of the template system in combination with various local EHR systems can facilitate the sharing and reuse of validated clinical information from different health care units. However, future system developments for these purposes should consider using the openEHR/CEN models with shareable archetypes.

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    Julius – a template based supplementary electronic health record system
  • 15.
    Chen, Rong
    et al.
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm.
    Enberg, Gösta
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Klein, Gunnar O.
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm; Department of Medicine, Karolinska Institutet, Stockholm.
    Julius: a template based supplementary electronic health record system2007In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 7, article id 10Article in journal (Refereed)
    Abstract [en]

    Background: EHR systems are widely used in hospitals and primary care centres but it is usually difficult to share information and to collect patient data for clinical research. This is partly due to the different proprietary information models and inconsistent data quality. Our objective was to provide a more flexible solution enabling the clinicians to define which data to be recorded and shared for both routine documentation and clinical studies. The data should be possible to reuse through a common set of variable definitions providing a consistent nomenclature and validation of data. Another objective was that the templates used for the data entry and presentation should be possible to use in combination with the existing EHR systems.

    Methods: We have designed and developed a template based system (called Julius) that was integrated with existing EHR systems. The system is driven by the medical domain knowledge defined by clinicians in the form of templates and variable definitions stored in a common data repository. The system architecture consists of three layers. The presentation layer is purely web-based, which facilitates integration with existing EHR products. The domain layer consists of the template design system, a variable/clinical concept definition system, the transformation and validation logic all implemented in Java. The data source layer utilizes an object relational mapping tool and a relational database.

    Results: The Julius system has been implemented, tested and deployed to three health care units in Stockholm, Sweden. The initial responses from the pilot users were positive. The template system facilitates patient data collection in many ways. The experience of using the template system suggests that enabling the clinicians to be in control of the system, is a good way to add supplementary functionality to the present EHR systems.

    Conclusion: The approach of the template system in combination with various local EHR systems can facilitate the sharing and reuse of validated clinical information from different health care units. However, future system developments for these purposes should consider using the openEHR/CEN models with shareable archetypes.

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  • 16.
    Chen, Rong
    et al.
    Linköping University, Linköping, Sweden; Cambio Healthcare System, Linköping, Sweden.
    Klein, Gunnar O.
    Karolinska Institutet, Solna, Sweden.
    Sundvall, Erik
    Linköping University, Linköping, Sweden.
    Karlsson, Daniel
    Linköping University, Linköping, Sweden.
    Åhlfeldt, Hans
    Linköping University, Linköping, Sweden.
    Archetype-based conversion of EHR content models: pilot experience with a regional EHR system2009In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 9, p. 33-, article id 33Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format.

    METHODS: The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates.

    RESULTS: Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats.

    CONCLUSION: The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.

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  • 17.
    Chen, Rong
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Klein, Gunnar O
    Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Solna, Sweden.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Archetype-based conversion of EHR content models: pilot experience with a regional EHR system2009In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 9, no 33Article in journal (Refereed)
    Abstract [en]

    Background: Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format. Methods: The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bidirectional conversion between openEHR archetypes and COSMIC templates. Results: Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats. Conclusion: The openEHR RM and AM are expressive enough to represent the existing clinical content models from the template based EHR system tested and legacy content models can automatically be converted to archetype format for sharing of knowledge. With some limitations, internationally available archetypes could be converted to the legacy EHR models. Archetype support can be added to legacy EHR systems in an incremental way allowing a migration path to interoperability based on standards.

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    Archetype-based conversion of EHR content models : pilot experience with a regional EHR system
  • 18. Davoody, Nadia
    et al.
    Koch, Sabine
    Krakau, Ingvar
    Hägglund, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Accessing and sharing health information for post-discharge stroke care through a national health information exchange platform: a case study2019In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 19, no 1, article id 95Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Patients and citizens need access to their health information to get a retrospective as well as a prospective view on their care and rehabilitation processes. However, patients' health information is stored in several health information systems and interoperability problems often hamper accessibility. In Sweden a national health information exchange (HIE) platform has been developed that enables information exchange between different health information systems. The aim of this study is to explore the opportunities and limitations of accessing and interacting with important health information through the Swedish national HIE platform.

    METHODS:

    A single case study approach was used for this study as an in-depth understanding of the subject was needed. A fictive patient case with a pseudo-name was created based on an interview with a stroke coordinator in Stockholm County. Information access through the national health information exchange platform and available service contracts and application programming interfaces were studied using different scenarios.

    RESULTS:

    Based on the scenarios created in this study, patients would be able to access some health related information from their electronic health records using the national health information exchange platform. However, there is necessary information which is not retrievable as it is either stored in electronic health records and eHealth services which are not connected to the national health information exchange platform or there is no service contract developed for these types of information. In addition, patients are not able to share information with healthcare professionals.

    CONCLUSION:

    The national Swedish HIE platform provides the building blocks needed to allow patients online access to their health information in a fragmented and distributed health system. However, more complex interaction scenarios allowing patients to communicate with their health care providers or to update their health related information are not yet supported. Therefore it is of great importance to involve patients throughout the design and evaluation of eHealth services on both national and local levels to ensure that their needs for interoperability and information exchange are met.

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  • 19. Davoody, Nadia
    et al.
    Koch, Sabine
    Krakau, Ingvar
    Hägglund, Maria
    Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services.2016In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 16, article id 66Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients' information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes.

    METHODS: Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed. Content analysis was used to analyse the data. Stroke patients' information needs was explored using patient journey model.

    RESULTS: Four main events (discharge from hospital, discharge from rehab clinic, coming home, and clinical encounters) and two phases (at rehab clinic, at home) have been identified in patients' post-discharge journey. The main categories identified in this study indicate that patients not only need to have access to health related information about their care and rehabilitation processes but also practical guidance through healthcare and community services. Patients also have different information needs at different events and during different phases. Potential supportive eHealth services were suggested by the researchers considering different parts of the patients' journeys.

    CONCLUSIONS: Patient journey models and qualitative analysis of patients' information needs are powerful tools that can be used to improve healthcare from a patient perspective. As patients' understanding of their illness changes over time, their need of more flexible support throughout the care and rehabilitation processes increases. To design appropriate eHealth services that meet patients' information needs, it is imperative to understand the current care and rehabilitation processes and identify patients' information needs throughout their journey.

  • 20.
    de Capretz, Pontus Olsson
    et al.
    Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Björkelund, Anders
    Lund University, Lund, Sweden.
    Björk, Jonas
    Lund University, Lund, Sweden; Skåne University Hospital, Lund, Sweden.
    Ohlsson, Mattias
    Halmstad University, School of Information Technology. Lund University, Lund, Sweden.
    Mokhtari, Arash
    Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Nyström, Axel
    Lund University, Lund, Sweden.
    Ekelund, Ulf
    Skåne University Hospital, Lund, Sweden; Lund University, Lund, Sweden.
    Machine learning for early prediction of acute myocardial infarction or death in acute chest pain patients using electrocardiogram and blood tests at presentation2023In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 23, no 1, p. 1-10, article id 25Article in journal (Refereed)
    Abstract [en]

    Aims: In the present study, we aimed to evaluate the performance of machine learning (ML) models for identification of acute myocardial infarction (AMI) or death within 30 days among emergency department (ED) chest pain patients. Methods and results: Using data from 9519 consecutive ED chest pain patients, we created ML models based on logistic regression or artificial neural networks. Model inputs included sex, age, ECG and the first blood tests at patient presentation: High sensitivity TnT (hs-cTnT), glucose, creatinine, and hemoglobin. For a safe rule-out, the models were adapted to achieve a sensitivity > 99% and a negative predictive value (NPV) > 99.5% for 30-day AMI/death. For rule-in, we set the models to achieve a specificity > 90% and a positive predictive value (PPV) of > 70%. The models were also compared with the 0 h arm of the European Society of Cardiology algorithm (ESC 0 h); An initial hs-cTnT < 5 ng/L for rule-out and ≥ 52 ng/L for rule-in. A convolutional neural network was the best model and identified 55% of the patients for rule-out and 5.3% for rule-in, while maintaining the required sensitivity, specificity, NPV and PPV levels. ESC 0 h failed to reach these performance levels. Discussion: An ML model based on age, sex, ECG and blood tests at ED arrival can identify six out of ten chest pain patients for safe early rule-out or rule-in with no need for serial blood tests. Future studies should attempt to improve these ML models further, e.g. by including additional input data. © 2023, The Author(s).

  • 21.
    de Vries, Arjen E.
    et al.
    University of Medical Centre Groningen, Netherlands.
    van der Wal, Martje H L.
    University of Medical Centre Groningen, Netherlands.
    Nieuwenhuis, Maurice M W.
    University of Medical Centre Groningen, Netherlands.
    de Jong, Richard M:
    University of Medical Centre Groningen, Netherlands.
    van Dijk, Rene B.
    Martini Hospital, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Hillege, Hans L.
    University of Medical Centre Groningen, Netherlands.
    Jorna, Rene J.
    University of Groningen, Netherlands.
    Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients2013In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 13, no 54Article in journal (Refereed)
    Abstract [en]

    Background

    Clinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T).

    Methods

    A questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed.

    Results

    The response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01).

    Conclusions

    Both cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.

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  • 22.
    Dentler, Kathrin
    et al.
    Vrije University of Amsterdam, Netherlands; University of Amsterdam, Netherlands.
    Cornet, Ronald
    Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology. University of Amsterdam, Netherlands.
    ten Teije, Annette
    Vrije University of Amsterdam, Netherlands.
    Tanis, Pieter
    University of Amsterdam, Netherlands.
    Klinkenbijl, Jean
    University of Amsterdam, Netherlands.
    Tytgat, Kristien
    University of Amsterdam, Netherlands.
    de Keizer, Nicolette
    University of Amsterdam, Netherlands.
    Influence of data quality on computed Dutch hospital quality indicators: a case study in colorectal cancer surgery2014In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 14, no 32Article in journal (Refereed)
    Abstract [en]

    Background: Our study aims to assess the influence of data quality on computed Dutch hospital quality indicators, and whether colorectal cancer surgery indicators can be computed reliably based on routinely recorded data from an electronic medical record (EMR). Methods: Cross-sectional study in a department of gastrointestinal oncology in a university hospital, in which a set of 10 indicators is computed (1) based on data abstracted manually for the national quality register Dutch Surgical Colorectal Audit (DSCA) as reference standard and (2) based on routinely collected data from an EMR. All 75 patients for whom data has been submitted to the DSCA for the reporting year 2011 and all 79 patients who underwent a resection of a primary colorectal carcinoma in 2011 according to structured data in the EMR were included. Comparison of results, investigating the causes for any differences based on data quality analysis. Main outcome measures are the computability of quality indicators, absolute percentages of indicator results, data quality in terms of availability in a structured format, completeness and correctness. Results: All indicators were fully computable based on the DSCA dataset, but only three based on EMR data, two of which were percentages. For both percentages, the difference in proportions computed based on the two datasets was significant. All required data items were available in a structured format in the DSCA dataset. Their average completeness was 86%, while the average completeness of these items in the EMR was 50%. Their average correctness was 87%. Conclusions: Our study showed that data quality can significantly influence indicator results, and that our EMR data was not suitable to reliably compute quality indicators. EMRs should be designed in a way so that the data required for audits can be entered directly in a structured and coded format.

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  • 23. Ellervall, Eva
    et al.
    Brehmer, Berndt
    Knutsson, Kerstin
    Malmö högskola, Faculty of Odontology (OD).
    How confident are general dental practitioners in their decision to administer antibiotic prophylaxis?2008In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 8, article id 57Article in journal (Refereed)
    Abstract [en]

    Background: Common dental procedures induce bacteremia. To prevent infectious complications from bacteremia in patients with specific medical conditions, antibiotic prophylaxis is considered. Recommendations are often unclear and ambiguous. In a previous study we reported wide variations in general dental practitioners’ (GDPs’) administrations of antibiotic prophylaxis. We hypothesized that within such a conflicting clinical area, decisions are made with a high level of personal uncertainty. This study examined GDPs’ confidence in their decisions and analyzed the extent to which case-related factors might explain individual variations in confidence. Methods: Postal questionnaires in combination with telephone interviews were used. The response rate was 51% (101/200). There were no significant differences between respondents and non-respondents regarding sex, age, or place of work. The GDPs were presented to patient cases of different medical conditions, where some should receive antibiotic prophylaxis according to recommendations when performing dental procedures that could cause gingival bleeding. The GDPs assessed on visual analogue scales how confident they were in their decisions. The extent to which case-related factors, medical condition and dental procedure, could explain individual variation in confidence was analyzed. Results: Overall the GDPs exhibited high confidence in their decisions regardless of whether they administered antibiotic prophylaxis or not, or whether their decisions were in accordance with recommendations or not. The case-related factors could explain between 30–100% of the individual variation in GDPs’ confidence. For 46%, the medical condition significantly explained the individual variation in confidence. However, for most of these GDPs, lower confidence was not presented for conditions where recommendations are unclear and higher confidence was not presented for conditions where recommendations are more clear. For 8% the dental procedure significantly explained the variation, although all procedures could cause bacteremia. For 46% neither the medical condition nor the dental procedure could significantly explain the individual variation in confidence. Conclusions: The GDPs presented high confidence in their decisions, and the majority of GDPs did not present what could be considered a justified varied level of confidence according to the clarity of recommendations. Clinicians who are overconfident in their decisions may be less susceptible to modifications of their behavior to more evidence-based strategies.

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  • 24. Ellervall, Eva
    et al.
    Brehmer, Berndt
    Swedish Defence University, Department of Military Studies, War Studies Division.
    Knutsson, Kerstin
    How confident are general dental practitioners in their decision to administer antibiotic prophylaxis?: A questionnaire study2008In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 8, p. 57-Article in journal (Refereed)
    Abstract [en]

    Background: Common dental procedures induce bacteremia. To prevent infectious complications from bacteremia in patients with specific medical conditions, antibiotic prophylaxis is considered. Recommendations are often unclear and ambiguous. In a previous study we reported wide variations in general dental practitioners' (GDPs') administrations of antibiotic prophylaxis. We hypothesized that within such a conflicting clinical area, decisions are made with a high level of personal uncertainty. This study examined GDPs' confidence in their decisions and analyzed the extent to which case-related factors might explain individual variations in confidence. Methods: Postal questionnaires in combination with telephone interviews were used. The response rate was 51% (101/200). There were no significant differences between respondents and non-respondents regarding sex, age, or place of work. The GDPs were presented to patient cases of different medical conditions, where some should receive antibiotic prophylaxis according to recommendations when performing dental procedures that could cause gingival bleeding. The GDPs assessed on visual analogue scales how confident they were in their decisions. The extent to which case-related factors, medical condition and dental procedure, could explain individual variation in confidence was analyzed. Results: Overall the GDPs exhibited high confidence in their decisions regardless of whether they administered antibiotic prophylaxis or not, or whether their decisions were in accordance with recommendations or not. The case-related factors could explain between 30-100% of the individual variation in GDPs' confidence. For 46%, the medical condition significantly explained the individual variation in confidence. However, for most of these GDPs, lower confidence was not presented for conditions where recommendations are unclear and higher confidence was not presented for conditions where recommendations are more clear. For 8% the dental procedure significantly explained the variation, although all procedures could cause bacteremia. For 46% neither the medical condition nor the dental procedure could significantly explain the individual variation in confidence. Conclusion: The GDPs presented high confidence in their decisions, and the majority of GDPs did not present what could be considered a justified varied level of confidence according to the clarity of recommendations. Clinicians who are overconfident in their decisions may be less susceptible to modifications of their behavior to more evidence-based strategies.

  • 25.
    Fors, Uno
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Kamwesiga, Julius T.
    Eriksson, Gunilla M.
    von Koch, Lena
    Guidetti, Susanne
    User evaluation of a novel SMS-based reminder system for supporting post-stroke rehabilitation2019In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 19, article id 122Article in journal (Refereed)
    Abstract [en]

    Background: According to WHO stroke is a growing societal challenge and the third leading cause of global disease-burden estimated using disability-adjusted life years. Rehabilitation after stroke is an area of mutual interest for health care in many countries. Within the health care sector there is a growing emphasis on ICT services to provide clients with easier access to information, self-evaluation, and self-management. ICT-supported care programs possible to use in clients' home environments are also recommended when there are long distances to the health care specialists. The aim of this study was to evaluate the technical usability of a SMS-based reminder system as well as user opinions when using such a system to assist clients to remember to perform daily rehabilitation activities, to rate their performance and to allow Occupational therapists (OT's) to track and follow-up clients' results over time. Methods: Fifteen persons with stroke were invited to participate in the study and volunteered to receive daily SMS-based reminders regarding three activities to perform on a daily basis as well as answer daily SMS-based questions about their success rate during eight weeks. Clients, a number of family members, as well as OTs were interviewed to evaluate their opinions of using the reminder system. Results: All clients were positive to the reminder system and felt that it helped them to regain their abilities. Their OTs agreed that the reminder and follow-up system was of benefit in the rehabilitation process. However, some technical and other issues were limiting the use of the system for some clients. The issues were mostly linked to the fact that the SMS system was based on a Swedish phone number, so that all messages needed to be sent internationally. Conclusion: In conclusion, it seems that this type of SMS-based reminder systems could be of good use in the rehabilitation process after stroke, even in low income counties where few clients have access to Internet or smart phones, and where access to healthcare services is limited. However, since the results are based on clients', OTs' and family members' expressed beliefs, we suggest that future research objectively investigate the intervention's beneficial effects on the clients' physical and cognitive health.

  • 26.
    Fors, Uno
    et al.
    Stockholm Univ, Dept Comp & Syst Sci DSV, Stockholm, Sweden.
    Kamwesiga, Julius T.
    Uganda Allied Hlth Examinat Board, Kampala, Uganda;Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Eriksson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Research in Disability and Habilitation. Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    von Koch, Lena
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden;Karolinska Univ Hosp, Theme Neuro, Stockholm, Sweden.
    Guidetti, Susanne
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    User evaluation of a novel SMS-based reminder system for supporting post-stroke rehabilitation2019In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 19, article id 122Article in journal (Refereed)
    Abstract [en]

    Background: According to WHO stroke is a growing societal challenge and the third leading cause of global disease-burden estimated using disability-adjusted life years. Rehabilitation after stroke is an area of mutual interest for health care in many countries. Within the health care sector there is a growing emphasis on ICT services to provide clients with easier access to information, self-evaluation, and self-management. ICT-supported care programs possible to use in clients' home environments are also recommended when there are long distances to the health care specialists. The aim of this study was to evaluate the technical usability of a SMS-based reminder system as well as user opinions when using such a system to assist clients to remember to perform daily rehabilitation activities, to rate their performance and to allow Occupational therapists (OT's) to track and follow-up clients' results over time.

    Methods: Fifteen persons with stroke were invited to participate in the study and volunteered to receive daily SMS-based reminders regarding three activities to perform on a daily basis as well as answer daily SMS-based questions about their success rate during eight weeks. Clients, a number of family members, as well as OTs were interviewed to evaluate their opinions of using the reminder system.

    Results: All clients were positive to the reminder system and felt that it helped them to regain their abilities. Their OTs agreed that the reminder and follow-up system was of benefit in the rehabilitation process. However, some technical and other issues were limiting the use of the system for some clients. The issues were mostly linked to the fact that the SMS system was based on a Swedish phone number, so that all messages needed to be sent internationally.

    Conclusion: In conclusion, it seems that this type of SMS-based reminder systems could be of good use in the rehabilitation process after stroke, even in low income counties where few clients have access to Internet or smart phones, and where access to healthcare services is limited. However, since the results are based on clients', OTs' and family members' expressed beliefs, we suggest that future research objectively investigate the intervention's beneficial effects on the clients' physical and cognitive health.

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  • 27.
    Forss, Anders
    et al.
    Karolinska Inst, Sweden.
    Myrelid, Pär
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
    Olen, Ola
    Karolinska Inst, Sweden; Stockholm South Gen Hosp, Sweden.
    Everhov, Asa H.
    Karolinska Inst, Sweden; South Gen Hosp, Sweden.
    Nordenvall, Caroline
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Halfvarson, Jonas
    Orebro Univ, Sweden.
    Ludvigsson, Jonas F.
    Karolinska Inst, Sweden; Orebro Univ Hosp, Sweden; Univ Nottingham, England; Columbia Univ Coll Phys and Surg, NY USA.
    Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register2019In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, BMC MEDICAL INFORMATICS AND DECISION MAKING, Vol. 19, no 1, article id 217Article in journal (Refereed)
    Abstract [en]

    Background

    About 50% of patients with Crohn’s disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes.

    Methods

    Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 randomly selected patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated.

    Results

    In total, 158 surgical procedure codes were registered in the NPR. One hundred fifty-five of these, representing 60 different procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant with the patient charts, corresponding to a PPV of 96.8% (95%CI = 93.9–99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI = 88.7–98.6), 100% (95%CI = 100–100) and 98.1% (95%CI = 93.1–100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI = 89.6–99.3). The specificity of the NPR was 98.5% (95%CI = 97.6–100).

    Conclusions

    Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery.

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  • 28.
    Forss, Anders
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Myrelid, Pär
    Department of Clinical and Experimental Medicine, Faculty of Health, Linköping University, Department of Surgery, Linköping University Hospital, Linköping, Sweden.
    Olén, Ola
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden.
    Everhov, Åsa H.
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, South General Hospital, Stockholm, Sweden.
    Nordenvall, Caroline
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden.
    Halfvarson, Jonas
    Örebro University, School of Medical Sciences. Department of Gastroenterology.
    Ludvigsson, Jonas F.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
    Validating surgical procedure codes for inflammatory bowel disease in the Swedish National Patient Register2019In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 19, no 1, article id 217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: About 50% of patients with Crohn's disease (CD) and about 20% of those with ulcerative colitis (UC) undergo surgery at some point during the course of the disease. The diagnostic validity of the Swedish National Patient Register (NPR) has previously been shown to be high for inflammatory bowel disease (IBD), but there are little data on the validity of IBD-related surgical procedure codes.

    METHODS: Using patient chart data as the gold standard, surgical procedure codes registered between 1966 and 2014 in the NPR were abstracted and validated in 262 randomly selected patients with a medical diagnosis of IBD. Of these, 53 patients had reliable data about IBD-related surgery. The positive predictive value (PPV), sensitivity and specificity of the surgical procedure codes were calculated.

    RESULTS: In total, 158 surgical procedure codes were registered in the NPR. One hundred fifty-five of these, representing 60 different procedure codes, were also present in the patient charts and validated using a standardized form. Of the validated codes 153/155 were concordant with the patient charts, corresponding to a PPV of 96.8% (95%CI = 93.9-99.1). Stratified in abdominal, perianal and other surgery, the corresponding PPVs were 94.1% (95%CI = 88.7-98.6), 100% (95%CI = 100-100) and 98.1% (95%CI = 93.1-100), respectively. Of 164 surgical procedure codes in the validated patient charts, 155 were registered in the NPR, corresponding to a sensitivity of the surgical procedure codes of 94.5% (95%CI = 89.6-99.3). The specificity of the NPR was 98.5% (95%CI = 97.6-100).

    CONCLUSIONS: Data on IBD-related surgical procedure codes are reliable, with the Swedish National Patient Register showing a high sensitivity and specificity for such surgery.

  • 29.
    Fristedt, Sofi
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Smith, Frida
    Regional Cancer Centre West, Gothenburg, Sweden; Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden.
    Grynne, Annika
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Browall, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Digi-Do: a digital information tool to support patients with breast cancer before, during, and after start of radiotherapy treatment: an RCT study protocol2021In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 21, article id 76Article in journal (Refereed)
    Abstract [en]

    Radiation Therapy (RT) is a common treatment after breast cancer surgery and a complex process using high energy X-rays to eradicate cancer cells, important in reducing the risk of local recurrence. The high-tech environment and unfamiliar nature of RT can affect the patient’s experience of the treatment. Misconceptions or lack of knowledge about RT processes can increase levels of anxiety and enhance feelings of being unprepared at the beginning of treatment. Moreover, the waiting time is often quite long. The primary aim of this study will be to evaluate whether a digital information tool with VR-technology and preparatory information can decrease distress as well as enhance the self-efficacy and health literacy of patients affected by breast cancer before, during, and after RT. A secondary aim will be to explore whether the digital information tool increase patient flow while maintaining or increasing the quality of care.

  • 30.
    Georgsson, Susanne
    et al.
    The Swedish Red Cross University College, Department of Health Sciences. Karolinska Institutet.
    Carlsson, Tommy
    The Swedish Red Cross University College, Department of Health Sciences. Uppsala University.
    Readability of web-based sources about induced abortion: a cross-sectional study2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 102Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: High-quality information is essential if clients who request an abortion are to reach informed decisions and feel prepared for the procedure, but little is known concerning the readability of web-based sources containing such material. The aim was to investigate the readability of web-based information about induced abortion.

    METHODS: The search engine Google was used to identify web pages about induced abortion, written in the English language. A total of 240 hits were screened and 236 web pages fulfilled the inclusion criteria. After correcting for duplicate hits, 185 web pages were included. The readability of the text-based content of each web page was determined with Flesch Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook, and Flesch Reading Ease. Data were analyzed with descriptive statistics, Pearson's correlation coefficient and Kruskal-Wallis with Dunn's test as post hoc analysis.

    RESULTS: Across all grade level measures, a small minority of the web pages had a readability corresponding to elementary school (n < 3, 1%), while the majority had readability corresponding to senior high school or above (n > 153, 65%). The means of the grade level measures ranged between 10.5 and 13.1, and the mean Flesch Reading Ease score was 45.3 (SD 13.6). Only weak correlations (rho < 0.2) were found between the readability measures and search rank in the hit lists. Consistently, web pages affiliated with health care had the least difficult readability and those affiliated with scientific sources had the most difficult readability.

    CONCLUSIONS: Overall, web-based information about induced abortions has difficult readability. Incentives are needed to improve the readability of these texts and ensure that clients encounter understandable information so that they may reach informed decisions and feel adequately prepared when requesting an abortion.

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  • 31. Georgsson, Susanne
    et al.
    Carlsson, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Readability of web-based sources about induced abortion: a cross-sectional study.2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 102Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: High-quality information is essential if clients who request an abortion are to reach informed decisions and feel prepared for the procedure, but little is known concerning the readability of web-based sources containing such material. The aim was to investigate the readability of web-based information about induced abortion.

    METHODS: The search engine Google was used to identify web pages about induced abortion, written in the English language. A total of 240 hits were screened and 236 web pages fulfilled the inclusion criteria. After correcting for duplicate hits, 185 web pages were included. The readability of the text-based content of each web page was determined with Flesch Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook, and Flesch Reading Ease. Data were analyzed with descriptive statistics, Pearson's correlation coefficient and Kruskal-Wallis with Dunn's test as post hoc analysis.

    RESULTS: Across all grade level measures, a small minority of the web pages had a readability corresponding to elementary school (n < 3, 1%), while the majority had readability corresponding to senior high school or above (n > 153, 65%). The means of the grade level measures ranged between 10.5 and 13.1, and the mean Flesch Reading Ease score was 45.3 (SD 13.6). Only weak correlations (rho < 0.2) were found between the readability measures and search rank in the hit lists. Consistently, web pages affiliated with health care had the least difficult readability and those affiliated with scientific sources had the most difficult readability.

    CONCLUSIONS: Overall, web-based information about induced abortions has difficult readability. Incentives are needed to improve the readability of these texts and ensure that clients encounter understandable information so that they may reach informed decisions and feel adequately prepared when requesting an abortion.

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  • 32.
    Georgsson, Susanne
    et al.
    Swedish Red Cross University. Karolinska Institutet, Sweden.
    Carlsson, Tommy
    Swedish Red Cross University, Department of Health Sciences. Uppsala University, Sweden.
    Readability, understandability and language accessibility of Swedish websites about the coronavirus disease 2019: a cross-sectional study2022In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 22, no 1, article id 131Article in journal (Refereed)
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  • 33.
    Georgsson, Susanne
    et al.
    Swedish Red Cross Univ, Huddinge, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol, Stockholm, Sweden..
    Carlsson, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Swedish Red Cross Univ, Huddinge, Sweden..
    Readability, understandability and language accessibility of Swedish websites about the coronavirus disease 2019: a cross-sectional study2022In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 22, no 1, article id 131Article in journal (Refereed)
    Abstract [en]

    Background The COVID-19 pandemic has caused significant morbidity and mortality. To mitigate its spread, members in the general population were prompted to apply significant behavioral changes. This required an effective dissemination of understandable information accessible for people with a wide range of literacy backgrounds. The aim of this study was to investigate the readability, understandability and language accessibility of Swedish consumer-oriented websites containing information about COVID-19. Methods Websites were identified through systematic searches in Google.se (n = 76), and were collected in May 2020 when the pandemic spread started in Sweden. Readability and understandability were assessed with the Readability Index, the Ensuring Quality Information for Patients (EQIP) tool, and the Patient Education Materials Assessment Tool Understandability subscale (PEMAT-PU). Results The median total sample score for Readability Index was 42.0, with the majority of scores being classified as moderate (n = 30, 39%) or difficult (n = 43, 57%). Median total sample scores were for EQIP 54.0% (IQR = 17.0, Range = 8-75) and for PEMAT-PU 60.0% (IQR = 14.75, Range = 12-87). The majority of the websites did not have any texts or links containing information in an alternative language (n = 58, 76%). Conclusions Swedish websites contained information of difficult readability and understandability at the beginning of the coronavirus disease 2019 pandemic, with few providing information available in alternative languages. It is possible that these deficits contributed to the spread and impact of the virus. There is a need for studies investigating methods aiming to enhance the readability, understandability and language accessibility of web-based information at the beginning of an epidemic or pandemic.

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  • 34.
    Gesicho, Milka Bochere
    et al.
    Univ Bergen, Norway; Moi Univ, Kenya.
    Were, Martin Chieng
    Vanderbilt Univ, TN USA; Moi Univ, Kenya.
    Babic, Ankica
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Univ Bergen, Norway.
    Data cleaning process for HIV-indicator data extracted from DHIS2 national reporting system: a case study of Kenya2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 293Article in journal (Refereed)
    Abstract [en]

    Background The District Health Information Software-2 (DHIS2) is widely used by countries for national-level aggregate reporting of health-data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic, and transparent data cleaning approaches form a core component of preparing DHIS2 data for analyses. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. The aim of this study was to report on methods and results of a systematic and replicable data cleaning approach applied on HIV-data gathered within DHIS2 from 2011 to 2018 in Kenya, for secondary analyses. Methods Six programmatic area reports containing HIV-indicators were extracted from DHIS2 for all care facilities in all counties in Kenya from 2011 to 2018. Data variables extracted included reporting rate, reporting timeliness, and HIV-indicator data elements per facility per year. 93,179 facility-records from 11,446 health facilities were extracted from year 2011 to 2018. Van den Broeck et al.s framework, involving repeated cycles of a three-phase process (data screening, data diagnosis and data treatment), was employed semi-automatically within a generic five-step data-cleaning sequence, which was developed and applied in cleaning the extracted data. Various quality issues were identified, and Friedman analysis of variance conducted to examine differences in distribution of records with selected issues across eight years. Results Facility-records with no data accounted for 50.23% and were removed. Of the remaining, 0.03% had over 100% in reporting rates. Of facility-records with reporting data, 0.66% and 0.46% were retained for voluntary medical male circumcision and blood safety programmatic area reports respectively, given that few facilities submitted data or offered these services. Distribution of facility-records with selected quality issues varied significantly by programmatic area (p &lt; 0.001). The final clean dataset obtained was suitable to be used for subsequent secondary analyses. Conclusions Comprehensive, systematic, and transparent reporting of cleaning-process is important for validity of the research studies as well as data utilization. The semi-automatic procedures used resulted in improved data quality for use in secondary analyses, which could not be secured by automated procedures solemnly.

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  • 35.
    Gesicho, Milka Bochere
    et al.
    Univ Bergen, Norway; Moi Univ, Kenya.
    Were, Martin Chieng
    Vanderbilt Univ, TN USA; Moi Univ, Kenya.
    Babic, Ankica
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. Univ Bergen, Norway.
    Evaluating performance of health care facilities at meeting HIV-indicator reporting requirements in Kenya: an application of K-means clustering algorithm2021In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 21, no 1, article id 6Article in journal (Refereed)
    Abstract [en]

    Background: The ability to report complete, accurate and timely data by HIV care providers and other entities is a key aspect in monitoring trends in HIV prevention, treatment and care, hence contributing to its eradication. In many low-middle-income-countries (LMICs), aggregate HIV data reporting is done through the District Health Information Software 2 (DHIS2). Nevertheless, despite a long-standing requirement to report HIV-indicator data to DHIS2 in LMICs, few rigorous evaluations exist to evaluate adequacy of health facility reporting at meeting completeness and timeliness requirements over time. The aim of this study is to conduct a comprehensive assessment of the reporting status for HIV-indicators, from the time of DHIS2 implementation, using Kenya as a case study. Methods: A retrospective observational study was conducted to assess reporting performance of health facilities providing any of the HIV services in all 47 counties in Kenya between 2011 and 2018. Using data extracted from DHIS2, K-means clustering algorithm was used to identify homogeneous groups of health facilities based on their performance in meeting timeliness and completeness facility reporting requirements for each of the six programmatic areas. Average silhouette coefficient was used in measuring the quality of the selected clusters. Results: Based on percentage average facility reporting completeness and timeliness, four homogeneous groups of facilities were identified namely: best performers, average performers, poor performers and outlier performers. Apart from blood safety reports, a distinct pattern was observed in five of the remaining reports, with the proportion of best performing facilities increasing and the proportion of poor performing facilities decreasing over time. However, between 2016 and 2018, the proportion of best performers declined in some of the programmatic areas. Over the study period, no distinct pattern or trend in proportion changes was observed among facilities in the average and outlier groups. Conclusions: The identified clusters revealed general improvements in reporting performance in the various reporting areas over time, but with noticeable decrease in some areas between 2016 and 2018. This signifies the need for continuous performance monitoring with possible integration of machine learning and visualization approaches into national HIV reporting systems.

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  • 36.
    Grauman, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Ancillotti, Mirko
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Veldwijk, Jorien
    Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.
    Mascalzoni, Deborah
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics. Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands.
    Precision cancer medicine and the doctor-patient relationship: a systematic review and narrative synthesis2023In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 23, no 1, article id 286Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The implementation of precision medicine is likely to have a huge impact on clinical cancer care, while the doctor-patient relationship is a crucial aspect of cancer care that needs to be preserved. This systematic review aimed to map out perceptions and concerns regarding how the implementation of precision medicine will impact the doctor-patient relationship in cancer care so that threats against the doctor-patient relationship can be addressed.

    METHODS: Electronic databases (Pubmed, Scopus, Web of Science, Social Science Premium Collection) were searched for articles published from January 2010 to December 2021, including qualitative, quantitative, and theoretical methods. Two reviewers completed title and abstract screening, full-text screening, and data extraction. Findings were summarized and explained using narrative synthesis.

    RESULTS: Four themes were generated from the included articles (n = 35). Providing information addresses issues of information transmission and needs, and of complex concepts such as genetics and uncertainty. Making decisions in a trustful relationship addresses opacity issues, the role of trust, and and physicians' attitude towards the role of precision medicine tools in decision-making. Managing negative reactions of non-eligible patients addresses patients' unmet expectations of precision medicine. Conflicting roles in the blurry line between clinic and research addresses issues stemming from physicians' double role as doctors and researchers.

    CONCLUSIONS: Many findings have previously been addressed in doctor-patient communication and clinical genetics. However, precision medicine adds complexity to these fields and further emphasizes the importance of clear communication on specific themes like the distinction between genomic and gene expression and patients' expectations about access, eligibility, effectiveness, and side effects of targeted therapies.

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  • 37. Gund, Anna
    et al.
    Lindecrantz, Kaj
    KTH, School of Technology and Health (STH), Medical sensors, signals and systems (MSSS).
    Schaufelberger, Maria
    Patel, Harshida
    Sjöqvist, Bengt Arne
    Attitudes among healthcare professionals towards ICT and home follow-up in chronic heart failure care2012In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 12, no 1, p. 138-Article in journal (Refereed)
    Abstract [en]

    Background: eHealth applications for out-of-hospital monitoring and treatment follow-up have been advocated for many years as a promising tool to improve treatment compliance, promote individualized care and obtain a person-centred care. Despite these benefits and a large number of promising projects, a major breakthrough in everyday care is generally still lacking. Inappropriate organization for eHealth technology, reluctance from users in the introduction of new working methods, and resistance to information and communication technology (ICT) in general could be reasons for this. Another reason may be attitudes towards the potential in out-of-hospital eHealth applications. It is therefore of interest to study the general opinions among healthcare professionals to ICT in healthcare, as well as the attitudes towards using ICT as a tool for patient monitoring and follow-up at home. One specific area of interest is in-home follow-up of elderly patients with chronic heart failure (CHF). The aim of this paper is to investigate the attitudes towards ICT, as well as distance monitoring and follow-up, among healthcare professionals working with this patient group. Method: This paper covers an attitude survey study based on responses from 139 healthcare professionals working with CHF care in Swedish hospital departments, i.e. cardiology and medicine departments. Comparisons between physicians and nurses, and in some cases between genders, on attitudes towards ICT tools and follow-up at home were performed. Results: Out of the 425 forms sent out, 139 were collected, and 17 out of 21 counties and regions were covered in the replies. Among the respondents, 66% were nurses, 30% physicians and 4% others. As for gender, 90% of nurses were female and 60% of physicians were male. Internet was used daily by 67% of the respondents. Attitudes towards healthcare ICT were found positive as 74% were positive concerning healthcare ICT today, 96% were positive regarding the future of healthcare ICT, and 54% had high confidence in healthcare ICT. Possibilities for distance monitoring/follow-up are good according to 63% of the respondents, 78% thought that this leads to increased patient involvement, and 80% thought it would improve possibilities to deliver better care. Finally, 72% of the respondents said CHF patients would benefit from home monitoring/follow-up to some extent, and 19% to a large extent. However, the best method of follow-up was considered to be home visits by nurse, or phone contact. Conclusion: The results indicate that a majority of the healthcare professionals in this study are positive to both current and future use of ICT tools in healthcare and home follow-up. Consequently other factors have to play an important role in the slow penetration of out-of-hospital eHealth applications in daily healthcare practice.

  • 38. Gund, Anna
    et al.
    Sjöqvist, Bengt Arne
    Wigert, Helena
    Hentz, Elisabet
    Lindecrantz, Kaj
    KTH, School of Technology and Health (STH), Medical sensors, signals and systems (MSSS).
    Bry, Kristina
    A randomized controlled study about the use of eHealth in the home health care of premature infants2013In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 13, no 1, p. 22-Article in journal (Refereed)
    Abstract [en]

    Background: One area where the use of information and communication technology (ICT), or eHealth, could be developed is the home health care of premature infants. The aim of this randomized controlled study was to investigate whether the use of video conferencing or a web application improves parents' satisfaction in taking care of a premature infant at home and decreases the need of home visits. In addition, nurses' attitudes regarding the use of these tools were examined. Method: Thirty-four families were randomized to one of three groups before their premature infant was discharged from the hospital to home health care: a control group receiving standard home health care (13 families); a web group receiving home health care supplemented with the use of a web application (12 families); a video group with home health care supplemented with video conferencing using Skype (9 families). Families and nursing staff answered questionnaires about the usefulness of ICT. In addition, semi-structured interviews were conducted with 16 families. Results: All the parents in the web group found the web application easy to use. 83% of the families thought it was good to have access to their child's data through the application. All the families in the video group found Skype easy to use and were satisfied with the video calls. 88% of the families thought that video calls were better than ordinary phone calls. 33% of the families in the web group and 75% of those in the video group thought the need for home visits was decreased by the web application or Skype. 50% of the families in the web group and 100% of those in the video group thought the web application or the video calls had helped them feel more confident in caring for their child. Most of the nurses were motivated to use ICT but some were reluctant and avoided using the web application and video conferencing. Conclusion: The families were satisfied with both the web application and video conferencing. The families readily embraced the use of ICT, whereas motivating some of the nurses to accept and use ICT was a major challenge.

  • 39.
    Göransson, Carina
    et al.
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden; School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Wengström, Yvonne
    Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, Stockholm, Sweden.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, Stockholm, Sweden.
    Ziegert, Kristina
    School of Health and Welfare, Halmstad University, Halmstad, Sweden.
    Blomberg, Karin
    Örebro University, School of Health Sciences.
    An app for supporting older people receiving home care - usage, aspects of health and health literacy: a quasi-experimental study2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 226Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people's usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time.

    METHODS: A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6-month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics.

    RESULTS: The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people's communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time.

    CONCLUSIONS: The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.

  • 40.
    Göransson, Carina
    et al.
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI). Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Wengström, Yvonne
    Theme Cancer, Karolinska University Hospital, Stockholm, Sweden & Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Hälleberg-Nyman, Maria
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    Langius-Eklöf, Ann
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Ziegert, Kristina
    Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI).
    Blomberg, Karin
    Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
    An app for supporting older people receiving home care – usage, aspects of health and health literacy: a quasi-experimental study2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, article id 226Article in journal (Refereed)
    Abstract [en]

    Background: During the last decade, there has been an increase in studies describing use of mHealth, usingsmartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time.Methods: A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics.Results: The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time.Conclusions: The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, andwhich aspects of health of importance to support by an app. © 2020 The Author(s).

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  • 41.
    Hagiwara, Magnus
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Suserud, Björn-Ove
    University of Borås, School of Health Sciences, 501 90 Borås, Sweden.
    Andersson-Gäre, Boel
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Sjöqvist, Bengt-Arne
    Department of Signals and Systems, Chalmers University of Technology, Gothenburg, Sweden.
    Henricson, Maria
    Jönköping University, School of Health and Welfare.
    Jonsson, Anders
    University of Borås, School of Health Sciences, 501 90 Borås, Sweden.
    The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study2014In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 14, no 70, p. 1-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST).

    METHODS:

    In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression.

    RESULTS:

    In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST.

    CONCLUSIONS:

    The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

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  • 42.
    Hamberg, Anna-Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Hellman, Jacob
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Nanotechnology and Functional Materials.
    Dahlberg, Jonny
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Nanotechnology and Functional Materials.
    Jonsson, E Niclas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Wadelius, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    A Bayesian decision support tool for efficient dose individualization of warfarin in adults and children2015In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 15, no 7Article in journal (Refereed)
    Abstract [en]

    Warfarin is the most widely prescribed anticoagulant for prevention and treatment of thromboembolic events. Although highly effective, the use of warfarin is limited by a narrow therapeutic range combined with a more than ten-fold difference in the dose required for adequate anticoagulation in adults. For each patient, an optimal dose that leads to a favourable balance between the wanted antithrombotic effect and the risk of bleeding, measured as the prothrombin time International Normalised Ratio (INR), must be found. A model capable of describing the time-course of the INR response to warfarin therapy can be used to aid dose selection, both before starting therapy (a priori dose prediction) and after therapy has been initiated (a posteriori dose revision). In this paper we describe the transfer of a population PKPD-model for warfarin developed in NONMEM to a platform independent decision support tool written in Java. The tool proved capable of solving a system of differential equations representing the pharmacokinetics and pharmacodynamics of warfarin, with a performance comparable to NONMEM. To estimate an a priori dose the user provides information on body weight, age, CYP2C9 and VKORC1 genotype, baseline and target INR. With addition of information about previous doses and INR observations, the tool will use a Bayesian forecasting method to suggest an a posteriori dose, i.e. the dose with the highest probability to result in the desired INR. Results are displayed as the predicted dose per day and per week, and graphically as the predicted INR curve. The tool can also be used to predict INR following any given dose regimen, e.g. a loading-dose regimen. We believe it will provide a clinically useful tool for initiating and maintaining warfarin therapy in the clinic. It will ensure consistent dose adjustment practices between prescribers, and provide more efficient individualization of warfarin dosing in both children and adults.

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  • 43.
    Hellström, Lina
    et al.
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Waern, Karolina
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Montelius, Emelie
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Rydberg, Tony
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Petersson, Göran
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Physicians' attitudes towards ePrescribing: evaluation of a Swedish full-scale implementation2009In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 9, no August, p. Article number: 37-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The penetration rate of Electronic Health Record (EHR) systems in health care is increasing. However, many different EHR-systems are used with varying ePrescription designs and functionalities. The aim of the present study was to evaluate experienced ePrescribers' attitudes towards ePrescribing for suggesting improvements. METHODS: Physicians (n = 431) from seven out of the 21 Swedish health care regions, using one of the six most widely implemented EHR-systems with integrated electronic prescribing modules, were recruited from primary care centers and hospital clinics of internal medicine, orthopaedics and surgery. The physicians received a web survey that comprised eight questions on background data and 19 items covering attitudes towards ePrescribing. Forty-two percent (n = 199) of the physicians answered the questionnaire; 90% (n = 180) of the respondents met the inclusion criteria and were included in the final analysis. RESULTS: A majority of the respondents regarded their EHR-system easy to use in general (81%), and for the prescribing of drugs (88%). Most respondents believed they were able to provide the patients better service by ePrescribing (92%), and regarded ePrescriptions to be time saving (91%) and to be safer (83%), compared to handwritten prescriptions. Some of the most frequently reported weaknesses were: not clearly displayed price of drugs (43%), complicated drug choice (21%), and the perception that it was possible to handle more than one patient at a time when ePrescribing (13%). Moreover, 62% reported a lack of receipt from the pharmacy after successful transmission of an ePrescription. Although a majority (73%) of the physicians reported that they were always or often checking the ePrescription a last time before transmitting, 25% declared that they were seldom or never doing a last check. The respondents suggested a number of improvements, among others, to simplify the drug choice and the cancellation of ePrescriptions. CONCLUSION: The Swedish physicians in the group studied were generally satisfied with their specific EHR-system and with ePrescribing as such. However, identified weaknesses warrant improvements of the EHR-systems as well as of their implementation in the individual health care organisation.

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  • 44.
    Henriksson, Aron
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Zhao, Jing
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Dalianis, Hercules
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Boström, Henrik
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Ensembles of randomized trees using diverse distributed representations of clinical events2016In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 16, p. 85-95, article id 69Article in journal (Refereed)
    Abstract [en]

    Background: Learning deep representations of clinical events based on their distributions in electronic health records has been shown to allow for subsequent training of higher-performing predictive models compared to the use of shallow, count-based representations. The predictive performance may be further improved by utilizing multiple representations of the same events, which can be obtained by, for instance, manipulating the representation learning procedure. The question, however, remains how to make best use of a set of diverse representations of clinical events – modeled in an ensemble of semantic spaces – for the purpose of predictive modeling. Methods: Three different ways of exploiting a set of (ten) distributed representations of four types of clinical events – diagnosis codes, drug codes, measurements, and words in clinical notes – are investigated in a series of experiments using ensembles of randomized trees. Here, the semantic space ensembles are obtained by varying the context window size in the representation learning procedure. The proposed method trains a forest wherein each tree is built from a bootstrap replicate of the training set whose entire original feature set is represented in a randomly selected set of semantic spaces – corresponding to the considered data types – of a given context window size. Results: The proposed method significantly outperforms concatenating the multiple representations of the bagged dataset; it also significantly outperforms representing, for each decision tree, only a subset of the features in a randomly selected set of semantic spaces. A follow-up analysis indicates that the proposed method exhibits less diversity while significantly improving average tree performance. It is also shown that the size of the semantic space ensemble has a significant impact on predictive performance and that performance tends to improve as the size increases. Conclusions: The strategy for utilizing a set of diverse distributed representations of clinical events when constructing ensembles of randomized trees has a significant impact on predictive performance. The most successful strategy – significantly outperforming the considered alternatives – involves randomly sampling distributed representations of the clinical events when building each decision tree in the forest.

  • 45.
    Henriksson, Aron
    et al.
    Stockholms universitet, Institutionen för data- och systemvetenskap.
    Zhao, Jing
    Stockholms universitet, Institutionen för data- och systemvetenskap.
    Dalianis, Hercules
    Stockholms universitet, Institutionen för data- och systemvetenskap.
    Boström, Henrik
    Stockholms universitet, Institutionen för data- och systemvetenskap.
    Ensembles of randomized trees using diverse distributed representations of clinical events2016In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 16, no 2, article id 69Article in journal (Refereed)
    Abstract [en]

    Background: Learning deep representations of clinical events based on their distributions in electronic health records has been shown to allow for subsequent training of higher-performing predictive models compared to the use of shallow, count-based representations. The predictive performance may be further improved by utilizing multiple representations of the same events, which can be obtained by, for instance, manipulating the representation learning procedure. The question, however, remains how to make best use of a set of diverse representations of clinical events – modeled in an ensemble of semantic spaces – for the purpose of predictive modeling. Methods: Three different ways of exploiting a set of (ten) distributed representations of four types of clinical events – diagnosis codes, drug codes, measurements, and words in clinical notes – are investigated in a series of experiments using ensembles of randomized trees. Here, the semantic space ensembles are obtained by varying the context window size in the representation learning procedure. The proposed method trains a forest wherein each tree is built from a bootstrap replicate of the training set whose entire original feature set is represented in a randomly selected set of semantic spaces – corresponding to the considered data types – of a given context window size. Results: The proposed method significantly outperforms concatenating the multiple representations of the bagged dataset; it also significantly outperforms representing, for each decision tree, only a subset of the features in a randomly selected set of semantic spaces. A follow-up analysis indicates that the proposed method exhibits less diversity while significantly improving average tree performance. It is also shown that the size of the semantic space ensemble has a significant impact on predictive performance and that performance tends to improve as the size increases. Conclusions: The strategy for utilizing a set of diverse distributed representations of clinical events when constructing ensembles of randomized trees has a significant impact on predictive performance. The most successful strategy – significantly outperforming the considered alternatives – involves randomly sampling distributed representations of the clinical events when building each decision tree in the forest.

  • 46.
    Holmner, Åsa
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics. Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Öhberg, Fredrik
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Bergmann, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Blomberg, Anders
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Wadell, Karin
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    How stable is lung function in patients with stable chronic obstructive pulmonary disease when monitored using a telehealth system?: A longitudinal and home-based study2020In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 20, no 1, article id 87Article in journal (Refereed)
    Abstract [en]

    Background: Many telehealth systems have been designed to identify signs of exacerbations in patients with chronic obstructive pulmonary disease (COPD), but few previous studies have reported the nature of recorded lung function data and what variations to expect in this group of individuals. The aim of the study was to evaluate the nature of individual diurnal, day-to-day and long-term variation in important prognostic markers of COPD exacerbations by employing a telehealth system developed in-house.

    Methods: Eight women and five men with COPD performed measurements (spirometry, pulse oximetry and the COPD assessment test (CAT)) three times per week for 4-6 months using the telehealth system. Short-term and long-term individual variations were assessed using the relative density and weekly means respectively. Quality of the spirometry measurements (forced expiratory volume in one second (FEV1) and inspiratory capacity (IC)) was assessed employing the criteria of American Thoracic Society (ATS)/European Respiratory Society (ERS) guidelines.

    Results: Close to 1100 measurements of both FEV1 and IC were performed during a total of 240 patient weeks. The two standard deviation ranges for intra-individual short-term variation were approximately +/- 210 mL and +/- 350 mL for FEV1 and IC respectively. In long-term, spirometry values increased and decreased without notable changes in symptoms as reported by CAT, although it was unusual with a decrease of more than 50 mL per measurement of FEV1 between three consecutive measurement days. No exacerbation occurred. There was a moderate to strong positive correlation between FEV1 and IC, but weak or absent correlation with the other prognostic markers in the majority of the participants.

    Conclusions: Although FEV1 and IC varied within a noticeable range, no corresponding change in symptoms occurred. Therefore, this study reveals important and, to our knowledge, previously not reported information about short and long-term variability in prognostic markers in stable patients with COPD. The present data are of significance when defining criteria for detecting exacerbations using telehealth strategies.

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  • 47.
    Hägglund, Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Participatory eHealth and Health Data Research Group. Uppsala University Hospital, Uppsala, Sweden; Health Informatics Center, Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Kristensson Ekwall, Anna
    Davoody, Nadia
    Farrokhnia, Nasim
    Escape to the future: a qualitative study of physicians' views on the work environment, education, and support in a digital context2023In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 23, no 1, article id 231Article in journal (Refereed)
    Abstract [en]

    Background

    The use of remote services such as video consultations (VCs) has increased significantly in the wake of the COVID-19 pandemic. In Sweden, private healthcare providers offering VCs have grown substantially since 2016 and have been controversial. Few studies have focused on physicians’ experiences providing care in this context. Our aim was to study physicians’ experiences of VCs, focusing on the work environment, quality of care, and educational needs.

    Methods

    Twenty-two semi-structured interviews were performed with physicians working with VCs in Sweden, and analyzed through inductive content analysis.

    Results

    We identified five categories; flexibility, social work environment, impact on care and society, continuous learning and career development, and organizational support. Flexibility and accessibility were considered positive features of working digitally by giving physicians control over their time and workplace and increasing patients’ timely access to healthcare. Regarding collegial contact and social activities in a digital context, the majority of the participants did not experience any significant difference compared to the physical context. Access to technical support services, educational support, and collegial support in decision-making, guidance, and consultations were described as well-functioning. Satisfied patients positively impacted the work environment, and participants felt that VCs have a positive socio-economic effect. Continuity of care was considered supported, but patients did not always prioritize this. Privacy risks were considered a challenge, as were poor development of clinical skills due to the low variation of patient cases. Working for an online healthcare provider was contributing to career advancements for junior clinicians.

    Conclusions

    Physicians appreciate the flexibility of the digital context and seem satisfied with a work environment where they have a high level of control, but few consider this a full-time career option. The pandemic year 2020 has led to a significant increase in the implementation of VCs in traditional care systems. How this affects the work environment and continuous education needs and career development remains to be seen.

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  • 48.
    Jalali, Amin
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Johannesson, Paul
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Perjons, Erik
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Askfors, Ylva
    Kalladj, Abdolazim Rezaei
    Shemeikka, Tero
    Vég, Anikó
    dfgcompare: a library to support process variant analysis through Markov models2021In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 21, no 1, article id 356Article in journal (Refereed)
    Abstract [en]

    Background: Data-driven process analysis is an important area that relies on software support. Process variant analysis is a sort of analysis technique in which analysts compare executed process variants, a.k.a. process cohorts. This comparison can help to identify insights for improving processes. There are a few software supports to enable process cohort comparison based on the frequencies of process activities and performance metrics. These metrics are effective in cohort analysis, but they cannot support cohort comparison based on the probability of transitions among states, which is an important enabler for cohort analysis in healthcare.

    Results: This paper defines an approach to compare process cohorts using Markov models. The approach is formalized, and it is implemented as an open-source python library, named dfgcompare. This library can be used by other researchers to compare process cohorts. The implementation is also used to compare caregivers' behavior when prescribing drugs in the Stockholm Region. The result shows that the approach enables the comparison of process cohorts in practice.

    Conclusions: We conclude that dfgcompare supports identifying differences among process cohorts.

  • 49.
    Jama Mahmud, Amina
    et al.
    Blekinge Institute of Technology, School of Health Science.
    Olander, Ewy
    Blekinge Institute of Technology, School of Health Science.
    Eriksén, Sara
    Blekinge Institute of Technology, School of Computing.
    Haglund, Bo
    Health communication in primary health care -A case study of ICT development for health promotion2013In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 13, no 17, p. 1-15Article in journal (Refereed)
    Abstract [en]

    Background Developing Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel. Methods A qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis. Results Health communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel. Conclusions Health communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate health communication for promoting health, i.e. ‘health promoting communication’.

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  • 50.
    Janssens, Rosanne
    et al.
    Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium.
    Huys, Isabelle
    Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium.
    van Overbeeke, Eline
    Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium.
    Whichello, Chiara
    Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
    Harding, Sarah
    Takeda International, UK Branch, 61 Aldwych, London, WC2B 4AE, UK.
    Kübler, Jürgen
    QSciCon, Europabadstr. 8, 35041, Marburg, Germany.
    Juhaeri, Juhaeri
    Sanofi, 55 Corporate Drive, Bridgewater Township, NJ, 08807, USA.
    Ciaglia, Antonio
    International Alliance of Patients’ Organizations, 49-51 East Rd, Hoxton, London, N1 6AH, UK.
    Simoens, Steven
    Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium.
    Stevens, Hilde
    Institute for Interdisciplinary Innovation in healthcare (I3h), Université libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium.
    Smith, Meredith
    Amgen, Inc., Thousand Oaks, California, USA.
    Levitan, Bennet
    Global R&D Epidemiology, Janssen Research & Development, 1125 Trenton-Harbourton Road, PO Box 200, Titusville, NJ, 08560, USA.
    Cleemput, Irina
    Belgian Health Care Knowledge Centre (KCE), Kruidtuinlaan 55, 1000, Brussels, Belgium.
    de Bekker-Grob, Esther
    Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
    Veldwijk, Jorien
    Erasmus School of Health Policy & Management (ESHPM) and Erasmus Choice Modelling Centre (ECMC), Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
    Opportunities and challenges for the inclusion of patient preferences in the medical product life cycle: a systematic review2019In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947Article in journal (Refereed)
    Abstract [en]

    Background: The inclusion of patient preferences (PP) in the medical product life cycle is a topic of growing interest to stakeholders such as academics, Health Technology Assessment (HTA) bodies, reimbursement agencies, industry, patients, physicians and regulators. This review aimed to understand the potential roles, reasons for using PP and the expectations, concerns and requirements associated with PP in industry processes, regulatory benefitrisk assessment (BRA) and marketing authorization (MA), and HTA and reimbursement decision-making. Methods: A systematic review of peer-reviewed and grey literature published between January 2011 and March 2018 was performed. Consulted databases were EconLit, Embase, Guidelines International Network, PsycINFO and PubMed. A two-step strategy was used to select literature. Literature was analyzed using NVivo (QSR international). Results: From 1015 initially identified documents, 72 were included. Most were written from an academic perspective (61%) and focused on PP in BRA/MA and/or HTA/reimbursement (73%). Using PP to improve understanding of patients’ valuations of treatment outcomes, patients’ benefit-risk trade-offs and preference heterogeneity were roles identified in all three decision-making contexts. Reasons for using PP relate to the unique insights and position of patients and the positive effect of including PP on the quality of the decision-making process. Concerns shared across decision-making contexts included methodological questions concerning the validity, reliability and cognitive burden of preference methods. In order to use PP, general, operational and quality requirements were identified, including recognition of the importance of PP and ensuring patient understanding in PP studies. Conclusions: Despite the array of opportunities and added value of using PP throughout the different steps of the MPLC identified in this review, their inclusion in decision-making is hampered by methodological challenges and lack of specific guidance on how to tackle these challenges when undertaking PP studies. To support the development of such guidance, more best practice PP studies and PP studies investigating the methodological issues identified in this review are critically needed.

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