handlingsplaner som spesifiserer viktige trinn i behandlingen av pasienter med definerte kliniske... more handlingsplaner som spesifiserer viktige trinn i behandlingen av pasienter med definerte kliniske problemer. Behandlingslinjer har vært benyttet i ulik grad ved norske sykehus og er nå et satsingsområde for Helse Sør-Øst RHF. I dette notatet angir vi noen kilder og verktøy som kan være aktuelle i arbeidet med behandlingslinjer. Metode: Vi søkte etter systematiske oversikter om effekten av behandlingslinjer og fokuserte på oversikter om effekten av behandlingslinjer generelt. På grunn av den forenklede metoden som ble brukt, har vår gjennomgang av dokumentasjonen klare metodologiske svakheter både i forhold til utvalg og vurdering av kvaliteten på oversiktene. Resultat: • Vi fant én Cochrane-protokoll for en kommende systematisk oversikt og to ferdige systematiske oversikter om den generelle effekten av behandlingslinjer. Cochrane-protokollen vil ventelig gi en god systematisk oversikt over forskningsgrunnlaget for behandlingslinjer. Publisering er planlagt i juni/juli 2008. Konklusj...
Population ageing has raised major concerns about the prevalence of age-related mental health det... more Population ageing has raised major concerns about the prevalence of age-related mental health deterioration which is further intensified amid the COVID-19 pandemic. Mobile health (mHealth) interventions bear promising impacts on alleviating the mental health burden of this vulnerable group. However, mHealth solutions often report a high drop-out rate suggesting a lack of motivation and engagement among users. Also, the limited number of clinically validated mHealth applications indicates an urgent demand for empirical evidence on the subject. This paper proposes a design framework for gamified mHealth activities to enhance mental and cognitive well-being of the elderly. Further, the paper outlines a research protocol to investigate the impacts of the framework on a cohort of 250 older adults in a developing country under a single-subject experimental design. Our social experiment may reveal valuable insights into the potential of mHealth solutions and gamification in this domain
Designing for a Digital and Globalized World, 2018
Over 70 randomised controlled trials (RCTs) are published in MEDLINE every day; in which the volu... more Over 70 randomised controlled trials (RCTs) are published in MEDLINE every day; in which the volume and velocity of unstructured evidence data have become a great challenge to human manual processing capabilities. There is an emerging need for a dynamic, evolving design of “living” evidence networks as the best source of health optimisation in evidence-based medicine. This study, therefore, investigated the text and layout features of unstructured full-texts in the biomedical literature to design IT artefacts for building high-quality and up-to-date evidence networks of RCTs. As a result, network meta-analyses can be automated for comparative adverse effects of treatments in chronic disorders such as Major Depressive Disorder and Bipolar Disorder. The study outcomes extended the technological boundary of health optimisation technologies, and contributed to the cumulative development of patient-relevant health care and shared decision-making.
Design science artifacts can be highly sophisticated due to the substantial complexity of their s... more Design science artifacts can be highly sophisticated due to the substantial complexity of their situated organizational structures, user characteristics, and technological infrastructure. Evaluation of complex design science artifacts is challenging; bec
EviCare var det første, offentlige innovasjonsprosjektet innen IKT i Norge som fikk støtte fra No... more EviCare var det første, offentlige innovasjonsprosjektet innen IKT i Norge som fikk støtte fra Norges Forskningsråd. Hovedmålet med prosjektet var å utvikle metoder og teknologi som leverer forskningsbasert kunnskap der behandling og omsorg gis, integrert i elektronisk pasientjournal (EPJ). Forventede effekter er at behandlingen får høyere kvalitet og at dokumentasjonen av arbeidsprosessene blir mer forståelig
European Journal for Person Centered Healthcare, 2015
The call for a renaissance in Evidence-Based Medicine will not result in the delivery of person-c... more The call for a renaissance in Evidence-Based Medicine will not result in the delivery of person-centred healthcare. In person-centred healthcare the relative importance of the considerations that matter to the person is elicited and combined, at the point of decision, with the best estimates available on the performance of the available options on those criteria. Prior option evaluations based on average preferences that constitute the conventional 'evidence-base' cannot be part of this process, even if some of the underlying data may be of use. The ethics of transparent person-centred care require the evidence-base to be reconceptualised as the unsynthesised matrix of option performance rates on person-important criteria. Abdicating in the face of the challenges resulting from this reconception is a case of the methodological tail wagging the ethical dog.
Background In patient-centred healthcare, the core components of a decision should be personalise... more Background In patient-centred healthcare, the core components of a decision should be personalised. The core knowledge components of a decision include the options and embedded procedures, the attributes of the options, and the probabilities associated with the attributes. Evidence about the knowledge components for an individual patient can be elicited from the patient herself, clinicians, caretakers, the electronic medical journal and from research-based sources such as textbooks and clinical guidelines. We name the functions that personalise general knowledge components for individual patients ‘clinical rules and modifiers’. In clinical practice, clinical rules often modify and personalise core components implicitly and unsystematically. The development of software functionality based on clinical rules and modifiers is a promising methodological approach for streamlining the personalisation of core decision components. We are developing a clinical rules and modifiers system as one component in a decision aid for patients with bipolar disorder. Objective We will evaluate the feasibility and validity of a clinical rules and modifiers system for patients with bipolar disorder type I. We will model the system in the Elicia and Annalisa software. Method We will examine the information related to the long-term treatment for individual patients with bipolar disorder type I, in high-quality textbooks and clinical guidelines. The purpose is to identify and extract clinicial rules and modifiers that personalise the options, the attributes of the options, the procedures that the options entail, and the probabilities of the attributes of the options. The content will be modelled using the survey and topic modifying functionality of the Elicia and Annalisa software. The clinical rules and modifiers system will include the following, but not restricted to: contraindications, measures taken to counter side effects, baseline risks, burdens of treatment, and possible interactions. We will determine the ratio of decision-relevant, personalising content in textbooks and guidelines that can be integrated into the software´s clinical rules and modifiers functionality. A heuristic, quantitative and qualitative evaluation of the system will be performed. We also compare the individualised core component output of the system with the output recommended by expert clinicians, using mock patient scenarios and a questionnaire. Results We will present the ratio of content in the textbooks and guidelines that can be included in the software, and the results from the heuristic, quantitative and qualitative evaluation of the system. We will evaluate the accuracy and reliability of the rules and modifiers system, and compare the system output with the recommendations made by the domain experts. Conclusion We will discuss the feasibility, reliability and validity of the clinical rules and modifiers system. []
Background Many patients with bipolar disorder experience poor decision quality. Common deficits ... more Background Many patients with bipolar disorder experience poor decision quality. Common deficits include suboptimal assessments of the positive and negative effects of former medication, a lack of monitoring of the effects of ongoing medication, low adherence, and a lack of opportunity to bring their own preferences to bear in the evaluation of their medication. The increasing number of medication options, a relative lack of easily-accessible head-to-head comparisons of pharmacotherapeutic alternatives on patient-important outcomes, and the insufficient personalisation of research findings to individual patients, add up to a formidable challenge for both patients and clinicians in selecting and monitoring optimal treatment. Objective To develop a web- and multi-criteria decision analysis-based patient decision aid that assists the evaluation, selection, monitoring and follow-up of pharmacotherapy in the long-term clinical management of bipolar disorder type I. The decision aid generates a one-screen, interactive, personalised summary of all the core components of long-term medication decisions in bipolar disorder. The system enables the inclusion and integration of evidence about the current state and future probabilities of the outcomes of the options from the patient, from the clinician, from the EMR, and from research findings. The decision aid will be used repeatedly for the improvement of decisions over time, monitoring the quality of the personalised decisions longitudinally, and generate visual images of trends in the crucial decision components. The aid will display the degree of – and long-term alterations in – concordance levels between the beliefs and preferences of the patient and the clinician, and the differences in opinions expressed by the patient him/herself at different stages of the disease. In contrast to patient decision aids that support one-off decisions, the decision aid supports ongoing decisions. It aims to provide continuous process support and a loop of forecasting, action, assessment, and new forecasting, thereby facilitating substantially augmented discussions and shared decision-making. Methods A manual for the production of the decision aid has been developed. Several small-scale literature reviews and summaries are being conducted in accordance with the manual, as well as a supplementary feasibility analysis, along with content and requirement specifications. A formal web-based elicitation process involving domain experts will be used to derive the baseline performance ratings of the medication options on the patient-important outcomes, where these are not available from network meta-analyses. The content will be modelled in a pre-existing template. Patient representatives and clinicians will perform simple, iterative usability testing. Results The implementation of the manual, our associated experiences, and preliminary findings will be described. The incremental gain of using elaborate vs. simple procedures to produce the basic input to the system will described. Conclusion In the next phase, a clinical study applying a single-subjects research design will establish feasibility of the system, and the effects of the decision aid on personalised decision quality in individual patients, adherence rates and patient-clinician communication. The manual developed for this project will be applied in the construction of other patient decision aids with the aim of arriving at a generic manual. []
NORSK: Kunnskapsbasert praksis er å integrere forskningskunnskap med klinisk ekspertise og pasien... more NORSK: Kunnskapsbasert praksis er å integrere forskningskunnskap med klinisk ekspertise og pasientens verdier og preferanser. Kunnskapssenteret fikk i 2005 forespørsel fra Helse Øst RHF om støtte til bedre kunnskapshåndtering i spesialisthelsetjenesten. Denne ...
handlingsplaner som spesifiserer viktige trinn i behandlingen av pasienter med definerte kliniske... more handlingsplaner som spesifiserer viktige trinn i behandlingen av pasienter med definerte kliniske problemer. Behandlingslinjer har vært benyttet i ulik grad ved norske sykehus og er nå et satsingsområde for Helse Sør-Øst RHF. I dette notatet angir vi noen kilder og verktøy som kan være aktuelle i arbeidet med behandlingslinjer. Metode: Vi søkte etter systematiske oversikter om effekten av behandlingslinjer og fokuserte på oversikter om effekten av behandlingslinjer generelt. På grunn av den forenklede metoden som ble brukt, har vår gjennomgang av dokumentasjonen klare metodologiske svakheter både i forhold til utvalg og vurdering av kvaliteten på oversiktene. Resultat: • Vi fant én Cochrane-protokoll for en kommende systematisk oversikt og to ferdige systematiske oversikter om den generelle effekten av behandlingslinjer. Cochrane-protokollen vil ventelig gi en god systematisk oversikt over forskningsgrunnlaget for behandlingslinjer. Publisering er planlagt i juni/juli 2008. Konklusj...
Population ageing has raised major concerns about the prevalence of age-related mental health det... more Population ageing has raised major concerns about the prevalence of age-related mental health deterioration which is further intensified amid the COVID-19 pandemic. Mobile health (mHealth) interventions bear promising impacts on alleviating the mental health burden of this vulnerable group. However, mHealth solutions often report a high drop-out rate suggesting a lack of motivation and engagement among users. Also, the limited number of clinically validated mHealth applications indicates an urgent demand for empirical evidence on the subject. This paper proposes a design framework for gamified mHealth activities to enhance mental and cognitive well-being of the elderly. Further, the paper outlines a research protocol to investigate the impacts of the framework on a cohort of 250 older adults in a developing country under a single-subject experimental design. Our social experiment may reveal valuable insights into the potential of mHealth solutions and gamification in this domain
Designing for a Digital and Globalized World, 2018
Over 70 randomised controlled trials (RCTs) are published in MEDLINE every day; in which the volu... more Over 70 randomised controlled trials (RCTs) are published in MEDLINE every day; in which the volume and velocity of unstructured evidence data have become a great challenge to human manual processing capabilities. There is an emerging need for a dynamic, evolving design of “living” evidence networks as the best source of health optimisation in evidence-based medicine. This study, therefore, investigated the text and layout features of unstructured full-texts in the biomedical literature to design IT artefacts for building high-quality and up-to-date evidence networks of RCTs. As a result, network meta-analyses can be automated for comparative adverse effects of treatments in chronic disorders such as Major Depressive Disorder and Bipolar Disorder. The study outcomes extended the technological boundary of health optimisation technologies, and contributed to the cumulative development of patient-relevant health care and shared decision-making.
Design science artifacts can be highly sophisticated due to the substantial complexity of their s... more Design science artifacts can be highly sophisticated due to the substantial complexity of their situated organizational structures, user characteristics, and technological infrastructure. Evaluation of complex design science artifacts is challenging; bec
EviCare var det første, offentlige innovasjonsprosjektet innen IKT i Norge som fikk støtte fra No... more EviCare var det første, offentlige innovasjonsprosjektet innen IKT i Norge som fikk støtte fra Norges Forskningsråd. Hovedmålet med prosjektet var å utvikle metoder og teknologi som leverer forskningsbasert kunnskap der behandling og omsorg gis, integrert i elektronisk pasientjournal (EPJ). Forventede effekter er at behandlingen får høyere kvalitet og at dokumentasjonen av arbeidsprosessene blir mer forståelig
European Journal for Person Centered Healthcare, 2015
The call for a renaissance in Evidence-Based Medicine will not result in the delivery of person-c... more The call for a renaissance in Evidence-Based Medicine will not result in the delivery of person-centred healthcare. In person-centred healthcare the relative importance of the considerations that matter to the person is elicited and combined, at the point of decision, with the best estimates available on the performance of the available options on those criteria. Prior option evaluations based on average preferences that constitute the conventional 'evidence-base' cannot be part of this process, even if some of the underlying data may be of use. The ethics of transparent person-centred care require the evidence-base to be reconceptualised as the unsynthesised matrix of option performance rates on person-important criteria. Abdicating in the face of the challenges resulting from this reconception is a case of the methodological tail wagging the ethical dog.
Background In patient-centred healthcare, the core components of a decision should be personalise... more Background In patient-centred healthcare, the core components of a decision should be personalised. The core knowledge components of a decision include the options and embedded procedures, the attributes of the options, and the probabilities associated with the attributes. Evidence about the knowledge components for an individual patient can be elicited from the patient herself, clinicians, caretakers, the electronic medical journal and from research-based sources such as textbooks and clinical guidelines. We name the functions that personalise general knowledge components for individual patients ‘clinical rules and modifiers’. In clinical practice, clinical rules often modify and personalise core components implicitly and unsystematically. The development of software functionality based on clinical rules and modifiers is a promising methodological approach for streamlining the personalisation of core decision components. We are developing a clinical rules and modifiers system as one component in a decision aid for patients with bipolar disorder. Objective We will evaluate the feasibility and validity of a clinical rules and modifiers system for patients with bipolar disorder type I. We will model the system in the Elicia and Annalisa software. Method We will examine the information related to the long-term treatment for individual patients with bipolar disorder type I, in high-quality textbooks and clinical guidelines. The purpose is to identify and extract clinicial rules and modifiers that personalise the options, the attributes of the options, the procedures that the options entail, and the probabilities of the attributes of the options. The content will be modelled using the survey and topic modifying functionality of the Elicia and Annalisa software. The clinical rules and modifiers system will include the following, but not restricted to: contraindications, measures taken to counter side effects, baseline risks, burdens of treatment, and possible interactions. We will determine the ratio of decision-relevant, personalising content in textbooks and guidelines that can be integrated into the software´s clinical rules and modifiers functionality. A heuristic, quantitative and qualitative evaluation of the system will be performed. We also compare the individualised core component output of the system with the output recommended by expert clinicians, using mock patient scenarios and a questionnaire. Results We will present the ratio of content in the textbooks and guidelines that can be included in the software, and the results from the heuristic, quantitative and qualitative evaluation of the system. We will evaluate the accuracy and reliability of the rules and modifiers system, and compare the system output with the recommendations made by the domain experts. Conclusion We will discuss the feasibility, reliability and validity of the clinical rules and modifiers system. []
Background Many patients with bipolar disorder experience poor decision quality. Common deficits ... more Background Many patients with bipolar disorder experience poor decision quality. Common deficits include suboptimal assessments of the positive and negative effects of former medication, a lack of monitoring of the effects of ongoing medication, low adherence, and a lack of opportunity to bring their own preferences to bear in the evaluation of their medication. The increasing number of medication options, a relative lack of easily-accessible head-to-head comparisons of pharmacotherapeutic alternatives on patient-important outcomes, and the insufficient personalisation of research findings to individual patients, add up to a formidable challenge for both patients and clinicians in selecting and monitoring optimal treatment. Objective To develop a web- and multi-criteria decision analysis-based patient decision aid that assists the evaluation, selection, monitoring and follow-up of pharmacotherapy in the long-term clinical management of bipolar disorder type I. The decision aid generates a one-screen, interactive, personalised summary of all the core components of long-term medication decisions in bipolar disorder. The system enables the inclusion and integration of evidence about the current state and future probabilities of the outcomes of the options from the patient, from the clinician, from the EMR, and from research findings. The decision aid will be used repeatedly for the improvement of decisions over time, monitoring the quality of the personalised decisions longitudinally, and generate visual images of trends in the crucial decision components. The aid will display the degree of – and long-term alterations in – concordance levels between the beliefs and preferences of the patient and the clinician, and the differences in opinions expressed by the patient him/herself at different stages of the disease. In contrast to patient decision aids that support one-off decisions, the decision aid supports ongoing decisions. It aims to provide continuous process support and a loop of forecasting, action, assessment, and new forecasting, thereby facilitating substantially augmented discussions and shared decision-making. Methods A manual for the production of the decision aid has been developed. Several small-scale literature reviews and summaries are being conducted in accordance with the manual, as well as a supplementary feasibility analysis, along with content and requirement specifications. A formal web-based elicitation process involving domain experts will be used to derive the baseline performance ratings of the medication options on the patient-important outcomes, where these are not available from network meta-analyses. The content will be modelled in a pre-existing template. Patient representatives and clinicians will perform simple, iterative usability testing. Results The implementation of the manual, our associated experiences, and preliminary findings will be described. The incremental gain of using elaborate vs. simple procedures to produce the basic input to the system will described. Conclusion In the next phase, a clinical study applying a single-subjects research design will establish feasibility of the system, and the effects of the decision aid on personalised decision quality in individual patients, adherence rates and patient-clinician communication. The manual developed for this project will be applied in the construction of other patient decision aids with the aim of arriving at a generic manual. []
NORSK: Kunnskapsbasert praksis er å integrere forskningskunnskap med klinisk ekspertise og pasien... more NORSK: Kunnskapsbasert praksis er å integrere forskningskunnskap med klinisk ekspertise og pasientens verdier og preferanser. Kunnskapssenteret fikk i 2005 forespørsel fra Helse Øst RHF om støtte til bedre kunnskapshåndtering i spesialisthelsetjenesten. Denne ...
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