Publications by authors named "Sabine Koch"

128 Publications

Use of Self-Reported Computerized Medical History Taking for Acute Chest Pain in the Emergency Department - the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS): Prospective Cohort Study.

J Med Internet Res 2021 Apr 27;23(4):e25493. Epub 2021 Apr 27.

Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, SE-182 88 Stockholm, Sweden.

Background: Chest pain is one of the most common chief complaints in emergency departments (EDs). Collecting an adequate medical history is challenging but essential in order to use recommended risk scores such as the HEART score (based on history, electrocardiogram, age, risk factors, and troponin). Self-reported computerized history taking (CHT) is a novel method to collect structured medical history data directly from the patient through a digital device. CHT is rarely used in clinical practice, and there is a lack of evidence for utility in an acute setting.

Objective: This substudy of the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS) aimed to evaluate whether patients with acute chest pain can interact effectively with CHT in the ED.

Methods: Prospective cohort study on self-reported medical histories collected from acute chest pain patients using a CHT program on a tablet. Clinically stable patients aged 18 years and older with a chief complaint of chest pain, fluency in Swedish, and a nondiagnostic electrocardiogram or serum markers for acute coronary syndrome were eligible for inclusion. Patients unable to carry out an interview with CHT (eg, inadequate eyesight, confusion or agitation) were excluded. Effectiveness was assessed as the proportion of patients completing the interview and the time required in order to collect a medical history sufficient for cardiovascular risk stratification according to HEART score.

Results: During 2017-2018, 500 participants were consecutively enrolled. The age and sex distribution (mean 54.3, SD 17.0 years; 213/500, 42.6% women) was similar to that of the general chest pain population (mean 57.5, SD 19.2 years; 49.6% women). Common reasons for noninclusion were language issues (182/1000, 18.2%), fatigue (158/1000, 15.8%), and inability to use a tablet (152/1000, 15.2%). Sufficient data to calculate HEART score were collected in 70.4% (352/500) of the patients. Key modules for chief complaint, cardiovascular history, and respiratory history were completed by 408 (81.6%), 339 (67.8%), and 291 (58.2%) of the 500 participants, respectively, while 148 (29.6%) completed the entire interview (in all 14 modules). Factors associated with completeness were age 18-69 years (all key modules: Ps<.001), male sex (cardiovascular: P=.04), active workers (all key modules: Ps<.005), not arriving by ambulance (chief complaint: P=.03; cardiovascular: P=.045), and ongoing chest pain (complete interview: P=.002). The median time to collect HEART score data was 23 (IQR 18-31) minutes and to complete an interview was 64 (IQR 53-77) minutes. The main reasons for discontinuing the interview prior to completion (n=352) were discharge from the ED (101, 28.7%) and tiredness (95, 27.0%).

Conclusions: A majority of patients with acute chest pain can interact effectively with CHT on a tablet in the ED to provide sufficient data for risk stratification with a well-established risk score. The utility was somewhat lower in patients 70 years and older, in patients arriving by ambulance, and in patients without ongoing chest pain. Further studies are warranted to assess whether CHT can contribute to improved management and prognosis in this large patient group.

Trial Registration: ClinicalTrials.gov NCT03439449; https://clinicaltrials.gov/ct2/show/NCT03439449.

International Registered Report Identifier (irrid): RR2-10.1136/bmjopen-2019-031871.
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http://dx.doi.org/10.2196/25493DOI Listing
April 2021

Digital Health during COVID-19: Informatics Dialogue with the World Health Organization.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

eHealth Development Association, Amman, Jordan.

Background: On December 16, 2020 representatives of the International Medical Informatics Association (IMIA), a Non-Governmental Organization in official relations with the World Health Organization (WHO), along with its International Academy for Health Sciences Informatics (IAHSI), held an open dialogue with WHO Director General (WHO DG) Tedros Adhanom Ghebreyesus about the opportunities and challenges of digital health during the COVID-19 global pandemic.

Objectives: The aim of this paper is to report the outcomes of the dialogue and discussions with more than 200 participants representing different civil society organizations (CSOs).

Methods: The dialogue was held in form of a webinar. After an initial address of the WHO DG, short presentations by the panelists, and live discussions between panelists, the WHO DG and WHO representatives took place. The audience was able to post questions in written. These written discussions were saved with participants' consent and summarized in this paper.

Results: The main themes that were brought up by the audience for discussion were: (a) opportunities and challenges in general; (b) ethics and artificial intelligence; (c) digital divide; (d) education. Proposed actions included the development of a roadmap based on the lessons learned from the COVID-19 pandemic.

Conclusions: Decision making by policy makers needs to be evidence-based and health informatics research should be used to support decisions surrounding digital health, and we further propose next steps in the collaboration between IMIA and WHO such as future engagement in the World Health Assembly.
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http://dx.doi.org/10.1055/s-0041-1726480DOI Listing
April 2021

The International Academy of Health Sciences Informatics (IAHSI): 2020 Report.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Department of Health Informatics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Objectives: To summarize the major activities of the International Academy of Health Sciences Informatics (IAHSI) in the 2020 time period and to welcome its 2020 Class of Fellows.

Method: Report from the members of the Academy's Board.

Results: Due to the SARS-CoV-2 pandemic, both Plenary meetings in 2020 had to be organized as virtual meetings. Scientific discussions, focusing on mobilizing computable biomedical knowledge and on data standards and interoperability formed major parts of these meetings. A statement on the use of informatics in pandemic situations was elaborated and sent to the World Health Organization. A panel on data standards and interoperability started its work. 34 Fellows were welcomed in the 2020 Class of Fellows so that the Academy now consists of 179 members.

Conclusions: There was a shift from supporting to strategic activities in the Academy's work. After having achieved organizational stability, the Academy can now focus on its strategic work and so on its main objective.
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http://dx.doi.org/10.1055/s-0041-1726479DOI Listing
April 2021

Corrigendum to "MR and PET-CT monitoring of tissue-engineered vascular grafts in the ovine carotid artery" [Biomaterials 216 (2019) 119228].

Biomaterials 2021 Apr 23;271:120723. Epub 2021 Feb 23.

Dept. of Biohybrid & Medical Textiles (BioTex), Institute of Applied Medical Engineering (AME), Helmholtz Institute Aachen and Institute for Textiles Engineering (ITA), RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.biomaterials.2021.120723DOI Listing
April 2021

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content.

Life (Basel) 2020 Dec 4;10(12). Epub 2020 Dec 4.

Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden.

Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.
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http://dx.doi.org/10.3390/life10120327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761950PMC
December 2020

International Comparison of Six Basic eHealth Indicators Across 14 Countries: An eHealth Benchmarking Study.

Methods Inf Med 2020 12 18;59(S 02):e46-e63. Epub 2020 Nov 18.

Clinical Informatics Center, Department of Pediatrics, Bioinformatics, and Population and Data Sciences, University of Texas Southwestern, Dallas, Texas, United States.

Background: Many countries adopt eHealth applications to support patient-centered care. Through information exchange, these eHealth applications may overcome institutional data silos and support holistic and ubiquitous (regional or national) information logistics. Available eHealth indicators mostly describe usage and acceptance of eHealth in a country. The eHealth indicators focusing on the cross-institutional availability of patient-related information for health care professionals, patients, and care givers are rare.

Objectives: This study aims to present eHealth indicators on cross-institutional availability of relevant patient data for health care professionals, as well as for patients and their caregivers across 14 countries (Argentina, Australia, Austria, Finland, Germany, Hong Kong as a special administrative region of China, Israel, Japan, Jordan, Kenya, South Korea, Sweden, Turkey, and the United States) to compare our indicators and the resulting data for the examined countries with other eHealth benchmarks and to extend and explore changes to a comparable survey in 2017. We defined "availability of patient data" as the ability to access data in and to add data to the patient record in the respective country.

Methods: The invited experts from each of the 14 countries provided the indicator data for their country to reflect the situation on August 1, 2019, as date of reference. Overall, 60 items were aggregated to six eHealth indicators.

Results: Availability of patient-related information varies strongly by country. Health care professionals can access patients' most relevant cross-institutional health record data fully in only four countries. Patients and their caregivers can access their health record data fully in only two countries. Patients are able to fully add relevant data only in one country. Finland showed the best outcome of all eHealth indicators, followed by South Korea, Japan, and Sweden.

Conclusion: Advancement in eHealth depends on contextual factors such as health care organization, national health politics, privacy laws, and health care financing. Improvements in eHealth indicators are thus often slow. However, our survey shows that some countries were able to improve on at least some indicators between 2017 and 2019. We anticipate further improvements in the future.
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http://dx.doi.org/10.1055/s-0040-1715796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728164PMC
December 2020

Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems: report by an international expert workshop at Karolinska Institutet.

Expert Rev Clin Pharmacol 2020 Sep 29;13(9):925-934. Epub 2020 Sep 29.

Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital , Stockholm, Sweden.

Introduction: Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap.

Areas Covered: The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed.

Expert Opinion: Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preferences. This field can progress by the establishment of an international policy group for developing a best practice guideline on the development, maintenance, governance, evaluation principles and financing of open-source knowledge bases and handling of real-world data.
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http://dx.doi.org/10.1080/17512433.2020.1805314DOI Listing
September 2020

Methods Refocused.

Methods Inf Med 2020 05 7;59(2-03):57-58. Epub 2020 Sep 7.

Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, United States.

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http://dx.doi.org/10.1055/s-0040-1715580DOI Listing
May 2020

Informatics in the Times of Change.

Authors:
Sabine Koch

Yearb Med Inform 2020 Aug 21;29(1). Epub 2020 Aug 21.

Karolinska Institutet, Stockholm, Sweden.

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http://dx.doi.org/10.1055/s-0040-1702006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442525PMC
August 2020

Physicians' Experiences of Patient-Initiated Online Consultations in Primary Care Using Direct-To-Consumer Technology.

Stud Health Technol Inform 2020 Jun;270:643-647

Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

Both private and public primary healthcare providers increasingly offer their patients online consultation services on request. However, the actual use of these services from a physician's perspective as well as the educational competencies required by the physicians are insufficiently studied. The aim of this study is therefore to explore how general practitioners (GPs) experience video consultations with patients compared to physical consultations in primary care in Sweden. We performed a web-based survey amongst 32 GPs. Despite the advantage of being perceived as time saving, more than half of the physicians did not agree that video consultations are more effective than physical consultations. Most physicians had a positive attitude towards the use of video consultations in their work but reliability of the technical platform was considered to be essential, younger physicians should have worked with physical consultations prior to working with online consultations and the use of (semi-) automatic triage systems was wanted when patients themselves can book appointments for online consultations.
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http://dx.doi.org/10.3233/SHTI200239DOI Listing
June 2020

The International Academy of Health Sciences Informatics (IAHSI): IMIAs Academy is Now Established and on Track.

Yearb Med Inform 2020 Aug 17;29(1):11-14. Epub 2020 Apr 17.

Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, USA.

Objectives: To summarize the major activities of the International Academy of Health Sciences Informatics (IAHSI) from 2018 until 2019, and to provide an outline of actions planned for 2020.

Method: Reporting about these activities and actions by the members of the Academy's first Board.

Results: Academy bylaws were accepted by the Academy Plenary and the IMIA General Assembly on August 25th, 2019 and August 26th, 2019, respectively. Academy's strategy and focus areas were developed. Based on the Academy's eligibility criteria, the 2018/2019 Class made of 26 new Academy Fellows was elected. Future activities will concentrate on building taskforces for developing and implementing major Academy focus areas.

Conclusions: We are glad to report that the Academy is strong and thriving.
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http://dx.doi.org/10.1055/s-0040-1701971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442511PMC
August 2020

A prospective cohort study of self-reported computerised medical history taking for acute chest pain: protocol of the CLEOS-Chest Pain Danderyd Study (CLEOS-CPDS).

BMJ Open 2020 01 21;10(1):e031871. Epub 2020 Jan 21.

Department of Learning, Informatics, Management and Ethics, Medical Management Centre, and Health Informatics Centre, Karolinska Institutet, Stockholm, Stockholm, Sweden.

Introduction: Management of acute chest pain focuses on diagnosis or safe rule-out of an acute coronary syndrome (ACS). We aim to determine the additional value of self-reported computerised history taking (CHT).

Methods And Analysis: Prospective cohort study design with self-reported, medical histories collected by a CHT programme (Clinical Expert Operating System, CLEOS) using a tablet. Women and men presenting with acute chest pain to the emergency department at Danderyd University Hospital (Stockholm, Sweden) are eligible. CHT will be compared with standard history taking for completeness of data required to calculate ACS risk scores such as History, ECG, Age, Risk factors and Troponin (HEART), Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI). Clinical outcomes will be extracted from hospital electronic health records and national registries. The CLEOS-Chest Pain Danderyd Study project includes (1) a feasibility study of CHT, (2) a validation study of CHT as compared with standard history taking, (3) a paired diagnostic accuracy study using data from CHT and established risk scores, (4) a clinical utility study to evaluate the impact of CHT on the management of chest pain and the use of resources, and (5) data mining, aiming to generate an improved risk score for ACS. Primary outcomes will be analysed after 1000 patients, but to allow for subgroup analysis, the study intends to recruit 2000 or more patients. This ongoing project may lead to new and more effective ways for collecting thorough, accurate medical histories with important implications for clinical practice.

Ethics And Dissemination: This study has been reviewed and approved by the Stockholm Regional Ethical Committee (now Swedish Ethical Review Authority). Results will be published, regardless of the outcome, in peer-reviewed international scientific journals.

Trial Registration Number: This study is registered at https://www.clinicaltrials.gov (unique identifier: NCT03439449).
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http://dx.doi.org/10.1136/bmjopen-2019-031871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044839PMC
January 2020

Current Trends in Biomedical and Health Informatics.

Authors:
Sabine Koch

Methods Inf Med 2019 09 12;58(2-03):61-62. Epub 2019 Sep 12.

Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

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http://dx.doi.org/10.1055/s-0039-1695764DOI Listing
September 2019

Effects of Dance Movement Therapy and Dance on Health-Related Psychological Outcomes. A Meta-Analysis Update.

Front Psychol 2019 20;10:1806. Epub 2019 Aug 20.

Department of Psychology, Friedrich-Schiller-University, Jena, Germany.

Dance is an embodied activity and, when applied therapeutically, can have several specific and unspecific health benefits. In this meta-analysis, we evaluated the effectiveness of dance movement therapy(DMT) and dance interventions for psychological health outcomes. Research in this area grew considerably from 1.3 detected studies/year in 1996-2012 to 6.8 detected studies/year in 2012-2018. We synthesized 41 controlled intervention studies ( = 2,374; from 01/2012 to 03/2018), 21 from DMT, and 20 from dance, investigating the outcome clusters of quality of life, clinical outcomes (with sub-analyses of depression and anxiety), interpersonal skills, cognitive skills, and (psycho-)motor skills. We included recent randomized controlled trials (RCTs) in areas such as depression, anxiety, schizophrenia, autism, elderly patients, oncology, neurology, chronic heart failure, and cardiovascular disease, including follow-up data in eight studies. Analyses yielded a medium overall effect ( = 0.60), with high heterogeneity of results ( = 72.62%). Sorted by outcome clusters, the effects were medium to large ( = 0.53 to = 0.85). All effects, except the one for (psycho-)motor skills, showed high inconsistency of results. Sensitivity analyses revealed that (DMT or dance) was a significant moderator of results. In the , the overall medium effect was small, significant, and homogeneous/consistent ( = 0.30, < 0.001, = 3.47). In the , the overall medium effect was large, significant, yet heterogeneous/non-consistent ( = 0.81, < 0.001, = 77.96). Results suggest that DMT decreases depression and anxiety and increases quality of life and interpersonal and cognitive skills, whereas dance interventions increase (psycho-)motor skills. Larger effect sizes resulted from observational measures, possibly indicating bias. Follow-up data showed that on 22 weeks after the intervention, most effects remained stable or slightly increased. Consistent effects of DMT coincide with findings from former meta-analyses. Most dance intervention studies came from preventive contexts and most DMT studies came from institutional healthcare contexts with more severely impaired clinical patients, where we found smaller effects, yet with higher clinical relevance. Methodological shortcomings of many included studies and heterogeneity of outcome measures limit results. Initial findings on long-term effects are promising.
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http://dx.doi.org/10.3389/fpsyg.2019.01806DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710484PMC
August 2019

Data Quality Governance at the Emergency Department: A Qualitative Study Influenced by Grounded Theory in Nine Swedish Emergency Departments.

Stud Health Technol Inform 2019 Aug;264:1980-1981

Health Informatics Centre, LIME, Karolinska Institutet, Sweden.

Vital Sign Data Quality is essential for successful implementation of clinical decision support systems in emergency care. Studies have shown that data quality is inadequate and needs improvement. This study shows that data quality is dependent on both technical and human factors and provides a conceptual model of data quality governance and improvement in the emergency department.
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http://dx.doi.org/10.3233/SHTI190744DOI Listing
August 2019

Towards a Framework for National eHealth Evaluation and Monitoring: A Combined Top-Down and Bottom-Up Approach Using Sweden as Example.

Stud Health Technol Inform 2019 Aug;264:954-958

Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.

Conducting evaluation and monitoring of national eHealth implementation aligned with national eHealth strategies should be prioritized concerning the insufficient scientific evidence and the current challenges in measuring eHealth effects and impacts where most approaches aim to measure at the micro level. This study aimed to build an evaluation and monitoring framework for national eHealth, using the Swedish national eHealth strategy as example, and to develop the process in doing so. Combining both top-down and bottom-up approaches, the WHO-ITU national eHealth strategy toolkit, as a systematic guidance, and two Swedish reports were used for development of the framework. Experts' opinions on the framework were collected and converged by the Delphi technique. The final draft suggested a framework containing 19 eHealth outcomes, 13 eHealth outputs, and 107 eHealth outcome and output indicators for 4 prioritized stakeholders, which can support comprehensive measurements to follow up the current advancement of eHealth in Sweden.
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http://dx.doi.org/10.3233/SHTI190365DOI Listing
August 2019

On the Right to Science: Recommendations of Selection Criteria for IMIA Scientific Meetings.

Yearb Med Inform 2019 Aug 16;28(1):11-13. Epub 2019 Aug 16.

IMIA President Elect.

The International Medical Informatics Association (IMIA), a non-governmental, not-for-profit, global organization promoting health and biomedical informatics, is committed to the right of communities/populations and individuals to science, comprised of three separate constituent rights: 1) the right to participate in science, 2) the right to benefit from science, and 3) the right to benefit from a person's own contribution to science or inventions. As such, IMIA provides a global platform where scientists, researchers, health information users, vendors, developers, consultants, health care consumers, and suppliers can meet in an environment of cooperation and sharing. In the context of IMIA's conferences, the IMIA board has discussed and identified the important central factors, which are essential considerations to host a scientific meeting. These factors will be used to help vet future contenders applying for the honor to host an IMIA conference: Reasonable safety and security, commitment by the host member society, freedom of travel, scientific freedom, and freedom from discrimination.
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http://dx.doi.org/10.1055/s-0039-1677924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697513PMC
August 2019

From Information Seekers to Innovators: Qualitative Analysis Describing Experiences of the Second Generation of E-Patients.

J Med Internet Res 2019 08 15;21(8):e13022. Epub 2019 Aug 15.

Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

Background: Current health care systems are rarely designed to meet the needs of people living with chronic conditions. However, some patients and informal caregivers are not waiting for the health care system to redesign itself. These individuals are sometimes referred to as e-patients. The first generation of e-patients used the internet for finding information and for communicating with peers. Compared with the first generation, the second generation of e-patients collects their own health data and appears to be more innovative.

Objective: The aim of this study was to describe the second generation of e-patients through exploration of their active engagement in their self-care and health care.

Methods: Semistructured interviews were conducted with 10 patients with chronic conditions and 5 informal caregivers. They were all recruited through a Web-based advertisement. Data were analyzed according to the framework analysis approach, using the 3 concepts of the self-determination theory-autonomy, relatedness, and competence-at the outset.

Results: Study participants were actively engaged in influencing their self-care and the health care system to improve their own health, as well as the health of others. This occurred at different levels, such as using their own experience when giving presentations and lectures to health care professionals and medical students, working as professional peers in clinical settings, performing self-tracking, contributing with innovations, and being active on social media. When interaction with health care providers was perceived as being insufficient, the participants sought support through their peers, which showed strong relatedness. Competence increased through the use of technology and learning experiences with peers. Their autonomy was important but was sometimes described as involuntary and to give up was not an option for them.

Conclusions: Like the first generation of e-patients, the participants frequently searched for Web-based information. However, the second generation of e-patients also produce their own health data, which they learn from and share. They also engage in the innovation of digital tools to meet health-related needs. Utilizing technological developments comes naturally to the second generation of e-patients, even if the health care system is not prepared to support them under these new circumstances.
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http://dx.doi.org/10.2196/13022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714498PMC
August 2019

EIT monitors valid and robust regional ventilation distribution in pathologic ventilation states in porcine study using differential DualEnergy-CT (ΔDECT).

Sci Rep 2019 07 5;9(1):9796. Epub 2019 Jul 5.

Institute for Experimental Molecular Imaging, University Hospital, RWTH Aachen University, 52074, Aachen, Germany.

It is crucial to precisely monitor ventilation and correctly diagnose ventilation-related pathological states for averting lung collapse and lung failure in Intensive Care Unit (ICU) patients. Although Electrical Impedance Tomography (EIT) may deliver this information continuously and non-invasively at bedside, to date there are no studies that systematically compare EIT and Dual Energy CT (DECT) during inspiration and expiration (ΔDECT) regarding varying physiological and ICU-typical pathological conditions such as atelectasis. This study aims to prove the accuracy of EIT through quantitative identification and monitoring of pathological ventilation conditions on a four-quadrant basis using ΔDECT. In a cohort of 13 pigs, this study investigated systematic changes in tidal volume (TV) and positive end-expiratory pressure (PEEP) under physiological ventilation conditions. Pathological ventilation conditions were established experimentally by single-lung ventilation and pulmonary saline lavage. Spirometric data were compared to voxel-based entire lung ΔDECT, and EIT intensities were compared to ΔDECT of a 12-cm slab of the lung around the EIT belt, the so called ΔDECT. To validate ΔDECT data with spirometry, a Pearson's correlation coefficient of 0.92 was found for 234 ventilation conditions. Comparing EIT intensity with ΔDECT, the correlation r = 0.84 was found. Normalized cross-correlation function (NCCF) between scaled global impedance (EIT) waveforms and global volume ventilator curves was r = 0.99 ± 0.003. The EIT technique correctly identified the ventilated lung in all cases of single-lung ventilation. In the four-quadrant based evaluation, which assesses the difference between end-expiratory lung volume (ΔEELV) and the corresponding parameter in EIT, i.e. the end-expiratory lung impedance (ΔEELI), the Pearson's correlation coefficient of 0.94 was found. The respective Pearson's correlation coefficients implies good to excellent concurrence between global and regional EIT ventilation data validated by ventilator spirometry and DECT imaging. By providing real-time images of the lung, EIT is a promising, EIT is a promising, clinically robust tool for bedside assessment of regional ventilation distribution and changes of end-expiratory lung volume.
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http://dx.doi.org/10.1038/s41598-019-45251-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611907PMC
July 2019

Usability Evaluation of Visual Representation Formats for Emergency Department Records.

Appl Clin Inform 2019 05 26;10(3):454-470. Epub 2019 Jun 26.

Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, Karolinska Institutet, Stockholm, Sweden.

Background: Integration of electronic information is a challenge for multitasking emergency providers, with implications for patient safety. Visual representations can assist sense-making of complex data sets; however, benefit and acceptability in emergency care is unproven.

Objectives: This article evaluates visually focused alternatives to lists or tabular formats, to better understand possible usability in Emergency Department Information System (EDIS).

Methods: A counterbalanced, repeated-measures experiment, satisfaction surveys, and narrative content analysis was conducted remotely by Web platform. Participants were 37 American emergency physicians; they completed 16 clinical cases comparing 4 visual designs to the control formats from a commercially available EDIS. They then evaluated two additional chart overview representations without controls.

Results: Visual designs provided benefit in several areas compared to controls. Task correctness (90% to 76%;  = 0.003) and completion time (median: 49-74 seconds;  < 0.001) were superior for a medication history timeline with class and schedule highlighting. Completion time (median: 45-60 seconds;  = 0.03) was superior for a past medical history design, using pertinent diagnosis codes in highlighting rules. Less mental effort was reported for visual allergy ( = 0.04), past medical history ( < 0.001), and medication timeline ( < 0.001) designs. Most of the participants agreed with statements of likeability, preference, and benefit for visual designs; nonetheless, contrary opinions were seen, and more complex designs were viewed less favorably.

Conclusion: Physician performance with visual representations of clinical data can in some cases exceed standard formats, even in absence of training. Highlighting of priority clinical categories was rated easier-to-use on average than unhighlighted controls. Perceived complexity of timeline representations can limit desirability for a subset of users, despite potential benefit.
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http://dx.doi.org/10.1055/s-0039-1692400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594835PMC
May 2019

MR and PET-CT monitoring of tissue-engineered vascular grafts in the ovine carotid artery.

Biomaterials 2019 09 27;216:119228. Epub 2019 May 27.

Dept. of Biohybrid & Medical Textiles (BioTex), Institute of Applied Medical Engineering (AME), Helmholtz Institute Aachen and Institute for Textiles Engineering (ITA), RWTH Aachen University, Forckenbeckstr. 55, 52074, Aachen, Germany. Electronic address:

The modification of biomaterials to comply with clinically employed monitoring techniques is a promising strategy to support clinical translation in regenerative medicine. Here, multimodal imaging of tissue-engineered vascular grafts (TEVG) was enabled by functionalizing the textile scaffold with ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles. The resulting MR-imageable grafts (iTEVG) were monitored non-invasively throughout their whole life-cycle, from initial quality control to longitudinal functional evaluation in an ovine model for up to 8 weeks. Crucial features such as the complete embedding of the textile mesh in the developing tissue and the grafts' structural stability were assessed in vitro using 1T-, 3T- and 7T-MRI scanners. In vivo, the grafts were imaged by 3T-MRI and PET-CT. Contrary to unlabeled constructs, iTEVG could be delineated from native arteries and precisely localized by MRI. USPIO labeling neither induced calcifications, nor negatively affected their remodeling with respect to tissue-specific extracellular matrix composition and endothelialization. Functionality was confirmed by MR-angiography. F-FDG uptake (assessed via PET-CT) indicated only transient post-surgical inflammation. In conclusion, USPIO-labeling enables accurate localization of TEVG and opens up opportunities for multimodal imaging approaches to assess transplant acceptance and function. Thereby, it can support clinical decision-making on the need for further pharmacological or surgical interventions.
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http://dx.doi.org/10.1016/j.biomaterials.2019.119228DOI Listing
September 2019

Augmenting Biogas Process Modeling by Resolving Intracellular Metabolic Activity.

Front Microbiol 2019 17;10:1095. Epub 2019 May 17.

Department of Environmental Microbiology, UFZ - Helmholtz Centre for Environmental Research, Leipzig, Germany.

The process of anaerobic digestion in which waste biomass is transformed to methane by complex microbial communities has been modeled for more than 16 years by parametric gray box approaches that simplify process biology and do not resolve intracellular microbial activity. Information on such activity, however, has become available in unprecedented detail by recent experimental advances in metatranscriptomics and metaproteomics. The inclusion of such data could lead to more powerful process models of anaerobic digestion that more faithfully represent the activity of microbial communities. We augmented the Anaerobic Digestion Model No. 1 (ADM1) as the standard kinetic model of anaerobic digestion by coupling it to Flux-Balance-Analysis (FBA) models of methanogenic species. Steady-state results of coupled models are comparable to standard ADM1 simulations if the energy demand for non-growth associated maintenance (NGAM) is chosen adequately. When changing a constant feed of maize silage from continuous to pulsed feeding, the final average methane production remains very similar for both standard and coupled models, while both the initial response of the methanogenic population at the onset of pulsed feeding as well as its dynamics between pulses deviates considerably. In contrast to ADM1, the coupled models deliver predictions of up to 1,000s of intracellular metabolic fluxes per species, describing intracellular metabolic pathway activity in much higher detail. Furthermore, yield coefficients which need to be specified in ADM1 are no longer required as they are implicitly encoded in the topology of the species' metabolic network. We show the feasibility of augmenting ADM1, an ordinary differential equation-based model for simulating biogas production, by FBA models implementing individual steps of anaerobic digestion. While cellular maintenance is introduced as a new parameter, the total number of parameters is reduced as yield coefficients no longer need to be specified. The coupled models provide detailed predictions on intracellular activity of microbial species which are compatible with experimental data on enzyme synthesis activity or abundance as obtained by metatranscriptomics or metaproteomics. By providing predictions of intracellular fluxes of individual community members, the presented approach advances the simulation of microbial community driven processes and provides a direct link to validation by state-of-the-art experimental techniques.
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http://dx.doi.org/10.3389/fmicb.2019.01095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6533897PMC
May 2019

Accessing and sharing health information for post-discharge stroke care through a national health information exchange platform - a case study.

BMC Med Inform Decis Mak 2019 05 3;19(1):95. Epub 2019 May 3.

Department of Womens and Childrens Health, Uppsala Universitet, Akademiska sjukhuset, 751 85, Uppsala, Sweden.

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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http://dx.doi.org/10.1186/s12911-019-0816-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500022PMC
May 2019

RedCom: A strategy for reduced metabolic modeling of complex microbial communities and its application for analyzing experimental datasets from anaerobic digestion.

PLoS Comput Biol 2019 02 1;15(2):e1006759. Epub 2019 Feb 1.

Max Planck Institute for Dynamics of Complex Technical Systems, Magdeburg, Germany.

Constraint-based modeling (CBM) is increasingly used to analyze the metabolism of complex microbial communities involved in ecology, biomedicine, and various biotechnological processes. While CBM is an established framework for studying the metabolism of single species with linear stoichiometric models, CBM of communities with balanced growth is more complicated, not only due to the larger size of the multi-species metabolic network but also because of the bilinear nature of the resulting community models. Moreover, the solution space of these community models often contains biologically unrealistic solutions, which, even with model linearization and under application of certain objective functions, cannot easily be excluded. Here we present RedCom, a new approach to build reduced community models in which the metabolisms of the participating organisms are represented by net conversions computed from the respective single-species networks. By discarding (single-species) net conversions that violate a minimality criterion in the exchange fluxes, it is ensured that unrealistic solutions in the community model are excluded where a species altruistically synthesizes large amounts of byproducts (instead of biomass) to fulfill the requirements of other species. We employed the RedCom approach for modeling communities of up to nine organisms involved in typical degradation steps of anaerobic digestion in biogas plants. Compared to full (bilinear and linearized) community models, we found that the reduced community models obtained with RedCom are not only much smaller but allow, also in the largest model with nine species, extensive calculations required to fully characterize the solution space and to reveal key properties of communities with maximum methane yield and production rates. Furthermore, the predictive power of the reduced community models is significantly larger because they predict much smaller ranges of feasible community compositions and exchange fluxes still being consistent with measurements obtained from enrichment cultures. For an enrichment culture for growth on ethanol, we also used metaproteomic data to further constrain the solution space of the community models. Both model and proteomic data indicated a dominance of acetoclastic methanogens (Methanosarcinales) and Desulfovibrionales being the least abundant group in this microbial community.
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http://dx.doi.org/10.1371/journal.pcbi.1006759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373973PMC
February 2019

Man vs machine in emergency medicine - a study on the effects of manual and automatic vital sign documentation on data quality and perceived workload, using observational paired sample data and questionnaires.

BMC Emerg Med 2018 12 13;18(1):54. Epub 2018 Dec 13.

Department of Learning, Informatics, Management and Ethics, Health Informatics Centre, 171 77, Stockholm, Sweden.

Background: Emergency medicine is characterized by a high patient flow where timely decisions are essential. Clinical decision support systems have the potential to assist in such decisions but will be dependent on the data quality in electronic health records which often is inadequate. This study explores the effect of automated documentation of vital signs on data quality and workload.

Methods: An observational study of 200 vital sign measurements was performed to evaluate the effects of manual vs automatic documentation on data quality. Data collection using questionnaires was performed to compare the workload on wards using manual or automatic documentation.

Results: In the automated documentation time to documentation was reduced by 6.1 min (0.6 min vs 7.7 min, p <  0.05) and completeness increased (98% vs 95%, p <  0.05). Regarding workflow temporal demands were lower in the automatic documentation workflow compared to the manual group (50 vs 23, p <  0.05). The same was true for frustration level (64 vs 33, p <  0.05). The experienced reduction in temporal demands was in line with the anticipated, whereas the experienced reduction in frustration was lower than the anticipated (27 vs 54, p < 0.05).

Discussion: The study shows that automatic documentation will improve the currency and the completeness of vital sign data in the Electronic Health Record while reducing workload regarding temporal demands and experienced frustration. The study also shows that these findings are in line with staff anticipations but indicates that the anticipations on the reduction of frustration may be exaggerated among the staff. The open-ended answers indicate that frustration focus will change from double documentation of vital signs to technical aspects of the automatic documentation system.
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http://dx.doi.org/10.1186/s12873-018-0205-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293611PMC
December 2018

A Brief Survey on Six Basic and Reduced eHealth Indicators in Seven Countries in 2017.

Appl Clin Inform 2018 07 5;9(3):704-713. Epub 2018 Sep 5.

Hong Kong Society of Medical Informatics, Hong Kong, China.

Background: Holistic, ubiquitous support of patient-centered health care (eHealth) at all health care institutions and in patients' homes through information processing is increasingly supplementing institution-centered care. While eHealth indicators may measure the transition from institution-centered (e.g., hospital-centered) information processing to patient-centered information processing, collecting relevant and timely data for such indicators has been difficult.

Objectives: This article aims to design some basic eHealth indicators, which are easily collected and measure how well information processing supports holistic patient-centered health care, and to evaluate penetrance of patient-centered health as measured by the indicators internationally via an expert survey.

Methods: We identified six basic indicators that measure access of health care professionals, patients, and caregivers to the patient's health record data and the ability of providers, patients, and caregivers to add information in the patient's record. In a survey of international informatics experts, these indicators' penetrance were evaluated for Austria, Finland, Germany, Hong Kong, South Korea, Sweden, and the United States in the summer of 2017.

Results: The eHealth status measured by the indicators varied significantly between these seven countries. In Finland, most practices measured by the indicators were fully implemented whereas in Germany only one practice was partially realized.

Conclusion: Progress in the implementation of practices that support patient-centered care could mainly be observed in those countries where the "political will" focused on achieving patient-centered care as opposed to an emphasis on institution-centered care. The six eHealth indicators seem to be useful for measuring national progress in patient-centered care. Future work will extend the number of countries analyzed.
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http://dx.doi.org/10.1055/s-0038-1669458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125136PMC
July 2018

Effects of Dance Movement Therapy on Adult Patients with Autism Spectrum Disorder: A Randomized Controlled Trial.

Behav Sci (Basel) 2018 Jun 29;8(7). Epub 2018 Jun 29.

Department of Therapy Sciences, SRH University Heidelberg, 69123 Heidelberg, Germany.

This study examines the effects of dance movement therapy (DMT) on empathy for adults with autism spectrum disorder (ASD). DMT based on the embodiment approach offers body-centered interventions, such as mirroring techniques, to address the needs of ASD patients. Accordingly, findings of a feasibility study suggest that DMT may be an effective approach for clients on the ASD spectrum. The present study is a randomized controlled trial that was conducted as a multicenter study within the framework of the EU-funded research project TESIS (Toward an Embodied Science of Intersubjectivity), and employed a two-factorial between-subject design. The treatment group ( = 35) participated in a 10-week manualized DMT intervention, whereas the control group ( = 22) received treatment only after a waiting period. Empathy, measured with the (), was the main variable of interest, analyzed by a repeated measures analysis of variance. In order to also include incomplete data cases, we used the expectation-maximization algorithm for missing data estimation. Results suggest no significant changes in overall empathy between groups. We discuss the results and limitations, as well as future research options.
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http://dx.doi.org/10.3390/bs8070061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6071290PMC
June 2018

User Requirements for an Electronic Medical Records System for Oncology in Developing Countries: A Case Study of Uganda.

AMIA Annu Symp Proc 2017 16;2017:1004-1013. Epub 2018 Apr 16.

Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.

Cancer is a major public health challenge in developing countries but the healthcare systems are not well prepared to deal with the epidemic. Health information technologies such as electronic medical records (EMRs) have the potential to improve cancer care yet their adoption remains low, in part due to EMR systems not meeting user requirements. This study aimed at analyzing the user requirements for an EMR for a cancer hospital in Uganda. A user-centered approach was taken, through focus group discussion and interviews with target end users to analyze workflow, challenges and wishes. Findings highlight the uniqueness of oncology in low-resource settings and the requirements including support for oncology-specific documentation, reuse of data for research and reporting, assistance with care coordination, computerized clinical decision support, and the need to meet the constraints in terms of technological infrastructure, stretched healthcare workforce and flexibility to allow variations and exceptions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977730PMC
March 2019

[Mental health, acculturation and religiosity in Jewish migrants from the former Soviet Union in Austria].

Neuropsychiatr 2018 Jun 29;32(2):84-92. Epub 2018 May 29.

Klinische Abteilung für Sozialpsychiatrie, Medizinische Universität Wien, Wien, Österreich.

Background: Research on migration provides controversial findings regarding the links between mental health and migration as well as the factors influencing the mental health of migrants. Even though there is evidence for differences between migrant groups from different countries of origin, almost no empirical studies about individual migrant groups in Austria have been undertaken so far.

Methods: In the present population-based study we compared depression and anxiety of 96 ex-Soviet Jews to a sample of 101 Austrians matched by age and sex. Furthermore, we investigated the impact of acculturation attitude and religiosity on the psychological condition of the migrants. Depression and anxiety were measured with Beck-Depression-Inventory (BDI), State-Trait-Anxiety-Inventory (STAI) and Brief Symptom Inventory (BSI). Acculturation attitude was assessed with Vancouver Index of Acculturation (VIA) and religiosity with a self-developed scale.

Results: Ex-Soviet Jews were significantly more depressed and more anxious than native Austrians but not more likely to be affected by clinical depression. Integration (i.e. interest in both the original and the receiving society's culture) as an acculturation strategy was associated with the lowest mental health burden. Religiosity had a protective effect against depression but not against anxiety.

Conclusion: The present study allows initial insights into the mental health of a migrant group which has hardly been subject to research, and it indicates a need for a greater opening of the Austrian majority population to migrants.
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http://dx.doi.org/10.1007/s40211-018-0265-2DOI Listing
June 2018

Monitoring and Benchmarking eHealth in the Nordic Countries.

Stud Health Technol Inform 2018 ;247:86-90

National Institute for Health and Welfare, Information Department, Helsinki, Finland.

The Nordic eHealth Research Network, a subgroup of the Nordic Council of Ministers eHealth group, is working on developing indicators to monitor progress in availability, use and outcome of eHealth applications in the Nordic countries. This paper reports on the consecutive analysis of National eHealth policies in the Nordic countries from 2012 to 2016. Furthermore, it discusses the consequences for the development of indicators that can measure changes in the eHealth environment arising from the policies. The main change in policies is reflected in a shift towards more stakeholder involvement and intensified focus on clinical infrastructure. This change suggests developing indicators that can monitor understandability and usability of eHealth systems, and the use and utility of shared information infrastructure from the perspective of the end-users - citizens/patients and clinicians in particular.
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June 2018