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Fagerlund AJ, Malm-Nicolaisen K, Pedersen R, Skrøvseth SO. Strukturerte helsedata – frustrerende eller nyttig? Tidsskr Nor Laegeforen 2023; 143:23-0228. [PMID: 37589348 DOI: 10.4045/tidsskr.23.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
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Berntsen GR, Linstad L, Skrøvseth SO. Digitale helsedata kan gi større ulikheter. Tidsskriftet 2019; 139:19-0599. [DOI: 10.4045/tidsskr.19.0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Mikalsen KØ, Soguero-Ruiz C, Jensen K, Hindberg K, Gran M, Revhaug A, Lindsetmo RO, Skrøvseth SO, Godtliebsen F, Jenssen R. Using anchors from free text in electronic health records to diagnose postoperative delirium. Comput Methods Programs Biomed 2017; 152:105-114. [PMID: 29054250 DOI: 10.1016/j.cmpb.2017.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Postoperative delirium is a common complication after major surgery among the elderly. Despite its potentially serious consequences, the complication often goes undetected and undiagnosed. In order to provide diagnosis support one could potentially exploit the information hidden in free text documents from electronic health records using data-driven clinical decision support tools. However, these tools depend on labeled training data and can be both time consuming and expensive to create. METHODS The recent learning with anchors framework resolves this problem by transforming key observations (anchors) into labels. This is a promising framework, but it is heavily reliant on clinicians knowledge for specifying good anchor choices in order to perform well. In this paper we propose a novel method for specifying anchors from free text documents, following an exploratory data analysis approach based on clustering and data visualization techniques. We investigate the use of the new framework as a way to detect postoperative delirium. RESULTS By applying the proposed method to medical data gathered from a Norwegian university hospital, we increase the area under the precision-recall curve from 0.51 to 0.96 compared to baselines. CONCLUSIONS The proposed approach can be used as a framework for clinical decision support for postoperative delirium.
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Affiliation(s)
- Karl Øyvind Mikalsen
- Department of Mathematics and Statistics, UiT The Arctic University of Norway, Tromsø, Norway; UiT Machine Learning Group, Norway.
| | - Cristina Soguero-Ruiz
- UiT Machine Learning Group, Norway; Department of Signal Theory and Comm., Telematics and Computing, Universidad Rey Juan Carlos, Fuenlabrada, Spain
| | - Kasper Jensen
- Norwegian Centre for E-health Research, University Hospital of North Norway (UNN), Tromsø, Norway
| | - Kristian Hindberg
- Department of Mathematics and Statistics, UiT The Arctic University of Norway, Tromsø, Norway
| | - Mads Gran
- Department of Gastrointestinal Surgery, UNN, Tromsø, Norway
| | - Arthur Revhaug
- Department of Gastrointestinal Surgery, UNN, Tromsø, Norway; Clinic for Surgery, Cancer and Women's Health, UNN, Tromsø, Norway; Institute of Clinical Medicine, UiT, Tromsø, Norway
| | - Rolv-Ole Lindsetmo
- Department of Gastrointestinal Surgery, UNN, Tromsø, Norway; Institute of Clinical Medicine, UiT, Tromsø, Norway
| | - Stein Olav Skrøvseth
- Department of Mathematics and Statistics, UiT The Arctic University of Norway, Tromsø, Norway; Norwegian Centre for E-health Research, University Hospital of North Norway (UNN), Tromsø, Norway
| | - Fred Godtliebsen
- Department of Mathematics and Statistics, UiT The Arctic University of Norway, Tromsø, Norway
| | - Robert Jenssen
- Department of Physics and Technology, UiT, Tromsø, Norway; Norwegian Centre for E-health Research, University Hospital of North Norway (UNN), Tromsø, Norway; UiT Machine Learning Group, Norway
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Soguero-Ruiz C, Hindberg K, Mora-Jiménez I, Rojo-Álvarez JL, Skrøvseth SO, Godtliebsen F, Mortensen K, Revhaug A, Lindsetmo RO, Augestad KM, Jenssen R. Predicting colorectal surgical complications using heterogeneous clinical data and kernel methods. J Biomed Inform 2016; 61:87-96. [PMID: 26980235 DOI: 10.1016/j.jbi.2016.03.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/27/2016] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In this work, we have developed a learning system capable of exploiting information conveyed by longitudinal Electronic Health Records (EHRs) for the prediction of a common postoperative complication, Anastomosis Leakage (AL), in a data-driven way and by fusing temporal population data from different and heterogeneous sources in the EHRs. MATERIAL AND METHODS We used linear and non-linear kernel methods individually for each data source, and leveraging the powerful multiple kernels for their effective combination. To validate the system, we used data from the EHR of the gastrointestinal department at a university hospital. RESULTS We first investigated the early prediction performance from each data source separately, by computing Area Under the Curve values for processed free text (0.83), blood tests (0.74), and vital signs (0.65), respectively. When exploiting the heterogeneous data sources combined using the composite kernel framework, the prediction capabilities increased considerably (0.92). Finally, posterior probabilities were evaluated for risk assessment of patients as an aid for clinicians to raise alertness at an early stage, in order to act promptly for avoiding AL complications. DISCUSSION Machine-learning statistical model from EHR data can be useful to predict surgical complications. The combination of EHR extracted free text, blood samples values, and patient vital signs, improves the model performance. These results can be used as a framework for preoperative clinical decision support.
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Affiliation(s)
- Cristina Soguero-Ruiz
- Dept. of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos, Fuenlabrada, Spain.
| | - Kristian Hindberg
- Dept. Mathematics and Statistics, University of Tromsø (UiT), Tromsø, Norway
| | - Inmaculada Mora-Jiménez
- Dept. of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos, Fuenlabrada, Spain
| | - José Luis Rojo-Álvarez
- Dept. of Signal Theory and Communications, Telematics and Computing, Universidad Rey Juan Carlos, Fuenlabrada, Spain
| | - Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, Norway; University Hospital of North Norway (UNN), Norway; IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Fred Godtliebsen
- Dept. Mathematics and Statistics, University of Tromsø (UiT), Tromsø, Norway
| | - Kim Mortensen
- Dept. of Gastrointestinal Surgery, UNN, Tromsø, Norway; Institute of Clinical Medicine, UiT, Tromsø, Norway
| | - Arthur Revhaug
- Dept. of Gastrointestinal Surgery, UNN, Tromsø, Norway; Clinic for Surgery, Cancer and Women's Health, UNN, Tromsø, Norway
| | - Rolv-Ole Lindsetmo
- Dept. of Gastrointestinal Surgery, UNN, Tromsø, Norway; Institute of Clinical Medicine, UiT, Tromsø, Norway
| | - Knut Magne Augestad
- Norwegian Centre for Integrated Care and Telemedicine, Norway; Dept. of Surgery, Hammerfest Hospital, Norway; Dept. of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, USA; Institute of Clinical Medicine, UiT, Tromsø, Norway
| | - Robert Jenssen
- Norwegian Centre for Integrated Care and Telemedicine, Norway; Dept. of Physics and Technology, UiT, Tromsø, Norway
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Soguero-Ruiz C, Fei WME, Jenssen R, Augestad KM, Álvarez JLR, Jiménez IM, Lindsetmo RO, Skrøvseth SO. Data-driven Temporal Prediction of Surgical Site Infection. AMIA Annu Symp Proc 2015; 2015:1164-1173. [PMID: 26958256 PMCID: PMC4765613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Analysis of data from Electronic Health Records (EHR) presents unique challenges, in particular regarding nonuniform temporal resolution of longitudinal variables. A considerable amount of patient information is available in the EHR - including blood tests that are performed routinely during inpatient follow-up. These data are useful for the design of advanced machine learning-based methods and prediction models. Using a matched cohort of patients undergoing gastrointestinal surgery (101 cases and 904 controls), we built a prediction model for post-operative surgical site infections (SSIs) using Gaussian process (GP) regression, time warping and imputation methods to manage the sparsity of the data source, and support vector machines for classification. For most blood tests, wider confidence intervals after imputation were obtained in patients with SSI. Predictive performance with individual blood tests was maintained or improved by joint model prediction, and non-linear classifiers performed consistently better than linear models.
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Affiliation(s)
- Cristina Soguero-Ruiz
- Department of Signal Theory and Communications, Telematics and Computing, Rey Juan Carlos University, Madrid, Spain
| | - Wang M E Fei
- Department of Computer Science and Engineering, University of Connecticut, Storrs, CT, USA
| | - Robert Jenssen
- Department of Physics and Technology, University of Tromsø - The Arctic University of Norway, Tromsø, Norway; Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Knut Magne Augestad
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway; Department of Surgery, Hammerfest Hospital, Hammerfest, Norway
| | - José-Luis Rojo Álvarez
- Department of Signal Theory and Communications, Telematics and Computing, Rey Juan Carlos University, Madrid, Spain
| | - Inmaculada Mora Jiménez
- Department of Signal Theory and Communications, Telematics and Computing, Rey Juan Carlos University, Madrid, Spain
| | - Rolv-Ole Lindsetmo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway; Department of Mathematics and Statistics, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
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Abstract
BACKGROUND A mobile phone-based application can be useful for patients with type 1 diabetes in managing their disease. This results in large datasets accumulated on the patient's devices, which can be used for individualized feedback. The effect of such feedback is investigated in this article. MATERIALS AND METHODS We developed an application that included a data-driven feedback module known as Diastat for patients on self-measured blood glucose regimens. Using a stepped-wedge design, both groups initially received an application without Diastat. Group 1 activated Diastat after 4 weeks, whereas Group 2 activated Diastat 12 weeks after startup (T1). End points were glycated hemoglobin (HbA1c) level and number of out-of-range (OOR) measurements (i.e., outside the range 72-270 mg/dL). RESULTS Thirty patients were recruited to the study, and 15 were assigned to each group after the initial meeting. There were no significant differences between groups at T1 in HbA1c or OOR events. Overall, all patients had a decrease of 0.6 percentage points in mean HbA1c (P < 0.001) and 14.5 in median OOR events over 2 weeks (P < 0.001). CONCLUSIONS The study does not provide evidence that data-driven feedback improves glycemic control. The decrease in HbA1c was sizeable and significant, even though the study was not powered to detect this. The overall improvement in glycemic control suggests that, in general, mobile phone-based interventions can be useful in diabetes self-management.
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Affiliation(s)
- Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- Department of Mathematics and Statistics, University of Tromsø, Tromsø, Norway
| | - Eirik Årsand
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- Department of Computer Science, University of Tromsø, Tromsø, Norway
| | - Fred Godtliebsen
- Department of Mathematics and Statistics, University of Tromsø, Tromsø, Norway
| | - Ragnar M. Joakimsen
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
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Skrøvseth SO, Augestad KM, Ebadollahi S. Data-driven approach for assessing utility of medical tests using electronic medical records. J Biomed Inform 2015; 53:270-6. [DOI: 10.1016/j.jbi.2014.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/27/2014] [Accepted: 11/23/2014] [Indexed: 11/25/2022]
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Geilhufe M, Held L, Skrøvseth SO, Simonsen GS, Godtliebsen F. Power law approximations of movement network data for modeling infectious disease spread. Biom J 2014; 56:363-82. [PMID: 24843881 DOI: 10.1002/bimj.201200262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Globalization and increased mobility of individuals enable person-to-person transmitted infectious diseases to spread faster to distant places around the world, making good models for the spread increasingly important. We study the spatiotemporal pattern of spread in the remotely located and sparsely populated region of North Norway in various models with fixed, seasonal, and random effects. The models are applied to influenza A counts using data from positive microbiology laboratory tests as proxy for the underlying disease incidence. Human travel patterns with local air, road, and sea traffic data are incorporated as well as power law approximations thereof, both with quasi-Poisson regression and based on the adjacency structure of the relevant municipalities. We investigate model extensions using information about the proportion of positive laboratory tests, data on immigration from outside North Norway and by connecting population to the movement network. Furthermore, we perform two separate analyses for nonadults and adults as children are an important driver for influenza A. Comparisons of one-step-ahead predictions generally yield better or comparable results using power law approximations.
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Augestad KM, Skrøvseth SO, Revhaug A, Kim M, Hindberg K, Godtliebsen F, Crawshaw BP, Lindsetmo RO, Delaney CP. Long-term readmissions and complications in open and laparoscopic colorectal cancer (CRC) surgery: a propensity score matched analysis. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schulz J, Skrøvseth SO, Tømmerås VK, Marienhagen K, Godtliebsen F. A semiautomatic tool for prostate segmentation in radiotherapy treatment planning. BMC Med Imaging 2014; 14:4. [PMID: 24460666 PMCID: PMC3933010 DOI: 10.1186/1471-2342-14-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 01/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delineation of the target volume is a time-consuming task in radiotherapy treatment planning, yet essential for a successful treatment of cancers such as prostate cancer. To facilitate the delineation procedure, the paper proposes an intuitive approach for 3D modeling of the prostate by slice-wise best fitting ellipses. METHODS The proposed estimate is initialized by the definition of a few control points in a new patient. The method is not restricted to particular image modalities but assumes a smooth shape with elliptic cross sections of the object. A training data set of 23 patients was used to calculate a prior shape model. The mean shape model was evaluated based on the manual contour of 10 test patients. The patient records of training and test data are based on axial T1-weighted 3D fast-field echo (FFE) sequences. The manual contours were considered as the reference model. Volume overlap (Vo), accuracy (Ac) (both ratio, range 0-1, optimal value 1) and Hausdorff distance (HD) (mm, optimal value 0) were calculated as evaluation parameters. RESULTS The median and median absolute deviation (MAD) between manual delineation and deformed mean best fitting ellipses (MBFE) was Vo (0.9 ± 0.02), Ac (0.81 ± 0.03) and HD (4.05 ± 1.3)mm and between manual delineation and best fitting ellipses (BFE) was Vo (0.96 ± 0.01), Ac (0.92 ± 0.01) and HD (1.6 ± 0.27)mm. Additional results show a moderate improvement of the MBFE results after Monte Carlo Markov Chain (MCMC) method. CONCLUSIONS The results emphasize the potential of the proposed method of modeling the prostate by best fitting ellipses. It shows the robustness and reproducibility of the model. A small sample test on 8 patients suggest possible time saving using the model.
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Affiliation(s)
- Jörn Schulz
- Department of Mathematics and Statistics, University of Tromsø, 9037 Tromsø, Norway.
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Zortea M, Schopf TR, Thon K, Geilhufe M, Hindberg K, Kirchesch H, Møllersen K, Schulz J, Skrøvseth SO, Godtliebsen F. Performance of a dermoscopy-based computer vision system for the diagnosis of pigmented skin lesions compared with visual evaluation by experienced dermatologists. Artif Intell Med 2013; 60:13-26. [PMID: 24382424 DOI: 10.1016/j.artmed.2013.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 11/28/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND It is often difficult to differentiate early melanomas from benign melanocytic nevi even by expert dermatologists, and the task is even more challenging for primary care physicians untrained in dermatology and dermoscopy. A computer system can provide an objective and quantitative evaluation of skin lesions, reducing subjectivity in the diagnosis. OBJECTIVE Our objective is to make a low-cost computer aided diagnostic tool applicable in primary care based on a consumer grade camera with attached dermatoscope, and compare its performance to that of experienced dermatologists. METHODS AND MATERIALS We propose several new image-derived features computed from automatically segmented dermoscopic pictures. These are related to the asymmetry, color, border, geometry, and texture of skin lesions. The diagnostic accuracy of the system is compared with that of three dermatologists. RESULTS With a data set of 206 skin lesions, 169 benign and 37 melanomas, the classifier was able to provide competitive sensitivity (86%) and specificity (52%) scores compared with the sensitivity (85%) and specificity (48%) of the most accurate dermatologist using only dermoscopic images. CONCLUSION We show that simple statistical classifiers can be trained to provide a recommendation on whether a pigmented skin lesion requires biopsy to exclude skin cancer with a performance that is comparable to and exceeds that of experienced dermatologists.
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Affiliation(s)
- Maciel Zortea
- Department of Mathematics and Statistics, University of Tromsø, 9037 Tromsø, Norway.
| | - Thomas R Schopf
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Kevin Thon
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Marc Geilhufe
- Department of Mathematics and Statistics, University of Tromsø, 9037 Tromsø, Norway
| | - Kristian Hindberg
- Department of Mathematics and Statistics, University of Tromsø, 9037 Tromsø, Norway
| | | | - Kajsa Møllersen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Jörn Schulz
- Department of Mathematics and Statistics, University of Tromsø, 9037 Tromsø, Norway
| | - Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, 9038 Tromsø, Norway
| | - Fred Godtliebsen
- Department of Mathematics and Statistics, University of Tromsø, 9037 Tromsø, Norway
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Skrøvseth SO, Årsand E, Godtliebsen F, Joakimsen RM. Model-driven diabetes care: study protocol for a randomized controlled trial. Trials 2013; 14:139. [PMID: 23672413 PMCID: PMC3655925 DOI: 10.1186/1745-6215-14-139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/26/2013] [Indexed: 12/03/2022] Open
Abstract
Background People with type 1 diabetes who use electronic self-help tools register a large amount of information about their disease on their participating devices; however, this information is rarely utilized beyond the immediate investigation. We have developed a diabetes diary for mobile phones and a statistics-based feedback module, which we have named Diastat, to give data-driven feedback to the patient based on their own data. Method In this study, up to 40 participants will be given a smartphone on which is loaded a diabetes self-help application (app), the Few Touch Application (FTA). Participants will be randomized into two groups to be given access to Diastat 4 or 12 weeks, respectively after receiving the smartphone, and will use the FTA with Diastat for 8 weeks after this point. The primary endpoint is the frequency of high and low blood-glucose measurements. Discussion The study will investigate the effect of data-driven feedback to patients. Our hypothesis is that this will improve glycemic control and reduce variability. The endpoints are robust indicators that can be assembled with minimal effort by the patient beyond normal routine. Trial registration Clinicaltrials.gov: NCT01774149
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Affiliation(s)
- Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø 9038, Norway.
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Augestad KM, Norum J, Dehof S, Aspevik R, Ringberg U, Nestvold T, Vonen B, Skrøvseth SO, Lindsetmo RO. Cost-effectiveness and quality of life in surgeon versus general practitioner-organised colon cancer surveillance: a randomised controlled trial. BMJ Open 2013; 3:e002391. [PMID: 23564936 PMCID: PMC3641467 DOI: 10.1136/bmjopen-2012-002391] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/28/2013] [Accepted: 02/14/2013] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess whether colon cancer follow-up can be organised by general practitioners (GPs) without a decline in the patient's quality of life (QoL) and increase in cost or time to cancer diagnoses, compared to hospital follow-up. DESIGN Randomised controlled trial. SETTING Northern Norway Health Authority Trust, 4 trusts, 11 hospitals and 88 local communities. PARTICIPANTS Patients surgically treated for colon cancer, hospital surgeons and community GPs. INTERVENTION 24-month follow-up according to national guidelines at the community GP office. To ensure a high follow-up guideline adherence, a decision support tool for patients and GPs were used. MAIN OUTCOME MEASURES Primary outcomes were QoL, measured by the global health scales of the European Organisation for Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ C-30) and EuroQol-5D (EQ-5D). Secondary outcomes were cost-effectiveness and time to cancer diagnoses. RESULTS 110 patients were randomised to intervention (n=55) or control (n=55), and followed by 78 GPs (942 follow-up months) and 70 surgeons (942 follow-up months), respectively. Compared to baseline, there was a significant improvement in postoperative QoL (p=0.003), but no differences between groups were revealed (mean difference at 1, 3, 6, 9, 12, 15, 18, 21 and 24-month follow-up appointments): Global Health; Δ-2.23, p=0.20; EQ-5D index; Δ-0.10, p=0.48, EQ-5D VAS; Δ-1.1, p=0.44. There were no differences in time to recurrent cancer diagnosis (GP 35 days vs surgeon 45 days, p=0.46); 14 recurrences were detected (GP 6 vs surgeon 8) and 7 metastases surgeries performed (GP 3 vs surgeon 4). The follow-up programme initiated 1186 healthcare contacts (GP 678 vs surgeon 508), 1105 diagnostic tests (GP 592 vs surgeon 513) and 778 hospital travels (GP 250 vs surgeon 528). GP organised follow-up was associated with societal cost savings (£8233 vs £9889, p<0.001). CONCLUSIONS GP-organised follow-up was associated with no decline in QoL, no increase in time to recurrent cancer diagnosis and cost savings. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00572143.
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Affiliation(s)
- Knut Magne Augestad
- Norwegian Center of Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Jan Norum
- Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Northern Norway Regional Health Authority Trust, Bodø, Norway
| | - Stefan Dehof
- Department of Surgery, Helgeland Hospital, Mo i Rana, Norway
| | - Ranveig Aspevik
- Department of Surgery, Helgeland Hospital, Mo i Rana, Norway
| | | | - Torunn Nestvold
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
| | - Barthold Vonen
- Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
| | - Stein Olav Skrøvseth
- Norwegian Center of Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Rolv-Ole Lindsetmo
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
- Faculty of Health Sciences, Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
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Tatara N, Arsand E, Skrøvseth SO, Hartvigsen G. Long-term engagement with a mobile self-management system for people with type 2 diabetes. JMIR Mhealth Uhealth 2013; 1:e1. [PMID: 25100649 PMCID: PMC4114413 DOI: 10.2196/mhealth.2432] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/31/2013] [Accepted: 02/25/2013] [Indexed: 02/04/2023] Open
Abstract
Background In a growing number of intervention studies, mobile phones are used to support self-management of people with Type 2 diabetes mellitus (T2DM). However, it is difficult to establish knowledge about factors associated with intervention effects, due to considerable differences in research designs and outcome measures as well as a lack of detailed information about participants’ engagement with the intervention tool. Objective To contribute toward accumulating knowledge about factors associated with usage and usability of a mobile self-management application over time through a thorough analysis of multiple types of investigation on each participant’s engagement. Methods The Few Touch application is a mobile-phone–based self-management tool for patients with T2DM. Twelve patients with T2DM who have been actively involved in the system design used the Few Touch application in a real-life setting from September 2008 until October 2009. During this period, questionnaires and semistructured interviews were conducted. Recorded data were analyzed to investigate usage trends and patterns. Transcripts from interviews were thematically analyzed, and the results were further analyzed in relation to the questionnaire answers and the usage trends and patterns. Results The Few Touch application served as a flexible learning tool for the participants, responsive to their spontaneous needs, as well as supporting regular self-monitoring. A significantly decreasing (P<.05) usage trend was observed among 10 out of the 12 participants, though the magnitude of the decrease varied widely. Having achieved a sense of mastery over diabetes and experiences of problems were identified as reasons for declining motivation to continue using the application. Some of the problems stemmed from difficulties in integrating the use of the application into each participant’s everyday life and needs, although the design concepts were developed in the process where the participants were involved. The following factors were identified as associated with usability and/or usage over time: Integration with everyday life; automation; balance between accuracy and meaningfulness of data with manual entry; intuitive and informative feedback; and rich learning materials, especially about foods. Conclusion Many grounded design implications were identified through a thorough analysis of results from multiple types of investigations obtained through a year-long field trial of the Few Touch application. The study showed the importance and value of involving patient-users in a long-term trial of a tool to identify factors influencing usage and usability over time. In addition, the study confirmed the importance of detailed analyses of each participant’s usage of the provided tool for better understanding of participants’ engagement over time.
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Affiliation(s)
- Naoe Tatara
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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15
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Årsand E, Skrøvseth SO, Hejlesen O, Horsch A, Godtliebsen F, Grøttland A, Hartvigsen G. Mobile patient applications within diabetes - from few and easy to advanced functionalities. Stud Health Technol Inform 2013; 192:1010. [PMID: 23920784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Patient diaries as apps on mobile phones are becoming increasingly common, and can be a good support tool for patients who need to organize information relevant for their disease. Self-management is important to achieving diabetes treatment goals and can be a tool for lifestyle changes for patients with Type 2 diabetes. The autoimmune disease Type 1 diabetes requires a more intensive management than Type 2 - thus more advanced functionalities is desirable for users. Both simple and easy-to-use and more advanced diaries have their respective benefits, depending on the target user group and intervention. In this poster we summarize main findings and experience from more than a decade of research and development in the diabetes area. Several versions of the mobile health research platform-the Few Touch Application (FTA) are presented to illustrate the different approaches and results.
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Affiliation(s)
- Eirik Årsand
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Norway
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16
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Abstract
Kernel density estimation and kernel regression are useful ways to visualize and assess the structure of data. Using these techniques we define a temporal scale space as the vector space spanned by bandwidth and a temporal variable. In this space significance regions that reflect a significant derivative in the kernel smooth similar to those of SiZer (Significant Zero-crossings of derivatives) are indicated. Significance regions are established by hypothesis tests for significant gradient at every point in scale space. Causality is imposed onto the space by restricting to kernels with left-bounded or finite support and shifting kernels forward. We show that these adjustments to the methodology enable early detection of changes in time series constituting live surveillance systems of either count data or unevenly sampled measurements. Warning delays are comparable to standard techniques though comparison shows that other techniques may be better suited for single-scale problems. Our method reliably detects change points even with little to no knowledge about the relevant scale of the problem. Hence the technique will be applicable for a large variety of sources without tailoring. Furthermore this technique enables us to obtain a retrospective reliable interval estimate of the time of a change point rather than a point estimate. We apply the technique to disease outbreak detection based on laboratory confirmed cases for pertussis and influenza as well as blood glucose concentration obtained from patients with diabetes type 1.
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Affiliation(s)
- Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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17
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Abstract
BACKGROUND Persons with type 1 diabetes who use electronic self-help tools, most commonly blood glucose meters, record a large amount of data about their personal condition. Mobile phones are powerful and ubiquitous computers that have a potential for data analysis, and the purpose of this study is to explore how self-gathered data can help users improve their blood glucose management. SUBJECTS AND METHODS Thirty patients with insulin-regulated type 1 diabetes were equipped with a mobile phone application for 3-6 months, recording blood glucose, insulin, dietary information, physical activity, and disease symptoms. The data were analyzed in terms of usage of the different modules and which data processing and visualization tools could be constructed to support the use of these data. RESULTS Eighteen patients (denoted "adopters") recorded complete data for over 80 consecutive days, up to 247 days. Among those who withdrew or did not use the application extensively, the most common reasons given were outdated or difficult-to-use phone. Data analysis using period finding and scale-space trends was found to yield significant patterns for most adopters. Pattern recognition methods to predict low or high blood glucose were found to be performing poorly. CONCLUSIONS Minimally intrusive mobile applications enable users with type 1 diabetes to record data that can provide data-driven feedback to the user, potentially providing relevant insight into their disease.
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Affiliation(s)
- Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Eirik Årsand
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- Department of Computer Science, University of Tromsø, Tromsø, Norway
| | - Fred Godtliebsen
- Department of Mathematics and Statistics, University of Tromsø, Tromsø, Norway
| | - Gunnar Hartvigsen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
- Department of Computer Science, University of Tromsø, Tromsø, Norway
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18
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Kummervold PE, Johnsen JAK, Skrøvseth SO, Wynn R. Using noninferiority tests to evaluate telemedicine and e-health services: systematic review. J Med Internet Res 2012; 14:e132. [PMID: 23022989 PMCID: PMC3510769 DOI: 10.2196/jmir.2169] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/15/2012] [Accepted: 09/04/2012] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND An increasing number of studies within the field of telemedicine and e-health are designed as noninferiority studies, aiming to show that the telemedicine/e-health solution is not inferior to the traditional way of treating patients. OBJECTIVE The objective is to review and sum up the status of noninferiority studies within this field, describing advantages and pitfalls of this approach. METHODS PubMed was searched according to defined criteria, and 16 relevant articles were identified from the period 2008-June 2011. RESULTS Most of the studies were related to the fields of psychiatry and emergency medicine, and most were published in journals relating to these fields or in general scientific or general medicine journals. All the studies claimed to be noninferiority studies, but 7 out of 16 tested for statistical differences as a proxy of noninferiority. CONCLUSIONS The methodological quality of the studies varied. We discuss optimal procedures for future noninferiority studies within the field of telemedicine and e-health and situations in which this approach is most appropriate.
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Årsand E, Frøisland DH, Skrøvseth SO, Chomutare T, Tatara N, Hartvigsen G, Tufano JT. Mobile health applications to assist patients with diabetes: lessons learned and design implications. J Diabetes Sci Technol 2012; 6:1197-206. [PMID: 23063047 PMCID: PMC3570855 DOI: 10.1177/193229681200600525] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Self-management is critical to achieving diabetes treatment goals. Mobile phones and Bluetooth® can supportself-management and lifestyle changes for chronic diseases such as diabetes. A mobile health (mHealth) research platform--the Few Touch Application (FTA)--is a tool designed to support the self-management of diabetes. The FTA consists of a mobile phone-based diabetes diary, which can be updated both manually from user input and automatically by wireless data transfer, and which provides personalized decision support for the achievement of personal health goals. Studies and applications (apps) based on FTAs have included: (1) automatic transfer of blood glucose (BG) data; (2) short message service (SMS)-based education for type 1diabetes (T1DM); (3) a diabetes diary for type 2 diabetes (T2DM); (4) integrating a patient diabetes diary with health care (HC) providers; (5) a diabetes diary for T1DM; (6) a food picture diary for T1DM; (7) physical activity monitoring for T2DM; (8) nutrition information for T2DM; (9) context sensitivity in mobile self-help tools; and (10) modeling of BG using mobile phones. We have analyzed the performance of these 10 FTA-based apps to identify lessons for designing the most effective mHealth apps. From each of the 10 apps of FTA, respectively, we conclude: (1) automatic BG data transfer is easy to use and provides reassurance; (2) SMS-based education facilitates parent-child communication in T1DM; (3) the T2DM mobile phone diary encourages reflection; (4) the mobile phone diary enhances discussion between patients and HC professionals; (5) the T1DM mobile phone diary is useful and motivational; (6) the T1DM mobile phone picture diary is useful in identifying treatment obstacles; (7) the step counter with automatic data transfer promotes motivation and increases physical activity in T2DM; (8) food information on a phone for T2DM should not be at a detailed level; (9) context sensitivity has good prospects and is possible to implement on today's phones; and (10) BG modeling on mobile phones is promising for motivated T1DM users. We expect that the following elements will be important in future FTA designs: (A) automatic data transfer when possible; (B) motivational and visual user interfaces; (C) apps with considerable health benefits in relation to the effort required; (D) dynamic usage, e.g., both personal and together with HC personnel, long-/short-term perspective; and (E) inclusion of context sensitivity in apps. We conclude that mHealth apps will empower patients to take a more active role in managing their own health.
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Affiliation(s)
- Eirik Årsand
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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20
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Thon K, Rue H, Skrøvseth SO, Godtliebsen F. Bayesian multiscale analysis of images modeled as Gaussian Markov random fields. Comput Stat Data Anal 2012. [DOI: 10.1016/j.csda.2011.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Skrøvseth SO, Arsand E, Godtliebsen F, Joakimsen RM. Model driven mobile care for patients with type 1 diabetes. Stud Health Technol Inform 2012; 180:1045-1049. [PMID: 22874353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We gathered a data set from 30 patients with type 1 diabetes by giving the patients a mobile phone application, where they recorded blood glucose measurements, insulin injections, meals, and physical activity. Using these data as a learning data set, we describe a new approach of building a mobile feedback system for these patients based on periodicities, pattern recognition, and scale-space trends. Most patients have important patterns for periodicities and trends, though better resolution of input variables is needed to provide useful feedback using pattern recognition.
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Affiliation(s)
- Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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22
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Skrøvseth SO, Dias A, Gorzelniak L, Godtliebsen F, Horsch A. Scale-space methods for live processing of sensor data. Stud Health Technol Inform 2012; 180:138-142. [PMID: 22874168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A temporal scale-space is a vector space spanned by time and a scale parameter, and by constructing the scale-space correctly a causal structure can be imposed on the scale-space. This enables early warning of significant changes in sensor data at an early time, and on any scale. We describe a feasibility study on how to use these ideas for live surveillance of monitoring processes such that important features can be visualized and users warned about changes an early stage. Sensor data from motion sensors on patients with chronic obstructive pulmonary disease are used as the example of such system, where important pattern are found and visualized using significance plots.
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Affiliation(s)
- Stein Olav Skrøvseth
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway.
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