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  • 1.
    Lindqvist, Ulla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Groth, Torgny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Lööf, L.
    Hellsing, K.
    A hyaluronan-loading test applied to patients with liver and joint diseases1992In: Clinica Chimica Acta, ISSN 0009-8981, E-ISSN 1873-3492, Vol. 210, no 1-2, p. 119-132Article in journal (Refereed)
    Abstract [en]

    The serum hyaluronan disappearance data, after an intravenous bolus injection of hyaluronan, were evaluated in terms of model-based parameters. The loading test was performed in 10 healthy persons (basal serum hyaluronan concentration, C0, 24.9 +/- 8.9 micrograms/l [mean +/- S.D.]), 6 patients with joint disease (62.3 +/- 41.1 micrograms/l) and 19 patients with liver disease (206 +/- 214 micrograms/l). The highest maximum Michaelis-Menten elimination rate (Vmax = 287 +/- 86 micrograms/min) was found in patients with joint disease, significantly higher than in healthy persons (Vmax = 179 +/- 16, P = 0.0015) and in patients with liver disease (Vmax = 149 +/- 59, P = 0.0002). C0 and Vmax were evaluated as discriminants for assessment of residual liver function. In patients with liver disease C0 correlated with liver function score (r = 0.875, P < 0.0001) and serum albumin concentration (r = -0.813, P < 0.0001). The Vmax parameter did not correlate with conventional liver function tests or with the liver score but a significantly negative correlation of Vmax with C0 was found in patients with liver disease. A combination of the C0 level and the Vmax parameter was found to discriminate between healthy persons, patients with joint disease and patients with liver disease and should be of benefit in separating patients, with or without elevated serum hyaluronan levels, into groups having increased influx or reduced elimination, respectively, of circulating hyaluronan.

  • 2.
    Malmsten, Martin
    et al.
    Institute for Surface Chemistry.
    Lassen, Bo
    Institute for Surface Chemistry.
    Westin, Jerker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Gölander, C G
    Larsson, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Nilsson, Ulf R
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Clinical Immunology.
    Adsorption of complement protein C3 at polymer surfaces and the demonstration of a specific binding of factor B by adsorbed C31996In: Journal of Colloid and Interface Science, ISSN 0021-9797, E-ISSN 1095-7103, Vol. 179, no 1, p. 163-172Article in journal (Refereed)
    Abstract [en]

    The adsorption of C3 at poly(methyl methacrylate) (PMMA) and poly(styrene) (PS) surfaces was investigated within situellipsometry and compared to that at (hydrophilic and negatively charged) silica and (hydrophobic) methylated silica. The adsorption of C3 at PMMA was higher than that at PS, while the adsorbed layer thickness was the same for the two surfaces. For both PMMA and PS the adsorbed layer thickness (10 ± 2 nm) corresponds rather closely to that of end-on oriented C3 molecules. The adsorption of C3 at PMMA and PS was found to be intermediate between that at silica and methylated silica, although the adsorbed layer thickness was similar for all surfaces. The competitive adsorption among C3, human serum albumin (HSA), and factor B was investigated with ellipsometry and total internal reflection fluorescence spectroscopy (TIRF). Addition of HSA after C3 preadsorption resulted in fractional C3 desorption for both PMMA and PS. Factor B deposition at PS after preadsorption of C3 and blocking with HSA was found to be largely due to specific binding to C3/C3b, while in the case of PMMA, factor B was largely accumulated through passive (displacement) adsorption.

  • 3.
    Memedi, Mevludin
    et al.
    Dalarna University.
    Westin, Jerker
    Dalarna University.
    Nyholm, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Dougherty, Mark
    Dalarna University.
    Groth, Torgny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    A web application for follow-up of results from a mobile device test battery for Parkinson’s disease patients2011In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 104, no 2, p. 219-226Article in journal (Refereed)
    Abstract [en]

    A test battery consisting of self-assessments and motor tests for patients with Parkinson’s disease (PD) was constructed and implemented on a hand computer with touch screen in a telemedicine setting. In this work, a Web-based system was developed to deliver decision support information to treating clinical staff for assessing PD symptoms in their patients. Test results from the hand unit are transferred to a central server and processed into scores for different symptom dimensions and an “overall test score” reflecting the overall condition of the patient during a test period. The IBM Computer System Usability Questionnaire was administered to assess the users’ satisfaction with the system. Results showed that a majority of users who completed the evaluation were quite satisfied with the usability although a sizeable minority were not.  Response times were tested by simulating up to 100 users accessing the web application at the same time. The average page completion times were in the range of 0.5 seconds indicating fast response. The system was able to summarize the test-battery data and present them in a useful manner. Its main contribution is a novel way to easily access symptom information from the home environment of patients.

  • 4.
    Scandurra, Isabella
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Building Usability into Health Informatics: Development and Evaluation of Information Systems for Shared Homecare2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    How can we develop usable and work process-oriented ICT systems for shared homecare?

    Shared homecare involves different professionals, consists of mobile work and requires immediate and ubiquitous access to patient-oriented information, supporting an integrated view on the care process.

    This thesis presents a new collaborative design method for user needs analysis and requirements specification in the context of health information systems development; the Multi-disciplinary Thematic Seminar (MdTS) method. The thesis also describes the MdTS method’s application and two different usability evaluations of the developed system.

    The MdTS addresses a significant problem with health information technologies; they tend to support collaborative work of healthcare professionals poorly, sometimes leading to a fragmentation of workflow and disruption of healthcare processes. Based on human-computer interaction methods, MdTS implies a multiple-user needs analysis by thorough investigation of the entire interdisciplinary cooperative work and its transformation into technical specifications in order to develop appropriate information and communication technology (ICT) for the users’ differing work situations.

    Application of the MdTS resulted in a prototype, the OLD@HOME Virtual Health Record (VHR), adapted to the specific demands in shared homecare. Through mobile devices each care professional accessed patient information in profession-specific views from an integrated platform.

    This thesis provides an interesting case, illustrating how mobile ICT can support shared homecare, thereby bridging health and social care activities and improving knowledge about joint work processes.

    Results from the usability evaluations were overall positive. Information needed at point of care was available on mobile devices and presented in an understandable manner. However, the evaluations also indicated that it is difficult to transfer results from one homecare setting to another due to differences in operational routines.

    In conclusion, application of the MdTS method, in this study, succeeded in elicitation of correct user needs and in transferring correct requirements specifications to system developers for implementation.

    List of papers
    1. From User Needs to System Specifications: Multi-disciplinary Thematic Seminars as a Collaborative Design Method for Development of Health Information Systems
    Open this publication in new window or tab >>From User Needs to System Specifications: Multi-disciplinary Thematic Seminars as a Collaborative Design Method for Development of Health Information Systems
    2008 (English)In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 41, no 4, p. 557-569Article in journal (Refereed) Published
    Abstract [en]

    This paper presents a new multi-disciplinary method for user needs analysis and requirements specification in the context of health information systems based on established theories from the fields of participatory design and computer supported cooperative work (CSCW). Whereas conventional methods imply a separate, sequential needs analysis for each profession, the "multi-disciplinary thematic seminar" (MdTS) method uses a collaborative design process. Application of the method in elderly homecare resulted in prototypes that were well adapted to the intended user groups. Vital information in the points of intersection between different care professions was elicited and a holistic view of the entire care process was obtained. Health informatics-usability specialists and clinical domain experts are necessary to apply the method. Although user needs acquisition can be time-consuming, MdTS was perceived to efficiently identify in-context user needs, and transformed these directly into requirements specifications. Consequently the method was perceived to expedite the entire ICT implementation process.

    Keywords
    collaborative design process, integrated healthcare systems, interdisciplinary communication, needs assessment, requirements engineering, participatory design
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96624 (URN)10.1016/j.jbi.2008.01.012 (DOI)000257924400005 ()
    Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2018-11-03Bibliographically approved
    2. Specific Demands for Developing IT-Systems for Shared Home Care – A User Centred Approach
    Open this publication in new window or tab >>Specific Demands for Developing IT-Systems for Shared Home Care – A User Centred Approach
    2005 In: J Qual Life Res, Vol. 3, no 2, p. 171-175Article in journal (Refereed) Published
    Abstract
    Identifiers
    urn:nbn:se:uu:diva-96625 (URN)
    Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2018-11-03Bibliographically approved
    3. Visualization and interaction design solutions to address specific demands in shared home care
    Open this publication in new window or tab >>Visualization and interaction design solutions to address specific demands in shared home care
    2006 (English)Conference paper, Published paper (Refereed)
    National Category
    Other Medical Sciences
    Research subject
    Medical Informatics
    Identifiers
    urn:nbn:se:uu:diva-96626 (URN)17108506 (PubMedID)
    Conference
    MIE2006
    Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2018-11-04
    4. Heuristic Evaluation Extended by User Analysis: A fast and efficient method to identify Potential Usability Problems in Health Information Systems
    Open this publication in new window or tab >>Heuristic Evaluation Extended by User Analysis: A fast and efficient method to identify Potential Usability Problems in Health Information Systems
    2006 In: Journal on Information Technology in Healthcare, Vol. 4, no 5, p. 317-25Article in journal (Refereed) Published
    Abstract
    Identifiers
    urn:nbn:se:uu:diva-96627 (URN)
    Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2018-11-03Bibliographically approved
    5. Usability Laboratory Test of a Novel Mobile Healthcare Application with Experienced Homecare Staff
    Open this publication in new window or tab >>Usability Laboratory Test of a Novel Mobile Healthcare Application with Experienced Homecare Staff
    2008 (English)In: Open Medical Informatics Journal, ISSN 1874-4311, Vol. 2, p. 117-128Article in journal (Refereed) Published
    National Category
    Other Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-96628 (URN)
    Available from: 2008-01-18 Created: 2008-01-18 Last updated: 2018-11-03
  • 5.
    Scandurra, Isabella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Hägglund, Maria
    Koch, Sabine
    From User Needs to System Specifications: Multi-disciplinary Thematic Seminars as a Collaborative Design Method for Development of Health Information Systems2008In: Journal of Biomedical Informatics, ISSN 1532-0464, E-ISSN 1532-0480, Vol. 41, no 4, p. 557-569Article in journal (Refereed)
    Abstract [en]

    This paper presents a new multi-disciplinary method for user needs analysis and requirements specification in the context of health information systems based on established theories from the fields of participatory design and computer supported cooperative work (CSCW). Whereas conventional methods imply a separate, sequential needs analysis for each profession, the "multi-disciplinary thematic seminar" (MdTS) method uses a collaborative design process. Application of the method in elderly homecare resulted in prototypes that were well adapted to the intended user groups. Vital information in the points of intersection between different care professions was elicited and a holistic view of the entire care process was obtained. Health informatics-usability specialists and clinical domain experts are necessary to apply the method. Although user needs acquisition can be time-consuming, MdTS was perceived to efficiently identify in-context user needs, and transformed these directly into requirements specifications. Consequently the method was perceived to expedite the entire ICT implementation process.

  • 6.
    Scandurra, Isabella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Hägglund, Maria
    Koch, Sabine
    Specific Demands for Developing IT-Systems for Shared Home Care – A User Centred Approach2005In: J Qual Life Res, Vol. 3, no 2, p. 171-175Article in journal (Refereed)
    Abstract
  • 7.
    Scandurra, Isabella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Hägglund, Maria
    Koch, Sabine
    Visualization and interaction design solutions to address specific demands in shared home care2006Conference paper (Refereed)
  • 8.
    Scandurra, Isabella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Hägglund, Maria
    Koch, Sabine
    Lind, Mats
    Usability Laboratory Test of a Novel Mobile Healthcare Application with Experienced Homecare Staff2008In: Open Medical Informatics Journal, ISSN 1874-4311, Vol. 2, p. 117-128Article in journal (Refereed)
  • 9.
    Scandurra, Isabella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Hägglund, Maria
    Moström, Dennis
    Koch, Sabine
    Heuristic Evaluation Extended by User Analysis: A fast and efficient method to identify Potential Usability Problems in Health Information Systems2006In: Journal on Information Technology in Healthcare, Vol. 4, no 5, p. 317-25Article in journal (Refereed)
    Abstract
  • 10. Tvedten, Harold W.
    et al.
    Ljusner, Jessika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Lilliehook, Inger E.
    Enumeration of feline platelets in ethylenediamine tetra-acetic acid anticoagulated blood with the ADVIA 2120 system and two manual methods: Leucoplate and Thrombo-TIC2013In: Journal of Veterinary Diagnostic Investigation, ISSN 1040-6387, E-ISSN 1943-4936, Vol. 25, no 4, p. 493-497Article in journal (Refereed)
    Abstract [en]

    A manual method (Thrombo-TIC; Bioanalytic GmbH, Umkirch/Freiburg, Germany) was advertised to disaggregate platelet clumps and to make human platelets spherical to improve platelet enumeration. The current study's hypothesis was that this method would perform better than current methods for feline blood anticoagulated with ethylenediamine tetra-acetic acid (EDTA), which often contains platelet aggregates. Platelet concentrations (PLTs) were determined in 21 feline blood samples by 3 methods. Thrombo-TIC was compared to the manual method (Leucoplate; Sobioda, Montbonnot-Saint-Martin, France) currently used in the authors' laboratory along with an ADVIA 2120 (Siemens AG, Eschborn, Germany) optical platelet concentration. Feline blood samples often contained platelet aggregates. ADVIA flagged for platelet aggregates in 11 of the 21 feline blood samples, and examination of blood smear revealed platelet aggregates in 14 of the 21 samples. The hemocytometers displayed more platelet aggregates with the Thrombo-TIC method than with Leucoplate. The method giving the greatest PLT was considered most accurate. The Leucoplate median PLT (238 x 10(9)/1) was greater than Thrombo-TIC (202 x 10(9)/1) or ADVIA (157 x 10(9)/1). Intra-assay precision was determined for the 3 methods using the 21 feline blood samples. Median Thrombo-TIC and Leucoplate precision (7.4% and 7.3% coefficient of variation [CV], respectively) were similar and not much worse than ADVIA (5.9% CV). The Thrombo-TIC method did not appear to perform better than the current manual method (Leucoplate). Leucoplate appeared least affected by platelet aggregation in feline blood. The ADVIA automated PLT appeared to be most negatively affected by platelet aggregation. The Thrombo-TIC method did not appear to prevent platelet aggregation in feline EDTA blood samples and, thus, is not recommended for such use.

  • 11.
    Weis, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Courivaud, Frederic
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Karlsson, F. Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Quantification of intramyocellular lipids in obese subjects using spectroscopic imaging with high spatial resolution2007In: Magnetic Resonance in Medicine, ISSN 0740-3194, E-ISSN 1522-2594, Vol. 57, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Quantification of intramyocellular lipids (IMCL) in obese subjects by single-voxel spectroscopy (SVS) or conventional spectroscopic imaging (SI) often fails due to overlap of IMCL spectral lines by extramyocellular lipids (EMCL), and signal contamination from subcutaneous fat and bone marrow. This study demonstrates that these problems can be solved by high-resolution SI with 128 phase-encoding steps and a read gradient during acquisition. The small voxels obtained in this way facilitated differentiation between EMCL and IMCL. This method offers the possibility of studying different muscle groups and the variation of lipids within one muscle.

  • 12.
    Westin, Jerker
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Decision Support for Treatment of Patients with Advanced Parkinson’s Disease2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of this thesis was to develop, deploy and evaluate new IT-based methods for supporting treatment and assessment of treatment of advanced Parkinson’s disease. In this condition a number of different motor and non-motor symptoms occur in episodes of varying frequency, duration and severity. In order to determine outcome of treatment changes, repeated assessments are necessary. Hospitalization for observation is expensive and may not be representative for the situation at home. Paper home diaries have questionable reliability and storage and retrieval of results are problematic. Approaches for monitoring using wearable sensors are unable to address important non-motor symptoms.

    A test battery system consisting of both self-assessments of symptoms and motor function tests was constructed for a touch screen mobile phone. Tests are performed on several occasions per day during test periods of one week. Data is transmitted over the mobile net to a central server where summaries in different symptom dimensions and an overall test score per patient and test period are calculated. There is a web application that graphically presents the results to treating clinical staff. As part of this work, a novel method for assessment of spiral drawing impairment useful during event-driven sampling was developed. To date, the system has been used by over 100 patients in 10 clinics in Sweden and Italy. Evidence is growing that the test battery is useful, reliable and valid for assessment of symptoms during advanced Parkinson’s disease.

    Infusion of a levodopa/carbidopa gel into the small intestine has been shown to reduce variation in plasma drug levels and improve clinical response in this patient category. A pharmacokinetic-pharmacodynamic model of this intestinal gel infusion was constructed. Possibly this model can assist the process of individualization of dosage for this treatment through in numero simulations. Results from an exploratory data analysis indicate that severity measures during oral levodopa treatment may be factors to consider when deciding candidates for infusion treatment.

    List of papers
    1. Outcome prediction of enteral levodopa/carbidopa infusion in advanced Parkinson's disease
    Open this publication in new window or tab >>Outcome prediction of enteral levodopa/carbidopa infusion in advanced Parkinson's disease
    Show others...
    2006 (English)In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 12, no 8, p. 509-513Article in journal (Refereed) Published
    Abstract [en]

    Two studies comparing intraduodenal infusion of a levodopa/carbidopa gel with oral treatments in advanced PD patients demonstrated improvement in UPDRS scores and in frequent clinical ratings on a global treatment response scale. Further analysis of data from these studies was performed to find predictive factors related to degree of improvement with infusion. Pearson's correlation coefficients between measures of improvement and baseline variables were calculated. Using data from one study, a prediction model was designed and was then evaluated using the other study's data. Correlations were found indicating that patients with more severe symptoms at baseline were most improved after infusion.

    Keywords
    Continuous dopaminergic stimulation, Improvement measure, Levodopa infusion, Outcome prediction, Parkinson's disease, Predictive factor
    National Category
    Medical and Health Sciences
    Research subject
    Medical Informatics; Neurology
    Identifiers
    urn:nbn:se:uu:diva-21768 (URN)10.1016/j.parkreldis.2006.02.006 (DOI)000243285100008 ()16731025 (PubMedID)
    Available from: 2007-01-04 Created: 2007-01-04 Last updated: 2017-12-07Bibliographically approved
    2. A home environment test battery for status assessment in patients with advanced Parkinson's disease
    Open this publication in new window or tab >>A home environment test battery for status assessment in patients with advanced Parkinson's disease
    2010 (English)In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 98, no 1, p. 27-35Article in journal (Refereed) Published
    Abstract [en]

    A test battery for assessing patient state in advanced Parkinson's disease, consisting of self-assessments and motor tests, was constructed and implemented on a hand computer with touch screen in a telemedicine setting. The aim of this work was to construct an assessment device, applicable during motor fluctuations in the patient's home environment. Selection of self-assessment questions was based on questions from an e-diary, previously used in a clinical trial. Both un-cued and cued tapping tests and spiral drawing tests were designed for capturing upper limb stiffnes, slowness and involuntary movements. The patient interface gave an audible signal at scheduled response times and was locked otherwise. Data messages in an XML-format were sent from the hand unit to a central server for storage, processing and presentation. In tapping tests, speed and accuracy were calculated and in spiral tests, standard deviation of frequency filtered radial drawing velocity was calculated. An overall test score, combining repeated assessments of the different test items during a test period, was defined based on principal component analysis and linear regression. An evaluation with two pilot patients before and after receiving new types of treatments was performed. Compliance and usability was assessed in a clinical trial (65 patients with advanced Parkinson's disease) and correlations between different test items and internal consistency were investigated. The test battery could detect treatment effect in the two pilot patients, both in self-assessments, tapping tests' results and spiral scores. It had good patient compliance and acceptable usability according to nine nurses. Correlation analysis showed that tapping results provided different information as compared to diary responses. Internal consistency of the test battery was good and learning effects in the tapping tests were small.

    National Category
    Neurology Biomedical Laboratory Science/Technology
    Research subject
    Neurology; Medical Informatics
    Identifiers
    urn:nbn:se:uu:diva-120734 (URN)10.1016/j.cmpb.2009.08.001 (DOI)000276544800003 ()19740563 (PubMedID)
    Available from: 2010-03-16 Created: 2010-03-16 Last updated: 2017-12-12Bibliographically approved
    3. A new computer method for assessing drawing impairment in Parkinson's disease
    Open this publication in new window or tab >>A new computer method for assessing drawing impairment in Parkinson's disease
    Show others...
    2010 (English)In: Journal of Neuroscience Methods, ISSN 0165-0270, E-ISSN 1872-678X, Vol. 190, no 1, p. 143-148Article in journal (Refereed) Published
    Abstract [en]

    A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing tasks) was used on 9482 test occasions by 62 patients with advanced Parkinson's disease (PD) in a telemedicine setting. On each test occasion, three Archimedes spirals were traced. A new computer method, using wavelet transforms and principal component analysis processed the spiral drawings to generate a spiral score. In a web interface, two PD specialists rated drawing impairment in spiral drawings from three random test occasions per patient, using a modification of the Bain & Findley 10-category scale. A standardised manual rating was defined as the mean of the two raters' assessments. Bland-Altman analysis was used to evaluate agreement between the spiral score and the standardised manual rating. Another selection of spiral drawings was used to estimate the Spearman rank correlations between the raters (r=0.87), and between the mean rating and the spiral score (r=0.89). The 95% confidence interval for the method's prediction errors was +/-1.5 scale units, which was similar to the differences between the human raters. In conclusion, the method could assess PD-related drawing impairments well comparable to trained raters.

    National Category
    Neurology Biomedical Laboratory Science/Technology
    Research subject
    Neurology; Medical Informatics
    Identifiers
    urn:nbn:se:uu:diva-128958 (URN)10.1016/j.jneumeth.2010.04.027 (DOI)000279888800019 ()20438759 (PubMedID)
    Available from: 2010-08-04 Created: 2010-08-04 Last updated: 2017-12-12Bibliographically approved
    4. A web application for follow-up of results from a mobile device test battery for Parkinson’s disease patients
    Open this publication in new window or tab >>A web application for follow-up of results from a mobile device test battery for Parkinson’s disease patients
    Show others...
    2011 (English)In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 104, no 2, p. 219-226Article in journal (Refereed) Published
    Abstract [en]

    A test battery consisting of self-assessments and motor tests for patients with Parkinson’s disease (PD) was constructed and implemented on a hand computer with touch screen in a telemedicine setting. In this work, a Web-based system was developed to deliver decision support information to treating clinical staff for assessing PD symptoms in their patients. Test results from the hand unit are transferred to a central server and processed into scores for different symptom dimensions and an “overall test score” reflecting the overall condition of the patient during a test period. The IBM Computer System Usability Questionnaire was administered to assess the users’ satisfaction with the system. Results showed that a majority of users who completed the evaluation were quite satisfied with the usability although a sizeable minority were not.  Response times were tested by simulating up to 100 users accessing the web application at the same time. The average page completion times were in the range of 0.5 seconds indicating fast response. The system was able to summarize the test-battery data and present them in a useful manner. Its main contribution is a novel way to easily access symptom information from the home environment of patients.

    Keywords
    Decision support, home assessment, Parkinson’s disease, telemedicine, test battery
    National Category
    Biomedical Laboratory Science/Technology Neurology
    Research subject
    Medical Informatics; Neurology
    Identifiers
    urn:nbn:se:uu:diva-132633 (URN)10.1016/j.cmpb.2011.07.017 (DOI)000296945100024 ()
    Available from: 2010-10-23 Created: 2010-10-23 Last updated: 2017-12-12Bibliographically approved
    5. Validation of a home environment test battery for supporting assessments in advanced Parkinson’s disease
    Open this publication in new window or tab >>Validation of a home environment test battery for supporting assessments in advanced Parkinson’s disease
    Show others...
    2012 (English)In: Neurological Sciences, ISSN 1590-1874, E-ISSN 1590-3478, Vol. 33, no 4, p. 831-838Article in journal (Refereed) Published
    Abstract [en]

    Test sequences in a test battery for Parkinson's disease patients, consisting of self-assessments and motor tests, were carried out repeatedly in a telemedicine setting, during week-long test periods and results were summarized in an 'overall score'. 35 patients in stable and fluctuating conditions (15 age- and gender-matched pairs) used the test battery for 1 week, and were then assessed with UPDRS and PDQ-39. This procedure was repeated 1 week later, without treatment changes. Reliability was assessed by intraclass correlation coefficients and Cronbach's alpha. Convergent validity was assessed by Spearman rank correlations and known-groups' validity, by the Mann-Whitney test. According to anonymous usability questionnaires, the patients could easily complete the tasks. Median compliance (93%) and test-retest reliability (0.88) were good. The correlations between overall score and total UPDRS (-0.64) and PDQ-39 (-0.72) were adequate. Median overall score was 18% better in the stable compared to the fluctuating group (p = 0.0014).

    Keywords
    Parkinson’s disease, Motor fluctuations, Telemedicine, Self-assessment, Motor tests, Validity
    National Category
    Biomedical Laboratory Science/Technology Neurology
    Research subject
    Medical Informatics; Neurology
    Identifiers
    urn:nbn:se:uu:diva-132632 (URN)10.1007/s10072-011-0844-5 (DOI)000306551000015 ()
    Available from: 2010-10-23 Created: 2010-10-23 Last updated: 2017-12-12Bibliographically approved
    6. A pharmacokinetic-pharmacodynamic model for duodenal levodopa infusion
    Open this publication in new window or tab >>A pharmacokinetic-pharmacodynamic model for duodenal levodopa infusion
    Show others...
    2011 (English)In: Clinical neuropharmacology, ISSN 0362-5664, E-ISSN 1537-162X, Vol. 34, no 2, p. 61-65Article in journal (Refereed) Published
    Abstract [en]

    Objective: The purpose of this work was to identify and estimate a population pharmacokinetic-pharmacodynamic model for duodenal infusion of a levodopa/carbidopa gel (Duodopa) to examine pharmacological properties of this treatment.

    Methods: The modeling involved pooling data from 3 studies (on advanced Parkinson disease) and fixing some parameters to values found in literature. The first study involved 12 patients studied on 3 occasions each and was previously published. The second study involved 3 patients on 2 occasions. A bolus dose was given after a washout during night. Plasma samples and motor ratings (clinical assessment of motor function on a 7-point treatment response scale ranging from "very off" to "very hyperkinetic") were collected until the clinical effect returned to baseline. The third study involved 5 patients on 3 occasions receiving 5 different dose levels. Different structural models were evaluated using the nonlinear mixed-effects modeling program NONMEM VI. Population mean parameter values, and interindividual, interoccasion, and residual variabilities were estimated.

    Results: Absorption of the levodopa/carbidopa gel can be adequately described with first-order absorption with bioavailability and lag time. Estimated population parameter values were a mean absorption time of 28.5 minutes, a lag time of 2.9 minutes, and a bioavailability of 88%. The pharmacodynamic model for motor ratings had the following population values: a half-life of effect delay of 21 minutes, a concentration at 50% effect of 1.55 mg/L, an E-max of 2.39 U on the treatment response scale, and a sigmoidicity of the E-max function of 11.6.

    Conclusions: For the typical unmedicated subject, it will take 51.4 minutes until the peak levodopa effect is reached after a bolus dose. This delay is, like the magnitude of the effect, highly variable in this patient group. The residual error magnitudes of 20% for levodopa concentrations and 0.92 U (SD) for motor ratings indicate that the models developed provide predictions of a relevant quality. The developed model may be a first step toward model-guided treatment individualization of duodenal infusion of levodopa.

    Keywords
    Levodopa, infusion, Parkinson’s disease, pharmacokinetic, pharmacodynamic
    National Category
    Medical and Health Sciences
    Research subject
    Medical Informatics; Neurology; Pharmacokinetics and Drug Therapy
    Identifiers
    urn:nbn:se:uu:diva-132634 (URN)10.1097/WNF.0b013e31820b570a (DOI)000288445400002 ()21297456 (PubMedID)
    Available from: 2010-10-23 Created: 2010-10-23 Last updated: 2017-12-12Bibliographically approved
  • 13.
    Westin, Jerker
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Dougherty, Mark
    Dalarna University.
    Nyholm, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Groth, Torgny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    A home environment test battery for status assessment in patients with advanced Parkinson's disease2010In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 98, no 1, p. 27-35Article in journal (Refereed)
    Abstract [en]

    A test battery for assessing patient state in advanced Parkinson's disease, consisting of self-assessments and motor tests, was constructed and implemented on a hand computer with touch screen in a telemedicine setting. The aim of this work was to construct an assessment device, applicable during motor fluctuations in the patient's home environment. Selection of self-assessment questions was based on questions from an e-diary, previously used in a clinical trial. Both un-cued and cued tapping tests and spiral drawing tests were designed for capturing upper limb stiffnes, slowness and involuntary movements. The patient interface gave an audible signal at scheduled response times and was locked otherwise. Data messages in an XML-format were sent from the hand unit to a central server for storage, processing and presentation. In tapping tests, speed and accuracy were calculated and in spiral tests, standard deviation of frequency filtered radial drawing velocity was calculated. An overall test score, combining repeated assessments of the different test items during a test period, was defined based on principal component analysis and linear regression. An evaluation with two pilot patients before and after receiving new types of treatments was performed. Compliance and usability was assessed in a clinical trial (65 patients with advanced Parkinson's disease) and correlations between different test items and internal consistency were investigated. The test battery could detect treatment effect in the two pilot patients, both in self-assessments, tapping tests' results and spiral scores. It had good patient compliance and acceptable usability according to nine nurses. Correlation analysis showed that tapping results provided different information as compared to diary responses. Internal consistency of the test battery was good and learning effects in the tapping tests were small.

  • 14.
    Westin, Jerker
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Ghiamati, Samira
    Dalarna University.
    Memedi, Mevludin
    Dalarna University.
    Nyholm, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Johansson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Dougherty, Mark
    Dalarna University.
    Groth, Torgny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    A new computer method for assessing drawing impairment in Parkinson's disease2010In: Journal of Neuroscience Methods, ISSN 0165-0270, E-ISSN 1872-678X, Vol. 190, no 1, p. 143-148Article in journal (Refereed)
    Abstract [en]

    A test battery, consisting of self-assessments and motor tests (tapping and spiral drawing tasks) was used on 9482 test occasions by 62 patients with advanced Parkinson's disease (PD) in a telemedicine setting. On each test occasion, three Archimedes spirals were traced. A new computer method, using wavelet transforms and principal component analysis processed the spiral drawings to generate a spiral score. In a web interface, two PD specialists rated drawing impairment in spiral drawings from three random test occasions per patient, using a modification of the Bain & Findley 10-category scale. A standardised manual rating was defined as the mean of the two raters' assessments. Bland-Altman analysis was used to evaluate agreement between the spiral score and the standardised manual rating. Another selection of spiral drawings was used to estimate the Spearman rank correlations between the raters (r=0.87), and between the mean rating and the spiral score (r=0.89). The 95% confidence interval for the method's prediction errors was +/-1.5 scale units, which was similar to the differences between the human raters. In conclusion, the method could assess PD-related drawing impairments well comparable to trained raters.

  • 15.
    Westin, Jerker
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Nyholm, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Groth, Torgny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Dougherty, Mark
    Dalarna University.
    Yerramsetty, Praveen
    Dalarna University.
    Pålhagen, Sven
    Karolinska Institute.
    Outcome prediction of enteral levodopa/carbidopa infusion in advanced Parkinson's disease2006In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 12, no 8, p. 509-513Article in journal (Refereed)
    Abstract [en]

    Two studies comparing intraduodenal infusion of a levodopa/carbidopa gel with oral treatments in advanced PD patients demonstrated improvement in UPDRS scores and in frequent clinical ratings on a global treatment response scale. Further analysis of data from these studies was performed to find predictive factors related to degree of improvement with infusion. Pearson's correlation coefficients between measures of improvement and baseline variables were calculated. Using data from one study, a prediction model was designed and was then evaluated using the other study's data. Correlations were found indicating that patients with more severe symptoms at baseline were most improved after infusion.

  • 16.
    Westin, Jerker
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Nyholm, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Pålhagen, Sven
    Willows, Thomas
    Groth, Torgny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Dougherty, Mark
    Karlsson, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    A pharmacokinetic-pharmacodynamic model for duodenal levodopa infusion2011In: Clinical neuropharmacology, ISSN 0362-5664, E-ISSN 1537-162X, Vol. 34, no 2, p. 61-65Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this work was to identify and estimate a population pharmacokinetic-pharmacodynamic model for duodenal infusion of a levodopa/carbidopa gel (Duodopa) to examine pharmacological properties of this treatment.

    Methods: The modeling involved pooling data from 3 studies (on advanced Parkinson disease) and fixing some parameters to values found in literature. The first study involved 12 patients studied on 3 occasions each and was previously published. The second study involved 3 patients on 2 occasions. A bolus dose was given after a washout during night. Plasma samples and motor ratings (clinical assessment of motor function on a 7-point treatment response scale ranging from "very off" to "very hyperkinetic") were collected until the clinical effect returned to baseline. The third study involved 5 patients on 3 occasions receiving 5 different dose levels. Different structural models were evaluated using the nonlinear mixed-effects modeling program NONMEM VI. Population mean parameter values, and interindividual, interoccasion, and residual variabilities were estimated.

    Results: Absorption of the levodopa/carbidopa gel can be adequately described with first-order absorption with bioavailability and lag time. Estimated population parameter values were a mean absorption time of 28.5 minutes, a lag time of 2.9 minutes, and a bioavailability of 88%. The pharmacodynamic model for motor ratings had the following population values: a half-life of effect delay of 21 minutes, a concentration at 50% effect of 1.55 mg/L, an E-max of 2.39 U on the treatment response scale, and a sigmoidicity of the E-max function of 11.6.

    Conclusions: For the typical unmedicated subject, it will take 51.4 minutes until the peak levodopa effect is reached after a bolus dose. This delay is, like the magnitude of the effect, highly variable in this patient group. The residual error magnitudes of 20% for levodopa concentrations and 0.92 U (SD) for motor ratings indicate that the models developed provide predictions of a relevant quality. The developed model may be a first step toward model-guided treatment individualization of duodenal infusion of levodopa.

  • 17.
    Westin, Jerker
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Biomedical Informatics and Engineering.
    Schiavella, Mauro
    Memedi, Mevludin
    Nyholm, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
    Dougherty, Mark
    Antonini, Angelo
    Validation of a home environment test battery for supporting assessments in advanced Parkinson’s disease2012In: Neurological Sciences, ISSN 1590-1874, E-ISSN 1590-3478, Vol. 33, no 4, p. 831-838Article in journal (Refereed)
    Abstract [en]

    Test sequences in a test battery for Parkinson's disease patients, consisting of self-assessments and motor tests, were carried out repeatedly in a telemedicine setting, during week-long test periods and results were summarized in an 'overall score'. 35 patients in stable and fluctuating conditions (15 age- and gender-matched pairs) used the test battery for 1 week, and were then assessed with UPDRS and PDQ-39. This procedure was repeated 1 week later, without treatment changes. Reliability was assessed by intraclass correlation coefficients and Cronbach's alpha. Convergent validity was assessed by Spearman rank correlations and known-groups' validity, by the Mann-Whitney test. According to anonymous usability questionnaires, the patients could easily complete the tasks. Median compliance (93%) and test-retest reliability (0.88) were good. The correlations between overall score and total UPDRS (-0.64) and PDQ-39 (-0.72) were adequate. Median overall score was 18% better in the stable compared to the fluctuating group (p = 0.0014).

1 - 17 of 17
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