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  • 1.
    Herzog, Almut
    et al.
    Linköping University, Department of Computer and Information Science, IISLAB - Laboratory for Intelligent Information Systems. Linköping University, The Institute of Technology.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Network solutions for home health care applications2003In: Technology and Health Care, ISSN 0928-7329, E-ISSN 1878-7401, Vol. 11, no 2, p. 77-87Article in journal (Refereed)
    Abstract [en]

    The growing number of the elderly in industrialised countries is increasing the pressure on respective health care systems. This is one reason for recent trends in the development and expansion of home health care organisations. With Internet access available to everyone and the advent of wireless technologies, advanced telehomecare is a possibility for a large proportion of the population.

    In the near future, one of the authors plans to implement a home health care infrastructure for patients with congestive heart failure and patients with chronic obstructive pulmonary disease. The system is meant to support regular and ad-hoc measurements of medical parameters in patient homes and transmission of measurement data to the home health care provider.

    In this paper we look at network technologies that connect sensors and input devices in the patient home to a home health care provider. We consider wireless and Internet technologies from functional and security-related perspectives and arrive at a recommendation for our system.

    Security and usability aspects of the proposed network infrastructures are explored with special focus on their impact on the patient home.

  • 2.
    Karlsson, Daniel
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. SICS East Swedish ICT, Linköping, Sweden.
    Archetype Representation of PROMs2015In: Digital Healthcare Empowering Europeans: Proceedings of MIE2015 / [ed] R. Cornet et al., Amsterdam: IOS Press, 2015, Vol. 210, p. 980-980Conference paper (Other academic)
  • 3.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Evaluation of the Use of Digital Pens for Pain Assessment in Palliative Home Healthcare2008In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 136, p. 101-106Article in journal (Refereed)
    Abstract [en]

    An information system supporting pain assessment in palliative home healthcare was implemented at the hospital-based home care clinic of University Hospital in Linkoping, Sweden. Using digital pens and pain diaries, pain assessments were sent from the patients home to the professional caregiver. A total of 12 patients participated in the study. Patients, spouses and professional caregivers were interviewed. Qualitative content analyses were performed on the study material. All patients managed to use the pain assessment method, they experienced an improved contact with the caregivers and had a sense of increased security. After an initial cautious outlook the caregivers experienced positive outcomes for themselves and their patients. The medical records showed that the method had had impact on treatment. In conclusion, the home healthcare solution provided an effortless method for pain assessment with a high degree of user acceptance for palliative patients and had positive influences on the care.

  • 4.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    The use of information technology in home healthcare: requirements and application development2003Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    The population's wish to receive care in the own home instead of at a hospital fits well with the Health Services' development in the direction of increasing home healthcare even when severe illness is involved. However, when care is moved from the hospital to the home the demands for high quality care still remain. Information and telecommunication technologies used in applications which are tailored to support caregivers and patients in home healthcare, can be part of the facilitation of this development towards an increasing home healthcare service. Remote monitoring of the patient in the home can support assuring this quality of care but such monitoring involves considering several requirement areas.

    This thesis describes problem areas in both basic and advanced home healthcare where information technology can be a part of the solution. Further, the thesis describes requirement areas to be considered when monitoring patients in the home, both in regard to subjective and objective variables. The requirement areas, which are described in the thesis, include security, mobility, and responsibility. Network solutions for home healthcare are discussed and two information technology applications in home healthcare are described. The first application concerns diabetes care and the second application concerns the use of digital pen technology for symptom assessments in advanced palliative home healthcare.

    List of papers
    1. Requirements and prototyping of a home health care application based on emerging JAVA technology.
    Open this publication in new window or tab >>Requirements and prototyping of a home health care application based on emerging JAVA technology.
    Show others...
    2002 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, Vol. 68, no 1-3, p. 129-139Article in journal (Refereed) Published
    Abstract [en]

    IT support for home health care is an expanding area within health care IT development. Home health care differs from other in- or outpatient care delivery forms in a number of ways, and thus, the introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging technologies. A prototype application for the follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications.

    Keywords
    Home health care, Diabetes patients, Requirements, Monitoring, JAVA technology
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14167 (URN)10.1016/S1386-5056(02)00071-0 (DOI)
    Available from: 2006-11-30 Created: 2006-11-30 Last updated: 2013-11-13
    2. Network solutions for home health care applications
    Open this publication in new window or tab >>Network solutions for home health care applications
    2003 (English)In: Technology and Health Care, ISSN 0928-7329, E-ISSN 1878-7401, Vol. 11, no 2, p. 77-87Article in journal (Refereed) Published
    Abstract [en]

    The growing number of the elderly in industrialised countries is increasing the pressure on respective health care systems. This is one reason for recent trends in the development and expansion of home health care organisations. With Internet access available to everyone and the advent of wireless technologies, advanced telehomecare is a possibility for a large proportion of the population.

    In the near future, one of the authors plans to implement a home health care infrastructure for patients with congestive heart failure and patients with chronic obstructive pulmonary disease. The system is meant to support regular and ad-hoc measurements of medical parameters in patient homes and transmission of measurement data to the home health care provider.

    In this paper we look at network technologies that connect sensors and input devices in the patient home to a home health care provider. We consider wireless and Internet technologies from functional and security-related perspectives and arrive at a recommendation for our system.

    Security and usability aspects of the proposed network infrastructures are explored with special focus on their impact on the patient home.

    National Category
    Computer Sciences
    Identifiers
    urn:nbn:se:liu:diva-24386 (URN)6479 (Local ID)6479 (Archive number)6479 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2018-01-13
    3. Symptom assessment in palliative advanced home healthcare using digital pens
    Open this publication in new window or tab >>Symptom assessment in palliative advanced home healthcare using digital pens
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Symptom control is one of the most important components of delivering effective palliative care, and adequate symptom assessment is a prerequisite for good symptom control. Patient receiving treatment in palliative home healthcare is geographically separated from the caregivers making symptom control a challenge, a challenge that could be met by the use of information and communication technology.

    This paper describes experiences from a project focused on symptom assessment using digital pen technology in advanced palliative home healthcare. As part of an ongoing quality assurance work within the hospital-based home care clinic at Linköping University Hospital, the project has designed, developed and implemented an IT-support system for pain assessments for patients at home using digital pen technology. The system uses mobile Internet technology together with digital pen technology from Anoto™ AB. From December 2002 to August 2003 the system was in use at the hospital-based home care clinic. Alternative techniques, for example the use of a PC or a touch-tone telephone for symptom assessment, are discussed.

    Keywords
    Digital Pens; Computer Terminals; Cellular Phones; Internet; Home Care Services, Hospital-Based
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-100837 (URN)
    Available from: 2013-11-13 Created: 2013-11-13 Last updated: 2013-11-13
  • 5.
    Lind, Leili
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Towards Effortless Use of Information Technology in Home Healthcare with a Networked Digital Pen2007In: Anoto Functionality Conference 2007,2007, 2007Conference paper (Other academic)
  • 6.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Towards Effortless Use of Information Technology in Home Healthcare with a Networked Digital Pen2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    When care is moved from the hospital to the home the demands for high quality care still remain. For problems arising from the geographical separation of patients and professional caregivers, information and communication technology may offer important solutions. The overall aim of this thesis was to describe relevant requirements, to design and implement an IT-based system, and finally to evaluate the system’s influence on symptom control and support for both patients/next-of-kin and professional caregivers in advanced home healthcare. Of importance were needs in basic as well as advanced home healthcare, as were usability perspectives of both patients and professional caregivers. Requirement areas such as security, mobility, and responsibility, which should be considered when monitoring patients in the home, were identified. A prototype system for everyday assistance for diabetes patients was designed, and a system for frequent pain assessment for palliative home healthcare patients using a pain diary, digital pen and mobile Internet technology, was developed and evaluated through a qualitative content analysis approach. Twelve palliative cancer patients and six professional caregivers participated. The data collected included an ease-of-use questionnaire, and interviews with patients, spouses and professional caregivers. Patients expressed increased and improved contact with the caregivers, increased participation in their own care, a sense of increased security, and easiness in using the equipment in spite of severe illness and difficulties in comprehending the technology and system intervention. The professional caregivers showed a shifting outlook towards the pain assessment method; an initial cautious outlook due to low expectations of the patients’ abilities to use the pain assessment method and the caregivers’ own reluctance to use the system and change their way-of-working. Despite this, the professional caregivers experienced positive outcomes in terms of an increased awareness of pain, and positive patient influences including increased participation in their care, increased security and improved changes in pain treatment as a response to reported pain assessments. In conclusion, the networked digital pen system provided an effortless method for pain assessment and had positive influences on the care. The results imply that digital pen technology is suitable for the assessment of symptoms by palliative patients since these patients often have a limited capacity to handle technology due to their state of health.

    List of papers
    1. Requirements and prototyping of a home health care application based on emerging JAVA technology.
    Open this publication in new window or tab >>Requirements and prototyping of a home health care application based on emerging JAVA technology.
    Show others...
    2002 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, Vol. 68, no 1-3, p. 129-139Article in journal (Refereed) Published
    Abstract [en]

    IT support for home health care is an expanding area within health care IT development. Home health care differs from other in- or outpatient care delivery forms in a number of ways, and thus, the introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging technologies. A prototype application for the follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications.

    Keywords
    Home health care, Diabetes patients, Requirements, Monitoring, JAVA technology
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14167 (URN)10.1016/S1386-5056(02)00071-0 (DOI)
    Available from: 2006-11-30 Created: 2006-11-30 Last updated: 2013-11-13
    2. A system for symptom assessment in advanced palliative home healthcare using digital pens.
    Open this publication in new window or tab >>A system for symptom assessment in advanced palliative home healthcare using digital pens.
    2004 (English)In: Medical informatics and the Internet in medicine, ISSN 1463-9238, Vol. 29, no 3-4, p. 199-210Article in journal (Refereed) Published
    Abstract [en]

    Symptom control is one of the most important components of delivering effective palliative care, and adequate symptom assessment is a prerequisite for good symptom control. Patients receiving treatment in palliative home healthcare is geographically separated from the caregivers making symptom control a challenge, a challenge that could be met by the use of information and communication technology. Technologies of today offer different ways for patients to assess their symptoms at home and send the assessments to the healthcare provider. Examples are the use of a PC, a touch-tone telephone, and a digital pen, which require different kinds of infrastructure in the patient's home, and which differ in strengths and weaknesses. As part of an ongoing quality assurance work within the hospital-based home care clinic at Linköping University Hospital, the project has designed, developed and implemented an IT-support system for pain assessments for patients at home using digital pen and mobile Internet technology. A questionnaire study indicated that pain assessment using digital pens was accepted by patients and that problems mainly arose from the use of the visual-analogue scale.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14168 (URN)10.1080/14639230400005966 (DOI)
    Available from: 2006-11-30 Created: 2006-11-30 Last updated: 2009-05-25
    3. Patients’ use of digital pens for pain assessment in advanced palliative home healthcare.
    Open this publication in new window or tab >>Patients’ use of digital pens for pain assessment in advanced palliative home healthcare.
    2008 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 77, no 2, p. 129-136Article in journal (Refereed) Published
    Abstract [en]

    Background: Appropriate pain assessment is a necessary prerequisite for adequate pain control. A way to follow-up on the pain is to let patients use paper-based or electronic pain diaries.

    Purpose: The aim was to explore and describe palliative home care patients’ experiences of assessing their pain by using a pain diary together with digital pen and mobile Internet technology.

    Methods: A system for the follow-up of pain treatment was developed and evaluated by means of a qualitative cross-case content analysis. From December 2002 until September 2003 12 palliative patients, who initially assessed VAS pain ≥ 35 mm (VAS 0–100 mm), used the system. Patients reported their momentary pain intensity and the number of consumed extra doses of analgesics three times per day. Analysis data were collected from interviews with patients and spouses, questionnaires, medical records, and the system log.

    Results: In spite of severe illness and difficulties in comprehending the technology and system intervention, patients found the pain diary and digital pen easy to use for pain assessment. Patients took a greater part in their own care and experienced an improved contact with their caregivers, which led to a sense of increased security. The medical records showed a quick response to variations in the patients’ health status by means of changes in medical treatment.

    Conclusions: The pain assessment system for palliative patients using pain diaries together with digital pen and wireless Internet technology constitutes an effortless method and has positive influences on the care.

    Keywords
    Pain assessment; Visual analogue scale; Palliative care; Home care services, Hospital-based; Digital pens; Mobile phones; Internet
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14169 (URN)10.1016/j.ijmedinf.2007.01.013 (DOI)
    Available from: 2006-11-30 Created: 2006-11-30 Last updated: 2017-12-13
    4. Digital pens and pain diaries in palliative home healthcare: Professional caregivers’ experiences.
    Open this publication in new window or tab >>Digital pens and pain diaries in palliative home healthcare: Professional caregivers’ experiences.
    2007 (English)In: Medical Informatics and the Internet in Medicine, ISSN 1753-8157, Vol. 32, no 4, p. 287-296Article in journal (Refereed) Published
    Abstract [en]

    Frequent pain assessment by the use of pain diaries for the follow-up of pain treatment can facilitate the caregivers' work with pain control in home health care. The aim was to explore and describe professional caregivers' experiences of palliative home health-care patients' use of pain diaries and digital pen technology for frequent pain assessment. A system for the follow-up of pain treatment was implemented in routine care and evaluated by means of a qualitative content analysis. Three nurses, two physicians and one secretary were interviewed. Additional analysis data were collected from patients' medical records, and the system log. The caregivers showed a shifting outlook towards the pain-assessment method, an initial cautious outlook due to low expectations of the patients' abilities to use the pain assessment method. Despite this, the caregivers experienced positive outcomes in terms of an increased awareness of pain, and positive patient influences including increased participation in their care, increased security, and improved changes in pain treatment as a response to reported pain assessments. Pain assessment by the use of pain diaries and digital pen technology has positive influences on palliative home-care patients and supports the caregivers' focus on the pain.

    Keywords
    Pain assessment; home care services, hospital-based; digital pens; mobile phones; Internet
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14170 (URN)10.1080/14639230701785381 (DOI)
    Available from: 2006-11-30 Created: 2006-11-30
  • 7.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Berglund, Aseel
    Saab Aerosystems, Linköping.
    Berglund, Erik
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Bång, Magnus
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Hägglund, Sture
    Linköping University, Department of Computer and Information Science, MDALAB - Human Computer Interfaces. Linköping University, The Institute of Technology.
    Effortless data capture for ambient e-services with digital pen and paper technology2010In: Designing Solution-Based Ubiquitous and Pervasive Computing: New Issues and Trends / [ed] Fransisco Milton Mendes Neto, Pedro Fernandes Ribeiro Neto, Information Science Publishing/IGI Global , 2010, p. 24-43Chapter in book (Other academic)
    Abstract [en]

    In order to counteract the digital divide and to enable the society to reach all its citizens with various kinds of e-services, there is a need to develop access methods and terminal technologies suited also for groups with weak access to the Internet, not the least elderly and people needing care in their homes. In this chapter, the authors will describe technologies for using digital pen and paper as data input media for e-services and computing applications, refer a number of applications together with studies and evaluations of their usability, and finally comment upon future prospects for integrating digital pen and paper as an effortless technique for data capture, especially in order to counteract and diminish the digital divide. The use of digital pen and paper technologies is exemplified with applications demonstrating its appropriateness in home care for elderly, for free-form recording of data on paper such as maps, and as a remote control for a TV set or other electronic appliances with rich functionality in the home.

  • 8.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. SICS East Swedish ICT, Linköping, Sweden.
    Carlgren, Gunnar
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Mudra, Jacqueline
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Synnergren, Henrik
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Hilding, Niclas
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    Karlsson, daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Wiréhn, Ann-Britt
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Persson, Hans Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Preliminary results of a telemonitoring study: COPD and heart failure patients exhibit great difference in their need of health care2015In: European Respiratory Journal: Official Scientific Journal of ERS / [ed] Marc Humbert, European Respiratory Society , 2015, Vol. 46/suppl 59, p. PA2790-PA2790Conference paper (Other academic)
    Abstract [en]

    Background: Growing populations of elderly patients with advanced stages of COPD or heart failure (HF) urge the need for specialized health care in the patients' home. A telemonitoring study has been initiated including patients using digital pens. Health care was provided by the specialized home care unit at a university hospital. Through an IT system the staff checked all daily patient reports. We hypothesized that the two groups of patients, advanced COPD or HF, would exhibit differences regarding exacerbations and the need of health care.

    Objective: To study exacerbations of COPD or HF, and patient health care consumption.

    Methods: A tele-monitoring system, the Health diary, which is based on digital pen technology, was employed. Exacerbations were identified using information provided through the telemonitoring system. Consumed health care was assessed as the number of patient contacts (home visits or telephone consultations).

    Results: Presently, 33 patients with advanced disease are enrolled (13 COPD and 20 HF patients) of which 11 patients (6 COPD and 5 HF patients) have completed the 1-yr study period or have died during the study period (2 COPD and 4 HF patients). Exacerbations were 2.8 and 0.8 and patient contacts were 96 and 42 per COPD and HF patient, respectively. While HF patients were significantly older than COPD patients, the two groups demonstrated no difference regarding gender distribution and comorbidity.

    Conclusions: COPD patients exhibit exacerbations more frequently and demand much more home health care than patients with HF do. It seems that this difference of health care consumption is mainly due to disease characteristics.

  • 9.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    A system for symptom assessment in advanced palliative home healthcare using digital pens.2004In: Medical informatics and the Internet in medicine, ISSN 1463-9238, Vol. 29, no 3-4, p. 199-210Article in journal (Refereed)
    Abstract [en]

    Symptom control is one of the most important components of delivering effective palliative care, and adequate symptom assessment is a prerequisite for good symptom control. Patients receiving treatment in palliative home healthcare is geographically separated from the caregivers making symptom control a challenge, a challenge that could be met by the use of information and communication technology. Technologies of today offer different ways for patients to assess their symptoms at home and send the assessments to the healthcare provider. Examples are the use of a PC, a touch-tone telephone, and a digital pen, which require different kinds of infrastructure in the patient's home, and which differ in strengths and weaknesses. As part of an ongoing quality assurance work within the hospital-based home care clinic at Linköping University Hospital, the project has designed, developed and implemented an IT-support system for pain assessments for patients at home using digital pen and mobile Internet technology. A questionnaire study indicated that pain assessment using digital pens was accepted by patients and that problems mainly arose from the use of the visual-analogue scale.

  • 10.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Digital pen technology in palliative home healthcare2004In: 11th World Congress on Medical Informatics MEDINFO04,2004, San Francisco: IOS Press , 2004, p. 1723-Conference paper (Refereed)
  • 11.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Digital pen-based telemonitoring of elderly heart failure patients2013In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 192, p. 1062-1062Article in journal (Refereed)
    Abstract [en]

    Considering that a majority of elderlies are non-users of computers and Internet we developed a telemonitoring system for elderly heart failure (HF) home care patients based on digital pen technology - a technology never used before by this patient group. We implemented the system in clinical use in a 13 months long study. Fourteen patients (mean/median age 84 years) with severe HF participated. They accepted the technology and performed daily reports of their health state using the digital pen and a Health Diary form. Via the system the clinicians detected all HF-related deteriorations at an early stage and thereby prevented hospital re-admissions for all patients during the study, implying improved symptom control and large cost savings.

  • 12.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology. Santa Anna IT Research Institute, Linköping, Sweden.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Electronic patient-reported symptom assessment in palliative end-of-life home care2013In: Health Systems, ISSN 2047-6965, E-ISSN 2047-6973, Vol. 2, no 3, p. 171-180Article in journal (Refereed)
    Abstract [en]

    Good symptom control in palliative end-of-life home care requires adequateaccess to patients’ symptom assessments. The aim of the study was to investigatethe feasibility of an electronic symptom assessment reporting system tosupport symptom control. A randomised controlled study was performedduring April 2008–December 2009. The intervention consisted of a networkeddigital-pen-based information system. The primary outcome measure chosenwas the time span from the patient’s reporting of a symptom to the careproviders’ noticing this assessment. Patients with at least moderately severesymptoms were invited to participate in the study. Eighteen (11 intervention,seven control) patients from four home care centres participated, submittinga total of 330 symptom assessments. There was a significantly shorter mediantime span from reporting to noticing for assessments in the intervention group.The system used allowed both frequent and regular symptom reporting frompatients that can contribute to more correct and prompt medical decisions inpalliative end-of-life home care. Trial registration number: ISRCTN09750271.Health Systems (2013) 2, 171–180. doi:10.1057/hs.2013.4;published online 17 May 2013; corrected online 4 June 2013

  • 13.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Home healthcare patients using digital pens for pain assessment: in Telemedicine journal and e-health(ISSN 1530-5627) vol 11, issue 22005Conference paper (Refereed)
  • 14.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Karlsson, Daniel
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Symptom assessment in home healthcare using digital pens2003In: AMIA05,2003, 2003, p. 914-Conference paper (Refereed)
  • 15.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Symptom assessment in palliative advanced home healthcare using digital pensManuscript (preprint) (Other academic)
    Abstract [en]

    Symptom control is one of the most important components of delivering effective palliative care, and adequate symptom assessment is a prerequisite for good symptom control. Patient receiving treatment in palliative home healthcare is geographically separated from the caregivers making symptom control a challenge, a challenge that could be met by the use of information and communication technology.

    This paper describes experiences from a project focused on symptom assessment using digital pen technology in advanced palliative home healthcare. As part of an ongoing quality assurance work within the hospital-based home care clinic at Linköping University Hospital, the project has designed, developed and implemented an IT-support system for pain assessments for patients at home using digital pen technology. The system uses mobile Internet technology together with digital pen technology from Anoto™ AB. From December 2002 to August 2003 the system was in use at the hospital-based home care clinic. Alternative techniques, for example the use of a PC or a touch-tone telephone for symptom assessment, are discussed.

  • 16.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. SICS East Swedish ICT, Linköping, Sweden.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Telehealth for “the Digital Illiterate”: Elderly Heart Failure Patients’ Experiences2014In: eHealth – For Continuity of Care: Proceedings of MIE2014 / [ed] Lovis, C., Séroussi, B., Hasman, A., Pape-Haugaard, L., Saka, O., Andersen, S.K., Amsterdam, Netherlands: IOS Press, 2014, Vol. 205, p. 353-357Conference paper (Refereed)
    Abstract [en]

    Telehealth solutions should be available also for elderly patients with nointerest in using, or capacity to use, computers and smartphones. Fourteen elderly,severely ill heart failure patients in home care participated in a telehealth study andused digital pens for daily reporting of their health state—a technology never usedbefore by this patient group. After the study seven patients and two spouses wereinterviewed face-to-face. A qualitative content analysis of the interview materialwas performed. The informants had no experience of computers or the Internet andno interest in learning. Still, patients found the digital pen and the health diaryform easy to use, thus effortlessly adopting to changes in care provision. Theyexperienced an improved contact with the caregivers and had a sense of increasedsecurity despite a multimorbid state. Our study shows that, given that technologiesare tailored to specific patient groups, even “the digital illiterate” may use theInternet.

  • 17.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Fridlund, Bengt
    School of Health Sciences & Social Work, Växjö University, Sweden.
    Digital pens and pain diaries in palliative home healthcare: Professional caregivers’ experiences.2007In: Medical Informatics and the Internet in Medicine, ISSN 1753-8157, Vol. 32, no 4, p. 287-296Article in journal (Refereed)
    Abstract [en]

    Frequent pain assessment by the use of pain diaries for the follow-up of pain treatment can facilitate the caregivers' work with pain control in home health care. The aim was to explore and describe professional caregivers' experiences of palliative home health-care patients' use of pain diaries and digital pen technology for frequent pain assessment. A system for the follow-up of pain treatment was implemented in routine care and evaluated by means of a qualitative content analysis. Three nurses, two physicians and one secretary were interviewed. Additional analysis data were collected from patients' medical records, and the system log. The caregivers showed a shifting outlook towards the pain-assessment method, an initial cautious outlook due to low expectations of the patients' abilities to use the pain assessment method. Despite this, the caregivers experienced positive outcomes in terms of an increased awareness of pain, and positive patient influences including increased participation in their care, increased security, and improved changes in pain treatment as a response to reported pain assessments. Pain assessment by the use of pain diaries and digital pen technology has positive influences on palliative home-care patients and supports the caregivers' focus on the pain.

  • 18.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Fridlund, Bengt
    Växjö University.
    Patients’ use of digital pens for pain assessment in advanced palliative home healthcare.2008In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, Vol. 77, no 2, p. 129-136Article in journal (Refereed)
    Abstract [en]

    Background: Appropriate pain assessment is a necessary prerequisite for adequate pain control. A way to follow-up on the pain is to let patients use paper-based or electronic pain diaries.

    Purpose: The aim was to explore and describe palliative home care patients’ experiences of assessing their pain by using a pain diary together with digital pen and mobile Internet technology.

    Methods: A system for the follow-up of pain treatment was developed and evaluated by means of a qualitative cross-case content analysis. From December 2002 until September 2003 12 palliative patients, who initially assessed VAS pain ≥ 35 mm (VAS 0–100 mm), used the system. Patients reported their momentary pain intensity and the number of consumed extra doses of analgesics three times per day. Analysis data were collected from interviews with patients and spouses, questionnaires, medical records, and the system log.

    Results: In spite of severe illness and difficulties in comprehending the technology and system intervention, patients found the pain diary and digital pen easy to use for pain assessment. Patients took a greater part in their own care and experienced an improved contact with their caregivers, which led to a sense of increased security. The medical records showed a quick response to variations in the patients’ health status by means of changes in medical treatment.

    Conclusions: The pain assessment system for palliative patients using pain diaries together with digital pen and wireless Internet technology constitutes an effortless method and has positive influences on the care.

  • 19.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Lyth, Johan
    Region Östergötland, Regional Board, Research and Development Unit.
    Karlsson, Daniel M. G.
    Linköping University, Department of Biomedical Engineering.
    Wiréhn, Ann-Britt
    Region Östergötland, Regional Board, Research and Development Unit.
    Persson, Lennart
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    COPD patients require more health care than heart failure patients2018In: ERS International Congress 2018, 2018Conference paper (Refereed)
    Abstract [en]

    Background: Populations of elderly patients with advanced stages of chronic obstructive pulmonary disease (COPD) or heart failure (HF) are growing, urging the need for specialized health care in the patients’ home. A 4 year (2013-2017) telehealth intervention single-centre clinical study has been completed. We hypothesized that the two groups of patients, advanced COPD or HF, would exhibit differences regarding exacerbations and the need of health care.

    Objective: To study exacerbations of COPD or HF, and patients’ need of health care.

    Methods: A telemonitoring system, the Health Diary, which is based on digital pen technology, was employed. Patients with at least 2 hospital admissions the previous year were included. Responsible nurses and physicians at a specialized home care unit at a university hospital checked all daily patient reports. Physicians identified exacerbations using information provided through the telemonitoring system and patient contacts. Consumed health care was assessed as the number of patient contacts (home visits or telephone consultations).

    Results: Totally, 94 patients with advanced disease were enrolled (36 COPD and 58 HF patients) of which 53 patients (19 COPD and 34 HF patients) completed the 1-yr study period. The major reason for not completing the study was death (13 COPD, 15 HF patients). Average numbers of exacerbations were 3.1 and 0.8 and patient contacts were 94 and 67 per COPD and HF patient, respectively.

    Conclusions: Compared to HF patients, COPD patients exhibit exacerbations more frequently and demand much more home health care. This difference of health care consumption is mainly due to disease characteristics.

  • 20.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Shahsavar, Nosrat
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Åhlfeldt, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Requirements and prototyping of a home health care application based on emerging JAVA technology.2002In: International Journal of Medical Informatics, ISSN 1386-5056, Vol. 68, no 1-3, p. 129-139Article in journal (Refereed)
    Abstract [en]

    IT support for home health care is an expanding area within health care IT development. Home health care differs from other in- or outpatient care delivery forms in a number of ways, and thus, the introduction of home health care applications must be based on a rigorous analysis of necessary requirements to secure safe and reliable health care. This article reports early experiences from the development of a home health care application based on emerging technologies. A prototype application for the follow-up of diabetes patients is presented and discussed in relation to a list of general requirements on home health care applications.

  • 21.
    Lind, Leili
    et al.
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Sundvall, Erik
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Experiences from development of home health care applications based on emerging Java technology2001In: MEDINFO 2001,2001, Amsterdam: IOS Press , 2001, p. 830-Conference paper (Refereed)
  • 22.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Implementation and testing of a digital pen and paper tool to support patients with heart failure and their health care providers in detecting early signs of deterioration and monitor adherence2011Conference paper (Other academic)
  • 23.
    Lind, Leili
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Health, Activity, Care. Linköping University, Faculty of Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Implementation and testing of the digital pen to support patients with heart failure and their health care providers in detecting early signs of deterioration and monitor adherence - a pilot study2011Conference paper (Other academic)
  • 24.
    Loutfi, Amy
    et al.
    Örebro University, Örebro, Sweden.
    Jönsson, Arne
    SICS East, Linköping, Sweden.
    Karlsson, Lars
    Örebro University, Örebro, Sweden.
    Lind, Leili
    SICS East, Linköping, Sweden.
    Linden, Maria
    Mälardalen University, Västerås, Sweden.
    Pecora, Federico
    Örebro University, Örebro, Sweden.
    Voigt, Thiemo
    SICS ICT, Stockholm, Sweden.
    Ecare@Home: A Distributed Research Environment on Semantic Interoperability2016In: Internet of Things Technologies for HealthCare: Third International Conference, HealthyIoT 2016, Västerås, Sweden, October 18-19, 2016, Revised Selected Papers / [ed] Mobyen Uddin Ahmed; Shahina Begum; Wasim Raad, Springer, 2016, p. 3-8Conference paper (Refereed)
    Abstract [en]

    This paper presents the motivation and challenges to developing semantic interoperability for an internet of things network that is used in the context of home based care. The paper describes a research environment which examines these challenges and illustrates the motivation through a scenario whereby a network of devices in the home is used to provide high-level information about elderly patients by leveraging from techniques in context awareness, automated reasoning, and configuration planning.

  • 25.
    Lyth, Johan
    et al.
    Region Östergötland, Regional Board, Research and Development Unit.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Karlsson, Daniel
    The National Board of Health and Welfare, Department for Knowledge-Based Policy of Social Services, eHealth and Structured Information Unit, Stockholm, Sweden.
    Persson, Lennart Hans
    Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Respiratory Medicine.
    Wiréhn, Ann-Britt
    Region Östergötland, Regional Board, Research and Development Unit.
    Can a telemonitoring system lead to decreased hospital admissions in elderly patients?2018Conference paper (Refereed)
    Abstract [en]

    Background: Populations of elderly patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) are growing. To prevent exacerbations leading to inpatient care, a 4 year (2013-2017) telehealth intervention non-randomized single-centre clinical study was performed. We hypothesized that the patients, grouped by advanced COPD or HF, would exhibit decreased need of hospital admissions.

    Objective: To study hospital admissions in patients with COPD or HF using a telemonitoring system, the Health Diary.

    Methods: A telemonitoring system, the Health Diary, based on digital pen technology, was employed. Patients with COPD or HF treated at the University Hospital in Linköping were included if they had at least 2 hospital admissions the previous year. Data on hospital admissions was obtained from the administrative healthcare database. Expected number of hospital admissions for the study year was calculated using 5-year data for a group of patients with matching diagnosis and history of hospital admissions and was compared to the actual value in the intervention group using Poisson regression.

    Results: Together with the included patients, 159 HF and 136 COPD non-intervention patients was used to calculate the expected values for hospital admissions. For the 58 included HF patients, the average number of hospital admissions of 0.81 was 32.8 percent (p=0.04) lower than expected. For the 36 included COPD patients, the average number of hospital admissions of 1.44 was 37.0 percent (p=0.02) lower than expected.

    Conclusions: Use of the telemonitoring system, the Health Diary, decreases hospital admissions in elderly with COPD and HF.

  • 26.
    Nyström, Mikael
    et al.
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Örman, Håkan
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Sundvall, Erik
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Shahsavar, Nosrat
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Karlsson, Daniel
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering.
    Det krävs en riktad satsning på e-hälsa2016In: Dagens medicin, ISSN 1104-7488, no 18, p. 22-Article in journal (Other (popular science, discussion, etc.))
  • 27.
    Santini, Marina
    et al.
    RISE Research Institutes of Sweden, Sweden.
    Jönsson, Arne
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. RISE Research Institutes of Sweden, Sweden.
    Strandqvist, Wiktor
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. RISE Research Institutes of Sweden, Sweden.
    Cederblad, Gustav
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering.
    Nyström, Mikael
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. RISE Research Institutes of Sweden, Sweden.
    Alirezaie, Marjan
    Örebro universitet, Institutionen för naturvetenskap och teknik.
    Lind, Leili
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering. RISE Research Institutes of Sweden, Sweden.
    Blomqvist, Eva
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering. RISE Research Institutes of Sweden, Sweden.
    Lindén, Maria
    Mälardalen University, Sweden.
    Kristoffersson, Annica
    Institutionen för naturvetenskap och teknik, Örebro universitet.
    Designing an Extensible Domain-Specific Web Corpus for “Layfication”: A Case Study in eCare at Home2019In: Cyber-Physical Systems for Social Applications / [ed] Maya Dimitrova and Hiroaki Wagatsuma, Hershey, PA, USA: IGI Global, 2019, p. 98-155Chapter in book (Refereed)
    Abstract [en]

    In the era of data-driven science, corpus-based language technology is an essential part of cyber physical systems. In this chapter, the authors describe the design and the development of an extensible domain-specific web corpus to be used in a distributed social application for the care of the elderly at home. The domain of interest is the medical field of chronic diseases. The corpus is conceived as a flexible and extensible textual resource, where additional documents and additional languages will be appended over time. The main purpose of the corpus is to be used for building and training language technology applications for the “layfication” of the specialized medical jargon. “Layfication” refers to the automatic identification of more intuitive linguistic expressions that can help laypeople (e.g., patients, family caregivers, and home care aides) understand medical terms, which often appear opaque. Exploratory experiments are presented and discussed.

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