A Self-Reporting Tool to Reduce the Occurrence of Postoperative Adverse Events After Total Hip Arthroplasty

This thesis presents a research that has designed and evaluated a high-fidelity smartphone prototype, called SafeTHA. SafeTHA has been designed for patients to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A User-Centered Design approach was utilized to facilitate an optimal user experience and to emphasize the end-user. The prototype has two main functionalities. Firstly, it enables patients to self-report their current state through answering five simple questions from evidence-based practices regarding pain, anxiety, mobility, progress, and quality of recovery. Secondly, it informs the user about several aspects of rehabilitation such as pain, known risk factors, wound management, and recommended activity level. The use of mobile technology could enable timely self-reporting and collection of subjective patient data out of a hospital setting. The low-, and mid-fidelity prototypes were assessed by experts of Interaction Design, Medical Informatics, Biomedical Engineering, and healthcare professionals with respect to interaction flow, information content, and self-reporting functionalities. They found it to be practical, intuitive, sufficient and simple for users. The high-fidelity prototype was evaluated by medical experts and usability experts through the rigorous methods, System Usability Scale (SUS) and Heuristic Evaluation (HE). The results indicate that patient self-reporting could help recognize safety issues, adverse events, and empower patients postoperatively. Additional testing in a clinical setting is needed to fully demonstrate its usefulness.Masteroppgave i informasjonsvitenskapINFO390MASV-INF

Mobile Design For Adverse Event Reporting And Pharmacovigilance

Patient safety is concerned with protecting patients from errors, injuries, accidents, and infections. It is also concerned with capturing adverse events and understanding their severity. Reporting of adverse events help prevent poor patient outcomes in their acute phase. Another way of dealing with adverse events is by preventing them through the practice of monitoring the effects of drugs, medical devices including the detection, assessment, and understanding of an adverse event; this approach is called pharmacovigilance. Design Science framework was used for creating two mobile design solutions in the field of arthroplasty: one for the adverse event reporting and the other one for the pharmacovigilance. User centered design was utilized to understand requirements, context, and possibilities of managing and retrieving information of relevance for patient safety. Firstly, a mobile design for reporting of adverse events has proposed user interface to enable entry of data specific for knee and hip implants. Besides that, the system supports entry of the adverse event, its classification (serious, non-serious), its follow-up. Safety reports can be initiated and retrieved on request and depending on the adjudication of the event. Suspected severe events should be followed up and reported internally as well as to the national regulatory authorities until they are resolved and concluded. Expert evaluation of the first design solution was performed using low fidelity prototype. It has shown that design was relevant, straightforward, done in a way that official reporting would commence. Some users were positive to the reporting; some felt it would demand more work. The second design was focused on pharmacovigilance which seemed to be more appealing to the target group. It deals with the safety of medical devices (implants) by understanding the risks and dangers already reported by other clinicians or researchers. Internet resources such as the Manufacturer And User Facility Device Experience (MAUDE) web-site are often retrieved due to the lack of internal, local safety databases. The designed mobile solution for pharmacovigilance was based on the web system called WebBISS (Web-based implant search system) using HCI approach. The goal was not only to improve usability, but also to stimulate physicians to enter their safety data and become contributors, and not only users of information. The expert evaluation has been positive and encouraged developing stronger help and error reporting functions regarding the mobile application.Masteroppgave i informasjonsvitenskapINFO390MASV-INF

Design Driven Development of a Web-Enabled System for Data Mining in Arthroplasty Registry

This research was inspired by the work at the Norwegian Arthroplasty Registry, which serves as a national resource for understanding the longevity of implanted prostheses, analyzing risks, and patient outcomes in general. At this moment, they have no online system that would help and enable several user groups to take advantage of the data for clinical, research, and informative purposes. This thesis has contributed with a high-fidelity prototype of a desktop application named LeddPOR. The system is dedicated to three user groups: patients, physicians, and researchers. The project was completed in collaboration with three other master students, comprising a back-end and front-end development team. Knut T. Hufthamer and Sølve Ånneland, who provided valuable data mining tasks to be incorporated in the prototype, and Arle Farsund Solheim created visualizations that allow interactive data exploration. The project followed the User-Centered Design approach, as a method to produce a prototype that would be appreciated by real users. The Design Science Research methodology allowed five iterations, within which prototypes from low- to high fidelity have taken form. The final, fully interactive prototype is intended for physicians, researchers, and patients. There are two dedicated parts; one for hip, and the other for knee. Under those, a number of data mining tasks could be performed at the convenience of the expert user. The sessions can be saved and reviewed according to users' preferences and needs. The patient part of the system is offering mainly information, but also some resources such as formerly developed applications supporting post-operative care. During this development, we have defined two patient personas, acknowledging their different needs. On the expert side, two personas were created, one for physicians and one for researchers. Usability testing was conducted with both expert and novice users, which suggested a high success rate. The final System Usability Score (SUS) of 95 points, as well as feedback from evaluation, indicate a potential to develop a product that could be valuable for several user groups.Masteroppgave i informasjonsvitenskapINFO390MASV-INF

Process of posthospital care involving telemedicine solutions for patients after total hip arthroplasty

The importance of telemedicine technologies around the world has been growing for many years, and it turned out to be a particularly important issue for conducting some medical procedures during the SARS-CoV-2 pandemic. It is necessary to create interdisciplinary teams to design and implement improved procedures using telemedicine tools. The aim of the article is to develop original, improved posthospital patient care process after total hip arthroplasty (THA) with the use of telemedicine technologies. In the study, a literature review and empirical research were used. The conducted research resulted in the designing an original posthospital patient care process after THA that uses telematics technologies. Due to the use of analyzed telemedicine technologies, the designed patient care process brings a possibility to increase the patient′s safety by monitoring life parameters, allowing for regular, remote contact with specialists and to be supervised remotely. All this may contribute to shortening the convalescence time, reducing the risk of complications, as well as reducing treatment costs. The designed model is ready for further clinical research with the participation of medical staff, patients after THA and patient caregivers

Augmented Reality: Mapping Methods and Tools for Enhancing the Human Role in Healthcare HMI

Background: Augmented Reality (AR) represents an innovative technology to improve data visualization and strengthen the human perception. Among Human–Machine Interaction (HMI), medicine can benefit most from the adoption of these digital technologies. In this perspective, the literature on orthopedic surgery techniques based on AR was evaluated, focusing on identifying the limitations and challenges of AR-based healthcare applications, to support the research and the development of further studies. Methods: Studies published from January 2018 to December 2021 were analyzed after a comprehensive search on PubMed, Google Scholar, Scopus, IEEE Xplore, Science Direct, and Wiley Online Library databases. In order to improve the review reporting, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used. Results: Authors selected sixty-two articles meeting the inclusion criteria, which were categorized according to the purpose of the study (intraoperative, training, rehabilitation) and according to the surgical procedure used. Conclusions: AR has the potential to improve orthopedic training and practice by providing an increasingly human-centered clinical approach. Further research can be addressed by this review to cover problems related to hardware limitations, lack of accurate registration and tracking systems, and absence of security protocols

e-Visits For Early Post-operative Visits Following Orthopaedic Surgery Can They Add Efficiency Without Sacrificing Effectiveness

We asked 217 sport surgery and 135 total knee arthroplasty (TKA) patients to complete a questionnaire (e-Visit) before attending their two and six-week post-operative appointment. Our primary objective was to use the questions asked of patients prior to their appointment to develop a model that could be used as web-based e-Visit to predict early post-operative adverse events. Gold standard comparison was the surgeon’s opinion as to the presence or absence of an event at follow-up. Secondary objective was evaluation of a simplified model. We found good area under the curve (AUC) statistics (0.76 (95% CI 0.69 - 0.84) and 0.80 (95% CI .74 - .85)) and good sensitivity (0.70, 0.83) and specificity (0.70, 0.80) for the two- week model and for the six-week model respectively. The simplified models and raw-data models were similar. Future work should improve the web-based interface, include educational content, and be validated using a large multicenter RCT

Development and validation of patients' surgical safety checklist

Background Poor uptake and understanding of critical perioperative information represent a major safety risk for surgical patients. Implementing a patient-driven surgical safety checklist might enhance the way critical information is given and increase patient involvement in their own safety throughout the surgical pathway. The aim of this study was to develop and validate a Surgical Patient Safety Checklist (PASC) for use by surgical patients. Method This was a prospective study, involving patient representatives, multidisciplinary healthcare professionals and elective surgical patients to develop and validate PASC using consensus-building techniques in two Norwegian hospitals. A set of items intended for PASC were rated by patients and then submitted to Content Validation Index (CVI) analyses. Items of low CVI went through a Healthcare Failure Mode and Effect Analysis (HFMEA) Hazard Scoring process, as well as a consensus process before they were either kept or discarded. Reliability of patients’ PASC ratings was assessed using Intraclass Correlation Coefficient analysis. Lastly, the face validity of PASC was investigated through focus group interviews with postoperative patients. Results Initial development of PASC resulted in a checklist consisting of two parts, one before (32 items) and one after surgery (26 items). After achieving consensus on the PASC content, 215 surgical patients from six surgical wards rated the items for the CVI analysis on a 1-4 scale and mostly agreed on the content. Five items were removed from the checklist, and six items were redesigned to improve PASCs’ user-friendliness. The total Scale-level index/Average (S-CVI/Ave) before revision was 0.83 and 0.86 for pre- and post-operative PASC items, respectively. Following revision, these increased to 0.86 and 0.93, respectively. The PASC items reliability score was 0.97 (95% confidence interval 0.96 to 0.98). The qualitative assessment identified that patients who used PASC felt more in control of their situation; this was achieved when PASC was given to them at what they felt was the right time and healthcare professionals took part in its usage. Conclusion Multidisciplinary perioperative care staff and surgical patients agreed upon PASC content, the checklist ratings were reliable, and qualitative assessment suggested good face validity. PASC appears to be a usable and valid checklist for elective surgical patients across specialties.publishedVersio