Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach

The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients’ engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application—ePATH (electronic Patient Activation in Treatment at Home)—with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management

A randomized study of the effect of patient positioning on setup reproducibility and dose distribution to organs at risk in radiotherapy of rectal cancer patients

Background:The patient positioning in pelvic radiotherapy (RT) should be decided based on both reproducibilityand on which position that yields the lowest radiation dose to the organs at risk (OAR), and thereby less sideeffects to patients. The present randomized study aimed to evaluate the influence of patient positioning on setupreproducibility and dose distribution to OAR in rectal cancer patients.Methods:Ninety-one patients were randomized into receiving RT in either supine or prone position. Therecruitment period was from 2005 to 2008. Position deviations were derived from electronic portal imageregistrations, and setup errors were defined as deviations between the expected and the actual position of bonylandmarks. Setup deviations were expressed into three table shift values (Δx,Δy,Δz) from which the deviationvectorv→were calculated. The estimated lengths ofv→defined the main outcome and were compared betweenprone and supine positions using linear mixed model statistics. The mean volume of each 5 Gy incrementsbetween 5 and 45 Gy was calculated for the small bowel and the total bowel, and the dose volumes werecompared between prone and supine position.Results and conclusion:Data from 83 patients was evaluable. The meanv→was 5.8 mm in supine position and7.1 mm in prone position (p= 0.024), hence the reproducibility was significantly superior in supine position.However, the difference was marginal and may have borderline clinical importance. The irradiated volumes of thesmall bowel and the total bowel were largest in the supine position for all dose levels, but none of those weresignificantly different. The patient positioning in RT of rectal cancer patients may therefore be decided based onother factors such as the most comfortable position for the patients

Anal carcinoma - Survival and recurrence in a large cohort of patients treated according to Nordic guidelines.

To evaluate treatment outcome in a large population-based cohort of patients with anal cancer treated according to Nordic guidelines

Variability in prostate and seminal vesicle delineations defined on magnetic resonance images, a multi-observer, -center and -sequence study

Background: The use of magnetic resonance (MR) imaging as a part of preparation for radiotherapy is increasing. For delineation of the prostate several publications have shown decreased delineation variability using MR compared to computed tomography (CT). The purpose of the present work was to investigate the intra- and inter-physician delineation variability for prostate and seminal vesicles, and to investigate the influence of different MR sequence settings used clinically at the five centers participating in the study. Methods: MR series from five centers, each providing five patients, were used. Two physicians from each center delineated the prostate and the seminal vesicles on each of the 25 image sets. The variability between the delineations was analyzed with respect to overall, intra-and inter-physician variability, and dependence between variability and origin of the MR images, i.e. the MR sequence used to acquire the data. Results: The intra-physician variability in different directions was between 1.3 - 1.9 mm and 3 - 4 mm for the prostate and seminal vesicles respectively (1 std). The inter-physician variability for different directions were between 0.7 - 1.7 mm and approximately equal for the prostate and seminal vesicles. Large differences in variability were observed for individual patients, and also for individual imaging sequences used at the different centers. There was however no indication of decreased variability with higher field strength. Conclusion: The overall delineation variability is larger for the seminal vesicles compared to the prostate, due to a larger intra-physician variability. The imaging sequence appears to have a large influence on the variability, even for different variants of the T2-weighted spin-echo based sequences, which were used by all centers in the study