Hadron Therapy (HT) exploits properties of ion radiation to gain therapeutic advantages over existing photon-based forms of external radiation therapy. However, its relative superiority and cost-effectiveness have not been proven for all clinical situations. Establishing a robust evidence base for the development of best treatment practices is one of the major challenges for the field. This thesis investigates two research infrastructures for building this essential evidence. First, the thesis develops main components of a metadata-driven software architecture for the collection of clinical information and its analysis. This architecture acknowledges the diversity in the domain and supports data interoperability by sharing information models. Their compliance to common metamodels guarantees that primary data and analysis results can be interpreted outside of the immediate production context. This is a fundamental necessity for all aspects of the evidence creation process. A metamodel of data capture forms is developed with unique properties to support data collection and documentation in this architecture. The architecture's potential to support complex analysis processes is demonstrated with the help of a novel metamodel for Markov model based simulations, as used for the synthesis of evidence in health-economic assessments. The application of both metamodels is illustrated on the example of HT. Since the biological effect of particle radiation is a major source of uncertainty in HT, in its second part, this thesis undertakes first investigations towards a new research facility for bio-medical experiments with ion beams. It examines the feasibility of upgrading LEIR, an existing accelerator at the European Organisation for Nuclear Research (CERN), with a new slow extraction and investigates transport of the extracted beam to future experiments. Possible configurations for the slow-resonant extraction process are identified, and designs for horizontal and vertical beam transport lines developed. The results of these studies indicate future research directions towards a new ion beam facility for biomedical research.

Diffusion Tensor Imaging (DTI) is a magnetic resonance imaging (MRI)-based technique that has frequently been used for the identification of brain biomarkers of neurodevelopmental and neurodegenerative disorders because of its ability to assess the structural organization of brain tissue. In this work, I present (1) preclinical findings of a longitudinal DTI study that investigated asymptomatic high school football athletes who experienced repetitive head impact and (2) an automated pipeline for assessing the quality of DTI images that uses a convolutional neural network (CNN) and transfer learning. The first section addresses the effects of repetitive subconcussive head trauma on the white matter of adolescent brains. Significant concerns exist regarding sub-concussive injury in football since many studies have reported that repetitive blows to the head may change the microstructure of white matter. This is more problematic in youth-aged athletes whose white matter is still developing. Using DTI and head impact monitoring sensors, regions of significantly altered white matter were identified and within-season effects of impact exposure were characterized by identifying the volume of regions showing significant changes for each individual. The second section presents a novel pipeline for DTI quality control (QC). The complex nature and long acquisition time associated with DTI make it susceptible to artifacts that often result in inferior diagnostic image quality. We propose an automated QC algorithm based on a deep convolutional neural network (DCNN). Adaptation of transfer learning makes it possible to train a DCNN with a relatively small dataset in a short time. The QA algorithm detects not only motion- or gradient-related artifacts, but also various erroneous acquisitions, including images with regional signal loss or those that have been incorrectly imaged or reconstructed.

Quality online health information/knowledge is globally in high demand. Achieving such quality necessitates a multi-disciplinary requirements engineering approach that enables elicitation, analysis and representation of the viewpoints from a broad variety of related sources. These sources include health and health education/promotion professionals, health informaticians and application design experts, and health consumers, the primary users of such knowledge. In addition, maintaining and improving quality over time requires such a large set of viewpoints to be updated regularly. This dissertation endeavors to provide an enabling methodology to address the above needs specifically in the field of eHealth. This research was conducted in two steps. In the first step, the existing methods of requirements engineering applicable into our particular scope of eHealth applications, aimed at health promotion/education, were reviewed to develop a framework for knowledge requirements engineering. In the second step, the usability and usefulness of the proposed framework were evaluated throughout a four-phase study (0-III). During this study, knowledge requirements engineering was used to specify the pieces of information that should be included in a quality health Web site targeting university students. Within the established framework, requirements data was gathered from various sources, including literature, existing Web sites, and interviews with local health professionals and university students. The evaluation results showed that the pieces of information and health topics specified using the framework consistently matched those the subjects preferred. In addition, the findings provided evidence that such information, when used by health search engines to index and retrieve online health resources, helped the subjects choose the resources that actually matched their interest. Finally, the data showed a higher satisfaction of the subjects with the health Web site that was built based on the knowledge requirements specified, as compared to the other selected health Web sites. This dissertation makes significant contributions to the fields of health informatics, health promotion, and requirements engineering. It contributes to the field of health informatics by expanding the scope of requirements engineering to include the field of eHealth and knowledge provision. The approach presented illustrates how various viewpoints related to requirements knowledge should be elicited, analyzed, and reasoned to build valid knowledge requirements specifications representing viewpoints of all sources consulted. It also illustrates how such specifications can be used as a basis to build quality eHealth applications. In the field of health promotion, this dissertation demonstrates a knowledge provision methodology that is grounded in the models of health behaviour change. This methodology allows health educators to rationally and accurately specify not only the health topics of high interests to health consumers, but also the type of knowledge they would prefer to be provided in the related knowledge artifacts. More particularly, this research has specified the health knowledge content of preference to adolescent consumers. These specifications highlight the particular knowledge needs of this age group, which can be used as a basis for local to national health promotion activities targeting these consumers. Finally, the research contributes to the field of requirements engineering by illustrating an integrated requirements engineering approach that accommodates multiple viewpoints and allows transparent reasoning and representation of requirements. It is anticipated that the concept of knowledge requirements engineering introduced and discussed in this dissertation will open a new area of research and practice for health informaticians. Subsequently, the methodology demonstrated can be improved and further advanced to address the needs of other domains of health and health-related knowledge.

This study investigates, within the current health care situation, the interrelationship of the user, resources and tool in the design of a prototype WELLNESS database-driven web site. A shift has taken place in health care, in which the base of conventional medicine has broadened to integrate other systems, practices and worldviews. These include complementary and alternative medicine, health promotion, disease prevention and wellness. Emphasis is placed on the need to take personal responsibility for one's own health and wellness. The global burden of chronic disease, reaching epidemic proportions, is increasingly linked to risk factors resulting from personal lifestyle choices. The growing evidence of the user's need to make personal, informed, lifestyle choices and their reliance on the Web for health information, required investigation. WELLNESS, a specific orientation to health and wellness, formed the framework within which the user and resources were defined and the tool designed. The user was profiled as the WELLNESS health information seeker, hereby contributing significantly to an understanding of the user in this new context. The user profile informed the establishment of resource selection criteria and tool design. The identification of WELLNESS content selection criteria, within a five-dimensional model, was required to ensure quality, relevant and credible resources. The tool is comprised of the WELLNESS thesaurus and WELLNESS database-driven web site. The WELLNESS thesaurus was constructed based on a combination of relevant thesauri. It will be used as an indexing tool. An investigation of existing health information web sites highlighted the importance of designing a specific WELLNESS database-driven web site. A database host was identified against which the original study's conceptual schema was assessed. A low-fidelity prototype web site was designed as the interface between the WELLNESS health information seeker and the database of WELLNESS health information resources. This study has epidemiological, philosophical, epistemological, sociological and psychological relevance. The provision of access to WELLNESS health information resources, made available in the WELLNESS database-driven web site, for personal, informed lifestyle choice by the WELLNESS health information seeker could potentially contribute to the reduction of the global burden of chronic disease. / Information Science / D.Litt. et Phil. (Information Science)

Eine stetig wachsende Zahl von Nutzern sucht im Internet nach Gesundheitsinformationen. Hierzu steht ihnen eine Vielzahl ganz unterschiedlicher Anbieter zur Verfügung, die bei divergierenden Interessen gesundheitsrelevante Angebote im Internet vorhalten. Abgesehen von der Informationsflut, mit der die Nutzer bei der Suche überhäuft werden, erhalten sie auch falsche, irreführende, veraltete und sogar gesundheitsgefährdende Informationen. In den letzten zehn Jahren haben verschiedene Wissenschaftler die Anforderungen an ein ideales Gesundheitsinformationssystem ermittelt. Im Rahmen des in diesem Beitrag beschriebenen Projekts wurde ein Gesundheitsinformationssystem als Prototyp zur anamnesebezogenen, internetbasierten Patienteninformation entwickelt und anhand einer Studie evaluiert. Dabei wird die Untersuchung auf deutschsprachige Erwachsene mit Kopfschmerzen eingegrenzt. Insgesamt wird die Hypothese überprüft, dass eine angeleitete, anamnesebezogene Internetsuche für den Patienten bessere Ergebnisse liefert, als dies durch die herkömmliche Nutzung von Gesundheitsportalen oder Suchmaschinen erreicht werden kann. Zur Evaluation wurde eine kontrollierte Zweigruppenstudie mit insgesamt 140 Teilnehmern in zwei Studienabschnitten durchgeführt. Dabei wurde im ersten Abschnitt festgestellt, dass bei einfach strukturierten Krankheitsfällen das Informationssystem gleichgute Ergebnisse liefert wie die herkömmliche Suche. Im zweiten Abschnitt konnte allerdings festgestellt werden, dass bei komplexen Kopfschmerzfällen mit Hilfe des Prototyps signifikant (P=0,031) bessere Diagnosen gestellt werden konnten als ohne. Medizinische Expertensysteme in Kombination mit einer Meta-Suche nach maßgeschneiderten qualitätsgesicherten Informationen erweisen sich als probate Möglichkeit, den Ansprüchen an eine geeignete Versorgung mit Gesundheitsinformationen gerecht zu werden. / A steadily increasing number of users search for health information online. Therefore, a multitude of totally different providers with diverging interests offer information. Apart from the information overload the users are flooded with, they may access false, misleading or even life threatening information. In the last 10 years scientists have determined the requirements of an ideal health information system. In the study described in this paper a prototype health information system providing anamnesis related internet-based consumer health information is evaluated. In total, the hypothesis that a computer-aided anamnesis-related internet search provides better results than the use of conventional search engines or health portals is evaluated. For evaluation a randomised controlled study with 140 participants has been conducted in two study sections. In the first section it was found, that for a less complex diagnosis the prototype information system did equally well as the conventional information retrieval. In the second study section it was found, that dealing with complex headache cases participants using the prototype determined significantly better (P=0.031) diagnoses than the control group did without prototype support. It has been shown, that medical expert systems in combination with a meta-search for tailored quality controlled information represents a feasible strategy to provide reliable health information.

Bakgrund: Den omänskliga faktorn kan vara en riskfaktor för verksamhetsnyttan, goda arbetsmiljön, säkerheten och hållbarheten i hälso- och sjukvården. Några av anledningarna till att Artificiell Intelligens (AI) har börjat bli realistiskt inom hälso- och sjukvården är datorernas ökade prestanda och tillgång till stora mängder data. AI har potential att fungera som ett verktyg för att implementera digitaliseringen inom hälso- och sjukvården, samtidigt som den mänskliga närvaron kan bevaras. Syfte: Undersöka hur vårdpersonalen förhåller sig till användningen av AI-system och deras upplevelse av kontroll och ansvar. Metod: Kvalitativ design används och semistrukturerade intervjuer genomfördes. Inledningsvis användes allmänna frågor för att fånga informanternas tidigare och nuvarande erfarenhet av AI-system i hälso- och sjukvården. Därefter utformades fortsatta frågor enligt vinjettmetoden. Kvalitativ analysmetod användes för att tolka intervjuerna. Resultat: Analysen resulterade i sex kategorier som belyser olika aspekter av vårdpersonalens samarbete med AI-system inom hälso- och sjukvården. Dessa kategorier inkluderar kontrollbehov, samstämmighet, prestation, övervakning, kunskap och prioritering. Diskussion: Motsats till AI kan människor hållas ansvariga för sina beslut och för de beslut som fattas av AI-system. Inom sjukvården upplever vårdpersonalen ett gemensamt helhetsansvar för patientvården, oavsett lagar och regler. Vetskapen om att behöva möta patienter eller anhöriga och framföra dåliga nyheter, är det som verkligen sätter ansvaret i perspektiv. Vid felaktigheter påverkas hela vårdteamet, även om de inte själva orsakat felet. I framtiden kommer vårdpersonalens roll att gå från att vara bedömare till att vara övervakare. Denna förändring kan dock orsaka problem, eftersom vårdpersonalens kontrollbehov för AI-system minskar i akuta situationer. I dessa situationer fokuserar vårdpersonalen på att normalisera situationen och prioriterar bort allt annat. Beslut som fattas görs med medvetenheten om att de sannolikt behöver omprövas när situationen har stabiliserats. Detta problematiserar den nya rollen som övervakare, eftersom vårdpersonalen i dessa situationer egentligen borde ha större fokus på att se till att AI-systemet fungerar korrekt. Slutsats: Det är osannolikt att vårdpersonalen kommer att kunna hantera de snabba och komplexa beslut som AI-systemet gör. Det kommer kräva ökad kunskap från vårdpersonalen för att identifiera situationer där AI-systemet kan göra fel och i händelse av en akut situation kommer personalen att prioritera detta över andra åtaganden. För att etablera ett samarbete mellan människa och maskin inom vården krävs utbildning och förståelse för det skifte som sker för vårdpersonalens roll, att gå från bedömning till övervakning av AI-systemen. / Background: The inhumane factor can be a risk factor for operational benefit, good working environment, safety and sustainability in healthcare. Some of the reasons why Artificial Intelligence (AI) has started to become realistic in healthcare are the increased performance of computers and access to large amounts of data. AI has the potential to act as a tool to implement digitization in healthcare, while preserving the human presence. Purpose: Investigate how healthcare professionals relate to the use of AI systems and their experience of control and responsibility. Method: Qualitative design is used and semi-structured interviews were conducted. Initially, general questions were used to capture the informants' previous and current experience with AI-systems in healthcare. Further questions were then designed according to the vignette method. Qualitative analysis method was used to interpret the interviews. Results: The analysis resulted in six categories that highlight different aspects of healthcare professionals collaboration with AI-systems in healthcare. These categories include control needs, compliance, performance, monitoring, knowledge, and prioritization. Discussion: Unlike AI, humans can be held accountable for their decisions and for the decisions made by AI-systems. In healthcare, the healthcare professionals experience a shared overall responsibility for patient care, regardless of laws and regulations. The knowledge of having to meet patients or relatives and deliver bad news is what really puts the responsibility into perspective. In the event of errors, the entire healthcare team is affected, even if they did not cause the error themselves. In the future, the role of healthcare professionals will change from being an assessor to instead monitor the AI-system. However, this change can cause problems, as healthcare professionals control needs for AI-systems are reduced in emergency situations. In these situations, the healthcare professionals focus on normalizing the situation and deprioritises everything else. Decisions that are made are made with the awareness that they will likely need to be reconsidered once the situation has stabilized. This problematizes the new role of supervisor, because in these situations the healthcare professionals should really be more focused on making sure the AI-system is working correctly. Conclusion: It is unlikely that healthcare professionals will be able to handle the rapid and complex decisions made by the AI-system. It will require increased knowledge from the healthcare professional, to identify situations where the AI system can make mistakes and in the event of an emergency, the staff will prioritize this over other commitments. In order to establish a collaboration between humans and machines in healthcare, training and understanding of the shift that is taking place for the role of the healthcare professionals, to go from assessment to monitoring of the AI systems, is required.

Bakgrund: Det råder en obalans i den svenska välfärdssektorn på grund av den demo­grafiska utvecklingen. Äldreomsorgen är ett välfärdsområde där digitaliseringen kan skapa stora möjligheter genom att tänka och arbeta på nya sätt i kombination med att använda digital teknik och e-hälsa men för att nyttja digitaliserings möjligheter behö­ver anpassningar göras inom äldreomsorgen. Syfte: Syftet med studien är att beskriva chefers och medarbetares erfarenheter av hur anpassning till förutsättningar vision, kompetens, belöning, resurser och handlings­plan kan främja förändring vid en digital transformation av en kommuns äldreomsorg. Metod: Genom en kvalitativ fallstudie genomfördes tre fokusgrupps­intervjuer med chefer och medarbetare inom äldreomsorgen i en mindre kommun. Urvalet av informanter baserades på ett generiskt ändamålsstyrt urval och fokus­gruppsintervjuerna utgick från en semistrukturerad intervjuguide. Resultatet analyse­rades genom kvalitativ riktad innehållsanalys med deduktiv ansats utifrån byggsten­arna i Thylefors förändringsmodell. Resultat: Chefers och medarbetares erfarenheter av hur anpassningar till förutsätt­ningar kan främja digital transformation inom äldreomsorgen i en kommun beskrivs samt chefers och medarbetares behov av stöd i förändringen. Totalt tio subkategorier identifierades till Thylefors byggstenar vision, kompetens, belöning, resurser och handlingsplan. Slutsats: Chefers och medarbetares erfarenheter av hur anpassningar kan främja för­ändring inom äldreomsorgen vid en digital transformation, i den kommun där studien genomfördes, visar att vision, förändringsledning och digital kompetens spelar en central roll. Chefers och medarbetares erfarenheter av stöd i förändringsprocessen vi­sar på behov av tid för utbildning och innovation samt en handlingsplan som bör in­kluderas i det systematiska kvalitetsarbetet. Chefer och medarbetare erfar liknande behov av anpassningar och stöd vilket skulle kunna indikera att resultatet kan beaktas vid digital transformation inom äldreomsorgen i en liknande kontext. Förslag till framtida forskning är bland annat att undersöka hur digital transformation inom äl­dreomsorgen kan främja ett hållbart ledarskap och utvecklande medarbetarskap. / Background: There is an imbalance in the Swedish welfare sector due to demogra­phic changes. Elderly care is an area of welfare where digitization can create great opportunities by thinking and working in new ways in combination with using digital technology and e-health. However, to take advantage of the opportunities, adaptations need to be made within the elderly care.  Aim: The purpose of the study is to describe managers' and employees' experiences of how adaptation to conditions such as vision, competence, incentives, resources, and action plan can promote change in a digital transformation of a municipality's elderly care.  Method: A qualitative case study was conducted, including three fo­cus group interviews with managers and employees in elderly care in a small muni­cipality. The selection of informants was based on a generic purpose-driven selection and the focus group interviews were based on a semi-structured interview guide. The data were analyzed through qualitative directed content analysis with a deductive ap­proach based on the building blocks in Thylefors' change model. Results: Managers' and employees' experiences of how adaptations to conditions can promote digital transformation in elderly care in a municipality are described, as well as managers' and employees' needs for support in the change. A total of ten subcate­gories were identified related to Thylefors' building blocks: vision, competence, in­centives, resources, and action plan.  Conclusion: Managers' and employees' experiences of how adaptations can promote change in elderly care during digital transformation, in the municipality where the case study was conducted, show that vision, change management and digital compe­tence play a central role. Managers' and employees' experiences of support in the change process show the need for time regarding training, innovation and an action plan which should be included in systematic quality management. Managers’ and em­ployees’ experience similar needs for adaptations and support, which could indicate that the findings can be considered in a similar context of digital transformation in elderly care. Suggestions for future research include for example investigating how digital transformation in elderly care can promote sustainable leadership and emplo­yee empowerment skills.

Bakgrund: Den tekniska utvecklingen går snabbt framåt och kan innebära en utmaning för många grupper i samhället, framförallt äldre. Sverige har som mål att år 2025 vara bäst på eHälsa och som ett delmål har ett register i form av Nationella Läkemedelslistan tagits fram. Registret ska ge patienter, vård- och apotekspersonalen tillgång till samma information med målet att öka patientsäkerheten och patienters delaktighet i vården. För att komma åt den här information krävs inloggning till eHälsomyndighetens tjänst Läkemedelskollen. Äldre personer har ofta mindre datorvana och väljer i många fall papper framför digitala tjänster. Apotekslistan är den analoga tjänsten som just nu erbjuder receptinformation i pappersform till patienterna. Syfte: Studiens syfte var att beskriva äldre patienters upplevelser av att använda receptinformation i analog form och deras uppfattning om digitala alternativ. Material och metod: En kvalitativ semistrukturerad intervjustudie har genomförts och urval har skett strategiskt och målstyrt för att fånga respondenter med olika nivå av teknikvana och på olika demografiska platser i Sverige. Rekrytering skedde med snöbollsurval och resulterade i 9 respondenter. Resultatet tolkades sedan med hjälp av UTAUT och TTF. Resultat: Den fysiska Apotekslistan fyller en viktig funktion i patientens läkemedelsprocess och skapar trygghet för individen. Många respondenter har svårt att se fördelarna med en digital version och upplever att den fysiska listan är tillförlitlig och uppfyller alla krav och behov som finns. Slutsats: En del av den åldrande befolkningen vill ha tillgång till det fysiska pappret som ett alternativ till digitala tjänster och upplever att den skapar trygghet och förenklar vardagen. För att locka fler äldre att testa Läkemedelskollen kan utbildningar tas fram för att minska äldre personers teknostress. En utveckling av tjänsten skulle kunna öka intresset och tillföra ett mervärde som förenklar livet med läkemedel. / Background: Technical development is advancing rapidly and entails a need for skills development for many groups in society, especially the elderly. Sweden aims to be the best in eHealth by 2025, and as an intermediate goal, a register in the form of the “National Medication List” has been introduced. The register will give patients, care and pharmacy staff access to the same information with the aim of increasing patient safety and patients' participation in care. To access this information, login to the eHealth Authority's service Läkemedelskollen is required. Older people often have less computer skills and, in many cases, choose paper over digital services. Apotekslistan is the analogue service that currently offers prescription information on paper to patients. Purpose: The purpose of the study was to describe elderly patients' experiences of using prescription information in analog form and their attitude to digital alternatives. Material and method: A qualitative semi-structured interview study were conducted and selection has been made strategically and goal-oriented to capture participants with different levels of technical knowledge and in different demographic locations in Sweden. Recruitment took place with a snowball selection and resulted in 9 participants. The result was interpreted using UTAUT and TTF. Result: The physical list Apotekslistan fulfills an important function in the patient's drug process and gives the patient a feeling of security. Many people find it difficult to see the benefits of a digital version and feel that the physical list is reliable and meets all the requirements and needs that exist. Conclusion: Part of the aging population wants access to the physical paper as an alternative to digital services and feels that it creates security and simplifies everyday life. To attract more elderly people to try Läkemedelskollen, training can be developed to reduce older people's technology stress. A development of the service could increase interest and add value that simplifies living with chronic disease.

<p dir="ltr">Digital Health technologies have revolutionized healthcare delivery, offering innovative solutions that enhance access, improve patient outcomes, and optimize the use of resources. Despite this advancement, health outcomes remain disparate across different social groups, with underprivileged populations at an increased risk of poor health outcomes due to inadequate access to care. Digital Health technologies serve as a critical intervention in mitigating these disparities, particularly for groups affected by geographical, economic, and infrastructural barriers.<br><br>The purpose of this study was to conduct a review of the current state of Digital Health technologies, including Software as a Medical Device (SaMD), Wearable Health, Portable Diagnostic Devices, and remote care platforms, and their impact on healthcare accessibility. Employing qualitative methodology, this metasynthesis emphasized an important discovery: the need for a paradigm shift among stakeholders in healthcare towards integrated and digitally-driven patient care. This shift requires more than just an understanding of new technologies. It demands a fundamental re-evaluation of patient care methods and the orchestration of the entire healthcare system towards integrated digital practices. Importantly, this study found that the pace of digitalization must be carefully managed and cultural factors must be considered and signals the urgency for a balanced approach to digital integration in healthcare.</p>

<p dir="ltr">Axial spondyloarthritis (axSpA), a disease that due to its complexity and rarity, presents challenges in diagnosis. With a focus on integrating expert knowledge into an intelligent diagnostic system, the research explores the intricate nature of axSpA, emphasizing the challenges associated with its diverse clinical presentation. By leveraging a comprehensive knowledge base curated by domain experts, encompassing insights into pathophysiology, genetic factors, and evolving diagnostic criteria of axSpA, the expert system strives to provide a nuanced understanding of the disease. The methodology employs a hybrid reasoning approach, combining both forward and backward chaining techniques. Forward chaining iteratively processes clinical data and available evidence, applying logical rules to infer potential diagnoses and refine hypotheses, while backward chaining starts with the desired diagnostic goal and works backward through the knowledge base to validate or refute hypotheses. Additionally, certainty theory is incorporated to manage uncertainty in the diagnostic process, assigning confidence levels to conclusions based on the strength of evidence and expert knowledge. By integrating knowledge base, forward and backward chaining, and certainty theory, the research aims to enhance diagnostic precision for this less common yet impactful inflammatory rheumatic condition, emphasizing the importance of early and accurate identification for effective management and improved patient outcomes. The results indicate a significant improvement in diagnostic accuracy, sensitivity, and specificity compared to traditional methods. The system's potential to enhance early diagnosis and treatment outcomes is discussed, along with suggestions for future research to further refine and expand the system.</p>