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  • 1.
    Ahmad, Farooq
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Selection of foundational ontology for collaborative knowledge modeling in healthcare domain2010In: Artificial intelligence: methodology, systems, and applications / [ed] Dicheva, Darina; Dochev, Danail, Springer Berlin/Heidelberg, 2010, p. 261-262Conference paper (Refereed)
    Abstract [en]

    Ontology design is an important process for structuring knowledge to be reused in different projects in the health domain. In this paper, we describe an ontology design for the collaborative knowledge building system ACKTUS to be used for developing personalized knowledge applications for different domains. Different foundational ontologies were compared with respect to selected criteria considered vital for the project, such as modularity and descriptiveness.

  • 2.
    Baskar, Jayalakshmi
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Semantic model for adaptive human-agent dialogues2014Manuscript (preprint) (Other academic)
    Abstract [en]

    A common conversation between an older adult and a nurse about health-related issues includes topics such as troubles with sleep, reasons for walking around nighttime, pain conditions, etc. Such a dialogue can be regarded as a "natural" dialogue emerging from the participating agents' lines of thinking, their roles, needs and motives, while switching between topics as the dialogue unfolds. The purpose of this work is to define a generic model of purposeful human-agent dialogues suitable for health-related topics. This is done based on analyses of scenarios, personas and models of human behavior. The results include four models, which need to be included in a software agent's belief base; i) a user model, ii) a model of the domain knowledge related to the topic of the dialogue, iii) an agent model, and iv) a dialogue activity model. The models were implemented into a prototype system for human-agent dialogues, which was evaluated by therapists and a group of older adults.

  • 3.
    Baskar, Jayalakshmi
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Towards personalised support for monitoring and improving health in risky environments2013In: VIII Workshop on Agents Applied in Health Care (A2HC), 2013, p. 93-104Conference paper (Refereed)
  • 4.
    Baskar, Jayalakshmi
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Surie, Dipak
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Yan, Chunli
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Yekeh, Farahnaz
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Personalisation and user models for support in daily living2012In: The 27th annual workshop of the Swedish Artificial Intelligence Society (SAIS), 14–15 May 2012 / [ed] Lars Karlsson, Julien Bidot, 2012, p. 7-16Conference paper (Refereed)
    Abstract [en]

    In recent years, the interest in developing personalised applications for home environment has grown since it has a wide reach in helping people in their daily activities. However, for our purposes the concept activities of daily living also need to include work and leisure activities not necessarily performed in home environments. In this article, we describe an ongoing effort to develop a generic framework for assessing ability and tailoring of support applications in the health domain. We also give an overview of the approaches that have been adopted for personalisation and user modelling to various application areas. Suggestions of future development are provided.

  • 5.
    Baskar, Jayalakshmi
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Yan, Chunli
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    User's control of personalised intelligent environments supporting health2013In: Intelligent Environments (IE), 2013 9th International Conference on, IEEE Computer Society, 2013, p. 270-273Conference paper (Refereed)
    Abstract [en]

    This research project aims at supporting workers in the mining and construction industries and older adults at home, in monitoring the risks of their daily work or living situation. A goal is to create awareness in the individual about risks and how to decrease risks. Methods and knowledge-based applications are developed, which synthesise knowledge about the user, the user’s activities, the environment and generic domain knowledge for the purpose of providing tailored support and advice to individuals. This knowledge is also what the user can relate to, interact with and control through different methods. In this paper we investigate different approaches to user control of intelligent environments and propose a dialogue-based method for user control.

  • 6.
    Eklund, Patrik
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Eriksson, S
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Karlsson, Johan
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Näslund, Annica
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Software development and maintenance strategies for guideline implementation2001In: EUNITE-Workshop: intelligent systems in patient care, Austrian Computer Society , 2001, p. 26-45Conference paper (Refereed)
    Abstract [en]

    In this paper we discuss various software engineering aspects of guideline computerisation, both from domain oriented as well as technology driven points of view. The discussion includes case studies on pharmacological treatment of hypertension, diagnosis of dementia, and drug interactions.

  • 7.
    Eklund, Patrik
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Helgesson, Robert
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Towards refining clinical evidence using general logics2008In: Artificial Intelligence and Soft Computing – ICAISC 2008: 9th International Conference Zakopane, Poland, June 22-26, 2008, Proceedings, Springer , 2008, p. 1029-1040Conference paper (Refereed)
    Abstract [en]

    Clinical knowledge building upon evidence-based medicine is typically represented in textual guidelines, thus providing a rather informal description from a logical point of view. Further, the context which provides utility of these guidelines is not specified in any detail with respect to workflow and underlying motivations for decision-making. In addition, the level of detail is mostly static in the sense that measurements and decision values are fixed and intended for specific user groups. There is thus a lack of flexibility which disables knowledge to be shifted coherently between user levels in the entire workflow and decision process. In this paper, we will discuss formalizations of the underlying logical structures of guidelines from the viewpoint of being represented appropriately at each user level. Further, to establish a formal correctness criterion, the shift from one level of representation to another is required to be morphic in the categorical sense. General logics [6] is the selected generalized, and categorical, framework for our approach to flexible guideline representation. Our medical scope is dementia differential diagnosis based on consensus guidelines [2], and we focus on types of cognitive disorders as a prerequisite for further diagnostic tasks.

  • 8.
    Eklund, Patrik
    et al.
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Towards Dementia Diagnosis Logic2006In: 11th Int. Conf. Information Processing and Management of Uncertainty in Knowledge-based Systems (IPMU'06), Paris: Editions EDK , 2006, p. 1251-1257Conference paper (Refereed)
    Abstract [en]
    Historical motivations for classification systems in health care are requirements of data collections for statistics. Aims to unify data collections eventually becomes a starting point for nomenclature and ontology developments. Diagnosis encoding plays an important role in shifting the paradigm from providing statistics to making decisions. For logic and decision support the situation is non-trivial as nomenclatures continuously change and diagnostic categories are extended. Further, management of both phenomenology and etiology in differential diagnosis requires organisation and logical structure of information modalities and disease taxonomies. In this paper we provide a logical analysis of a diagnostic manual dividing mental disorders into disorder types. The subdivision is based on criteria (rule) sets and defining features (facts). Our focus is on dementia and we show and compare how particular underlying logic for encoding the dementia classifier can manage heterogeneity of individuals sharing a diagnosis and manyvaluedness of truth regarding diagnosis of boundary cases.
  • 9.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    ALI, an ambient assisted living system for supporting behavior change2013In: VIII Workshop on Agents Applied in Health Care (A2HC 2013), 2013, p. 81-92Conference paper (Refereed)
  • 10.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    ALI, an Assisted Living System Based on a Human-Centric Argument-Based Decision Making Framework2013In: 13th Workshop on Computational Models of Natural Arguments (CMNA 2013), 2013, p. 46-51Conference paper (Refereed)
  • 11.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    ALI: an assisted living system for persons with mild cognitive impairment2013In: 2013 IEEE 26th International symposium on computer-based medical systems (CBMS), 2013, p. 526-527Conference paper (Refereed)
    Abstract [en]

    We introduce the Assisted Living system ALI, which is a novel approach to providing assistance and support in activities of daily life. We integrate a human behavior theory with a default reasoning decision making framework. This integration allows us to model a decision making problem from a human activity centric point of view and at the same time, formalize these elements using a possibilistic argumentation theory. ALI sends personalized notifications suggesting the most suitable activities to perform and determines what activities were performed during a time period.

  • 12.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    ALI: an Assisted Living System for Persons with Mild Cognitive Impairment2013In: 26th IEEE International Symposium on Computer-Based Medical Systems (CBMS 2013), IEEE Computer Society, 2013, p. 526-527Conference paper (Refereed)
    Abstract [en]

    We introduce the Assisted Living system ALI, which is a novel approach to providing assistance and support in activities of daily life. We integrate a human behavior theory with a default reasoning decision making framework. This integration allows us to model a decision making problem from a human activity centric point of view and at the same time, formalize these elements using a possibilistic argumentation theory. ALI sends personalized notifications suggesting the most suitable activities to perform and determines what activities were performed during a time period.

  • 13.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Arguing through the well-founded semantics: an argumentation engine2014Article in journal (Refereed)
  • 14.
    Guerrero, Esteban
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nieves, Juan Carlos
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Semantic-based construction of arguments: an answer set programming approach2015In: International Journal of Approximate Reasoning, ISSN 0888-613X, E-ISSN 1873-4731, Vol. 64, p. 54-74Article in journal (Refereed)
    Abstract [en]

    In this paper, we introduce an argumentation approach which takes an extended logic program as input and gives a set of arguments with the respective disagreements among them as output. We establish the notion of an argument under the Well-Founded semantics and Stable semantics inferences, allowing us to identify arguments with stratified programs as support, even when the input for the argument engine is a non-stratified program. We propose a set of rationality postulates for argument-based systems under extended logic programs, which are based on a definition of closure for a set of clauses that consider the well-known Gelfond-Lifschitz reduction. We establish the conditions under which our approach satisfies these principles. In addition, we present a standalone argumentation-tool based on the XSB system which implements our argumentation approach.

  • 15.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Activity Theoretical Evaluation of a Decision Support System for Dementia Care2003In: Proceedings of Medical Informatics in Europe (MIE 2003), CD-version, 2003Conference paper (Refereed)
    Abstract [en]
    Clinical decision support systems (CDSS) are developed for the purpose of supporting the user’s cognitive processes and generating a higher quality of medical care. A critical phase in the development process is the implementation of a system into clinical practice. In the view of Activity theory the system will not be complete and meaningful to evaluate until it meets praxis. In the development of a CDSS for dementia care an evaluation was made of a prototype system where general practitioners were observed using the system and interviewed. The results of the evaluation was analyzed according to the framework of Activity theory, in order to obtain a better understanding of reasons for failure and success in the process of implementing a decision support system into clinical practice.
  • 16.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Activity-Theoretical Model as a Tool for Clinical Decision-Support Development2006In: Poster Proc. EKAW 2006 - 15th International Conference on Knowledge Engineering and Knowledge Management, 2006Conference paper (Refereed)
    Abstract [en]
    Clinical investigation activities are complex processes, which are situated, emergent and directed by the individual need of the patient, but also restricted or enhanced by the available resources at different points in the process. For the purpose of creating a system which provides support throughout the investigation process, i.e. functioning as a cognitive tool for the user, the clinical investigation process needs to be assessed and formalized. The presented work is based on analyzes of the domain knowledge and case studies of investigations of actual patients and provides a conceptual model for a clinical investigation activity. The framework of cultural-historical activity theory was used for the interpretation of the data and the model is used for identifying which actions are appropriate for formalization in a decisionsupport system.
  • 17.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Assessment of Clinical Activity for Decision-Support Development2006Report (Other academic)
  • 18.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Collaborative and Distributed Guideline Modeling in the dementia domain: an evaluation study of ACKTUS2010In: MEDINFO 2010: Proceedings of the 13th World Congress on Medical Informatics / [ed] Edited by C. Safran, S. Reti, H.F. Marin, Amsterdam: IOS Press , 2010, Vol. 160Conference paper (Refereed)
  • 19.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Collaborative Knowledge Building for Decision-Support System Development2008In: Human-Computer Interaction Symposium (HCIS2008) : IFIP World Computer Congress 2008 (WCC 2008), Berlin/Heidelberg: Springer , 2008, p. 201-206Conference paper (Refereed)
    Abstract [en]
    The clinical domain of cognitive diseases and dementia is recognized by its highly complex knowledge domain, requiring expertise and experience in handling situations with a variety of symptoms and diseases, distributed over different levels in organizations and different professions. In this paper a pilot study is presented where eight experienced physicians in Sweden and Japan used an early prototype of the decision-support system DMSS (Dementia Management and Support System) in one to five well-known patient cases each. The prototype functioned as a mediator of a reflective conceptual artifact, i.e., the current understanding of the activity in focus in each patient case. The aim was to develop a common understanding of the clinical domain knowledge, differences in local process knowledge, needs for support and interactivity, by using the prototype as mediator. The physicians were observed using the system and interviewed individually and in groups. Results include adjustments of knowledge sources, terminology and design of user interface, interaction and knowledge base.
  • 20.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Computer-Supported Diagnostic Reasoning in Dementia Care2012In: Sweden - Korea Dementia Forum 2012 / [ed] Daein Kang, 2012, p. 107-118Conference paper (Other (popular science, discussion, etc.))
  • 21.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Conceptual Model as a Tool for Assessing Knowledge in Decision-Support Development2007In: MEDINFO 2007 : Poster proceedings of the 12th World Congress on Health (Medical) Informatics, 2007Conference paper (Refereed)
    Abstract [en]
    In the development of a decision-support system the domain knowledge as well as the target work environment need to be assessed in order to capture the knowledge to be integrated in and provided by the system. This work describes the model used for the assessment, which is based on Activity theory and case studies of patients investigated concerning suspected dementia. The purpose is to investigate to what extent the theory is useful for the assessment and for transforming the informal knowledge into formal descriptions for knowledge representation and design of interaction. The resulting structure provides the data and their sorts and qualities, the tools that are used in assessing the data, the actions of transforming the data and contextual factors such as who is responsible for a certain action. The semi-formal structure can be transformed into a formal structure for representation by using the structure to identify requirements for formalisation languages.
  • 22.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Conceptual Model of Activity as Tool for Developing a Dementia Care Support System2008In: Knowledge Management in Action – WCC 2008, Berlin/Heidelberg: Springer , 2008, p. 97-109Conference paper (Refereed)
    Abstract [en]
    The clinical domain of cognitive diseases and dementia is recognized by its highly complex knowledge domain, requiring expertise and experience in handling situations with a variety of symptoms and diseases, distributed over different levels in organizations and different professions. In this paper a case study is presented where the process of investigating suspected dementia in patient cases were analyzed. An early prototype of the decision-support system DMSS (Dementia Management and Support System) was integrated in the process. The main aim for the case study was to capture and model the complex target activity for the purpose of knowledge acquisition and formalization in the development of a decision-support system for the domain. The resulting model is general, in that it captures structures and required knowledge at different levels of care, however, specific enough to provide a perception of use context and semi-formal base for further development of the system for different use environments, with different local solutions to work division, etc. The results are fed into the development of DMSS and the general activity analysis framework is being developed.
  • 23.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Decision support in dementia care: developing systems for interactive reasoning2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is a need to improve dementia care in Sweden. The main issues discussed are how to improve the competence of medical personnel and the quality of diagnosis and intervention. In this thesis the process of developing a decision-support system for the investigation of dementia is described, as one means to meet the need. The resulting prototype system DMSS (Dementia Management Support System) has been developed in cooperation with domain experts, and has been evaluated and redesigned in the process in an iterative development process. The process involves the assessment of evidence-based domain knowledge and its characteristics, the assessment of the procedural knowledge residing in clinical practice, and reasoning processes. Further, the terminology and main reasoning process integrated in the system have been validated. Qualitative methods have been used for these parts of the project for the purpose of assessing as many different aspects as possible, and for practical reasons due to the limited access to domain experts, patients and primary care physicians in the area. Triangulation of methods has been applied in order to validate results in the process. The development has been extended to also include prototypes for Japanese clinical environments.

    Clinical investigation activities are complex processes, which are situated, emergent and directed by the individual need of the patient, but also restricted or enhanced by the available resources at different points and at different care levels in the process. For the purpose of creating a system which provides support throughout the investigation process, the domain knowledge and the clinical investigation process was analysed and formalised in a conceptual model of clinical activity, developed based on activity theory and case studies of patients. The need for methods for the transformation of informal results from field studies into formal knowledge and design is addressed by providing the framework, which integrates the conceptual model of clinical activity and a method for the assessment and transformation of the knowledge to be integrated in a decision-support system.

    The model was used to identify actions and their characteristics suitable for formalisation in a decision-support system. Several sources of domain knowledge need to be integrated that express the knowledge differently, which increases the demands on a formalism for representation. The work towards formalising the diagnostic reasoning process in both typical and atypical patient's cases is presented, where the evidence in ambiguous cases is valued within different frames of references in order to improve specificity. Different logical frameworks have been applied, evaluated and developed using case studies of patients. Two lines of work towards a dementia logic and flexible guideline representation is presented; the defeasible, non-monotonic approach where many-valued dictionaries are used in a context-based argumentation framework; and the monotonic approach of integrating reasoning in a fundamental view of transformations between logics, using general logics as generalised and categorical framework.

  • 24.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Decision support system supporting clinical reasoning process: an evaluation study in dementia care2008In: EHealth Beyond the Horizon: Get IT There - Proceedings of MIE2008 / [ed] Stig Kjaer Andersen, Gunnar O. Klein, Stefan Schulz, Jos Aarts, M. Cristina Mazzoleni, IOS Press, 2008, Vol. 136, p. 315-320Conference paper (Refereed)
    Abstract [en]

    In this paper, a case study is presented in which an early prototype of a decision-support system was integrated in the process of investigating patients with suspected dementia and evaluated. The aims were to capture and model the complex target activity for the purpose of knowledge acquisition and formalization, and qualitatively evaluate the system's compliance with reasoning and work processes as part of the development of a decision-support system for the domain. The results show that contextual factors such as local routines in clinical practice motivate further development of the support integrated in the system for establishing preliminary diagnoses in the investigation process.

  • 25.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    DIcog - A Decision Support System for Clinical Investigation of Cognitive Diseases2004In: Proc. AILS-04 Workshop, Lund: Lund University , 2004, p. 87-88Conference paper (Refereed)
    Abstract [en]
    In this paper a prototype system as a tool for clinical decision support in the domain of cognitive diseases is presented. The number of patients is increasing while the number of patients that the general practitioner (GP) meets in primary care still is too low to make the GP well trained in diagnostics and management of patients in the area of cognitive diseases. In addition, new treatment strategies are established in clinical routine directed towards cognitive deficiencies with behavioral and psychological symptoms in the presence of dementia (BPSD). Additional support is needed in the investigation process of cognitive diseases. The system DIcog supports the clinician by challenging, complementing and/or confirming the individual’s own reasoning; providing with reminders of additional factors to consider; and functioning as a common ground for consultations and teamwork. A combination of inference techniques is used in the system; if-then rules for typical patient’s cases and for atypical cases an argumentative reasoning approach, which is currently being developed for the domain of cognitive diseases.
  • 26.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Integrating clinical decision support system development into a development process of clinical practice: experiences from dementia care2011In: Artificial Intelligence in Medicine: 13th Conference on Artificial Intelligence in Medicine, AIME 2011, Bled, Slovenia, July 2-6, 2011 / [ed] Mor Peleg, Nada Lavrac and Carlo Combi, Springer Verlag , 2011, p. 129-138Conference paper (Refereed)
    Abstract [en]

    This paper describes the process of developing the decision-support system DMSS (Dementia Management and Support System) and some lessons learned. An action research and participatory design approach has been adopted during development, with a strong research focus on optimizing support to physicians in dementia diagnosis assessment, involving a number of physicians and clinics in the process. A stand-alone version is currently used in 11 clinics distributed over four countries. Results from evaluation studies show that the system and the physician comply in 84,6% of the patient cases and that reasons for non-compliance lie primarily in physician’s insufficient knowledge. The impact the system has had on the individual physician’s diagnostic procedure in observation studies, factors identified enabling the integration and obstacles to use are presented and discussed. The system’s support for assessing basic cognitive functions is being improved, primarily as a feature for personalization of a future web-based version of DMSS.

  • 27.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Knowledge Artifacts as Tools to Communicate and Develop Knowledge in Collaborative User-Driven Design2012In: 25th IEEE International Symposium on Computer-Based Medical Systems (CBMS 2012), IEEE Computer Society, 2012, p. 210-215Conference paper (Refereed)
    Abstract [en]

    We investigate an ongoing user-driven collaborative knowledge engineering and interaction design process. The anticipated outcomes are knowledge-based support applications for health care professionals and other actors in the dementia domain.The two major goals for the activity in focus are: 1) to accomplish international collaboration across organizational, language and professional boundaries in the modeling of knowledge and design of interaction, and 2) in a local community provide ICT support for collaboration and communication between organizations, increase knowledge development in individual actors and increase the quality of dementia care. The semantic web-based prototype system ACKTUS is introduced as a tool for modeling and communicating knowledge and interaction, and its role in the process is evaluated. The activity is organized as a part of a collaborative work between different organizations to develop their local clinical practice. Obstacles and success factors when enabling the endusers to design their own tools are detected and discussed.

  • 28.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Limitations in physicians' knowledge when assessing dementia diseases: an evaluation study of a decision-support system2011In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 169, p. 120-124Article in journal (Refereed)
    Abstract [en]

    There is a need to provide tools for the medical professional at the point of care in the assessment of a suspected dementia disease. Early diagnosis is important in order to provide appropriate care so that the disease does not cause unnecessary suffering for the patient and relatives. DMSS (Dementia Management and Support System) is a clinical decision-support system that provides support in the diagnosis of a dementia disease, which is in use in controlled clinical evaluation settings in four countries. This paper reports the results of evaluations done in use environments in these places during a period of two years. Data in 218 patient cases were collected by 21 physicians during their use of the system in clinical practice. In 50 of the cases the use of the system were also observed and the physicians were interviewed in 88 cases. The collected data and inferences made by the system were analyzed. To summarize the results, DMSS gave appropriate support considering the patient case, available information and the user's skills and knowledge in the domain. However, the results also illuminated the need for extended and personalized support for the less skilled physician in the assessment of basic information about patients.

  • 29.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Managing Knowledge in the Development of a Decision-Support System for the Investigation of Dementia2005Licentiate thesis, monograph (Other academic)
  • 30.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Personalisation of internet-mediated activity support systems in the rehabilitation of older adults: a pilot study2009In: AIME 2009 International Workshop on Personalisation for e-Health / [ed] Floriana Grasso, Cécile Paris, 2009, p. 20-27Conference paper (Refereed)
    Abstract [en]

    The inclusion and autonomy of older people in the society where large parts of the life is organized with computer and Internet use as means is addressed in an ongoing project in the rehabilitation and health domains. Part from investigating the potentials of using ICT for rehabilitation of older people with limited or no computer skills, the aim for the project is to develop methods and tools for the purpose, and also for the interaction design domain where systems are developed for older people. This paper reports results from using activity theory and the notion of ZPD for prototype development and evaluation of decision and activity support systems as a common tool for the patient and professional in the rehabilitation process. The results include a protocol for capturing the users’ development of skills in Internet-mediated activity. The protocol is used for informing the design of the system in an iterative process.

  • 31.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Sociotechnical systems as innovation systems in the medical and health domain2013In: Context Sensitive Health Informatics: Human and Sociotechnical Approaches / [ed] Marie-Catherine Beuscart-Zéphir, Monique Jaspers, Craig Kuziemsky, Christian Nøhr, Jos Aarts, IOS Press, 2013, Vol. 194, p. 35-40Conference paper (Refereed)
    Abstract [en]

    It is argued that a development of healthcare systems should emerge within a healthcare providing organization and as part of daily practice instead of something implemented by a third party, in order to become successful. This sociotechnical view on system development is shared with new methods developed in the end-user development field. However, is it possible to realize this in practice? This paper explores the obstacles and potentials in the realization, leading to a discussion about sociotechnical systems as innovation systems. We describe two examples of sociotechnical innovation systems, and discuss the results from an end user driven innovation process perspective.

  • 32.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Towards context-based inquiry dialogues for personalized interaction2011In: Advances in practical applications of agents and multiagent systems / [ed] Yves Demazeau, Michal Pechoucek, Juan M. Corchado and Javier Bajo Pérez, Springer Berlin/Heidelberg, 2011, p. 151-161Conference paper (Refereed)
    Abstract [en]

    ACKTUS is a semantic web application for modeling knowledge to be integrated in support systems for health care, and for designing the interaction with the end user applications. This paper presents the ongoing work on integrating argument-based inquiry dialogues between agents that include contextual factors in the reasoning. Practical applications of agent-based and interactive dialogue systems are rare in the medical and health domain, partly due to its safety-critical nature. The purpose of the work presented in this paper is to demonstrate the added value a personalized dialogue system can provide a clinician in clinical practice in terms of learning and decision making as supplement to a regular decision-support system in the dementia domain.

  • 33.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Towards personalized decision support in the dementia domain based on clinical practice guidelines2011In: User modeling and user-adapted interaction, ISSN 0924-1868, E-ISSN 1573-1391, Vol. 21, no 4-5, p. 377-406Article in journal (Refereed)
    Abstract [en]

    A set of evidence-based clinical practice guidelines has been synthesized and integrated in the clinical decision support system DMSS-R (Dementia Management and Support System) to support clinical routines and reasoning processes as performed by individual health professionals in daily practice. DMSS-R provides advice, tailored to individual and often exceptional patient cases, to the user while providing guidance to the next step in the assessments and support for hypothesis generation and evaluation throughout the process. This paper describes DMSS-R and the results of a case study in clinical practice where the system was used. The case study included interviews and observations of the clinical investigation process as undertaken in 41 real patient cases with suspected dementia. Two physicians participated, one of whom was considered a novice regarding dementia while the other had a moderate level of skills. Initially, both physicians were unfamiliar with DMSS-R. A group of nurses together with care personnel and relatives were also involved. The most important contribution of DMSS-R at the point of care, apart from the tailored explanatory support related to a patient case, was the educational support it provided. This was partly manifested in a change of routines in the encounter with patients. Aspects regarding the individual health care professional’s need for a personalized support system are discussed and put in relation to the team’s need for support, and in relation to the diversity of disease manifestations in this group of patients, which reinforces patient-centric assessments.

  • 34.
    Lindgren, Helena
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Towards using argumentation schemes and critical questions for supporting diagnostic reasoning in the dementia domain2009In: Computational models of natural arguments (CMNA'09), 2009, p. 10-14Conference paper (Refereed)
  • 35.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Burström, Lage
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Järvholm, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Developing Ambient Support Technology for Risk Management in the Mining Industry2014In: Ambient Intelligence - Software and Applications: 5th International Symposium on Ambient Intelligence / [ed] Carlos Ramos, Paulo Novais, Céline Ehrwein Nihan, Juan M. Corchado Rodríguez, Springer, 2014, Vol. 291, p. 161-69Chapter in book (Refereed)
    Abstract [en]

    There is a major goal in the mining industry to reduce risks and maintain health in work environments. Moreover, the industry is obliged to monitor the risks in work environment as well as employers’ health statuses. The potentials in using ambient information for the purpose to reduce risks, prevent work-related injuries and monitor health in individuals has been explored. Applications tailored to the individual are being developed to aid the worker in mining or mining-related work environments in valuing the risks of their work situation and create awareness in the individual about how he or she can decrease risks for primarily physical damages. The purpose is to encourage the worker to act upon the level of risk for injuries, and upon the new insights the worker gain from the applications. The identified opportunities for and obstacles to integrating ambient information in these health applications are discussed.

  • 36.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Dierential diagnosis of dementia in an argumentation framework2006In: Journal of Intelligent & Fuzzy Systems, ISSN 1064-1246, E-ISSN 1875-8967, Vol. 17, no 4, p. 387-394Article in journal (Refereed)
    Abstract [en]

    In order to provide support for differential diagnosis of dementia in medical practice, logical specification of a single clinical guideline is not sufficient. Therefore, a synthesis guideline has been formalized using core features from selected clinical guidelines which report high sensitivity, using conventional two-valued propositional logic. This guideline is sufficient for capturing the major part of typical cases of patients in the domain. However, in order to provide support in atypical cases, additional clinical guidelines are needed in the reasoning process which report higher specificity but are pervaded with more uncertainty. In order to capture the different levels of significance in evidence expressed in the clinical guidelines an argumentation framework based on a many-valued propositional logic is adapted for the domain. This is accomplished in a context of transformations between logics. Formal frameworks will be given as well as a clinical case study where the sets of values that are attached to arguments correspond to the vocabulary used in the clinical guidelines, as well as the functions which compute the significance.

  • 37.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Eklund, Patrik
    Differential diagnosis of dementia in an argumentation framework2006In: Journal of Intelligent & Fuzzy Systems, ISSN 1064-1246, E-ISSN 1875-8967, Vol. 17, no 4, p. 387-394Article in journal (Refereed)
    Abstract [en]

    In order to provide support for differential diagnosis of dementia in medical practice, logical specification of a single clinical guideline is not sufficient. Therefore, a synthesis guideline has been formalized using core features from selected clinical guidelines which report high sensitivity, using conventional two-valued propositional logic. This guideline is sufficient for capturing the major part of typical cases of patients in the domain. However, in order to provide support in atypical cases, additional clinical guidelines are needed in the reasoning process which report higher specificity but are pervaded with more uncertainty. In order to capture the different levels of significance in evidence expressed in the clinical guidelines an argumentation framework based on a many-valued propositional logic is adapted for the domain. This is accomplished in a context of transformations between logics. Formal frameworks will be given as well as a clinical case study where the sets of values that are attached to arguments correspond to the vocabulary used in the clinical guidelines, as well as the functions which compute the significance.

  • 38.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Logic of Dementia Guidelines in a Probabilistic Argumentation Framework2005In: Symbolic and Quantitative Approaches to Reasoning with Uncertainty: 8th European Conference, ECSQARU 2005, Barcelona, Spain, July 6-8, 2005, Proceedings, Springer , 2005, p. 341-352Conference paper (Refereed)
    Abstract [en]
    In order to give full support for differential diagnosis of dementia in medical practice, one single clinical guideline is not sufficient. A synthesis guideline has been formalized using core features from selected clinical guidelines for the purpose of providing decision support for clinicians in clinical practice. This guideline is sufficient for typical cases in the domain, but in order to give support in atypical cases additional clinical guidelines are needed which are pervaded with more uncertainty. In order to investigate the applicability of a probabilistic formalism language for the formalization of these guidelines, a case study was made using the qualitative probabilistic reasoning approach developed in [1]. The case study is placed in context of a foundational view of transformations between logics. The clinical decision-making motivation and utility for this transformation will be given together with some formal indications concerning this transformation.
  • 39.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Eriksson, S.
    Clinical decision support system in dementia care2002In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 90, p. 568-576Article in journal (Refereed)
    Abstract [en]

    In this paper we present a prototype system as a tool for clinical decision support in the domain of cognitive diseases. The number of patients is increasing while the number of patients that the general practitioner (GP) meets in primary care still is too low to make the GP well trained in diagnostics and management of patients in the area of cognitive diseases. In addition, new treatment strategies are established in clinical routine directed towards cognitive deficiencies with behavioural and psychological symptoms in the presence of dementia (BPSD).

  • 40. Lindgren, Helena
    et al.
    Eklund, Patrik
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Clinical decision support system in dementia care.2002In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 90, p. 568-71Article in journal (Refereed)
    Abstract [en]

    In this paper we present a prototype system as a tool for clinical decision support in the domain of cognitive diseases. The number of patients is increasing while the number of patients that the general practitioner (GP) meets in primary care still is too low to make the GP well trained in diagnostics and management of patients in the area of cognitive diseases. In addition, new treatment strategies are established in clinical routine directed towards cognitive deficiencies with behavioural and psychological symptoms in the presence of dementia (BPSD).

  • 41.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Decision-Support System for the Investigation of Dementia2005In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 17, no 2, p. 277-277Article in journal (Refereed)
  • 42.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    DMSS - Dementia management and support system for interactive reasoning and decision-making2007In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 19, no 1, p. 281-282Article in journal (Refereed)
  • 43.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Departement of Computing Science.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
    Managing Knowledge for Decision Support in the Investigation of Cognitive Disorders2005In: Proc. Medical Informatics in Europe (MIE 2005), CD-version, 2005Conference paper (Refereed)
    Abstract [en]
    In the development of a clinical decision-support system for the domain of cognitive disorders, the domain knowledge was analysed. Certain qualitative aspects of the knowledge were of special interest, which, when taken into account, allow the system to be used as the intended cognitive tool which mediates learning, reasoning and decision-making in a clinical setting. The aspects concerned granularity, complexity and ambiguity in the evidence. Motives for how these are managed in the system development are given. The domain knowledge was integrated in a model of the clinical reasoning process, which was valuated by interviewing and observing domain experts and primary care physicians while using the prototype system with the model integrated. The resulting support given by the system throughout the reasoning process includes the distinction between typical and atypical cases of patients, an interpretation of the evidence concerning a patient within different contexts of clinical guidelines, thus eliciting ambiguities and their sources. The system also provides different level of support depending on the user’s need and experience.
  • 44.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Sociotechnical integration of decision support in the dementia domain2010In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 157, p. 79-84Article in journal (Refereed)
    Abstract [en]

    The need for improving dementia care has driven the development of the clinical decision support system DMSS (Dementia Management and Support System). A sociotechnical approach to design and development has been applied, with an activity-centered methodology and user participation throughout the process. Prototypes have been developed based on the characteristics of clinical practice and domain knowledge, while clinical practice has been subjected to different efforts for development such as education and organizational change. This paper addresses the lessons learned and role and impact DMSS has had, and is expected to have on the clinical assessment of dementia in different clinics in Sweden, South Korea and Japan. Furthermore, it will be described in what way the development of DMSS and the development of dementia care in these three areas are interlinked. Results indicate that the most important contribution of DMSS at the point of care, is the educational support that DMSS provides, part from the tailored explanatory support related to a patient case. This effect was partly manifested in a change of routines in the encounter with patients.

  • 45.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Pohl, Petra
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Sandlund, Marlene
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    End users transforming experiences into formal information and process models for personalised health interventions2014In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 205, p. 378-382Article in journal (Refereed)
    Abstract [en]

    Five physiotherapists organised a user-centric design process of a knowledge-based support system for promoting exercise and preventing falls. The process integrated focus group studies with 17 older adults and prototyping. The transformation of informal medical and rehabilitation expertise and older adults' experiences into formal information and process models during the development was studied. As tool they used ACKTUS, a development platform for knowledge-based applications. The process became agile and incremental, partly due to the diversity of expectations and preferences among both older adults and physiotherapists, and the participatory approach to design and development. In addition, there was a need to develop the knowledge content alongside with the formal models and their presentations, which allowed the participants to test hands-on and evaluate the ideas, content and design. The resulting application is modular, extendable, flexible and adaptable to the individual end user. Moreover, the physiotherapists are able to modify the information and process models, and in this way further develop the application. The main constraint was found to be the lack of support for the initial phase of concept modelling, which lead to a redesigned user interface and functionality of ACKTUS.

  • 46.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Designing systems for health promotion and autonomy in older adults2009In: Interact´09, Springer , 2009, p. 700-703Conference paper (Refereed)
    Abstract [en]

    The inclusion and autonomy of older people in the society where large parts of the life is organized with computer and Internet use as means is addressed in an ongoing project in the rehabilitation and health domains. Part from investigating the potentials of using ICT for rehabilitation of older people with limited or no computer skills, the aim for the project is to develop methods and tools for the purpose, and also for the interaction design domain where systems are developed for older people. The resulting methods are used for informing the design of the system in an iterative process.

  • 47.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Towards User-Authored Agent Dialogues for Assessment in Personalised Ambient Assisted Living2013In: International Journal of Web Engineering and Technology, ISSN 1741-9212, Vol. 8, no 2, p. 154-176Article in journal (Refereed)
    Abstract [en]

    Existing approaches to ambient assisted living (AAL) often fail to consider a human agent's needs from a holistic perspective. In particular, the regular assessment of their changing abilities, skills and limitations are often treated as a separate matter in healthcare, thereby affecting the possibilities to provide support tailored to their current condition. Therefore, the objective of this work is to integrate assessment done by the healthcare professional into the framework of AAL. We use a case scenario as base for domain experts in their development of the interaction between software agents and with the older adult in assessment and adaptation for supporting him/her in a home environment. The potentials in allowing professionals author and design the dialogue systems as part of a meta-design process is evaluated and discussed.

  • 48.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Surie, Dipak
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Nilsson, Ingeborg
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Agent-supported assessment for adaptive and personalized ambient assisted living2011In: Trends in practical applications of agents and multiagent systems / [ed] Juan M. Corchado, Bajo Pérez, Kasper Hallenborg, Paulina Golinska and Rafael Corchuelo, Berlin/Heidelberg: Springer Berlin/Heidelberg, 2011, Vol. 90, p. 25-32Conference paper (Refereed)
    Abstract [en]

    Existing approaches to ambient assisted living (AAL) often fail to consider a human agent's needs from a holistic perspective. In particular the regular assessment of their changing abilities, skills and limitations are often treated as a separate matter in healthcare, thereby affecting the possibilities to provide support tailored to their current condition. Therefore, the objective of this work is to integrate assessment done by the healthcare professional into the framework of AAL. We propose a framework based on a model for activity-centered modeling of knowledge and interaction tailored to users (ACKTUS) and an egocentric interaction model. We exemplify the interaction between system modules as agent dialogues in assessment and adaptation for supporting an older adult in a home environment.

  • 49.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Winnberg, Patrik J.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Winnberg, Peter
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Domain Experts Tailoring Interaction to Users – An Evaluation Study2011In: Human-Computer Interaction – INTERACT 2011: 13th IFIP TC 13 International Conference, Lisbon, Portugal, September 5-9, 2011, Proceedings, Part III / [ed] Pedro Campos, Nicholas Graham, Joaquim Jorge, Nuno Nunes, Philippe Palanque and Marco Winckler, Springer, 2011, p. 644-661Conference paper (Refereed)
    Abstract [en]

    This paper presents ACKTUS, a modeling tool for developingknowledge-based systems for the health domain, and an evaluation study of thesystem. The main purpose of the evaluation was to investigate whether thefunctionality and interaction design of ACKTUS was sufficiently intuitive forthe domain experts to contribute with knowledge and to model the interactiondesign of the three end users’ applications. Another purpose was to evaluate theapplicability of the activity assessment protocol AAIMA for analysis. The studydesign was qualitative and formative, using observations and interviews withusers to collect data. Three medical experts and two experts in occupationaltherapy participated, providing expertise in four different domains. Theparticipants increased their understanding and skills during the evaluationperiod leading to improved knowledge-based applications. The AAIMAprotocol proved to be useful and the results are fed into ongoing developmentwork on developing the adaptive functionality of the ACKTUS systems.

  • 50.
    Lindgren, Helena
    et al.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Winnberg, Patrik J.
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Yan, Chunli
    Umeå University, Faculty of Science and Technology, Department of Computing Science.
    Collaborative development of knowledge-based support systems: a case study2012In: Quality of life through quality of information, 2012, Vol. 180, p. 1111-1113Conference paper (Refereed)
    Abstract [en]

    We investigate a user-driven collaborative knowledge engineering and interaction design process. The outcome is a knowledge-based support application tailored to physicians in the local dementia care community. The activity is organized as a part of a collaborative effort between different organizations to develop their local clinical practice. Six local practitioners used the generic decision-support prototype system DMSS-R developed for the dementia domain during a period and participated in evaluations and re-design. Additional two local domain experts and a domain expert external to the local community modeled the content and design of DMSS-R by using the modeling system ACKTUS. Obstacles and success factors occurring when enabling the end-users to design their own tools are detected and interpreted using a proposed framework for improving care through the use of clinical guidelines. The results are discussed.

12 1 - 50 of 73
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