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- Hellstrand Tang, Ulla, et al.
(författare)
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Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations : Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool
- 2024
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Ingår i: JMIR Human Factors. - : JMIR Publications. - 2292-9495. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations.OBJECTIVE: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up.METHODS: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges.RESULTS: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting.CONCLUSIONS: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.
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| 2. |
- Archer, Trevor, 1949, et al.
(författare)
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Pharmacogenomics and Personalized Medicine in Mood Disorders
- 2013
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Ingår i: Handbook of Neurotoxicity. - : Springer. - 9781461458357 ; , s. 2181-2205
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Bokkapitel (refereegranskat)abstract
- Neurotoxic vulnerability that putatively contributes to the etiopathogenesis of schizophrenia spectrum disorders encompasses perinatal adversity, genetic linkage, epigenetic disadvantage, and neurodegenerative propensities that affect both symptom domains, positive, negative, and cognitive and biomarkers of the disorder. Molecular and cellular apoptosis/excitotoxicity that culminates in regional brain loss, reductions reelin expression, trophic disruption, perinatal adversity, glycogen kinase-3 dysregulation, and various instances of oxidative stress all influence the final end point. The existence of prodromal psychotic phases, structural-functional aspects of regional neuroimaging, dopamine signal overexpression, and psychosis propensity provide substance for neurodegenerative influences. The pathophysiology of schizophrenia spectrum disorders encompasses the destruction of normal functioning of the neurotrophins, in particular brain-derived neurotrophic factor (BDNF), dyskinesia of necessary ,ovements, and metabolic-metabolomic and proteomic markers. Neurotoxic accidents combined with genetic susceptibility appear to play a role in interfering with normal neurodevelopment or in tissue-destructive neurodegeneration or both, thereby elevating the eventual risk for disorder tendencies and eventual expression
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| 3. |
- Brain, Cecilia, 1969, et al.
(författare)
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Drug attitude and other predictors of medication adherence in schizophrenia : 12 months of electronic monitoring (MEMS (R)) in the Swedish COAST-study
- 2013
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Ingår i: European Neuropsychopharmacology. - : Elsevier BV. - 0924-977X .- 1873-7862. ; 23:12, s. 1754-1762
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate clinical predictors of adherence to antipsychotics. Medication use was electronically monitored with a Medication Event Monitoring System (MEMS (R)) for 12 months in 112 outpatients with schizophrenia and schizophrenia-like psychosis according to DSM-IV. Symptom burden, insight, psychosocial function (PSP) and side effects were rated at baseline. A comprehensive neuropsychological test battery was administered and a global composite score was calculated. The Drug Attitude Inventory (DAI-10) was filled in. A slightly modified DAI-10 version for informants was distributed as a postal questionnaire. Nonadherence (MEMS (R) adherence <= 0.80) was observed in 27%. In univariate regression models low scores on DAI-10 and DAI-10 informant, higher positive symptom burden, poor function, psychiatric side effects and lack of insight predicted non-adherence. No association was observed with global cognitive function. In multivariate regression models, low patient-rated DAI-10 and PSP scores emerged as predictors of non-adherence. A ROC analysis showed that DAI-10 had a moderate ability to correctly identify non-adherent patients (AUC=0.73, p<0.001). At the most "optimal" cut-off of 4, one-third of the adherent would falsely be. identified as non-adherent. A somewhat larger AUC (0.78, p<0.001) was observed when the ROC procedure was applied to the final regression model including DAI-10 and PSP. For the subgroup with informant data, the AUC for the DAI-10 informant version was 0.68 (p=0.021). Non-adherence cannot be properly predicted in the clinical setting on the basis of these instruments alone. The DAI-10 informant questionnaire needs further testing.
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| 4. |
- Helldin, Lars, et al.
(författare)
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Experience of quality of life and attitude to care and treatment in patients with schizophrenia : Role of cross-sectional remission
- 2008
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Ingår i: International journal of psychiatry in clinical practice (Print). - : Informa UK Limited. - 1365-1501 .- 1471-1788. ; 12:2, s. 97-104
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Tidskriftsartikel (refereegranskat)abstract
- Objective The concept of cross-sectional remission was investigated in a sample of patients with schizophrenia. A total of 243 patients were tested for quality of life, burden and handicap, insight and satisfaction with the care provided in an epidemiological study. The question addressed was if remission is of importance for outcome. Methods Cross-sectional remission was defined by applying the symptom criteria of remission, where none of eight selected PANSS items should exceed 3 points. Out of 243 patients, 38% were in met cross-sectional remission. Quality of life was assessed with the MOS SF-36 and the Rosser Index. The Patients' understanding of their illness was assessed based on symptoms and disorder insight. Finally, attitudes to care and, health service were assessed by the UKU/Consumer Satisfaction Questionnaire and the Drug Attitude Inventory. Results Patients who were in cross-sectional remission reported higher quality of life and reduced burden related to the disorder, a greater level of insight into their symptoms and the illness, and a more positive attitude to treatment, including drugs. Conclusion This study implies that remission, here expressed in terms of cross-sectional remission, is of importance for patients' well-being. Patients who had no interference from symptoms in their daily functioning found their life better, had a superior insight and were more positive to treatment.
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| 8. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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Illness Related Components for the Family Burden of Relatives to Patients with Psychotic Illness
- 2010
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 45:2, s. 275-283
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous research has shown that symptom severity often implies an increased family burden. Few other illness related variables have, however, been investigated in this context. This study investigates how family burden is affected by symptom, function, and cognition, as well as how the patient perceives his/her illness and quality of life. Method: A total of 99 relatives, to as many patients diagnosed with psychosis and with their illness at a stable level, participated in this study. The relatives estimated their perceived burden, the patients rated the distress caused by their illness as well as the quality of their lives, and the care staff rated the patients’ symptom and function as well as tested their cognitive abilities. Results: Increased family burden can be tied to the patients’ increased symptom severity, to their impaired functioning as well as to the patients’ higher self ratings regarding distress. The family burden is also connected to the patient’s reduced working memory and reduced executive functioning, but this connection is not totally clear and should be further investigated. Of the variables that the patients were rated on, it was the overall functional ability measured with GAF that had the single most impact on perceived family burden. Conclusions: To control illness related variables such as symptoms, impaired functioning, impaired working memory and executive functioning, as well as the patients’ own experiences of distress, is important in order to lessen the burden for the relatives. All aspects of family burden are, however, not explained by these factors, which is why further research within this realm is required.
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| 9. |
- Karilampi, Ulla, et al.
(författare)
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Cognition and global assessment of functioning in male and female outpatients with schizophrenia spectrum disorders.
- 2011
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Ingår i: The Journal of nervous and mental disease. - 1539-736X. ; 199:7, s. 445-8
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Tidskriftsartikel (refereegranskat)abstract
- The relationship between the symptom and function subscales of the Global Assessment of Functioning (GAF) and neurocognitive test performance was studied in 195 outpatients with schizophrenia, schizoaffective disorder, or delusional disorder who were assigned to functional groups based on their sex. A composite cognition score was created based on z-scores. Stepwise multiple regression analysis was used to assess the predictive value of GAF Symptom and GAF Function on composite cognition and to check for the effect of the individual cognitive tests against the GAF subscales. Better composite cognition scores were predicted by higher function levels in male patients and by lower symptom levels in female patients. There was also a sex-specific difference in neurocognitive components, indicating that executive functioning may have a greater impact on the symptom and function profiles of male schizophrenia spectrum patients than on that of female patients. The results suggest that endophenotypes in schizophrenia may be sex-specific.
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| 10. |
- Karilampi, Ulla
(författare)
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Cognitive and Functional Subgroups in Scizophrenia
- 2010
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to explore global and specific aspects of neurocognition in a clinically representative group of schizopsychotic patients, i.e. patients with schizophrenia or related psychotic disorders, in comparison with a population of matched healthy volunteers. In Study I, 196 schizopsychotic outpatients were combined with 196 healthy volunteers into one single group, which was then divided into three subgroups of verbal learning performance based on their scores on a verbal learning test. MANOVA and discriminant function analysis were used to analyze and compare neurocognitive test profiles related to different levels of verbal learning performance among schizopsychotic patients and healthy volunteers, in order to identify the major predictors of category assignment. The results showed working memory to be related to verbal learning on all three levels of verbal learning performance and vocabulary to be related to verbal learning for the better performing patients. The study showed that despite similar capacity in verbal learning, working memory and vocabulary, the better performing schizopsychotic patients did not perform on an overall level equal to the healthy volunteers. This finding indicates retarded visuomotor processing speed, which has been suggested to be a generalised characteristic of the schizophrenic process. In Study II, the relationship between neurocognitive test performance and global assessment of functioning was studied in 195 schizopsychotic outpatients that were assigned to functional groups on the basis of their sex. A global cognition score was created based on previously presented area-under-the-curve values. Global cognition was best predicted by GAF Symptom levels in the female schizopsychotic patients, and by GAF function levels in the male patients. There was also a gender-specific difference in the neurocognitive components, indicating that executive functioning may have a greater impact on the symptom and function profiles of schizopsychotic males than on schizopsychotic females. The eventual contributions of different mediating variables are discussed.
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