Employing a design science research approach building on four modes of inquiry, this study presents a Clinical Decision Support System for predicting heart failure readmissions, combining machine learning, inpatient care process analysis, and user experience design. It introduces three key design principles: contextual integration, actionable insights, and adaptive explanation levels, to support the design of decision support in clinical settings. The research, while focused on a specific healthcare context, offers a model for integrating technical precision and user-centric design in inpatient care processes, suggesting broader applications and future research directions in diverse healthcare environments. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024.

Background: Care for patients with heart failure (HF) causes a substantial load on health care systems where a prominent challenge is the elevated rate of readmissions within 30 days following initial discharge. Clinical professionals face high levels of uncertainty and subjectivity in the decision-making process on the optimal timing of discharge. Unwanted hospital stays generate costs and cause stress to patients and potentially have an impact on care outcomes. Recent studies have aimed to mitigate the uncertainty by developing and testing risk assessment tools and predictive models to identify patients at risk of readmission, often using novel methods such as machine learning (ML).

Objective: This study aims to investigate how a developed clinical decision support (CDS) tool alters the decision-making processes of health care professionals in the specific context of discharging patients with HF, and if so, in which ways. Additionally, the aim is to capture the experiences of health care practitioners as they engage with the system’s outputs to analyze usability aspects and obtain insights related to future implementation.

Methods: A quasi-experimental design with randomized crossover assessment will be conducted with health care professionals on HF patients’ scenarios in a region located in the South of Sweden. In total, 12 physicians and nurses will be randomized into control and test groups. The groups shall be provided with 20 scenarios of purposefully sampled patients. The clinicians will be asked to take decisions on the next action regarding a patient. The test group will be provided with the 10 scenarios containing patient data from electronic health records and an outcome from an ML-based CDS model on the risk level for readmission of the same patients. The control group will have 10 other scenarios without the CDS model output and containing only the patients’ data from electronic medical records. The groups will switch roles for the next 10 scenarios. This study will collect data through interviews and observations. The key outcome measures are decision consistency, decision quality, work efficiency, perceived benefits of using the CDS model, reliability, validity, and confidence in the CDS model outcome, integrability in the routine workflow, ease of use, and intention to use. This study will be carried out in collaboration with Cambio Healthcare Systems.

Results: The project is part of the Center for Applied Intelligent Systems Research Health research profile, funded by the Knowledge Foundation (2021-2028). Ethical approval for this study was granted by the Swedish ethical review authority (2022-07287-02). The recruitment process of the clinicians and the patient scenario selection will start in September 2023 and last till March 2024.

Conclusions: This study protocol will contribute to the development of future formative evaluation studies to test ML models with clinical professionals. © 2024 JMIR Publications Inc.. All rights reserved.

Background: Artificial intelligence (AI) applications in health care are expected to provide value for health care organizations, professionals, and patients. However, the implementation of such systems should be carefully planned and organized in order to ensure quality, safety, and acceptance. The gathered view of different stakeholders is a great source of information to understand the barriers and enablers for implementation in a specific context.

Objective: This study aimed to understand the context and stakeholder perspectives related to the future implementation of a clinical decision support system for predicting readmissions of patients with heart failure. The study was part of a larger project involving model development, interface design, and implementation planning of the system.

Methods: Interviews were held with 12 stakeholders from the regional and municipal health care organizations to gather their views on the potential effects implementation of such a decision support system could have as well as barriers and enablers for implementation. Data were analyzed based on the categories defined in the nonadoption, abandonment, scale-up, spread, sustainability (NASSS) framework.

Results: Stakeholders had in general a positive attitude and curiosity toward AI-based decision support systems, and mentioned several barriers and enablers based on the experiences of previous implementations of information technology systems. Central aspects to consider for the proposed clinical decision support system were design aspects, access to information throughout the care process, and integration into the clinical workflow. The implementation of such a system could lead to a number of effects related to both clinical outcomes as well as resource allocation, which are all important to address in the planning of implementation. Stakeholders saw, however, value in several aspects of implementing such system, emphasizing the increased quality of life for those patients who can avoid being hospitalized.

Conclusions: Several ideas were put forward on how the proposed AI system would potentially affect and provide value for patients, professionals, and the organization, and implementation aspects were important parts of that. A successful system can help clinicians to prioritize the need for different types of treatments but also be used for planning purposes within the hospital. However, the system needs not only technological and clinical precision but also a carefully planned implementation process. Such a process should take into consideration the aspects related to all the categories in the NASSS framework. This study further highlighted the importance to study stakeholder needs early in the process of development, design, and implementation of decision support systems, as the data revealed new information on the potential use of the system and the placement of the application in the care process. © The Author(s) 2023.

To date, there is no empirical evidence suggesting greater jump heights or cushioned landings when using figure skating (FS) blades of different mass and design. This study examined the effect of lightweight (Gold Seal Revolution from John Wilson) and traditional (Apex Supreme from Jackson Ultima and Volant from Riedell) blades, a new prototype blade with an integrated damping system (damping blade) in two different damping configurations, and running shoes (Runfalcon from Adidas) on kinetics and kinematics during simulated on-ice landings from 0.6 m and maximal countermovement jumps on synthetic ice, and measured dampening properties of the damping blade. Seventeen participants executed trials in the six footwear conditions blinded to the different blades and acted as their own control for statistical comparison. There were no differences between the lightweight and traditional blades on the maximal vertical ground reaction force during the landing. Image analysis showed a damping effect in the damping blade that significantly decreased the landing load for all participants (mean 4.38 ± 0.68 bodyweight) (p ≤ 0.006), on average between 10.1 and 14.3% compared to lightweight and traditional blades (4.87 ± 1.01 to 5.11 ± 0.88 bodyweight). The maximal jump height achieved was the same in all FS blades. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

The evolution of clinical decision support (CDS) tools has been improved by usage of new technologies, yet there is an increased need to develop user-friendly, evidence-based, and expert-curated CDS solutions. In this paper, we show with a use-case how interdisciplinary expertise can be combined to develop CDS tool for hospital readmission prediction of heart failure patients. We also discuss how to make the tool integrated in clinical workflow by understanding end-user needs and have clinicians-in-the-loop during the different development stages. © 2023 European Federation for Medical Informatics (EFMI) and IOS Press.

Background: Digital health technologies have the potential to transform health care services to be more cost-effective, coordinated, and accessible on equal terms for entire populations. In the future, people will be assisted by such technologies to monitor their health status, take preventive measures, and have more control of their health situation. An increase in digital supplementation or substitution of physical care visits can potentially add value to patients and care providers by increasing accessibility, safety, and quality of care. However, health care organizations struggle with the challenges of developing and implementing digital health technologies and services in practice. As a response to this, we have developed a national multidisciplinary research school to increase competence and capacity for research on the development, implementation, and dissemination of digital health technology solutions. The overall aim of the research school is to increase national competence and capacity for the development, implementation, and dissemination of digital health technology to increase the preparedness to support and facilitate the ongoing digital transformation in the health care system.

Objective: The purpose of this paper is to outline the protocol for the development and implementation of a national multidisciplinary doctoral education program of health innovation supporting digital transformation in the health care system.

Methods: A national multidisciplinary research school for health innovation was planned in collaboration between 7 Swedish universities and their partners from industry and the public sector. The research school will run over 6 years, of which 5 years are dedicated for the doctoral education program and 1 year for the project start-up and closing. In this paper, we outline the methodological approach of the research school; the combining of knowledge and expertise of the universities that are important to run the research school; the jointly formulated research-oriented and societally relevant research focus, goals, and objectives for the research school; the established and developed relationships with partners from industry and the public sector for joint research training projects; the forms of collaboration in the research school; and the format of the doctoral education process.

Results: The research school was funded in December 2021 and started in March 2022. The research school starts with an initiation period from March 2022 to December 2022 where the infrastructure and the action plans to run the school are set up. The PhD projects start in January 2023, and these projects will be completed in 5 years. Additional activities within the research program are doctoral courses, networking activities, and dissemination of results.

Conclusions: The network of several partners from industry, public sector, and academia enables the research school to pose research questions that can contribute to solving relevant societal problems related to the development, evaluation, implementation, and dissemination of methods and processes assisted by digital technologies. Ultimately, this will promote innovation to improve health outcomes, quality of care, and prioritizations of resources. © Jens M Nygren, Lina Lundgren, Ingela Bäckström, Petra Svedberg. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 31.05.2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

Introduction: Artificial intelligence (AI) is widely seen as critical for tackling fundamental challenges faced by health systems. However, research is scant on the factors that influence the implementation and routine use of AI in healthcare, how AI may interact with the context in which it is implemented, and how it can contribute to wider health system goals. We propose that AI development can benefit from knowledge generated in four scientific fields: intervention, innovation, implementation and improvement sciences.

Aim: The aim of this paper is to briefly describe the four fields and to identify potentially relevant knowledge from these fields that can be utilized for understanding and/or facilitating the use of AI in healthcare. The paper is based on the authors' experience and expertise in intervention, innovation, implementation, and improvement sciences, and a selective literature review.

Utilizing knowledge from the four fields: The four fields have generated a wealth of often-overlapping knowledge, some of which we propose has considerable relevance for understanding and/or facilitating the use of AI in healthcare.

Conclusion: Knowledge derived from intervention, innovation, implementation, and improvement sciences provides a head start for research on the use of AI in healthcare, yet the extent to which this knowledge can be repurposed in AI studies cannot be taken for granted. Thus, when taking advantage of insights in the four fields, it is important to also be explorative and use inductive research approaches to generate knowledge that can contribute toward realizing the potential of AI in healthcare. © 2022 Nilsen, Reed, Nair, Savage, Macrae, Barlow, Svedberg, Larsson, Lundgren and Nygren. 

In most rotational power assessments, discrete variables are used for subsequent examination; however, movements are continuous, and data can be collected in time series. The purpose of this investigation was to examine the velocity- and power-time series characteristics of a standing rotation test and identify relationships with golf performance. Thirty-one golfers performed a golfspecific rotation test (GSRT) with 3 different resistances (6, 10, and 14 kg) in a robotic engine system. Time series of velocity and power was calculated from the raw data, and each repetition was then normalized to 0–100%. Principal component analyses (PCAs) were performed on velocity and power waveforms. The PCA used an eigenvalue analysis of the data covariance matrix. The relationship between clubhead speed (CHS) and all principal components (PC) was examined using linear regression. Ten velocity parameters and 6 power parameters explained 80% of the variance in the data. For velocity, the first 2 PCs identified both magnitude and phase shift features while PCs 3–5 identified difference features. For power, the first 2 PCs identified both magnitude and phase shift features, the third PC identified a phase shift feature, and the fourth PC identified a difference feature. The highest relationship with CHS was shown for GSRT with 14 kg in PC2 for power (R2 5 0.48, p , 0.001). The PCA of the GSRT power test could distinguish intraindividual differences, external loads, and sex-based differences. Athletes should focus on accelerating smoothly through the movement, particularly with heavier loads, and not pulling aggressively at the beginning of the rotational AU3 movement to achieve maximum power. Copyright © 2019 by the National Strength & Conditioning Association.

Blood lactate accumulation is a crucial fatigue indicator during sports training. Previous studies have predicted cycling fatigue using surface-electromyography (sEMG) to non-invasively estimate lactate concentration in blood. This study used sEMG to predict muscle fatigue while running and proposes a novel method for the automatic classification of running fatigue based on sEMG. Data were acquired from 12 runners during an incremental treadmill running-test using sEMG sensors placed on the vastus-lateralis, vastus-medialis, biceps-femoris, semitendinosus, and gastrocnemius muscles of the right and left legs. Blood lactate samples of each runner were collected every two minutes during the test. A change-point segmentation algorithm labeled each sample with a class of fatigue level as (1) aerobic, (2) anaerobic, or (3) recovery. Three separate random forest models were trained to classify fatigue using 36 frequency, 51 time-domain, and 36 time-event sEMG features. The models were optimized using a forward sequential feature elimination algorithm. Results showed that the random forest trained using distributive power frequency of the sEMG signal of the vastus-lateralis muscle alone could classify fatigue with high accuracy. Importantly for this feature, group-mean ranks were significantly different (p < 0.01) between fatigue classes. Findings support using this model for monitoring fatigue levels during running. © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).