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Abstract Introduction This paper outlines the design, implementation, and usability study results of the patient empowerment process for chronic disease management, using Patient Reported Outcome Measurements and Shared Decision-Making Processes. Background The ADLIFE project aims to develop innovative, digital health solutions to support personalized, integrated care for patients with severe long-term conditions such as Chronic Obstructive Pulmonary Disease, and/or Chronic Heart Failure. Successful long-term management of patients with chronic conditions requires active patient self-management and a proactive involvement of patients in their healthcare and treatment. This calls for a patient-provider partnership within an integrated system of collaborative care, supporting self-management, shared-decision making, collection of patient reported outcome measures, education, and follow-up. Methods ADLIFE follows an outcome-based and patient-centered approach where PROMs represent an especially valuable tool to evaluate the outcomes of the care delivered. We have selected 11 standardized PROMs for evaluating the most recent patients’ clinical context, enabling the decision-making process, and personalized care planning. The ADLIFE project implements the "SHARE approach’ for enabling shared decision-making via two digital platforms for healthcare professionals and patients. We have successfully integrated PROMs and shared decision-making processes into our digital toolbox, based on an international interoperability standard, namely HL7 FHIR. A usability study was conducted with 3 clinical sites with 20 users in total to gather feedback and to subsequently prioritize updates to the ADLIFE toolbox. Results User satisfaction is measured in the QUIS7 questionnaire on a 9-point scale in the following aspects: overall reaction, screen, terminology and tool feedback, learning, multimedia, training material and system capabilities. With all the average scores above 6 in all categories, most respondents have a positive reaction to the ADLIFE PEP platform and find it easy to use. We have identified shortcomings and have prioritized updates to the platform before clinical pilot studies are initiated. Conclusions Having finalized design, implementation, and pre-deployment usability studies, and updated the tool based on further feedback, our patient empowerment mechanisms enabled via PROMs and shared decision-making processes are ready to be piloted in clinal settings. Clinical studies will be conducted based at six healthcare settings across Spain, UK, Germany, Denmark, and Israel.

Objective: Speech perception relies on precise spectral and temporal cues. However, cochlear implant (CI) processing is confined to a limited frequency range, affecting the information transmitted to the auditory system. This study analyzes the influence of channel interaction and the number of channels on word recognition scores (WRS) within the CI simulation framework. Methods: Two distinct experiments were conducted. The first experiment (n=29, average age =23 years, 14 females) evaluated the number of channels using eight, twelve, sixteen, and 22 channel vocoded and nonvocoded word lists for WRS assessment. The second experiment (n=29, average age =25 years, 16 females) explored channel interaction across low, middle, and high-interaction conditions. Results: In the first experiment, participants scored 57.93%, 80.97%, 83.59%, 91.03%, and 95.45% under 8, 12, 16, and 22-channel vocoder and non-vocoder conditions, respectively. The number of vocoder channels significantly affected WRS, with significant differences observed in all conditions except between the 12-channel and 16-channels (p

BackgroundThe increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). ObjectiveThis paper’s objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. MethodsThe DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. ResultsAs of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. ConclusionsIt has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

BackgroundThere is an increasing need to organize the care around the patient and not the disease, while considering the complex realities of multiple physical and psychosocial conditions, and polypharmacy. Integrated patient-centered care delivery platforms have been developed for both patients and clinicians. These platforms could provide a promising way to achieve a collaborative environment that improves the provision of integrated care for patients via enhanced information and communication technology solutions for semiautomated clinical decision support. ObjectiveThe Collaborative Care and Cure Cloud project (C3-Cloud) has developed 2 collaborative computer platforms for patients and members of the multidisciplinary team (MDT) and deployed these in 3 different European settings. The objective of this study is to pilot test the platforms and evaluate their impact on patients with 2 or more chronic conditions (diabetes mellitus type 2, heart failure, kidney failure, depression), their informal caregivers, health care professionals, and, to some extent, health care systems. MethodsThis paper describes the protocol for conducting an evaluation of user experience, acceptability, and usefulness of the platforms. For this, 2 “testing and evaluation” phases have been defined, involving multiple qualitative methods (focus groups and surveys) and advanced impact modeling (predictive modeling and cost-benefit analysis). Patients and health care professionals were identified and recruited from 3 partnering regions in Spain, Sweden, and the United Kingdom via electronic health record screening. ResultsThe technology trial in this 4-year funded project (2016-2020) concluded in April 2020. The pilot technology trial for evaluation phases 3 and 4 was launched in November 2019 and carried out until April 2020. Data collection for these phases is completed with promising results on platform acceptance and socioeconomic impact. We believe that the phased, iterative approach taken is useful as it involves relevant stakeholders at crucial stages in the platform development and allows for a sound user acceptance assessment of the final product. ConclusionsPatients with multiple chronic conditions often experience shortcomings in the care they receive. It is hoped that personalized care plan platforms for patients and collaboration platforms for members of MDTs can help tackle the specific challenges of clinical guideline reconciliation for patients with multimorbidity and improve the management of polypharmacy. The initial evaluative phases have indicated promising results of platform usability. Results of phases 3 and 4 were methodologically useful, yet limited due to the COVID-19 pandemic. Trial RegistrationClinicalTrials.gov NCT03834207; https://clinicaltrials.gov/ct2/show/NCT03834207 International Registered Report Identifier (IRRID)RR1-10.2196/21994

Anlık gönüllüler, afet ve acil durumlar sonrası müdahale ve iyileştirme çalışmalarında sıklıkla görülen fenomenlerden biridir. Literatürde, anlık gönüllüler bir yönüyle önemli bir iş gücü ve ekonomik kaynak olarak nitelendirilebilirken, diğer yandan organize olunamaması, afet ve acil durumlar konusunda yeterli bilgi ve beceriden yoksun kişileri de barındırabilmesi, güvenlik açısından risk oluşturulması ve idarenin söz konusu kişilere yönelik yasal sorumluluklarındaki belirsizlik gibi başlıklar yönüyle çeşitli sorunların da birer parçası olabilmektedirler. Bu çalışmada, afet ve acil durumlarda anlık gönüllülerin potansiyel rollerine ilişkin literatür taraması yapılarak, “anlık gönüllü” kavramının Türkçe literatüre kazandırılması ve gelecekte bu konuda yapılacak çalışmalara temel oluşturacak ve ivme kazandıracak bir farkındalığın yaratılması amaçlanmıştır. Bu amaç doğrultusunda, Türkiye’de afet ve acil durumlara ilişkin yasal ve idari düzenlemeler incelenmiştir. Bunun sonucunda, ilgili düzenlemelerde anlık gönüllülere ilişkin düzenleyici hükümlere yer verilmediği ve gelecek planlarında bu gönüllülerin, afet ve acil durum yönetimine ilişkin politika ve stratejilerde dikkate alınmadığı görülmüştür. Bu nedenle, afet ve acil durumlar sonrası yürütülen faaliyetlerde yer alan anlık gönüllüler ile ilgili yasal zeminin oluşturulması, afet yönetim sistemine entegre edilmesi ve afetlere dirençli bir toplum oluşturmak için anlık gönüllü faaliyetleri konusunda toplumun bilinçlendirilmesi gerekmektedir.

Aim:Three-dimensional (3D) printing has gained popularity among all fields of science in recent years. New research studies about the utilization of 3D printing in the medical field, in terms of medical devices and implants, have been published recently. We tried to adapt this technology into thoracic surgery by implanting 3D produced ribs following chest wall resection with a novel material called Nylon 680 Co-Polymer. We, hereby, present the preliminary results of this experimental study.Materials and Methods:We ordered multi detector computerized tomography of the chest for 2 pigs. We measured the area that we planned to resect on chest wall and used the data for printing custom-made rib for the reconstruction of the resected area. Then, we produced ribs with a USA Food and Drug Administration approved material called Nylon 680 Co-polymer (Taulman 3D, Saint Peters, MO, USA) by using 3D printer (Afinia H480, Chanhassen, MO, USA). Pigs were operated under general anesthesia. and the resected areas were reconstructed with custom-made 3D printed ribs.Results:One of the pigs passed away due to myocardial infarction while waking up from anesthesia. We followed up the other pig for 45 days. Then, we sacrificed the animal and resected the operated part for histopathological evaluation. Histopathologic evaluation revealed moderate chronic inflammation with a few giant cells containing pigmented foreign bodies.Conclusion:Although we need more studies, it is an important step for adapting 3D-printing into thoracic surgery. Additionally, it is important to identify a potential new material (Nylon 680 Co-polymer) for the future studies. We can use this new material for 3D-printed implant and mesh production, which enables us to produce custom-made products with lower cost in shorter time.

Objective:This study aimed to evaluate clinical musical perception, analyze the relationship between speech recognition and music perception, and investigate the effects of a three-month musical perception activities on these parameters in adult cochlear implant (CI) users with post-lingual hearing loss.Methods:Free-field hearing and speech tests in a quiet environment, the Turkish matrix test, and the Turkish version of the clinical assessment of musical perception test were performed on 18 adult unilateral CI users before and after the three-month music training. Results were compared with those of 18 healthy controls.Results:Prior to the musical perception activities, word recognition scores, Turkish matrix test results, and 500, 1000, and 6000 Hz free-field hearing thresholds were significantly correlated with the clinical assessment of musical perception test scores in the CI group (p