A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report.

BACKGROUND: The 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). OBJECTIVE: This 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. METHODS: The 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. RESULTS: As 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. CONCLUSIONS: It 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.

Emotions and Psychological Mechanisms of Listening to Music in Cochlear Implant Recipients.

OBJECTIVES: Music is a multidimensional phenomenon and is classified by its arousal properties, emotional quality, and structural characteristics. Although structural features of music (i.e., pitch, timbre, and tempo) and music emotion recognition in cochlear implant (CI) recipients are popular research topics, music-evoked emotions, and related psychological mechanisms that reflect both the individual and social context of music are largely ignored. Understanding the music-evoked emotions (the "what") and related mechanisms (the "why") can help professionals and CI recipients better comprehend the impact of music on CI recipients' daily lives. Therefore, the purpose of this study is to evaluate these aspects in CI recipients and compare their findings to those of normal hearing (NH) controls. DESIGN: This study included 50 CI recipients with diverse auditory experiences who were prelingually deafened (deafened at or before 6 years of age)-early implanted (N = 21), prelingually deafened-late implanted (implanted at or after 12 years of age-N = 13), and postlingually deafened (N = 16) as well as 50 age-matched NH controls. All participants completed the same survey, which included 28 emotions and 10 mechanisms (Brainstem reflex, Rhythmic entrainment, Evaluative Conditioning, Contagion, Visual imagery, Episodic memory, Musical expectancy, Aesthetic judgment, Cognitive appraisal, and Lyrics). Data were presented in detail for CI groups and compared between CI groups and between CI and NH groups. RESULTS: The principal component analysis showed five emotion factors that are explained by 63.4% of the total variance, including anxiety and anger, happiness and pride, sadness and pain, sympathy and tenderness, and serenity and satisfaction in the CI group. Positive emotions such as happiness, tranquility, love, joy, and trust ranked as most often experienced in all groups, whereas negative and complex emotions such as guilt, fear, anger, and anxiety ranked lowest. The CI group ranked lyrics and rhythmic entrainment highest in the emotion mechanism, and there was a statistically significant group difference in the episodic memory mechanism, in which the prelingually deafened, early implanted group scored the lowest. CONCLUSION: Our findings indicate that music can evoke similar emotions in CI recipients with diverse auditory experiences as it does in NH individuals. However, prelingually deafened and early implanted individuals lack autobiographical memories associated with music, which affects the feelings evoked by music. In addition, the preference for rhythmic entrainment and lyrics as mechanisms of music-elicited emotions suggests that rehabilitation programs should pay particular attention to these cues.

CAREPATH: Developing Digital Integrated Care Solutions for Multimorbid Patients with Dementia.

CAREPATH project is focusing on providing an integrated solution for sustainable care for multimorbid elderly patients with dementia or mild cognitive impairment. The project has a digitally enhanced integrated patient-centered care approach clinical decision and associated intelligent tools with the aim to increase patients' independence, quality of life and intrinsic capacity. In this paper, the conceptual aspects of the CAREPATH project, in terms of technical and clinical requirements and considerations, are presented.

Localisation, Personalisation and Delivery of Best Practice Guidelines on an Integrated Care and Cure Cloud Architecture: The C3-Cloud Approach to Managing Multimorbidity.

BACKGROUND: C3-Cloud is an integrated care ICT infrastructure offering seamless patient-centered approach to managing multimorbidity, deployed in three European pilot sites. Challenge: The digital delivery of best practice guidelines unified for multimorbidity, customized to local practice, offering the capability to improve patient personalization and benefit. METHOD: C3-Cloud has adopted a co-production approach to developing unified multimorbidity guidelines, by collating and reconciling best practice guidelines for each condition. Clinical and technical teams at pilot sites and the C3-Cloud consortium worked in tandem to create the specification and technical implementation. RESULTS: C3-Cloud offers CDSS for diabetes, renal failure, depression and congenital heart failure, with over 300 rules and checks that deliver four best practice guidelines in parallel, customized for each pilot site. CONCLUSIONS: The process provided a traceable, maintainable and audited digitally delivered collated and reconciled guidelines.

Long-term Average Speech Spectra of Postlingual Cochlear Implant Users.

Long term average speech spectra (LTASS) is a commonly used voice analysis method for different purposes. This method offers an acoustic representation of the language in daily conservations. Results of that method can be altered by the deteriorations in the auditory feedback loop. Hearing losses occurred in the post lingual stage of life have some serious negative effects on the auditory feedback loop. Cochlear implantation may help these patients with regards to auditory feedback loop. Therefore, we aimed to evaluate the LTASS of cochlear implant users whose have a post lingual hearing loss. We assessed the LTASS of 24 cochlear implant users and compared our findings with normal hearing subjects. Our findings revealed that cochlear implant users have similar LTASS findings with normal hearing subjects. We conclude that cochlear implantation helps to the recovery of auditory feedback loop in patients with post lingual hearing losses.

Passiflora incarnata Linneaus as an anxiolytic before spinal anesthesia.

PURPOSE: Patients who undergo regional anesthesia experience anxiety in the preoperative period. Passiflora incarnata Linneaus is a plant that has traditionally been used as an anxiolytic and sedative. We aimed to investigate the effect of preoperative oral administration of Passiflora incarnata Linneaus on anxiety, psychomotor functions, sedation, and hemodynamics in patients undergoing spinal anesthesia. METHODS: Under local ethics committee approval, 60 patients who were aged 25-55 years and ASAI-II and who were scheduled for spinal anesthesia were enrolled in this prospective, randomized, double-blind and placebo-controlled study. Thirty minutes before spinal anesthesia, baseline hemodynamic parameters, State-Trait Anxiety Inventory (STAI) score, sedation score, and psychomotor function test results were measured, then patients were randomly assigned to two groups: oral Passiflora incarnata Linneaus extract or placebo was given to the patients. Tests were repeated just before spinal anesthesia. Hemodynamics, sedation score, sensory-motor block and side effects were assessed during the operation. Psychomotor function tests were repeated at the end of the operation and 60 min after the operation. RESULTS: There was a statistically significant difference between the two groups for the increase in State Anxiety Inventory (STAI-S) score obtained just before spinal anesthesia when compared to the baseline. There was no statistically significant difference in psychomotor function from the baseline for either group. A significant difference was not found between the two groups in demographics, psychomotor function, sedation score, hemodynamics, and side effects. CONCLUSION: Oral preoperative administration of Passiflora incarnata Linneaus suppresses the increase in anxiety before spinal anesthesia without changing psychomotor function test results, sedation level, or hemodynamics.