The capsular polysaccharide fromCryptococcus neoformans serotype C has been studied using the usual methods for the elucidation of chemical structure. The results are consistent with the occurrence of a polysaccharide having an α 1,3 linked backbone ofd-mannopyranoside residues, every other one of which is doubly substituted with two terminald-xylopyranosyl residues linked β (1,2 and β 1,4 respectively, and with the remainder of the mannosyl residues substituted with a terminald-glucuronosidopyranosyl residue linked β 1,2. Alternatively, the terminal glucuronic acid residue may be β (1,2 linked to a mannosyl residue in the chain already hearing a singly branched β 1,4 xylopyranosyl residue, while the neighboring mannosyl residue carries a single branch of β 1.2 xylopyranoside.

Background: Home-based noninvasive ventilation has proven cost-effective. But, adherence to therapy still constitutes a common clinical problem. We hypothesized that a behavioral intervention supported by a mobile health (mHealth) app could enhance patient self-efficacy. It is widely accepted that mHealth-supported services can enhance productive interactions among the stakeholders involved in home-based respiratory therapies. Objective: This study aimed to measure changes in self-efficacy in patients with chronic respiratory failure due to diverse etiologies during a 3-month follow-up period after the intervention. Ancillary objectives were assessment of usability and acceptability of the mobile app as well as its potential contribution to collaborative work among stakeholders. Methods: A single-blind, single-center, randomized controlled trial was conducted between February 2019 and June 2019 with 67 adult patients with chronic respiratory failure undergoing home-based noninvasive ventilation. In the intervention group, a psychologist delivered a face-to-face motivational intervention. Follow-up was supported by a mobile app that allowed patients to report the number of hours of daily noninvasive ventilation use and problems with the therapy. Advice was automatically delivered by the mobile app in case of a reported problem. The control group received usual care. The primary outcome was the change in the Self Efficacy in Sleep Apnea questionnaire score. Secondary outcomes included app usability, app acceptability, continuity of care, person-centered care, and ventilatory parameters. Results: Self-efficacy was not significantly different in the intervention group after the intervention (before: mean 3.4, SD 0.6; after: mean 3.4, SD 0.5, P=.51). No changes were observed in adherence to therapy nor quality of life. Overall, the mHealth tool had a good usability score (mean 78 points) and high acceptance rate (mean score of 7.5/10 on a Likert scale). It was considered user-friendly (mean score of 8.2/10 on a Likert scale) and easy to use without assistance (mean score of 8.5/10 on a Likert scale). Patients also scored the perception of continuity of care and person-centered care as high. Conclusions: The integrated care intervention supported by the mobile app did not improve patient self-management. However, the high acceptance of the mobile app might indicate potential for enhanced communication among stakeholders. The study identified key elements required for mHealth tools to provide effective support to collaborative work and personalized care. Trial Registration: ClinicalTrials.gov NCT03932175; https://clinicaltrials.gov/ct2/show/NCT03932175

Background: Digital health tools may facilitate the continuity of care. Enhancement of digital aid is imperative to prevent information gaps or redundancies, as well as to facilitate support of flexible care plans. Objective: The study presents Health Circuit, an adaptive case management approach that empowers health care professionals and patients to implement personalized evidence-based interventions, thanks to dynamic communication channels and patient-centered service workflows; analyze the health care impact; and determine its usability and acceptability among health care professionals and patients. Methods: From September 2019 to March 2020, the health impact, usability (measured with the system usability scale; SUS), and acceptability (measured with the net promoter score; NPS) of an initial prototype of Health Circuit were tested in a cluster randomized clinical pilot (n=100) in patients with high risk for hospitalization (study 1). From July 2020 to July 2021, a premarket pilot study of usability (with the SUS) and acceptability (with the NPS) was conducted among 104 high-risk patients undergoing prehabilitation before major surgery (study 2). Results: In study 1, Health Circuit resulted in a reduction of emergency room visits (4/7, 13% vs 7/16, 44%), enhanced patients’ empowerment (P<.001) and showed good acceptability and usability scores (NPS: 31; SUS: 54/100). In study 2, the NPS was 40 and the SUS was 85/100. The acceptance rate was also high (mean score of 8.4/10). Conclusions: Health Circuit showed potential for health care value generation and good acceptability and usability despite being a prototype system, prompting the need for testing a completed system in real-world scenarios. Trial Registration: ClinicalTrials.gov NCT04056663; https://clinicaltrials.gov/ct2/show/NCT04056663

Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain). Prospective cohort study over one year period, 2017–2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data. HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified. We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care. ClinicalTrials.gov (26/04/2017; NCT03130283).

Introduction: Complex chronic patients are prone to unplanned hospitalizations leading to a high burden on healthcare systems. To date, interventions to prevent unplanned admissions show inconclusive results. We report a qualitative analysis performed into the EU initiative JADECARE (2020–2023) to design a digitally enabled integrated care program aiming at preventing unplanned hospitalizations. Methods: A two-phase process with four design thinking (DT) sessions was conducted to analyse the management of complex chronic patients in the region of Catalonia (ES). In Phase I, Discovery, two DT sessions, October 2021 and February 2022, were done using as background information: i) the results of twenty structured interviews (five patients and fifteen professionals), ii) two governmental documents on regional deployment of integrated care and on the Catalan digital health strategy, respectively, and iii) the results of a cluster analysis of 761 hospitalizations. In Phase II, Confirmation, we examined the 30- and 90-day post-discharge periods of 49,604 hospitalizations as input for two additional DT sessions conducted in November and December 2022. Discussion: The qualitative analysis identified poor personalization of the interventions, the need for organizational changes, immature digitalization, and suboptimal services evaluation as main explanatory factors of the observed efficacy-effectiveness gap. Additionally, a program for prevention of unplanned hospitalizations, to be evaluated during the period 2024–2025, was generated. Conclusions: A digitally enabled adaptive case management approach to foster collaborative work and personalization of care, as well as organizational re-engineering, are endorsed for value-based prevention of unplanned hospitalizations. Resum Introducció: Els pacients crònics complexos són propensos a hospitalitzacions no planificades que comporten una gran càrrega per els sistemes sanitaris arreu del mon. Les intervencions per prevenir ingressos no planificats mostren resultats poc concloents pel que fa a efectivitat. Aquest estudi descriu una anàlisi qualitativa realitzada, en el marc de l’Acció Conjunta Europea JADECARE (2020–2023), per dissenyar un programa d’atenció integrada, amb suport digital, que te per objectiu prevenir les hospitalitzacions no planificades. Mètodes: L’estudi va consistir en un procés de co-disseny efectuat a partir de l’anàlisi de la gestió de pacients crònics complexos en la demarcació de Catalunya (ES). Es va efectuar en dues fases amb un total de quatre sessions de “Design Thinking (DT)”. A la Fase I, Discovery, es van fer dues sessions de DT, Octubre de 2021 i Febrer de 2022, utilitzant com a informació de fons: i) Els resultats de vint entrevistes estructurades (cinc pacients i quinze professionals), ii) Dos documents governamentals sobre el desplegament regional de l’atenció integrada i sobre l’estratègia de salut digital, respectivament, i iii) Els resultats d’una anàlisi de clústers de 761 hospitalitzacions. A la Fase II, Confirmació, vam examinar els resultats als 30 i 90 dies post-alta hospitalària de 49.604 casos en a dues sessions de DT addicionals realitzades durant els mesos de Novembre i Desembre de 2022. Discussió: L’anàlisi qualitativa va identificar: i) Insuficient personalització de les intervencions, ii) Necessitat de canvis organitzatius, iii) Immaduresa de la digitalització, i iv) Avaluació sub-óptima del desplegament dels serveis com a principals factors explicatius de la bretxa entre eficàcia i efectivitat observada en estudis previs. L’estudi proposa un programa de prevenció d’hospitalitzacions no planificades, a avaluar durant el període 2024–2025. Conclusions: Els resultats de l’anàlisi qualitativa donen suport a la modalitat de gestió adaptativa de casos, amb suport digital, per fomentar el treball col·laboratiu i la personalització de l’atenció. També plantegen la necessitat de reenginyeria dels processos clínics per assolir una prevenció eficient i basada en valors, de les hospitalitzacions no planificades en el mon real. Paraules Clau: Gestió adaptativa de casos; “Design Thinking”; Digitalització; Atenció personalitzada; Prevenció d’ingressos hospitalaris no planificats