Digital Transformation in Cardiology: Today and Tomorrow

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Ali Serdar FAK
Marmara Üniversitesi Hipertansiyon ve Ateroskleroz Eğitim, Uygulama ve Araştırma Merkezi, İstanbul, Türkiye
Article Language: TR
Dijital dönüşüm tıp ve sağlık alanında da kapımızı çaldı ve artık birlikteliğimiz kaçınılmaz.

Sanayi, ekonomi, iletişim ve eğlence alanlarında daha erken başlamış olan dijital dönüşümün en hızlı yaşandığı ve hissedildiği tıp ve sağlık alanlarının başında ise kardiyoloji yer almakta.

Bugün şimdiden birçok akıllı cihaz ve bazı yapay zekâ (YZ) uygulamaları, kardiyoloji alanında tıbbi yönden geçerli sertifikalarını almış durumdadır. Bu nedenle 2020 yılını kapatırken Türkiye Klinikleri ile bu kitabı 'Kardiyolojide Dijital Dönüşüm: Bugün ve Yarın' olarak hazırlamaya karar verdik.

Aslında daha yıllar önce dünyada ve ülkemizde sağlık kurumlarında elektronik veri bankacılığına geçilmesi, dijital dönüşüm için atılan temelleri oluşturmuştu. Hemen ardından akıllı telefonlarla hastalarımızla mesajlaşırken, paylaşılan tetkik sonuçları ve EKG görüntülerini yorumlayıp uzaktan hastaların tedavilerini düzenlerken, kendimizi farkında olmadan veya ister istemez bir dönüşümün içinde bulmaya başladığımızı söyleyebiliriz. Elbette dijital dönüşüm sadece verilerin uzaktan paylaşıldığı ve karşılıklı etkileşim kurulabildiği bir süreçle sınırlı değil. Son birkaç yılda çeşitli akıllı cihazlarla günün her anında üretilen her veriyi işleyip ve yorumlayıp bize bilgi olarak sunan veri madenciliği/derin öğrenme/yapay zekâ (YZ) platformları bizlerin öğrenme, sorgulama ve mesleğimizi uygulama biçimimizi değiştirmeye başladı.

Kardiyoloji, sayılarla kolayca ifade edilebilen ilgi alanlarına sahip olduğu için dijital dönüşüm açısından "şanslı" bir alan olarak öne çıkmaktadır. Bu nedenle kan basıncı, nabız (kalp) hızı, EKG başta olmak üzere akıllı cihazlarla saptanan ve YZ uygulamaları ile işlenen birçok biyolojik veri, kardiyolojide şimdiden klinik kullanıma girdi.

Hipertansiyonun tedavisi ve takibi artık FDA onaylı akıllı cihazlarla1 ve bu cihazların bağlanabildiği profesyonellere açık platformlar üzerinden yapılabilir hâle geldi. Bunun ötesinde hipertansiyon paternlerini belki de 24 saat holter kan basıncı kaydı yapmaksızın veri madenciliği ile tahmin edebileceğiz.2 "Hipertansiyon Yönetiminde Dijital Tabanlı Uygulama Örnekleri" yazımızda hipertansiyon yönetiminde şimdiye dek akıllı cihazlar ve uygulamaların hipertansiyon tedavisine katkıları ve hasta hekim davranışına etkileri tartışıldı ve bugünden yarına bu alanda beklenen gelişmeler ele alındı.

Akıllı cihazlarda yıllardır spor amaçlı parametreler olarak sınırlı kalan nabız sayısı ve kalp ritmi, son birkaç yılda "tıbbi veri" niteliği aldı. Akıllı saatler veya bileklikler ile kalp ritmi- nin takibi ve atriyal fibrilasyonun (AF) tanınması hem iOS tabanlı 3 hem de android tabanlı 4 sistemlerde artık mümkün hâle geldi. Böylece toplumda risk gruplarında sessiz AF taramasının ve AF'ye bağlı komplikasyonların daha erken ve etkin önlenebilmesinin yolu açıldı. Diğer yandan yakın gelecekte AF riskini veya tromboemboli riskini YZ uygulamaları ile bugünden daha iyi öngörebilmemiz mümkün olabilecektir. "Kardiyak Aritmi Yönetiminde Dijital Tabanlı Uygulama Örnekleri" yazımızda bu çerçevede aritmik hastalıkların yönetimine akıllı cihazların ve dijital uygulamaların getireceği dönüşüm ele alındı.

Kalp yetersizliği de düzenli veri takibi gerektirdiği için, dijital tıp çalışmalarının yoğun olduğu bir alandır. Hastanın kendi ortamında, günlük yaşantısını etkilemeden kalp yetersizliğinin olası erken belirteçleri hakkında verileri toplayıp bu verileri işleyecek bir ağa gönderen akıllı cihazlar ve bu verileri karar destek sistemi olarak sağlık profesyonellerine sunacak platformlar hakkında çalışmalar devam ediyor. Bugün için şimdilik YZ uygulamalarının bu alanda gösterilmiş başarısı; düşük ejeksiyon fraksiyonlu kalp yetersizliği ile korunmuş ejeksiyon fraksiyonlu kalp yetersizliği olgularını, uzman kardiyologlar derecesinde hatta bazen daha iyi doğrulukla ayırt edebilmesidir. "Kalp Yetersizliği Yönetiminde Dijital Tabanlı Uygulama Örnekleri" yazımızda bu alanda bugünkü durum tartışıldı.

Akut koroner sendrom (AKS) zamana karşı yarışılan, "zamanın kalp kası, belki de yaşam" olduğunu bildiğimiz tablolardan. Olası AKS hastasına en erken zamanda ulaşılması, tanının en kısa sürede kesinleştirilmesi ve en uygun tedavinin en erken zamanda başlatılıp gerçekleştirilmesi için akıllı teknolojilerin büyük yararı olacağını uzun süreden bu yana tahmin ediyorduk. Ambulanstan gönderilen EKG paylaşımlarından bugün artık yerel veya ulusal düzeyde AKS acil tanı ve tedavi dijital alt yapı örgütlenmelerine gelindi. "Akut Koroner Sendromlarda Tele Tıp Uygulamaları" yazımızda bu alandaki gelişmeler ele alındı.

Kardiyovasküler görüntüleme alanı dijital anlamda çok yoğun veri birikimini içermektedir ve bu verilerle son yıllarda YZ temelli klinik araştırma sayısı hızla artmaktadır. Bu çalışmalar kardiyologlara, karar destek sistemi dâhilinde daha hızlı ve daha yüksek doğruluk payı ile tanıya ulaşmalarını sağlamada yardımcı olacağa benziyor. "Kardiyovasküler Görüntülemede Dijital Tabanlı Uygulama Örnekleri" yazımızda bu uygulamaların kardiyovasküler görüntülemeye getireceği yenilikler ve katkılar tartışıldı.

Kitabımızda konuk yazarımız Prof. Dr. Ata Akın, tıp alanında dijital dönüşümün hekimler, sağlık çalışanları ve mühendislerle birlikte gerçekleştirileceğini tartıştı. Herhangi bir akıllı cihazın veya bir tıbbi uygulamanın birey-hasta-hasta yakını-sağlık profesyonellerince birlikte kabul gördükten sonra ancak değeri olabileceğini "Sağlıkta Yapay Zekâyı Hekimlerle Birlikte Biz Mühendisler Geliştireceğiz" yazısında ele alarak tartıştı.

Yine dijital dönüşümün ulusal boyutta gerçekleşebilmesi için özellikle bilimsel projelerde kamu ortaklığının gerekliliği, "Sağlığın Dijital Dönüşümünde Kamu Projeleri ve Akademi ile Ortaklığın Önemi" yazısında ayrıntıları ile konuk yazarlarımızca tartışıldı.

Dijital dönüşüm elbette bazı güçlüklerle birlikte yeni olanaklar ve yeni ufuklar getiriyor. Farklı disiplinleri birbirine yaklaştırıyor. Bu durumda özellikle genç kardiyologlar için yeni araştırma ve iş olanaklarına, "Dijital Dönemde Pazarda Fırsatlar ve Engeller: Genç Kardiyologlar İçin Öneriler" yazısında değinildi.

Gerek kardiyoloji uzmanlık eğitiminde gerekse mesleğimizi uygularken dijital çağın gerçeklerine uygun davranmak aynı zamanda mesleğimizin ihtiyaçları doğrultusunda dijital dönüşüme yön verecek refleksleri de gösterebilmek durumundayız. "Dijital Çağda Öğrenme: Kardiyoloji Uzmanlık Eğitiminde E-Öğrenme" yazımızda Türk Kardiyoloji Derneği'nin uluslararası diğer uzmanlık dernekleri ile birlikte bu yöndeki çabaları ve programları anlatıldı.

Avrupa Kardiyoloji Derneği 2016 yılında bu alanda "position paper" yayınlamış, eksiklikleri, öncelikleri belirlemiş ve yapılması gerekenler konusunda yol haritası çizmiştir.5 Ülkemizde uzmanlık dernekleri arasında bir ilk olarak Türk Kardiyoloji Derneği'nde de 2018 yılında "Dijital Sağlık Proje Grubu" kurulmuş ve çalışmalarına devam etmektedir.6 Diğer yandan Marmara Üniversitesi Tıp Fakültesi'nde hekim adaylarının dijital iletişim, veri bilimi ve yapay zekânın temel kavramları gibi konularda bilgi ve donanımlarını artırmak amacıyla 2018 yılında "Dijital Sağlık Seçmeli Stajı" başlatılmıştır.7 Bu alanda ülkemizdeki ilk örnek olan bu multidisipliner eğitim programlarının çoğalmasını ve tıp eğitimi programında daha fazla yer almasını temenni ederiz.

Bu kitabımız hazırlanırken tüm dünyada olanca şiddetiyle yaşamaya başladığımız COVID-19 pandemisi de her alanda dijital dönüşümün ne kadar gerekli olduğunu bir kez daha gösterdi. Kongrelerimiz, eğitimlerimiz çevrimiçi hâle geldi, sağlık kurumları uzaktan sağlık hizmeti verebilmenin yollarını aramaya başladılar.

Sağlık alanında elbette almamız gereken çok mesafe var. Sağlık hukuku, mahremiyet, veri güvenliği, sistemlerin entegrasyonu, hastaların ve sağlık çalışanlarının dijital sağlık okur-yazarlığı gibi konular hepimizin katılımını ve katkısını bekliyor. Dijital dönüşümü cihazların ve yapay zekânın bizim için daha çok çalıştığı ve sağlık hizmeti sunarken hastalarımıza daha fazla zaman ayırabildiğimiz yönde şekillendirmemizde yarar var.

Bu kitabımız ağırlıklı olarak Türk Kardiyoloji Derneği Çalışma Grupları ve Dijital Sağlık Proje Grubu üyelerince ve ayrıca konuk yazarlarca hazırlandı. Katkıları için tüm yazarlara ayrı ayrı teşekkür ederim.

Türkiye Klinikleri'ne; hepimizin mesleğini, düşünme ve araştırma tarzını "dönüştürecek" ve birçok disiplini bir araya getiren "Dijital Kardiyoloji' konusunu kitap olarak gündeme aldığı için teşekkürü borç bilirim. Umarım meslektaşlarımız için yararlı olur.

Prof. Dr. Ali Serdar FAK
Editör

KAYNAKLAR
1. https://www.accessdata.fda.gov/cdrh_docs/pdf14/K140067.pdf
2. Altikardeş ZA, Erdal H, Baba AF, Fak AS, Korkmaz H. Performance evaluation of classification algorithms by excluding the most relevant attributes for dipper non dipper pattern estimation in Type 2 DM patients. International Journal of Computer Information Systems and Industrial Management Applications. 2016;8:247-56.
3. Perez MV, Mahaffey KW, Hedlin H, Rumsfeld JS, Garcia A, Ferris T, et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med. 2019;381(20):1909-17.
4. Guo Y, Wang H, Zhang H, Liu T, Liang Z, Xia Y, et al. Mobile Photoplethysmographic Technology to Detect Atrial Fibrillation. J Am Coll Cardiol. 2019;74(19):2365-75.
5. Cowie MR, Bax J, Bruining N, Cleland JGF, Koehler F, Malik M, et al. e-Health: a position statement of the European Society of Cardiology. Eur Heart J. 2016;37(1):63-6.
6. https://tkd.org.tr/dijital-saglik-proje-grubu/yonetim-kurulu ve https://tkd.org.tr/dijital-saglik-proje-grubu
7. https://www.facebook.com/MarmaraUniversityDigitalHealth
Digital transformation has knocked on our door also in the field of medicine and health and here we are together. Cardiology is one of the health fields in which digital transformation has had a quick start.

Today, many smart devices and some artificial intelligence (AI) applications have already received valid medical certificates in the field of cardiology. Therefore, while closing the year of 2020 we have decided to prepare this book with Türkiye Klinikleri named "Digital Transformation in Cardiology: Today and Tomorrow'.

In fact, many years ago, the transition to electronic data banking in health institutions in the world and in our country laid the foundations for digital transformation. Immediately afterwards, we can say that we started to find ourselves in a transformation without realizing or inevitably while we were texting our patients with smart phones, interpreting the shared examination results and ECG images and arranging the treatment of our patients remotely by the way. Of course, digital transformation is not limited to a process where data can be shared remotely and interacted. In the last few years, data mining/deep learning/artificial intelligence (AI) platforms have started to change the way we learn, question and practice our profession by processing and interpreting every data produced at every moment of the day with various smart devices.

Cardiology stands out as a "lucky" field in terms of digital transformation, as it has interests that can be easily expressed in numbers. For this reason, many biological data, such as blood pressure, heart rate, ECG, detected with some smart devices and processed with AI applications, have already entered our clinical use in cardiology.

The treatment and follow-up of hypertension has now become possible with FDA-approved smart devices1 and platforms open to professionals where these devices can be connected. Moreover, we will be able to predict 24-h hypertension patterns through data mining, perhaps without 24-hour Holter blood pressure recording.2 In our article "Digital Based Application Examples in Hypertension Management", the contributions of smart devices and applications to hypertension treatment and the effects of the patient physician behavior in hypertension management were discussed and the expected developments in this field from today to tomorrow are discussed.

Pulse rate and heart rhythm, which have been limited as sports-oriented parameters in smart devices for years, have become "medical data" in the last few years. Monitoring heart rhythm and recognition of atrial fibrillation (AF) with smart watches or wristbands is now possible in both iOS-based3 and android-based4 systems. This may pave the way for early and effective prevention of silent AF screening and AF-related complications in risk groups in the community. On the other hand, it might be possible for us to better predict the risk of AF or thromboembolism risk today with AI applications in the near future. In this article, "Digital Based Application Examples in Cardiac Arrhythmia Management", the transformation of smart devices and digital applications to the management of arrhythmic diseases is discussed.

Heart failure is an area where digital medicine studies are intensive, as it requires regular data monitoring. Studies continue on smart devices that collect data about possible early indicators of heart failure without affecting the daily life of the patient his or her own environment and send them to a network that could process this data, and platforms that will present this data to health professionals as a decision support system. For now, the success of AI applications in this field is that it can distinguish low ejection fraction heart failure cases with preserved ejection fraction heart failure with the degree of expert cardiologists and sometimes even better. In our article "Digital Based Practice Examples in Heart Failure Management", the current situation in this field is discussed.

Acute coronary syndrome (ACS) is one of the clinical pictures we know that "time is the heart muscle or maybe life", competing against time. We have long predicted that smart technologies would be of great benefit to reach the possible ACS patient as soon as possible, to confirm the diagnosis as soon as possible, and to initiate and perform the most appropriate treatment as soon as possible. Today, the success level in ACS has reached from ECG sharing in the ambulance to digital infrastructure organizations for emergency diagnosis and treatment at local or national level in most countries. In our article "Tele Medicine Applications in Acute Coronary Syndromes", developments in this field are discussed.

The field of cardiovascular imaging includes digitally dense data accumulation, and with these data, the number of AI-based clinical studies has been rapidly increasing in recent years. These studies seem to help cardiologists reach a diagnosis faster and with higher accuracy within the decision support system. In our article "Digital Based Application Examples in Cardiovascular Imaging", the innovations and contributions of these applications to cardiovascular imaging are discussed.

In this book we have guest writers one is Prof. Dr. Ata Akın who discussed that digital transformation in the field of medicine will be realized together with physicians, healthcare professionals and engineers. He states that a smart device or a medical application can only be of value only after being accepted by individuals-patients-patient relatives-health professionals, in the article "We Will Develop Artificial Intelligence in Health with Physicians".

The details of the article "The Importance of Partnership with the Academy and Public Projects in the Digital Transformation of Health" are discussed by our guest authors, in order to realize digital transformation on a national scale, especially in scientific projects.

Digital transformation, of course, brings new possibilities and new horizons, with some challenges. It brings different disciplines closer to each other. In this case, new research and job opportunities especially for young cardiologists are mentioned in the article "Opportunities and Barriers in the Market in the Digital Age: Recommendations for Young Cardiologists".

We have to act in accordance with the realities of the digital age, both in cardiology residency training and while practicing our profession, and at the same time, we must be able to show the reflexes that will guide digital transformation in line with the needs of our profession.

In the article "Learning in the Digital Age: E-Learning in Cardiology Specialization Training", the efforts and programs of the Turkish Society of Cardiology together with other international specialty associations are explained.

The European Society of Cardiology finally published a "position paper" in this field in 2016, identified the deficiencies, priorities and drew a roadmap for what to do.5 As a first among the medical specialty societies in our country, the "Digital Health Project Group" was established in 2018 in the Turkish Society of Cardiology and continues to work.6

On the other hand, "Digital Health Elective Internship" was initiated in 2018 in order to increase the knowledge and equipment of physician candidates in Marmara University School of Medicine in areas such as digital communication, basic concepts in data science and artificial intelligence and digital security.7 We hope that these multidisciplinary education programs which are the first examples in our country in this field will increase and take more place in the medical education program.

While preparing this special issue, we started to experience the Covid-19 pandemic with the violence all over the world and we all realized once again how necessary digital transformation is in every field. Our congresses and trainings went online, and healthcare institutions desperately started looking for ways to provide remote healthcare services.

Of course, we have a long way to go in the field of health. Issues such as privacy, data security, systems integration, digital health literacy of patients and healthcare professionals await our participation and contribution.

We need to shape the digital transformation in the way that devices and AI work harder for us hence we can devote more time to our patients while providing healthcare.

This book was prepared mainly by the members of the Digital Health Project Group of the Turkish Society of Cardiology and the Working Groups the Turkish Society of Cardiology and also by guest authors. I would like to thank all the authors for their contributions.

I would also thank to Turkish Clinics for making a special issue on "Digital Cardiology" a new era of most of us and for bringing various scientific disciplines together. I hope this book will be useful for our colleagues.

With respects.

Prof. Dr. Ali Serdar FAK
Editor

REFERENCES

1. https://www.accessdata.fda.gov/cdrh_docs/pdf14/K140067.pdf
2. Altikardeş ZA, Erdal H, Baba AF, Fak AS, Korkmaz H. Performance evaluation of classification algorithms by excluding the most relevant attributes for dipper non dipper pattern estimation in Type 2 DM patients. International Journal of Computer Information Systems and Industrial Management Applications. 2016;8:247-56.
3. Perez MV, Mahaffey KW, Hedlin H, Rumsfeld JS, Garcia A, Ferris T, et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med. 2019;381(20):1909-17.
4. Guo Y, Wang H, Zhang H, Liu T, Liang Z, Xia Y, et al. Mobile Photoplethysmographic Technology to Detect Atrial Fibrillation. J Am Coll Cardiol. 2019;74(19):2365-75.
5. Cowie MR, Bax J, Bruining N, Cleland JGF, Koehler F, Malik M, et al. e-Health: a position statement of the European Society of Cardiology. Eur Heart J. 2016;37(1):63-6.
6. https://tkd.org.tr/dijital-saglik-proje-grubu/yonetim-kurulu ve https://tkd.org.tr/dijital-saglik-proje-grubu
7. https://www.facebook.com/MarmaraUniversityDigitalHealth

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4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com