Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs

Bladder cancer ranks among the most common cancers globally. At diagnosis, 75% of patients have non-muscle-invasive bladder cancer (NMIBC). Patients with low-risk NMIBC have a good prognosis, but recurrence and progression rates remain high in intermediate- and high-risk NMIBC, despite the decades-long availability of effective treatments for NMIBC such as intravesical Bacillus Calmette-Guérin (BCG). The present review provides an overview of NMIBC, including its burden and treatment options, and then reviews aspects that counteract the successful treatment of NMIBC, referred to as unmet treatment needs. The scale and reasons for each unmet need are described based on a comprehensive review of the literature, including insufficient adherence to treatment guidelines by physicians because of insufficient knowledge, training, or access to certain therapy options. Low rates of lifestyle changes and treatment completion by patients, due to BCG shortages or toxicities and adverse events as well as their impact on social activities, represent additional areas of potential improvement. Highly heterogeneous evidence for the effectiveness and safety of some treatments limits the comparability of results across studies. As a result, efforts are underway to standardize treatment schedules for BCG, but intravesical chemotherapy schedules remain unstandardized. In addition, risk-scoring models often perform unsatisfactorily due to significant differences between derivation and real-world cohorts. Reporting in clinical trials suffers from a lack of consistent outcomes reporting in bladder cancer clinical trials, paired with an under-representation of racial and ethnic minorities in many trials

ePresciption as an Element of Interprofessional Pathways for continuous medication safety management (eRIKA) – a Living Lab as an Iterative Co-Design Process for a Participative Intervention Development

Physicians and pharmacies often do not have access to relevant and comprehensive information needed for safe drug prescribing and comprehensive pharmaceutical consultations [1]. Medication errors based on information deficits are frequently observed in routine care, which leads to patient harm [2–8]. About half of adverse drug reactions are traced back to medication errors and inadequate prescriptions and are thus preventable [5, 9–14]. This is often caused by physicians’ lack of knowledge of prescription standards [15–17]. Shortcomings in communication within the health sector, including between physicians and pharmacists, are common factors causing adverse drug events [18]. Insufficient information for patients about their medication further favours errors in drug use. Several digital interventions for safer drug prescription, administration and management have been proposed, developed and tested [19, 20]. Despite the increasing availability of digital interventions, few show health improvements or sustained use by patients or providers. This is often explained by a disconnect between users and developers, who do not take users’ perspectives and needs into consideration [21]. Usability is a key determinant for implementation and sustained use of new (digital) interventions [22]. Through (1) early engagement of target users and (2) user testing, user-centered designs can help overcome implementation challenges and user dissatisfaction [22] and improve the translation of evidence-based interventions from health research into routine care [23]. The Living Lab, a collaborative and iterative process for intervention design, is part of a larger interprofessional project with a mixed-methods design funded by the Innovation Fund of the Federal Joint Committee. The aim of the digital eRIKA intervention itself is to facilitate communication on pharmacotherapy information between physicians, pharmacists and hospitals alongside the introduction of the German ePrescription to ensure safer pharmacotherapy for patients with polypharmacy. The intervention will be implemented and tested in the regions Saarland, Westfalen-Lippe and Berlin-Brandenburg. Characteristics of eRIKA will be (1) the use of the ePrescription in accordance with the legal framework, (2) the use of dispensing data to enable a continuous, comprehensive and up-to-date electronic medication plan (BMP), (3) central storage of patients medication data through the BMP and electronic patient records, which is usable and editable for physicians and pharmacists, (4) electronically supported assessments of each prescription in the current medication plan, (5) optimized pharmaceutical consultation when filling a prescription through the availability of the complete medication plan and patient individual factors, (6) easier communication between physicians and pharmacists through KIM (Kommunikation im Medizinwesen – communication in medicine), the communication service provided for medical practices, (7) batch-specific traceability of drugs to the patient, (8) drug safety assessments at the point of prescription