Patientenbindung durch Kommunikation - Impulse für das Pharmamarketing

Der zunehmende Einfluss des Patienten auf die Therapieentscheidung und damit auf die Verschreibung eines Medikaments erfordert patientenorientierte Führungskonzepte. Der ehemalige Verschreibermarkt entwickelt sich vor allem bei chronisch Kranken auf Grund zunehmender Selbstverantwortung und größerer Wahlmöglichkeiten zu einem Käufermarkt mit mündigen Entscheidern. Insbesondere bei dieser Patientengruppe sind auf Grund der Langfristigkeit und Komplexität der Erkrankung umfangreiche Kommunikations- und Informationsaktivitäten erforderlich. Solche zusätzlichen Serviceleistungen neben dem Arzneimittel fördern die Stabilität und Intensität der Beziehung zwischen pharmazeutischem Unternehmen und Patient. Die aus der subjektiv wahrgenommenen Dienstleistungsqualität resultierende Patientenbindung kann somit als entscheidender Wettbewerbsfaktor genutzt werden. Der Schwerpunkt der vorliegenden Arbeit liegt deshalb auf dem Teilbereich der Patientenbindung. Es wird zunächst ein Messinstrument für das Konstrukt Patientenbindung konzeptualisiert und validiert. Anschließend wird ein Patientenbindungsmodell entwickelt, um sowohl den Einfluss der Qualität der Kernleistung in Form des Arzneimittels als auch der direkten Kommunikation zwischen Patient und Pharmaunternehmen auf die Beziehungsqualität und die Patientenbindung zu bestimmen. Das entwickelte Modell dient der kontinuierlichen Überprüfung der Unternehmensleistungen und dem rechtzeitigen Ergreifen von Korrekturmaßnahmen zur langfristigen Optimierung des Leistungsangebots eines pharmazeutischen Unternehmens. Auf diese Weise kann auch im Pharmabereich ein konsequentes Kundenbeziehungsmanagement implementiert werden

Die Messung der Patientenzufriedenheit

Die Wettbewerbsintensivierung auf dem Markt für Krankenhausdienstleistungen erfordert patientenorientierte Führungskonzepte. Durch das Ausscheiden des Preises als Wettbewerbsinstrument sowie den eingeschränkten kommunikationspolitischen Möglichkeiten eines Krankenhauses im deutschsprachigen Raum kommen der Konzentration auf die Zielgruppen und deren Zufriedenstellung eine herausragende ökonomische Bedeutung zu. Die aus der subjektiv wahrgenommenen Dienstleistungsqualität resultierende Patientenzufriedenheit wird somit zum entscheidenden Wettbewerbsfaktor. An dieser Stelle setzt die vorliegende Arbeit an. Ziel ist es, ein Messinstrument zur Erfassung der Dienstleistungsqualität in Krankenhäusern zu entwickeln. Das vorgeschlagene Modell basiert auf der subjektiven Wahrnehmung der Patientenzufriedenheit und beschränkt sich auf den stationären Krankenhausaufenthalt auf Normalstationen. Die aufgestellte Hypothesenstruktur wird mit Hilfe eines linearen Strukturgleichungsmodells überprüft und mit zwei weiteren Modellen zur Messung der Dienstleistungsqualität verglichen. Das entwickelte Basismodul ermöglicht im Sinne eines Früherkennungssystems eine permanente, multiattributive Messung der Patientenzufriedenheit zur kontinuierlichen Überprüfung der eigenen Versorgungsleistungen und zum rechtzeitigen Ergreifen von Korrekturmaßnahmen

Patient Relationship Management - Konzeption und Umsetzung

Zur Sicherstellung der gesundheitlichen Versorgung auf hohem Niveau werden Versicherte im Zuge einer politisch gewollten Förderung der Selbstverantwortung zunehmend an den Gesundheitskosten beteiligt. Hierdurch entwickeln sich Patienten – in Verbindung mit der steigenden Bedeutung des Gutes Gesundheit – zu mündigen Konsumenten. Als Mitentscheider in Therapiefragen und somit auch bei der Verschreibung eines Medikaments müssen Konsumenten pharmazeutischer Leistungen als Zielgruppe in die Marketingaktivitäten pharmazeutischer Unternehmen eingebunden werden. Insbesondere bei chronisch Kranken, die in der Regel verschreibungspflichtige Arzneimittel beziehen, lassen sich auf Grund der Langfristigkeit und Komplexität der Erkrankung umfangreiche Maßnahmen ableiten, um eine dauerhafte Beziehung zwischen pharmazeutischem Unternehmen und Patienten aufzubauen. Pharmaunternehmen müssen sich dieser Herausforderung stellen und den Wandel vom „Pillenproduzenten“ zum Versorgungsdienstleister vollziehen. Diese Studie stellt ein umfassendes Konzept des Patient Relationship Management (PRM) vor. Neben der Abgrenzung der für ein solches Konzept geeigneten Zielgruppe werden die Grundlagen und die zentralen Voraussetzungen für die Umsetzung eines erfolgreichen PRM diskutiert sowie Möglichkeiten zur Kontrolle der PRM-Aktivitäten vorgestellt

A fast and robust hepatocyte quantification algorithm including vein processing

<p>Abstract</p> <p>Background</p> <p>Quantification of different types of cells is often needed for analysis of histological images. In our project, we compute the relative number of proliferating hepatocytes for the evaluation of the regeneration process after partial hepatectomy in normal rat livers.</p> <p>Results</p> <p>Our presented automatic approach for hepatocyte (HC) quantification is suitable for the analysis of an entire digitized histological section given in form of a series of images. It is the main part of an automatic hepatocyte quantification tool that allows for the computation of the ratio between the number of proliferating HC-nuclei and the total number of all HC-nuclei for a series of images in one processing run. The processing pipeline allows us to obtain desired and valuable results for a wide range of images with different properties without additional parameter adjustment. Comparing the obtained segmentation results with a manually retrieved segmentation mask which is considered to be the ground truth, we achieve results with sensitivity above 90% and false positive fraction below 15%.</p> <p>Conclusions</p> <p>The proposed automatic procedure gives results with high sensitivity and low false positive fraction and can be applied to process entire stained sections.</p

Safety and efficacy of mTOR inhibitor treatment in patients with tuberous sclerosis complex under 2 years of age – a multicenter retrospective study

Background: Tuberous sclerosis complex (TSC) is a multisystem disease with prominent neurologic manifestations such as epilepsy, cognitive impairment and autism spectrum disorder. mTOR inhibitors have successfully been used to treat TSC-related manifestations in older children and adults. However, data on their safety and efficacy in infants and young children are scarce. The objective of this study is to assess the utility and safety of mTOR inhibitor treatment in TSC patients under the age of 2 years. Results: A total of 17 children (median age at study inclusion 2.4 years, range 0–6; 12 males, 5 females) with TSC who received early mTOR inhibitor therapy were studied. mTOR inhibitor treatment was started at a median age of 5 months (range 0–19 months). Reasons for initiation of treatment were cardiac rhabdomyomas (6 cases), subependymal giant cell astrocytomas (SEGA, 5 cases), combination of cardiac rhabdomyomas and SEGA (1 case), refractory epilepsy (4 cases) and disabling congenital focal lymphedema (1 case). In all cases everolimus was used. Everolimus therapy was overall well tolerated. Adverse events were classified according to the Common Terminology Criteria of Adverse Events (CTCAE, Version 5.0). Grade 1–2 adverse events occurred in 12 patients and included mild transient stomatitis (2 cases), worsening of infantile acne (1 case), increases of serum cholesterol and triglycerides (4 cases), changes in serum phosphate levels (2 cases), increase of cholinesterase (2 cases), transient neutropenia (2 cases), transient anemia (1 case), transient lymphopenia (1 case) and recurrent infections (7 cases). No grade 3–4 adverse events were reported. Treatment is currently continued in 13/17 patients. Benefits were reported in 14/17 patients and included decrease of cardiac rhabdomyoma size and improvement of arrhythmia, decrease of SEGA size, reduction of seizure frequency and regression of congenital focal lymphedema. Despite everolimus therapy, two patients treated for intractable epilepsy are still experiencing seizures and another one treated for SEGA showed no volume reduction. Conclusion: This retrospective multicenter study demonstrates that mTOR inhibitor treatment with everolimus is safe in TSC patients under the age of 2 years and shows beneficial effects on cardiac manifestations, SEGA size and early epilepsy

A comparative ultrastructural and molecular biological study on Chlamydia psittaci infection in alpha-1 antitrypsin deficiency and non-alpha-1 antitrypsin deficiency emphysema versus lung tissue of patients with hamartochondroma

BACKGROUND: Chlamydiales are familiar causes of acute and chronic infections in humans and animals. Human pulmonary emphysema is a component of chronic obstructive pulmonary disease (COPD) and a condition in which chronic inflammation manifested as bronchiolitis and intra-alveolar accumulation of macrophages is common. It is generally presumed to be of infectious origin. Previous investigations based on serology and immunohistochemistry indicated Chlamydophila pneumoniae infection in cases of COPD. Furthermore, immunofluorescence with genus-specific antibodies and electron microscopy suggested involvement of chlamydial infection in most cases of pulmonary emphysema, but these findings could not be verified by PCR. Therefore, we examined the possibility of other chlamydial species being present in these patients. METHODS: Tissue samples from patients having undergone lung volume reduction surgery for advanced alpha-1 antitrypsin deficiency (AATD, n = 6) or non-alpha-1 antitrypsin deficiency emphysema (n = 34) or wedge resection for hamartochondroma (n = 14) were examined by transmission electron microscopy and PCR. RESULTS: In all cases of AATD and 79.4% of non-AATD, persistent chlamydial infection was detected by ultrastructural examination. Intra-alveolar accumulation of macrophages and acute as well as chronic bronchiolitis were seen in all positive cases. The presence of Chlamydia psittaci was demonstrated by PCR in lung tissue of 66.7% AATD vs. 29.0% non-AATD emphysema patients. Partial DNA sequencing of four positive samples confirmed the identity of the agent as Chlamydophila psittaci. In contrast, Chlamydophila pneumoniae was detected only in one AATD patient. Lung tissue of the control group of non-smokers with hamartochondroma was completely negative for chlamydial bodies by TEM or chlamydial DNA by PCR. CONCLUSIONS: These data indicate a role of Chlamydophila psittaci in pulmonary emphysema by linking this chronic inflammatory process to a chronic infectious condition. This raises interesting questions on pathogenesis and source of infection

Insights from the genome of the biotrophic fungal plant pathogen Ustilago maydis

Ustilago maydis is a ubiquitous pathogen of maize and a well-established model organism for the study of plant-microbe interactions. This basidiomycete fungus does not use aggressive virulence strategies to kill its host. U. maydis belongs to the group of biotrophic parasites (the smuts) that depend on living tissue for proliferation and development. Here we report the genome sequence for a member of this economically important group of biotrophic fungi. The 20.5-million-base U. maydis genome assembly contains 6,902 predicted protein-encoding genes and lacks pathogenicity signatures found in the genomes of aggressive pathogenic fungi, for example a battery of cell-wall-degrading enzymes. However, we detected unexpected genomic features responsible for the pathogenicity of this organism. Specifically, we found 12 clusters of genes encoding small secreted proteins with unknown function. A significant fraction of these genes exists in small gene families. Expression analysis showed that most of the genes contained in these clusters are regulated together and induced in infected tissue. Deletion of individual clusters altered the virulence of U. maydis in five cases, ranging from a complete lack of symptoms to hypervirulence. Despite years of research into the mechanism of pathogenicity in U. maydis, no 'true' virulence factors had been previously identified. Thus, the discovery of the secreted protein gene clusters and the functional demonstration of their decisive role in the infection process illuminate previously unknown mechanisms of pathogenicity operating in biotrophic fungi. Genomic analysis is, similarly, likely to open up new avenues for the discovery of virulence determinants in other pathogens. ©2006 Nature Publishing Group.J.K., M. B. and R.K. thank G. Sawers and U. Kämper for critical reading of the manuscript. The genome sequencing of Ustilago maydis strain 521 is part of the fungal genome initiative and was funded by National Human Genome Research Institute (USA) and BayerCropScience AG (Germany). F.B. was supported by a grant from the National Institutes of Health (USA). J.K. and R.K. thank the German Ministry of Education and Science (BMBF) for financing the DNA array setup and the Max Planck Society for their support of the manual genome annotation. F.B. was supported by a grant from the National Institutes of Health, B.J.S. was supported by the Natural Sciences and Engineering Research Council of Canada and the Canada Foundation for Innovation, J.W.K. received funding from the Natural Sciences and Engineering Research Council of Canada, J.R.-H. received funding from CONACYT, México, A.M.-M. was supported by a fellowship from the Humboldt Foundation, and L.M. was supported by an EU grant. Author Contributions All authors were involved in planning and executing the genome sequencing project. B.W.B., J.G., L.-J.M., E.W.M., D.D., C.M.W., J.B., S.Y., D.B.J., S.C., C.N., E.K., G.F., P.H.S., I.H.-H., M. Vaupel, H.V., T.S., J.M., D.P., C.S., A.G., F.C. and V. Vysotskaia contributed to the three independent sequencing projects; M.M., G.M., U.G., D.H., M.O. and H.-W.M. were responsible for gene model refinement, database design and database maintenance; G.M., J. Kämper, R.K., G.S., M. Feldbrügge, J.S., C.W.B., U.F., M.B., B.S., B.J.S., M.J.C., E.C.H.H., S.M., F.B., J.W.K., K.J.B., J. Klose, S.E.G., S.J.K., M.H.P., H.A.B.W., R.deV., H.J.D., J.R.-H., C.G.R.-P., L.O.-C., M.McC., K.S., J.P.-M., J.I.I., W.H., P.G., P.S.-A., M. Farman, J.E.S., R.S., J.M.G.-P., J.C.K., W.L. and D.H. were involved in functional annotation and interpretation; T.B., O.M., L.M., A.M.-M., D.G., K.M., N.R., V. Vincon, M. VraneŠ, M.S. and O.L. performed experiments. J. Kämper, R.K. and M.B. wrote and edited the paper with input from L.-J.M., J.G., F.B., J.W.K., B.J.S. and S.E.G. Individual contributions of authors can be found as Supplementary Notes

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Search for new particles in events with energetic jets and large missing transverse momentum in proton-proton collisions at root s=13 TeV

A search is presented for new particles produced at the LHC in proton-proton collisions at root s = 13 TeV, using events with energetic jets and large missing transverse momentum. The analysis is based on a data sample corresponding to an integrated luminosity of 101 fb(-1), collected in 2017-2018 with the CMS detector. Machine learning techniques are used to define separate categories for events with narrow jets from initial-state radiation and events with large-radius jets consistent with a hadronic decay of a W or Z boson. A statistical combination is made with an earlier search based on a data sample of 36 fb(-1), collected in 2016. No significant excess of events is observed with respect to the standard model background expectation determined from control samples in data. The results are interpreted in terms of limits on the branching fraction of an invisible decay of the Higgs boson, as well as constraints on simplified models of dark matter, on first-generation scalar leptoquarks decaying to quarks and neutrinos, and on models with large extra dimensions. Several of the new limits, specifically for spin-1 dark matter mediators, pseudoscalar mediators, colored mediators, and leptoquarks, are the most restrictive to date.Peer reviewe