A critical investigation of the Osterwalder business model canvas: an in-depth case study

Although the Osterwalder business model canvas (BMC) is used by professionals worldwide, it has not yet been subject to a thorough investigation in academic literature. In this first contribution we present the results of an intensive, interactive process of data analysis, visual synthesis and textual rephrasing to gain insight into the business model of a single case (health television). The (textual and visual) representation of the business model needs to be consistent and powerful. Therefore, we start from the total value per customer segment. Besides the offer (or core value) additional value is created through customer related activities. The understanding of activities both on the strategic and tactical level reveals more insight into the total value creation. Moreover, value elements for one customer segment can induce value for others. The interaction between value for customer segments and activities results in a powerful customer value centred business model representation. Total value to customers generates activities and costs on the one hand and a revenue model on the other hand. Gross margins and sales volumes explain how value for customers contributes to profit. Another main challenge in business model mapping is in denominating the critical resources behind the activities. The Osterwalder business model canvas lacks consistency and power due to many overlaps which in turn are caused by the fixed architecture, the latter too easily leading to a filling-in exercise. Through its business model representation a company should first of all gain thorough understanding of it. Only then companies can evaluate the model and finally consider some adaptations

From the Osterwalder canvas to an alternative business model representation

The Osterwalder business model canvas (BMC) is used by many entrepreneurs, managers, consultants and business schools. In our research we have investigated whether the canvas is a valid instrument for gaining an in-depth, accurate insight into business models. Therefore we have performed initial multiple case study research which concluded that the canvas does not generate valid business model (BM) representations. In our second multiple case study, we have constructed an alternative BM framework, on the basis of which we have finally built a BM tool to design, evaluate and re-design any business model

Geneesmiddelengebruik in RVT's

A

Interventions to optimise prescribing for older people in care homes

Background There is a substantial body of evidence that prescribing for care home residents is suboptimal and requires improvement. Consequently, there is a need to identify effective interventions to optimise prescribing and resident outcomes in this context. This is an update of a previously published review (Alldred 2013). Objectives The objective of the review was to determine the effect of interventions to optimise overall prescribing for older people living in care homes. Search methods For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Specialised Register), MEDLINE, EMBASE and CINAHL to May 2015. We also searched clinical trial registries for relevant studies. Selection criteria We included randomised controlled trials evaluating interventions aimed at optimising prescribing for older people (aged 65 years or older) living in institutionalised care facilities. Studies were included if they measured one or more of the following primary outcomes: adverse drug events; hospital admissions; mortality; or secondary outcomes, quality of life (using validated instrument); medication-related problems; medication appropriateness (using validated instrument); medicine costs. Data collection and analysis Two authors independently screened titles and abstracts, assessed studies for eligibility, assessed risk of bias and extracted data. We presented a narrative summary of results. Main results The 12 included studies involved 10,953 residents in 355 (range 1 to 85) care homes in ten countries. Nine studies were cluster-randomised controlled trials and three studies were patient-randomised controlled trials. The interventions evaluated were diverse and often multifaceted. Medication review was a component of ten studies. Four studies involved multidisciplinary case-conferencing, five studies involved an educational element for health and care professionals and one study evaluated the use of clinical decision support technology. We did not combine the results in a meta-analysis due to heterogeneity across studies. Interventions to optimise prescribing may lead to fewer days in hospital (one study out of eight; low certainty evidence), a slower decline in health-related quality of life (one study out of two; low certainty evidence), the identification and resolution of medication-related problems (seven studies; low certainty evidence), and may lead to improved medication appropriateness (five studies out of five studies; low certainty evidence). We are uncertain whether the intervention improves/reduces medicine costs (five studies; very low certainty evidence) and it may make little or no difference on adverse drug events (two studies; low certainty evidence) or mortality (six studies; low certainty evidence). The risk of bias across studies was heterogeneous. Authors' conclusions We could not draw robust conclusions from the evidence due to variability in design, interventions, outcomes and results. The interventions implemented in the studies in this review led to the identification and resolution of medication-related problems and improvements in medication appropriateness, however evidence of a consistent effect on resident-related outcomes was not found. There is a need for high-quality cluster-randomised controlled trials testing clinical decision support systems and multidisciplinary interventions that measure well-defined, important resident-related outcomes

Personalised dosing: Printing a dose of one's own medicine

© 2015 Elsevier B.V. All rights reserved. Ink-jet printing is a versatile, precise and relatively inexpensive method of depositing small volumes of solutions with remarkable accuracy and repeatability. Although developed primarily as a technology for image reproduction, its areas of application have expanded significantly in recent years. It is particularly suited to the manufacture of low dose medicines or to short production runs and so offers a potential manufacturing solution for the paradigm of personalised medicines. This review discusses the technical and clinical aspects of ink-jet printing that must be considered in order for the technology to become widely adopted in the pharmaceutical arena and considers applications in the literature

Systems to identify potentially inappropriate prescribing in people with advanced dementia: a systematic review

BACKGROUND: Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia. METHODS: Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 – August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually. RESULTS: Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals’ opinions on appropriateness of specific medications in different clinical scenarios. CONCLUSIONS: Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications

Utilisation actuelle et évaluation des applications mobiles de santé par les patients suivis par leur médecin généraliste pour une maladie chronique

Introduction : les maladies chroniques représentent une part importante des dépenses de santé. La e-santé est en plein essor et va faire partie de la prise en charge future des patients. Elle pourrait ainsi avoir un rôle dans la prévention et leséconomies de santé.Matériel et méthodes : nous avons mené une étude monocentrique dans un cabinet de médecine générale de l’Essonne (91). Les médecins distribuaient un questionnaire papier comprenant 26 questions à leurs patients suivis pour au moins une maladie chronique. L’objectif principal de notre travail est d’étudier la prévalence d’utilisation des applications mobiles chez les patients suivis en ville. Un total de 50 questionnaires était nécessaire pour mener notre étude.Résultats : nous avons obtenu 57 questionnaires réponses dont 50 répondants aux critères d’inclusions. 32% de notre cohorte déclare avoir déjà téléchargé une application mobile de santé. Cela correspond à une augmentation de 12% parrapport à 2013. Mais seulement 6% des téléchargements ciblent une application en rapport avec la maladie chronique du patient. Ces résultats sont corrélés à une augmentation du taux de possession de smartphone passant de 74% (+/- 3%) avant 2015 à 88% au sein de notre cohorte. La moitié des téléchargements sont réalisés par les moins de 50 ans et dans 44% des cas par des patients suivis pour leur maladie chronique depuis moins de 5 ans. Au contraire, aucun patient de plus de 70 ans ne déclare avoir téléchargé.Conclusions : il y a une augmentation du nombre de téléchargements d’applications mobiles de santé avecactuellement 32% de téléchargement chez les patients suivis pour une maladie chronique