Search

Background: Lateral lumbar interbody fusion (LLIF) with posterior screw fusion is a safe and effective treatment for patients suffering from degenerative spine disorders. While LLIF has been shown to restore disc height, decompress neural components, correct sagittal imbalances, and improve pain scores, the approach requires repositioning patients for posterior pedicle fixation, which requires 2 separate surgeries. The evolution of surgical techniques, navigation, and robotics has allowed for a single position approach to LLIF with the patient in the prone position. The purpose of this study was to perform a systematic review and meta-analysis comparing the prone single position (PSP) LLIF approach to the dual position LLIF approach. We hypothesized that PSP LLIF will have a reduced operative time, complication rate, and blood loss compared with the dual position LLIF procedure., Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed and Embase databases were searched with key terms: (lateral AND [interbody OR "inter body"] AND lumbar AND fusion) AND (prone OR single). Results were extracted and reviewed by 2 authors (MR and RB) per selection criteria. Patient demographics were extracted from the selected studies, along with surgical, patient-reported, and radiographic outcomes. A meta-analysis was performed using an unstandardized mean difference or log odds ratio with a confidence level of 95%., Results: Fifteen studies were included in the systematic review and 5 studies compared PSP LLIF to dual position LLIF for meta-analysis. PSP LLIF had a reduced operative time and length of stay compared with the dual position approach, although there was no significant reduction in estimated blood loss. Additionally, PSP LLIF improved lumbar lordosis more effectively than dual position LLIF. There was no difference in segmental lordosis or pelvic tilt. There was no difference in intraoperative complications, postoperative complications, or reoperations., Conclusions: PSP LLIF reduces operative time and length of stay, with no relative increase in complications or reoperations compared with the dual position approach. Additionally, PSP LLIF improves lumbar lordosis relative to dual position LLIF, which may improve functional outcomes and reduce the risk of developing adjacent segment disease., Clinical Relevance: The associated operative and postoperative benefits of PSP LLIF may improve long-term outcomes of patients undergoing spinal fusion., (This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.)

Background: The COVID-19 pandemic impacted healthcare resource allocation and utilization of preventative medical services. It is unknown if there is resultant stage migration of melanoma, breast, and colorectal cancer when comparing extended time periods before and after the pandemic onset., Methods: A retrospective cohort study of melanoma, breast, and colorectal cancer patients was completed. Clinical and pathological staging was compared utilizing 12 and 22-month timeframes before and after the pandemic outbreak., Results: Between the 22-month pre- and post-COVID-19 groups, breast cancer clinical stage T2 significantly increased, and pathological stage 2 decreased. Colorectal cancer clinical stage T1 decreased, stage T4 increased, and stage 0 decreased in the 22-month groups. In the 12-month groups, melanoma clinical stage T1 increased, and colorectal cancer clinical stage N2 increased., Conclusions: Evaluating extended timeframes beyond the immediate pre- and post-COVID-19 period revealed significant increases in clinical staging of breast and colorectal cancer, suggesting advanced disease is becoming more evident as time progresses., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Effective portfolio management is crucial for innovation and sustaining revenue in pharmaceutical companies. This article holistically reviews trends, challenges, and approaches to pharmaceutical portfolio management and focuses, in particular, on cognitive biases in portfolio decision-making. Portfolio managers strongly rely on external innovation and face increasing competitive pressure and portfolio complexity. The ability to address biases and make robust decisions remains a challenge. Portfolio management practitioners most commonly face confirmation bias, champion bias, or misaligned incentives, which they seek to mitigate through expert input, team diversity, and rewarding truth-seeking. Ultimately, highest-quality portfolio management decision-making could be enabled by three factors: high-quality data, structured review processes, and comprehensive mitigating measures against biases in decision-making., (Copyright © 2023. Published by Elsevier Ltd.)

Most clinical trials are delayed due to scientific and/or operational challenges. Any effort to minimize delays can generate value for patients and sponsors. This article reviews critical path process steps commonly identified by practitioners, such as during protocol development, site contracting, or patient recruitment. Commonly considered measures, such as adding more trial sites or countries, were contrasted with less frequented measures, such as evidence-based feasibility or real-world evidence analysis, to help validate assumptions before clinical trial initiation. In a broad analysis, we integrated a literature review with a practitioner survey into a framework to help decision makers on the most critical process steps when setting up or conducting clinical trials in order to bring critical treatments to patients faster., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Gastruloids are 3D structures generated from pluripotent stem cells recapitulating fundamental principles of embryonic pattern formation. Using single-cell genomic analysis, we provide a resource mapping cell states and types during gastruloid development and compare them with the in vivo embryo. We developed a high-throughput handling and imaging pipeline to spatially monitor symmetry breaking during gastruloid development and report an early spatial variability in pluripotency determining a binary response to Wnt activation. Although cells in the gastruloid-core revert to pluripotency, peripheral cells become primitive streak-like. These two populations subsequently break radial symmetry and initiate axial elongation. By performing a compound screen, perturbing thousands of gastruloids, we derive a phenotypic landscape and infer networks of genetic interactions. Finally, using a dual Wnt modulation, we improve the formation of anterior structures in the existing gastruloid model. This work provides a resource to understand how gastruloids develop and generate complex patterns in vitro., Competing Interests: Declaration of interests M.P.L. is an employee of Roche and has equity in Roche., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: Digitalization of medical prescriptions is a core element for the digitalization of healthcare. While some countries have introduced electronic prescriptions over 20 years ago and nearly reached 100 % penetration, physicians in Germany have only been able to use electronic prescriptions since mid-2021 and currently only 0.1 % of prescriptions are transmitted electronically. This study investigates German physicians' viewpoint towards electronic prescriptions as a potential reason for the low penetration and investigates levers to drive adoption., Basic Procedures: We conducted a two-stage sequential mixed methods study consisting of semi-structured interviews followed by an online survey among 1136 physicians testing the main dimensions of the Unified Theory of Acceptance and Use of Technology model., Main Findings: Our initial interviews suggested that there was a high technology acceptance by physicians, but due to technical barriers, they were not able to use the system, explaining the low penetration. However, with the larger sample size of the survey, we identified, that while physicians see barriers for introducing electronic prescriptions, such as unclear cost reimbursement or lack of time to deal with the implementation, the majority believes these can be overcome within twelve months. Furthermore, we found that only one third of physicians is in favor of replacing paper-based prescriptions with electronic prescriptions and most physicians considers it unlikely that they will issue more than half of their prescriptions electronically within the next twelve month. Additionally, respondents perceived limited usefulness and expect high effort for using electronic prescriptions., Principal Conclusion: Low electronic prescription penetration in Germany seems to be driven by low technology acceptance, not technical barriers. This can be linked to low perceived usefulness, high effort expectancy and low perceived patient demand. Improving technical stability, system functionality and increasing physicians' level of information were seen as main levers to drive electronic prescription adoption., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Mobile health applications and their subset digital therapeutics-defined as evidence-based software interventions to prevent, manage, or treat a medical condition-offer great potential to improve patient care. However, such solutions often struggle to reach widespread adoption., Objective: This study seeks to explore healthcare stakeholders' roles and potential for fostering patient access and adherence to evidence-based digital therapeutics and thereby improve health outcomes from the perspective of digital therapeutics developers and distributors., Methods: Semi-structured qualitative and semiquantitative interviews were conducted with 19 experts from developers and distributors of digital therapeutics in Germany to discuss their perceived relevance of different healthcare stakeholders and strategies in promoting patient access and adherence to digital therapeutics., Results: Healthcare professionals were found to have the greatest potential to promote both access and patient adherence to digital therapeutics, followed by health insurers, pharmaceutical companies, and patients themselves. In terms of patient access, healthcare professionals have potential due to their ability to prescribe digital therapeutics. Other stakeholders' potential stems from their capacity to influence healthcare professionals prescription decision. In terms of patient adherence, only healthcare professionals are of high relevance by onboarding patients and monitoring digital therapeutics use. Most healthcare stakeholders currently do not fully leverage their potential. Further educating healthcare professionals and simplifying processes for them, empowering patients to seek treatment with digital therapeutics, and designing digital therapeutics' product features for better adherence can help improve patient access and adherence., Conclusions: Established healthcare stakeholders and digital therapeutics developers both need to take action to improve patient access and adherence to digital therapeutics. Several macro-level changes can support these efforts, including broader information dissemination, improved financial incentives, simplified prescription and activation processes, and a wider adoption of blended care and pay-for-performance payment models., Competing Interests: Declaration of conflicting interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This paper’s study was conducted as part of doctoral and habilitation research projects at the University Witten/Herdecke. All but the fourth author participated in these projects while on academic leave from (first and second authors) or employed by (third, fifth, and sixth authors) McKinsey & Company. The 4th author is only associated with the University Witten/Herdecke and served as doctoral supervisor and academic researcher. The study was executed during the authors’ personal time. McKinsey & Company was at no point involved in the research. There was also no funding, pay, or other commercial interest from McKinsey & Company., (© The Author(s) 2022.)

»: Conventional total hip arthroplasty (THA) largely remains an unguided procedure dependent on the ability and experience of the surgeon. New technologies, such as patient-specific instrumentation and robotics, have shown promising results in improving implant positioning, which has the potential to improve patient outcomes., »: The use of off-the-shelf (OTS) implant designs, however, limits the success of the technological advances since they are unable to recreate the native anatomy of the joint. The inability to restore femoral offset and version or the presence of implant-related leg-length discrepancies often lead to suboptimal surgical results that increase the risk of dislocation, fractures, and component wear, compromising postoperative functional outcomes and implant longevity., »: A customized THA system, whereby the femoral stem is designed to restore patient anatomy, has recently been introduced. The THA system uses computed tomography (CT)-derived 3D imaging to create a custom stem, patient-specific component placement, and patient-specific instrumentation that matches the patient's native anatomy., »: The purpose of this article is to provide information on the design and manufacturing process of this new THA implant, to illustrate the associated preoperative planning, and to describe the surgical technique; 3 surgical cases are presented., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A834)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Innovative pharmaceutical companies have started to explore quantum computing (QC). In this article, we provide a collective industry perspective from QC domain leaders at leading pharmaceutical companies. There are immediate nonfinancial benefits in engaging with QC, some likely financial returns in the short term in drug development, manufacturing, and supply chain, and potentially large scientific benefits in drug discovery long term. We discuss the required activities for institutionalizing QC: how to create an understanding of QC among researchers and management, which and how to deploy external resources, and how to identify the problems to be addressed with QC. If (and once) deployable, QC will likely have a similar trajectory to that of computer-aided drug design (CADD) and artificial intelligence (AI) during the 1990s and 2010s, respectively., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: In October 2020, Germany became the first country, worldwide, to approve certain mobile health (mHealth) apps, referred to as DiGA (Digitale Gesundheitsanwendungen, in German, meaning digital health applications), for prescription with costs covered by standard statutory health insurance. Yet, this option has only been used to a limited extent so far., Objective: The aim of this study was to investigate physicians' and psychotherapists' current attitudes toward mHealth apps, barriers to adoption, and potential remedies., Methods: We conducted a two-stage sequential mixed methods study. In phase one, semistructured interviews were conducted with physicians and psychotherapists for questionnaire design. In phase two, an online survey was conducted among general practitioners, physicians, and psychotherapists., Results: A total of 1308 survey responses by mostly outpatient-care general practitioners, physicians, and psychotherapists from across Germany who could prescribe DiGA were recorded, making this the largest study on mHealth prescriptions to date. A total of 62.1% (807/1299) of respondents supported the opportunity to prescribe DiGA. Improved adherence (997/1294, 77.0%), health literacy (842/1294, 65.1%), and disease management (783/1294, 60.5%) were most frequently seen as benefits of DiGA. However, only 30.3% (393/1299) of respondents planned to prescribe DiGA, varying greatly by medical specialty. Professionals are still facing substantial barriers, such as insufficient information (1135/1295, 87.6%), reimbursement for DiGA-related medical services (716/1299, 55.1%), medical evidence (712/1298, 54.9%), legal uncertainties (680/1299, 52.3%), and technological uncertainties (658/1299, 50.7%). To support professionals who are unsure of prescribing DiGA, extended information campaigns (1104/1297, 85.1%) as well as recommendations from medical associations (1041/1297, 80.3%) and medical colleagues (1024/1297, 79.0%) were seen as the most impactful remedies., Conclusions: To realize the benefits from DiGA through increased adoption, additional information sharing about DiGA from trusted bodies, reimbursement for DiGA-related medical services, and further medical evidence are recommended., (©Florian Dahlhausen, Maximillian Zinner, Linn Bieske, Jan P Ehlers, Philip Boehme, Leonard Fehring. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 23.11.2021.)