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CCR Publications

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Digitalizing time-consuming Medical Review Processes by Artificial Intelligence (AI) in Clinical Studies


Smart AI accelerates Drug Development, hence, extends Time Span for Return on Investment within Patent Term This article discusses the potential of using smart artificial intelligence (AI)-driven 3-dimensional (3D), virtual reality (VR), augmented reality (AR) data visualization for Medical Data Listing Review and large language model AI for Medical Data Profile Review in clinical research drug development. Integrating these technologies can accelerate the development timeline, extend the market exclusivity period, and enhance the return on investment (ROI) for new drugs.


Joachim Linke, Jason Marsh, Bill Morton

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Smart AI accelerates Drug Development, hence, extends Time Span for ROI within Patent Time

Innovative treatment allows prolongation of Type 1 Diabetes mellitus outbreak in potential risk subjects: Can AI create an Answer to the Question How and When to Screen Subjects at Risk?


In times of growing influence of artificial intelligence (AI) in industry—including the pharmaceutical industry—it is of utmost interest to check the possibilities and chances and to what extent these new techniques can help to develop and narrow down scientific questions. The medical-scientific rationale for this specific exercise described hereafter is the availability of new pharmaceutical approaches (CD3-directed monoclonal antibody treatment [1], Sanofi) which have shown a disease delaying effect on Type 1 Diabetes mellitus (T1DM). The earlier the detection of potential T1DM patients, the better the substantial prolongation of the T1DM manifestation in these patients with T1DM risk [2][3][4]. With the prolongation of the manifestation of T1DM also the T1DM concomitant diseases caused by hyperglycemia can be prolonged e.g. micro- and macrovascular complications. The availability of new drugs prolonging the manifestation of T1DM, the detection of potential T1DM patients brought the screening into the focus since subjects with risk for T1DM mostly benefit from an early detection and therapy. In this context, we wanted to know the capabilities of a LLM (Large Language Model) to extract relevant information from only a few text sources to answer questions concerning the screening for T1DM.



Joachim Linke, Steffen Berhorst, Sophie Yavuz

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Publication in press -Publish Date ca. June 2024

Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial

Remimazolam, a short-acting benzodiazepine, may be used for induction and maintenance of total intravenous anaesthesia, but its role in the management of patients with multiple comorbidities remains unclear. In this phase 3 randomised controlled trial, we compared the anaesthetic efficacy and the incidence of postinduction hypotension during total intravenous anaesthesia with remimazolam vs. propofol. A total of 365 patients (ASA physical status 3 or 4) scheduled for elective surgery were assigned randomly to receive total intravenous anaesthesia with remimazolam (n = 270) or propofol (n = 95). Primary outcome was anaesthetic effect, quantified as the percentage of time with Narcotrend Index values ≤ 60, during surgery (skin incision to last skin suture), with a non-inferiority margin of -10%. Secondary outcome was the incidence of postinduction hypotensive events. Mean (SD) percentage of time with Narcotrend Index values ≤ 60 during surgery across all patients receiving remimazolam (93% (20.7)) was non-inferior to propofol (99% (4.2)), mean difference (97.5% CI) -6.28% (-8.89–infinite); p = 0.003. Mean (SD) number of postinduction hypotension events was 62 (38.1) and 71 (41.1) for patients allocated to the remimazolam and propofol groups, respectively; p = 0.015. Noradrenaline administration events (requirement for a bolus and/or infusion) were also lower in patients allocated to remimazolam compared with propofol (14 (13.5) vs. 20 (14.6), respectively; p < 0.001).

In conclusion, in patients who were ASA physical status 3 or 4, the anaesthetic effect of remimazolam was noninferior to propofol.

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Datenströme und ihre

Visualisierung – KI führt Nutzer

durch relevante Analysen

Die Digitalisierung im Gesundheitswesen führt zu wachsenden medizinischen Datenströmen. Diese bergen werthaltige Informationen für Forschung und Entwicklung. Die heute schon verfügbaren Visualisierungstools ermöglichen beeindruckende Einsichten in den Datenbestand. Ein nächster Schritt ist die statistische Analyse dieser Datenströme, die sich auf Künstliche Intelligenz (KI) stützt und dabei neue Hypothesen generiert für weiterführende wissenschaftliche Untersuchungen, die auf dem klassischen Weg nicht formuliert worden wären. Wie das aussehen könnte, erläutern die Autoren in Folge III ihres Beitrags zur Wertschöpfungskette

„Medizinische Daten“.

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Der medizinische Datenstrom –

Hintergrund, praktische

Beispiele und Kommentare

Die moderne Gesundheitsversorgung stützt sich mehr und mehr auf sogenannte ”Big Data“, um die Routinepflege, eine effiziente Behandlung bis hin zur angemessenen Bewertung von Gesundheitstechnologien und Kosteneffizienz zu gewährleisten. Der Datenstrom für Big Data stammt dabei aus vielen verschiedenen Quellen. Die Autoren hatten sich in der Folge I allgemeintheoretisch mit dem Thema der Digitalisierung im Gesundheitswesen beschäftigt. Nachfolgend wird die Wertschöpfungskette „Medizinische Daten“ dargestellt und es werden praktische Beispiele diskutiert und von Teilnehmern am Gesundheitssystem kommentiert, die ihre Erfahrungen mit spezifischen medizinischen Datenströmen erläutern.

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Der medizinische Datenstrom kann zahllose werthaltige Informationen offenbaren

Die moderne Gesundheitsversorgung stützt sich mehr und mehr auf sogenannte ”Big Data“, um die Routinepflege, eine effiziente Behandlung bis hin zur angemessenen Bewertung von Gesundheitstechnologien und Kosteneffizienz zu gewährleisten. Der Datenstrom für Big Data stammt nicht nur aus den traditionellen Datenquellen wie elektronischen Krankenakten, Rezepten und Versicherungsansprüchen, sondern auch aus dem Internet, beispielsweise aus sozialen Medien, Suchmaschinen sowie von Patienten aufgezeichneten bzw. gemeldeten Daten (aus sogenannten Apps = Applikationen; kleinere Softwareanwendungen auf Mobiltelefonen und Tablets). Nachfolgend beschäftigen sich die Autoren zunächst allgemeintheoretisch mit dem Thema der Digitalisierung im Gesundheitswesen. In der nächsten Ausgabe dieses Journals werden die Autoren Aspekte einer „Wertschöpfungskette Medizinische Daten“ beschreiben und auch praktisch-medizinische Beispiele erläutern sowie einen Ausblick über mögliche zukünftige Entwicklungen der Datengewinnung und Datenanalyse geben.

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Planning and Performing
Clinical Research for a DiGA – Route to pVE

In general, the term “health research”, or sometimes referred to as “medical research” or “clinical research,” refers to scientifi c investigation that is conducted to better understand human health or to make disease prevention and treatment more effective and safer. In other words, any observation or intervention, which is performed on human subjects to understand, improve or preserve their health, will belong to the competence of clinical research. This also applies to digital health applications or DiGAs (Digitale Gesundheitsanwendung).
A DiGA is a piece of software running on a smart device. However, beside gathering data and providing information, in comparison to a standard non-DiGA application, a DiGA provides feedback to the patient, to the health care provider, or to the health care industry, and by this improves patient’s health, quality of life or health literacy, and optimises health resource utilisation [1][2][3][4]. Accordingly, as the authors have detailed in their previous article (Building a DiGA—an IT and Medical Multidisciplinary Venture [2]), a DiGA is challenged to comply not just with the requirements of the IT industry and its regulations, but also with the requirements and regulations regarding clinical research. In the following article the authors provide details on which of the rules, precepts, and norms of clinical research apply for the development and approval of DiGAs. They show how to plan and perform clinical research to demonstrate and prove positive health care effects (positiver Versorgungseffekt – pVE).
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Building a DiGA—an IT and 
Medical Multidisciplinary Venture

As part of our second article on “Digital Health Applications” we illustrate the multidisciplinary venture of building a Digital Health Application (DiGA). Assessing a health related outcome does not transform a mobile application or a software into a DiGA. Hence, elevating an app to DiGA level means state-of-the-art-upgrade of the two major pillars—the IT platform and the content—of a health application. Several legal requirements and regulatory expectations are to be met by both these components (separately and in conjunction) before the app will be authorised as a DiGA. In contrast to a simple health related app, where the IT platform and the content can be freely developed, in case of a DiGA this is much more complicated, requiring careful planning and execution of all necessary steps. It’s an endeavour which introduces the app development company into
the interesting world of the medical, pharmaceutical and clinical research, while forces the health and pharmaceutical companies to dive into the technical environment of the IT sector. Despite, both these industries require innovation and high-level training in their particular fi eld, when it comes to development of a DiGA, intersection of the personnel of two giants is needed, which might be sometimes challenging. These challenges
can be overcome only by putting together a multidisciplinary team, comprising the best specialist from both parties.
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Digital Health and Digital
Treatments: The New Reality 

It started with the new EU Medical Device Regulation (MDR). The MDR considers software used in “diagnosis, prognosis, prevention, monitoring, treatment or alleviation of a disease, injury or handicap as well as investigating,
replacing or modifying the anatomy or a physiological process or controlling conception” to be medical devices. Some of these software solutions are bound tight to specifi c medical hardware, and are used exclusively by physicians or specialists. However, a different subgroup of these software, called now “digital health applications”, emerged in conjunction with the expansion of mobile technology. 
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Stand-alone Emollient Treatment Reduces Flares After Discontinuation of Topical Steroid Treatment in Atopic Dermatitis: A Double-blind, Randomized, Vehicle-controlled, Left-right Comparison Study

Irena ANGELOVA-FISCHER, Frank RIPPKE, Daniel RICHTER, Alexander FILBRY, Craig ARROWITZ, Teresa WEBER, Tobias W. FISCHER and Detlef ZILLIKENS, Acta Dermato-Venereologica, January 2018
 
 

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Prospective, randomised trial of the time dependent antiplatelet
effects of 500 mg and 250 mg acetylsalicylic acid i. v. and 300 mg p.o.in ACS (ACUTE)

Uwe Zeymer, Thomas Hohlfeld, Jürgen vom Dahl, Raimund Erbel, Thomas Münzel, Ralf Zahn, Alexander Roitenberg,
Stefanie Breitenstein, Ákos Ferenc Pap, Dietmar Trenk, Atherosclerosis and Ischaemic Disease, January 2017
 
 

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Effectiveness and tolerability of treatment intensification to basal–bolus therapy in patients with type 2 diabetes on previous basal insulin-supported oral therapy with insulin glargine or supplementary insulin therapy with insulin glulisine: the PARTNER observational study

Martin Pfohl, Thorsten Siegmund, Stefan Pscherer, Katrin Pegelow, Jochen Seufert, Vascular Health and Risk Management, November 2015
 
 

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Diabetes mellitus Typ 2 und Arzneimittelinteraktionen in der hausärztlichen Praxis

An pharmakokinetische Arzneitmittelinteraktionen ist bei Verschreibung und Absetzen von Arzneimitteln zu denken.
J. Linke, K.L. Rost



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Beneficial Effects of Fish-Oil-Containing Versus Soybean Oil Lipid Emulsions on Liver Function Parameters in Parenteral Nutrition

Topp H, Mueller I, Bark S, Mertes N, Grimm H, Singer P and Shaffer J, ISICEM, Brussels, March 2010



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Can the use of the multivariate statistical method MANOVA reduce the number of pateints needed in clinical trials?

Linke J, Topp H, Mueller I, Bark S, Singer P and Shaffer J, ESPEN, Nizza, September 2010
 
 

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Switching to Insulin Glargine 300 U/mL (Gla-300) Improves Glycemic Control After Failure of Basal-Bolus Therapy (BBT) with Other Basal Insulins (BI) in Patients (Pts) with Type 1 Diabetes (T1DM)

Andreas Fritsche, Stean Pscherer, Helmut Anderten, Katrin Pegelow, Jochen Seufert, Martin Pfohl
 
 

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Switching to Insulin Glargine 300 U/mL (Gla-300) Improves Glycemic Control and Reduces Nocturnal Hypoglycemia in Patients (Pts) with Type 2 Diabetes (T2DM) on Basal Insulin Supported Oral Therapy (BOT)

Jochen Seufert, Andreas Fritsche, Helmut Anderten, Katrin Pegelow, Stean Pscherer, Martin Pfohl
 
 

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Initiating Basal Insulin Supported Oral Therapy (BOT) with Insulin Glargine 300 U/mL (Gla-300) Improves Glycemic Control in Patients (Pts) with Type 2 Diabetes (T2DM) Without Increasing Hypoglycemia Risk

Martin Pfohl, Andreas Fritsche, Helmut Anderten, Katrin Pegelow, Stean Pscherer, Jochen Seufert
 
 

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