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von Markus Zeige 19 Mai, 2023
Ich erhalte wöchentlich einen Newsletter mit neuen KI Modellen. Letzte Woche war eine der vorgestellten Apps Leny.ai - eine Medical AI Assistant. Eher skeptisch, wie profund er / sie wohl antworten wird, tippte ich einen Prompt zu einem Familienmitglied ein, welches an einer ausgeprägten Herzinsuffizienz leidet, mit eher atypischer Ödemverteilung. Das Ergebnis machte mich sprachlos. Lesen Sie selbst: You: 82 year old woman suffering form water in stomach area accompanied by nauseaness due to a severe heart insufficiency. Using Torasemid is solving the problem on the one hand but leads to massive dehyration of brain area on the other hand. What do you suggest how to balance this out? Leny: I suggest the following steps to balance the use of Torasemid and avoid dehydration of the brain area: 1. Review the current dose of Torasemid and consider reducing it to the lowest effective dose. According to the European Society of Cardiology guidelines for the management of acute and chronic heart failure, the initial dose of Torasemid in heart failure patients is usually 5-10 mg once daily, which may be increased up to 20-40 mg daily if needed. However, the dose should be individualized based on the patient's renal function and response to treatment. 2. Monitor the patient's fluid and electrolyte balance regularly, especially potassium and sodium levels. Hypokalemia (low potassium) can cause adverse effects on the brain, such as confusion and weakness. Therefore, it is important to ensure that the patient's potassium levels are within the normal range (3.5-5 mmol/L) and supplement it if needed. 3. Consider adding a potassium-sparing diuretic, such as Spironolactone or Eplerenone, to the treatment regimen. These drugs can help to reduce fluid retention and edema while minimizing the risk of electrolyte imbalances and dehydration. However, they should be used with caution in patients with renal impairment or hyperkalemia. 4. Evaluate the need for other medications that may exacerbate dehydration or electrolyte imbalances, such as non-steroidal anti-inflammatory drugs (NSAIDs) or ACE inhibitors. These drugs should be avoided or used with caution in patients with heart failure and renal impairment. 5. Consider non-pharmacological interventions to manage fluid overload, such as dietary sodium and fluid restriction, elevation of the legs, and use of compression stockings. These measures can complement the use of diuretics and help to improve symptoms and quality of life. You: Follow up question: Would you consider the usage of digitoxin to empower the heart beat? Leny: The use of digitoxin (a cardiac glycoside) in heart failure patients can be considered in certain situations when other treatments have failed or are not suitable. However, it should be used with caution and under close monitoring due to its narrow therapeutic index and potential toxicity. Here are some points to consider: 1. Digitoxin works by increasing the contractility of the heart muscle, which can improve cardiac output and symptoms in heart failure patients. However, it also has potential toxic effects on the heart, such as arrhythmias, and on other organs such as the brain and kidneys. 2. The use of digitoxin requires careful assessment of the patient's renal function, electrolyte levels (especially potassium), and concomitant medications that may interact with it or increase the risk of toxicity. 3. Other treatments, such as diuretics and ACE inhibitors/ARBs, should be optimized before considering the use of digitoxin. 4. The recommended doses of digitoxin in heart failure patients are lower than those used for arrhythmias, and the drug levels should be carefully monitored to avoid toxicity. The usual maintenance dose of digitoxin is 0.125-0.25 mg daily, but it may be lower in elderly patients or those with renal impairment. 5. The use of digitoxin in heart failure patients is not supported by strong clinical evidence, as most of the studies were conducted before the era of modern heart failure treatments and did not show significant improvement in survival or hospitalization rates. Therefore, its use should be individualized and based on the patient's clinical status and response to treatment. In summary, the use of digitoxin in heart failure patients should be considered carefully, taking into account the potential benefits and risks, and under close monitoring. It should be reserved for cases where other treatments have failed or are not suitable. You: What other positive ionotrope drugs would you recommend instead? Leny: There are several positive inotropic drugs that can be used in heart failure to improve cardiac function and symptoms. These drugs work by increasing the contractility of the heart muscle and improving cardiac output. Here are some examples: 1. Dobutamine: This is a synthetic catecholamine that acts primarily on beta-1 adrenergic receptors in the heart to increase contractility and heart rate. It is usually given intravenously and can be titrated to achieve the desired hemodynamic effect. Dobutamine is commonly used in acute heart failure or decompensated chronic heart failure. 2. Milrinone: This is a phosphodiesterase-3 inhibitor that increases intracellular levels of cyclic AMP, leading to increased contractility and vasodilation. It is given intravenously and can be used in acute or chronic heart failure, especially when there is concurrent pulmonary hypertension. 3. Levosimendan: This is a calcium sensitizing agent that enhances the sensitivity of cardiac myofilaments to calcium, leading to increased contractility. It also has vasodilatory effects and can improve diastolic function. Levosimendan is given intravenously and is approved for use in acute heart failure, especially in patients with low cardiac output or cardiogenic shock. 4. Digoxin: This is a cardiac glycoside that increases contractility by inhibiting the sodium-potassium ATPase pump, leading to increased intracellular calcium levels. It also has other effects, such as slowing heart rate and improving diastolic function. Digoxin is given orally and is usually reserved for patients with atrial fibrillation or when other treatments have failed. It is important to note that these drugs have different mechanisms of action, pharmacokinetics, and side effect profiles, and their use should be individualized based on the patient's clinical status and response to treatment. Combination therapy may also be considered in some cases to achieve optimal hemodynamic and clinical outcomes. You: Would you prefer the usage of Digoxin over Digitoxin? Leny: The choice between digoxin and digitoxin in heart failure patients depends on several factors, including the patient's age, renal function, and comorbidities, as well as the potential drug interactions and side effects. Here are some points to consider: 1. Both digoxin and digitoxin are cardiac glycosides that have similar mechanisms of action and therapeutic effects in heart failure. However, they have different pharmacokinetics and dosing regimens. Digitoxin has a longer half-life and is given once daily, whereas digoxin is given once or twice daily and has a shorter half-life. 2. The use of digoxin is supported by more clinical evidence than digitoxin, as it has been extensively studied in large randomized trials, such as the DIG trial and the AFFIRM trial. These studies showed that digoxin can improve symptoms, quality of life, and hospitalization rates in heart failure patients, especially those with atrial fibrillation. 3. The use of digitoxin is limited by its potential toxicity and narrow therapeutic index, which requires careful monitoring of drug levels and electrolytes. Digitoxin also has a higher risk of drug interactions than digoxin, as it is metabolized by CYP3A4 and Pglycoprotein. 4. The recommended doses of digoxin and digitoxin differ, with digoxin usually given at a lower dose than digitoxin (0.125-0.25 mg daily vs. 0.1-0.2 mg daily). The dose should be adjusted based on the patient's age, renal function, and lean body weight. In summary, the choice between digoxin and digitoxin in heart failure patients should be individualized based on the patient's clinical status and characteristics, as well as the potential risks and benefits of each drug. Digoxin is generally preferred over digitoxin due to its better safety profile, lower risk of drug interactions, and stronger clinical evidence. However, in certain situations, such as renal impairment or intolerance to digoxin, digitoxin may be considered as an alternative. References: 1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(27):2129-2200. 2. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161.
von Markus Zeige 13 Feb., 2022
Im Online- und Software-Geschäft ist der klassische Lizenzkauf inzwischen zur Seltenheit geworden. Während die meisten Unternehmen auf monatliche Gebühren beharren, gibt es nur noch vereinzelte Angebote, die nach einem einmaligen Kauf nie wieder nach Geld fragen. Zu diesen Ausnahmen gehört auch der Schweizer Cloud-Anbieter pCloud : Nach einer einmaligen Zahlung stehen die 500 Gigabyte bzw. 2 Terabyte Speicherpläne ein Leben lang zur Verfügung. Auf beide Speichergrößen sparen Sie noch bis zum 15. Februar satte 75 Prozent. Quelle: https://amp.pcwelt.de/article/11180160
von Markus Zeige 24 Dez., 2021
Ein weiterer, sehr lesenswerter Artikel, erschienen auf inc.com am 14.12.2021 zum Thema "Brainfood". Gerade auch für Inhaber von mittelständischen Unternehmen. Happy reading! As a leader, your words have a genetic impact on your organization. Words create stories, and stories form the basis of all human decision-making-- particularly in new, unusual environments. Leaders set the narrative tone from the top. Your stories seep into your organization's bloodstream and drive behavior at every level. Simply put, success originates in culture. Culture originates in language. As a leader, language originates in you. That said, here are a few lessons I've learned about language, and how you can use it to encourage a healthy corporate culture. Use words that normalize failure and enable quick decision-making. Some of our most powerful stories revolve around failure. The words "success" and "failure" are understood to be opposites, with "success" being preferable most of the time. One of my company's core values is "Defy Conventions". What this means in practice is we want the team to question the status quo, be nimble and embrace change. If you're not failing, you're not learning. We want a culture that encourages a test and learn approach, which means that failures and learnings are constantly present. Like all growing companies, our early days were full of mistakes whose lessons paved the way for our future successes. As we've become bigger, we've had to work hard to avoid becoming more risk-averse, where decision-making and pushing the boundaries slows down. Particularly for innovative, growth-oriented companies, it's crucial that perfect not be the enemy of good. It's much more important to foster a culture of quick, informed decision-making -- one that's comfortable acting with 80 percent certainty, rather than waiting for 100 percent. 100 percent certainty doesn't exist. You become a better decision-maker by learning from the results of imperfect decisions. Rather than calling them "successes" and "failures," my team uses the terms "hits" and "misses." A "miss" sounds much less punishing than a "failure," especially when we couch it in learning-oriented terms. Use words that encourage your team to learn lessons and apply them to what's next. This is particularly important after a miss, when your people turn to you for the story. If your story revolves around negative outcomes, it will have a negative impact on your team. But if your story revolves around lessons you can carry forward, your team will understand that mistakes build successes. Misses help you home in on your target. For example, we recently overbought in a certain product style. We have more inventory than we'd like. In the aftermath, I encouraged us to ask questions like: How do we reposition ourselves? What have we learned? How do we talk about it, and how do we fix it? We made that buying decision with a particular view of the world. Now, we learn from it and use the lessons to reorient moving forward. This framing is just as important after hits as misses. Oftentimes, when junior team members report to me after hits, they describe an outcome without telling me what's next. The positive rewards of success can make us bypass the lesson-learning phase, assuming that a good result was due to a great decision. After both hits and misses, encourage reflection, lesson-learning, and future-crafting. "That's an awesome learning -- how can we push it forward? What are you going to do next?" Encourage your people to think of results -- positive and negative -- as part of a continuum, not isolated points on a graph. Use words that encourage out-of-the-box thinking. The poet Robert Kelly said, "We sleep in language if language does not come to wake us with its strangeness." I believe what he meant was that if you use the same old language, you'll get the same old results. New language, on the other hand, wakes us up. It makes us see familiar things in a new light. It prompts us to visualize a future more aligned with our values. If your language grows dull, repetitive, or is otherwise indistinguishable from your competitors' language, neither your team nor your customers will develop a personal connection with your mission. Fresh, distinct language builds a fresh, distinct culture, one whose members feel confident thinking against the status quo. Of course, different conditions call for different kinds of action. Sometimes, you have to add processes, learning to act more deliberately; other times, you have to act quickly, taking results as they come. ThirdLove has gone through periods of both. Indeed, individual departments often have different needs with regard to action versus deliberation. But whatever our circumstances, using the right language helps my team take stock, respond accordingly, and learn valuable lessons. Quelle: https://www.inc.com/heidi-zak/your-words-create-your-companys-culture-for-better-or-for-worse-take-control-with-these-tips.html
von Markus Zeige 22 Dez., 2021
Der nachfolgende Artikel erschien am 20.12.2021 auf inc.com. Für alle Kollegen, die etwas über den eigenen Tellerrand hinausschauen wollen, sicher ein äußerst lesenswerter Input. Das lange Feiertagswochenende bietet womöglich Gelegenheit dazu. Und ein ganz konkreter Bezug zur Digitalisierung innerhalb der eigenen Apotheke findet sich dann für alle Interessierten unter www.creiss-systems.de . Happy reading! As Covid-19 vaccinations increase globally, life is getting back to normal. However, it's no longer the world we experienced before the pandemic. The long-term nature of this global crisis has changed customer needs and daily lifestyles. This will, in turn, change what I expect the world to look like in 2022 and beyond. Let's review the top 10 technology and business trends that we'll likely encounter in the coming year. Momentum in Life Science Technologies The life science industry comprises pharmaceuticals, biotechnology, environmental sciences, biomedicine, nutraceuticals, neuroscience, cell biology, and biophysics. Partially because of increased investments in mRNA vaccine technology and high-performance Covid-19 testing, 2021 has driven great innovation in life science technologies. Examples of this innovation include the mRNA-based vaccines developed by Pfizer-BioNTech and by Moderna. Recent Covid drug developments by Merck have also pushed the life science industry forward rapidly. Looking ahead, I expect we'll see strong movement in the several life science sectors, including advanced research; application of robotics technology; artificial intelligence (A.I.) tools; use of cloud technology; the improvement of drug testing speed; integration of genetic information; and usage of gene technology. I also foresee the development of personalized medicine through advancements in genetics technology. The startup 23andMe, for example, helps people access, understand, and benefit from the human genome. Networking and Interconnectivity: Expansion of 5G-6G and Satellite-Based Internet Usage As remote working becomes commonplace, internet reliability becomes more vital than ever. The internet of things (IoT) makes the internet a more integral part of our lives, and developments at all network levels will continue to drive research and push the internet economy forward. According to Cisco's Visual Networking Index forecast update for 2018 , there will be 1.4 billion more people using the internet by 2022, compared with 3.4 billion users in 2017. This equates to almost 60 percent of the global population, assuming a population of eight billion by 2022. By then, internet users are expected to consume 4.8 zettabytes of data per year, 11 times the amount of IP traffic generated in 2012, with 437 exabytes. While 5G may be in its infancy, we'll see an increased focus on 6G in 2022. China started research into 6G in 2018. By late 2020, the country had launched a satellite to test terahertz signal transmission. Huawei and ZTE were involved. The U.S. also started 6G research in 2018 with the Federal Communications Commission (FCC) opening higher frequency spectrum for experimental use. A Next G Alliance was started in 2020, with companies on board including Apple, AT&T, and Google. Korea, Japan, and some European countries have started looking into 6G seriously, and we expect to see more announcements in 2022. High-Performance Computing Becomes Mainstream Given the recent growth of big data-based research and analysis and cloud-based computing, I expect high-performance computing usage to surge in 2022. From drug discovery to cancer research to space exploration, high-performance computing will become increasingly important, and quantum computing technology needs to keep up with business demand. We've already seen massive development in quantum computing space by players including Google, IBM, Microsoft, Amazon, and Alibaba. Startups such as Rigetti Computing, D-Wave Systems, ColdQuanta,1QBit, Zapata Computing, and QC Ware have exceeded the industry expectations in their technology and their growth. I expect rapid progress in quantum computing during 2022, because the high demand for larger machine power is going to accelerate development in this sector. We'll likely see announcements of large qubit developments in the new year. Commercial quantum computing will soon be within our reach, and new breakthroughs will occur at an accelerated pace. Continued Growth in Artificial Intelligence, Big Data Analytics, and Cloud Computing A.I. has become an integral part of our lives. From improvements to personalization, ranking search results, recommending products, and understanding and controlling devices to building better models of the environment to automating industry, we see the application of artificial intelligence everywhere as we look toward 2022. Organizations are using predictive analytics to forecast future trends. According to a report published by Facts & Factors, the global predictive analytics market is growing at a compound average growth rate of around 24.5 percent and is expected to reach $22.1 billion by the end of 2026. We will also see massive growth in cloud computing. By 2022, the cloud will be more entrenched and more computing workloads will run on the cloud. The internet of things will push this space in a bigger way, for sure. According to predictions from Gartner, global spending on cloud services is expected to reach over $482 billion in 2022, up from $314 billion in 2020. Internet Security and Privacy Dominate As the world becomes more digital, we're seeing an increased number of personal and organizational cyberattacks around the world. Several corporations have been the target of major cyberattacks in recent days, and businesses have become more vulnerable to destructive attacks, in part because of increased remote work given the pandemic. During 2022, I expect that we'll see cyberattacks across sectors, and we will see the industry take a variety of counteractive measures. Defending against cyberattacks will include educating individuals so they can identify and avoid network assaults, thereby safeguarding their company's image. Applying A.I. will make robust cybersecurity protocols easier and less expensive to create and more effective than ever. Use of A.I. can enable cybersecurity to spot risks and learn the behaviors of cybercriminals, thus preventing prevent future attacks. It can also help cut down on the time it takes cybersecurity specialists to do their daily tasks. The Metaverse Will Shine in 2022 The metaverse is a digital reality combining social media, online gaming, augmented reality, virtual reality, and cryptocurrencies to allow virtual user interaction. The metaverse may refer to anything on the internet, including all of AR's offerings. Virtual space of the future describes the metaverse, providing access to all kinds of entertainment and projects, including the opportunity to work. We expect the metaverse to be immersive, ubiquitous, and free to access. It will be digitally focused, and potentially involves entertainment, social connection, work productivity, and behavior modification at scale. It will create an entire ecosystem for developers, apps, ads, and new digital innovations. The metaverse will facilitate convenience, consumption, and a frictionless access to services. Only a few companies today have a real stake in the metaverse. They include ByteDance, Tencent, Facebook, Spotify, Zoom, Amazon (Twitch), Alibaba, Roblox, Bilibili, Snapchat, Kuaishou, and Huawei. Apple's wearables also point to the metaverse with AR glasses coming soon. Microsoft with Microsoft Teams and gaming is perhaps the most advanced company in the world regarding the metaverse. WeChat's ability to facilitate payments and access to a variety of services is the start of the metaverse super apps. As the metaverse ecosystem grows in 2022, I expect it will have a direct impact on the future of many technology sectors. These include gaming, wearables, VR and AR, collaborative productivity (Canva, Slack), consumer tech products (including AR glasses or smart speakers), social networks, educational technology, health technology, communication technology (Zoom), digital currencies, and convenience mobilization and on-demand consumption (Amazon, Meituan, Alibaba, JD.com, Shopify). NFT Platforms Will Boom A non-fungible token (NFT) is a digital object: computer code and data that conveys ownership of something. The property may be online: for example, virtual real estate in the digital world or special equipment in a video game. Or it could be real: real estate, a painting, or a seat at a concert. An NFT can also be a hybrid: for example, the right to decide who can rent a room in a cooperative living space. A baseball card, Ronaldo's first ball, a vintage car, or a piece of land in Central London: All are one of a kind and can be transferred to the NFT. In 2022, we are likely to see NFTs everywhere; this includes in movies, TV shows, books, and more. NFTs are part of the digital economy and are becoming mainstream because they allow people to own something that represents a part of something bigger than themselves -- a piece of art or a character, for example. The digital economy is made up of a variety of online markets, including game economies, virtual real estate, and even social media platforms like Facebook. Our society has changed rapidly over the past decade, especially because of the 2008 to 2009 economic crisis and the pandemic. These trends are coming together to shape a world where NFTs will beat traditional collectibles, making 2022 a tremendous year. The Robotics Sector Will Become More Prevalent We expect to see an increased use of robotics in everyday life during 2022. Usage will include the health care, agriculture, automotive, warehousing, and supply chain management sectors, and we will see more robotics-based automation that will continue to progress. The Covid-19 pandemic presents both problems and opportunities for robotics companies in the logistics and supermarket industries. Unexpected strains on supply systems and product shortages have highlighted the need for better supply chain efficiency. It's also become obvious that robots and automation provide a safe means for manufacturers to keep employees socially separated yet allow the business to continue operating. The use of robotics process automation (RPA) helps automate activities that are performed repeatedly; we expect RPA to grow in 2022 and become a standard technology for business. CIO reports that chief information officers are using RPA to free workers from boring, repetitive tasks and allow them to do more fulfilling work. Finally, we're seeing a rise in nanorobotics, tiny sensors with limited processing power. The first useful applications of these nano-machines may be in nanomedicine. Biological machines, for example, are used to identify and destroy cancer cells or deliver drugs. Increased Urgency in the Renewable Energy Technology Sector Climate change and dramatic news headlines are driving rapid growth in sustainable energy adoption. During the pandemic, this has been the only energy sector that has grown. According to the International Energy Agency (IEA), 40 percent more green energy was generated and used in 2020; the agency expects continued growth in 2022. The falling cost of generating sustainable energy also helps ensure that mass adoption is likely. While newer energy technologies like nuclear fusion, biofuel, and liquid hydrogen might take longer to come full circle, we look forward to serious advancements in 2022. I also expect to see massive growth in the production and usage of solar and wind technology. Storage (battery) technologies are playing a larger role, since there will be an increased need to store renewable energy. Blockchain Technology Prevails Blockchain, an innovative breed of distributed ledger, enables companies to track a transaction and do business with unverified parties -- even without the assistance of financial institutions. This new capability significantly lessens business conflicts; it also adds other benefits such as append-only data structure, transparency, security, immutability, and decentralization. Blockchain technology has enjoyed massive adoption and continues to disrupt many industries, from gaming and governance to finance. According to the International Data Corporation, companies will spend almost $6.6 billion on blockchain solutions in 2021, a 50 percent increase from the previous year. This number is expected to grow beyond $15 billion in 2024. With the new rise of NFTs and the metaverse, blockchain will become more important in 2022. Businesses are encouraged to start studying blockchain technology, since it is expected to generate significant business opportunities; Statista reports that global blockchain technology is predicted to grow to more than $23.3 billion by 2023. A notable existing blockchain deployment is that of Walmart's supply chain database application, allowing the monitoring of individual products directly to their very source, effectively elevating food supply standards. Amazon is rolling out its blockchain initiatives for 2019, which allow its Amazon Web Services clients to benefit from distributed ledger solutions. Looking Ahead There's little doubt that 2022 will see rapid progress in these and other technologies, as the world emerges from the Covid-19 pandemic. I see a prime opportunity for smart startups, corporations, and investors to capitalize on these emerging technology and business trends to become more successful than ever. Let's hope that the resulting innovation makes the world better for people and businesses. Quelle: https://www.inc.com/anis-uzzaman/the-top-10-technology-business-trends-of-2022.html
von Markus Zeige 18 Nov., 2021
Der Slogan "eRezept ready" wird aktuell recht inflationär verwendet. Auch die Preise der verschiedenen Hardwareanbieter kommen in Bezug auf die eRx-Scanner mitunter diesem Adjektiv nahe. Eine preiswerte Alternative für alle Kollegen und Kolleginnen, die - ausgestattet mit einer rechten und einer linken Hand - schon mal eine USB Device angeschlossen haben, bietet dieses Gerät. Auch für das Scannen direkt vom Smartphone des Kunden geeignet, ob eRezept oder Impfzertifikat, ohne dass die Spiegelreflexe der Glasscheibe Probleme bereiten. Eine Aktivierungstaste zum Scannen ist nicht nötig. Der Scanner erkennt automatisch, sobald ihm ein Dokument / Code vorgehalten wird. Lediglich der QR-Code für das deutsche Tastaturlayout muss einmalig vom beiliegenden Manual gescannt werden. Happy Scanning. :-)
von Markus Zeige 12 Aug., 2021
Wie Sie bestimmte Anhänge in Outlook filtern, um Ransomwareangriffe darüber zu verhindern.
von Markus Zeige 14 Dez., 2020
5-20% des Rezeptumsatzes einer Apotheke gehen laut Schätzungen mittelfristig verloren, wenn das eRezept kommt. Wie stellen Sie sich dieser Herausforderung? Sie ganz persönlich in / mit / für Ihre Apotheke? Schon mal über professionelle Pflegeversorgung nachgedacht - ambulant & stationär? Lernen Sie, wie Sie Pflegeeinrichtungen einzigartige Dienstleistungen vorstellen können. Erwerben Sie sich einen Stamm treuer und dauerhafter Kunden & Partner. Caredemy zeigt Ihnen wie es geht. Mit unserem Wissen haben Apotheken in mehreren Bundesländern diverse Pflegeträger und Pflegeeinrichtungen überzeugt. Bauen Sie sich ein zweites, solides und langfristiges Standbein für Ihre Apotheke auf. Die Kundenstatements auf unserer Seite sprechen für sich.
von Markus Zeige 15 Feb., 2019
Apothekenmitarbeiter kennen alle die folgende Situation: Die Offizin steht gerade voller Kunden und die Kollegen kommen nicht schnell genug hinterher mit dem Bedienen. Einige Rezepturen sind auch noch zeitnah herzustellen. Ein Vertreter wartet zudem seit 15 Minuten auf die für den Einkauf verantwortliche Person. Der Großhandelsfahrer benötigt die unterschriebenen BTM-Belege… und dann klingelt auch schon wieder das Telefon. Ein Anruf einer Pflegefachkraft aus einer von ihnen versorgten Pflegeeinrichtung, die eine Bestellung durchgeben möchte. Dieser gehörige Arbeitsdruck „schreit“ geradezu nach „Streamlining“. Glücklicherweise gibt es (auch) hier digitale Möglichkeiten der Prozessoptimierung. Beispiel gefällig? Schon einmal überlegt, Ihre Telefonanlage (physisch oder virtuell) mit einem Anrufermenü auszustatten? Mit einem derartigen Menü lässt sich so Manches kanalisieren. Etwa: „Drücken Sie die Taste 1, wenn Sie unsere aktuellen Öffnungszeiten wissen wollen. Drücken Sie die Taste 2, wenn Sie als Patient eine Bestellung aufgeben möchten oder eine Nachfrage haben… u.s.w.). Für andere Anfragen, z.B. an die Buchhaltung empfiehlt sich die Weiterleitung an ein preiswertes digitales Sekretariat, welches die Anfragen aufnimmt und eine standardisierte Mail an ihre Buchhaltung schickt. Wer es dann noch prozessoptimierter möchte, kann sich (wirklich ohne großen finanziellen Aufwand) ein eigenes CRM System einrichten, welches die Sekretariats-E-Mails liest und gleich - je nach Abteilung - Tickets anlegt. Klingt komplex? Ist leichter als erwartet. Caredemy gibt als Unternehmen mit Apothekenhintergrund Ihnen gerne Schützenhilfe. Haben wir Sie neugierig gemacht? Schreiben Sie uns Ihre aktuellen Herausforderungen. Hier gehts weiter
von Markus Zeige 01 Feb., 2019
Gravierendes Securpharm-Problem bei der Versorgung von Pflegeeinrichtungen.
von Daniel Härte 06 Jan., 2019
Nehmen wir mal an, zu Ihren Dienstleistungen gehört ein Rezeptmanagement für Ihre Pflegeeinrichtungen. Das heißt die Rezeptanforderung beim Arzt übernehmen Sie und Ihre Mitarbeiter ebenso, wie die Rezeptabholung in den Praxen (wenn der Patient dies wünscht) und die Auslieferung - kurzum Sie übernehmen die gesamte Logistik, bis das Folgemedikament beim Kunden ankommt. Eine gute Kommunikation ist hier ein elementarer Baustein für reibungslose Prozesse. In vielen Pflegeeinrichtungen gehört der Mangel an Fachkräften leider mittlerweile zum Alltag. Der daraus entstehende Druck auf die Mitarbeiter der Pflege sorgt mitunter dafür, dass Alltägliches, wie Mitteilungen über geänderte Medikationen oder die rechtzeitige Anforderung von Bedarfsmedikationen, mitunter im Alltag untergeht. Resultat ist für alle Parteien ein oftmals größerer Arbeitsaufwand, um den Pflegepatienten richtig und sicher zu versorgen. Ein gut ausgebildeter Apothekeninnendienst, der die Abläufe in den Pflegeeinrichtungen kennt, spielt hier eine eminent wichtige Rolle, weil er die Kommunikation professionalisieren kann. Ein Ansatz dazu können regelmäßige Jour Fixe mit den Pflegeeinrichtungen sein. Sie geben beiden Seiten die Möglichkeit, gelungene Prozesse weiterzuführen und Punkte, bei denen es hakt, gemeinsam anzugehen. Zudem schafft ein regelmäßiger, persönlicher Austausch Vertrauen und Verständnis. Haben wir Sie neugierig gemacht? Schreiben Sie uns Ihre Erfahrungen (sowohl bisherige Erfolge als auch aktuelle Herausforderungen) in der Pflegeversorgung oder auch im Apothekenalltag allgemein. Hier gehts weiter.
Weitere Beiträge
von Markus Zeige 19 Mai, 2023
Ich erhalte wöchentlich einen Newsletter mit neuen KI Modellen. Letzte Woche war eine der vorgestellten Apps Leny.ai - eine Medical AI Assistant. Eher skeptisch, wie profund er / sie wohl antworten wird, tippte ich einen Prompt zu einem Familienmitglied ein, welches an einer ausgeprägten Herzinsuffizienz leidet, mit eher atypischer Ödemverteilung. Das Ergebnis machte mich sprachlos. Lesen Sie selbst: You: 82 year old woman suffering form water in stomach area accompanied by nauseaness due to a severe heart insufficiency. Using Torasemid is solving the problem on the one hand but leads to massive dehyration of brain area on the other hand. What do you suggest how to balance this out? Leny: I suggest the following steps to balance the use of Torasemid and avoid dehydration of the brain area: 1. Review the current dose of Torasemid and consider reducing it to the lowest effective dose. According to the European Society of Cardiology guidelines for the management of acute and chronic heart failure, the initial dose of Torasemid in heart failure patients is usually 5-10 mg once daily, which may be increased up to 20-40 mg daily if needed. However, the dose should be individualized based on the patient's renal function and response to treatment. 2. Monitor the patient's fluid and electrolyte balance regularly, especially potassium and sodium levels. Hypokalemia (low potassium) can cause adverse effects on the brain, such as confusion and weakness. Therefore, it is important to ensure that the patient's potassium levels are within the normal range (3.5-5 mmol/L) and supplement it if needed. 3. Consider adding a potassium-sparing diuretic, such as Spironolactone or Eplerenone, to the treatment regimen. These drugs can help to reduce fluid retention and edema while minimizing the risk of electrolyte imbalances and dehydration. However, they should be used with caution in patients with renal impairment or hyperkalemia. 4. Evaluate the need for other medications that may exacerbate dehydration or electrolyte imbalances, such as non-steroidal anti-inflammatory drugs (NSAIDs) or ACE inhibitors. These drugs should be avoided or used with caution in patients with heart failure and renal impairment. 5. Consider non-pharmacological interventions to manage fluid overload, such as dietary sodium and fluid restriction, elevation of the legs, and use of compression stockings. These measures can complement the use of diuretics and help to improve symptoms and quality of life. You: Follow up question: Would you consider the usage of digitoxin to empower the heart beat? Leny: The use of digitoxin (a cardiac glycoside) in heart failure patients can be considered in certain situations when other treatments have failed or are not suitable. However, it should be used with caution and under close monitoring due to its narrow therapeutic index and potential toxicity. Here are some points to consider: 1. Digitoxin works by increasing the contractility of the heart muscle, which can improve cardiac output and symptoms in heart failure patients. However, it also has potential toxic effects on the heart, such as arrhythmias, and on other organs such as the brain and kidneys. 2. The use of digitoxin requires careful assessment of the patient's renal function, electrolyte levels (especially potassium), and concomitant medications that may interact with it or increase the risk of toxicity. 3. Other treatments, such as diuretics and ACE inhibitors/ARBs, should be optimized before considering the use of digitoxin. 4. The recommended doses of digitoxin in heart failure patients are lower than those used for arrhythmias, and the drug levels should be carefully monitored to avoid toxicity. The usual maintenance dose of digitoxin is 0.125-0.25 mg daily, but it may be lower in elderly patients or those with renal impairment. 5. The use of digitoxin in heart failure patients is not supported by strong clinical evidence, as most of the studies were conducted before the era of modern heart failure treatments and did not show significant improvement in survival or hospitalization rates. Therefore, its use should be individualized and based on the patient's clinical status and response to treatment. In summary, the use of digitoxin in heart failure patients should be considered carefully, taking into account the potential benefits and risks, and under close monitoring. It should be reserved for cases where other treatments have failed or are not suitable. You: What other positive ionotrope drugs would you recommend instead? Leny: There are several positive inotropic drugs that can be used in heart failure to improve cardiac function and symptoms. These drugs work by increasing the contractility of the heart muscle and improving cardiac output. Here are some examples: 1. Dobutamine: This is a synthetic catecholamine that acts primarily on beta-1 adrenergic receptors in the heart to increase contractility and heart rate. It is usually given intravenously and can be titrated to achieve the desired hemodynamic effect. Dobutamine is commonly used in acute heart failure or decompensated chronic heart failure. 2. Milrinone: This is a phosphodiesterase-3 inhibitor that increases intracellular levels of cyclic AMP, leading to increased contractility and vasodilation. It is given intravenously and can be used in acute or chronic heart failure, especially when there is concurrent pulmonary hypertension. 3. Levosimendan: This is a calcium sensitizing agent that enhances the sensitivity of cardiac myofilaments to calcium, leading to increased contractility. It also has vasodilatory effects and can improve diastolic function. Levosimendan is given intravenously and is approved for use in acute heart failure, especially in patients with low cardiac output or cardiogenic shock. 4. Digoxin: This is a cardiac glycoside that increases contractility by inhibiting the sodium-potassium ATPase pump, leading to increased intracellular calcium levels. It also has other effects, such as slowing heart rate and improving diastolic function. Digoxin is given orally and is usually reserved for patients with atrial fibrillation or when other treatments have failed. It is important to note that these drugs have different mechanisms of action, pharmacokinetics, and side effect profiles, and their use should be individualized based on the patient's clinical status and response to treatment. Combination therapy may also be considered in some cases to achieve optimal hemodynamic and clinical outcomes. You: Would you prefer the usage of Digoxin over Digitoxin? Leny: The choice between digoxin and digitoxin in heart failure patients depends on several factors, including the patient's age, renal function, and comorbidities, as well as the potential drug interactions and side effects. Here are some points to consider: 1. Both digoxin and digitoxin are cardiac glycosides that have similar mechanisms of action and therapeutic effects in heart failure. However, they have different pharmacokinetics and dosing regimens. Digitoxin has a longer half-life and is given once daily, whereas digoxin is given once or twice daily and has a shorter half-life. 2. The use of digoxin is supported by more clinical evidence than digitoxin, as it has been extensively studied in large randomized trials, such as the DIG trial and the AFFIRM trial. These studies showed that digoxin can improve symptoms, quality of life, and hospitalization rates in heart failure patients, especially those with atrial fibrillation. 3. The use of digitoxin is limited by its potential toxicity and narrow therapeutic index, which requires careful monitoring of drug levels and electrolytes. Digitoxin also has a higher risk of drug interactions than digoxin, as it is metabolized by CYP3A4 and Pglycoprotein. 4. The recommended doses of digoxin and digitoxin differ, with digoxin usually given at a lower dose than digitoxin (0.125-0.25 mg daily vs. 0.1-0.2 mg daily). The dose should be adjusted based on the patient's age, renal function, and lean body weight. In summary, the choice between digoxin and digitoxin in heart failure patients should be individualized based on the patient's clinical status and characteristics, as well as the potential risks and benefits of each drug. Digoxin is generally preferred over digitoxin due to its better safety profile, lower risk of drug interactions, and stronger clinical evidence. However, in certain situations, such as renal impairment or intolerance to digoxin, digitoxin may be considered as an alternative. References: 1. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(27):2129-2200. 2. Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136(6):e137-e161.
von Markus Zeige 13 Feb., 2022
Im Online- und Software-Geschäft ist der klassische Lizenzkauf inzwischen zur Seltenheit geworden. Während die meisten Unternehmen auf monatliche Gebühren beharren, gibt es nur noch vereinzelte Angebote, die nach einem einmaligen Kauf nie wieder nach Geld fragen. Zu diesen Ausnahmen gehört auch der Schweizer Cloud-Anbieter pCloud : Nach einer einmaligen Zahlung stehen die 500 Gigabyte bzw. 2 Terabyte Speicherpläne ein Leben lang zur Verfügung. Auf beide Speichergrößen sparen Sie noch bis zum 15. Februar satte 75 Prozent. Quelle: https://amp.pcwelt.de/article/11180160
von Markus Zeige 24 Dez., 2021
Ein weiterer, sehr lesenswerter Artikel, erschienen auf inc.com am 14.12.2021 zum Thema "Brainfood". Gerade auch für Inhaber von mittelständischen Unternehmen. Happy reading! As a leader, your words have a genetic impact on your organization. Words create stories, and stories form the basis of all human decision-making-- particularly in new, unusual environments. Leaders set the narrative tone from the top. Your stories seep into your organization's bloodstream and drive behavior at every level. Simply put, success originates in culture. Culture originates in language. As a leader, language originates in you. That said, here are a few lessons I've learned about language, and how you can use it to encourage a healthy corporate culture. Use words that normalize failure and enable quick decision-making. Some of our most powerful stories revolve around failure. The words "success" and "failure" are understood to be opposites, with "success" being preferable most of the time. One of my company's core values is "Defy Conventions". What this means in practice is we want the team to question the status quo, be nimble and embrace change. If you're not failing, you're not learning. We want a culture that encourages a test and learn approach, which means that failures and learnings are constantly present. Like all growing companies, our early days were full of mistakes whose lessons paved the way for our future successes. As we've become bigger, we've had to work hard to avoid becoming more risk-averse, where decision-making and pushing the boundaries slows down. Particularly for innovative, growth-oriented companies, it's crucial that perfect not be the enemy of good. It's much more important to foster a culture of quick, informed decision-making -- one that's comfortable acting with 80 percent certainty, rather than waiting for 100 percent. 100 percent certainty doesn't exist. You become a better decision-maker by learning from the results of imperfect decisions. Rather than calling them "successes" and "failures," my team uses the terms "hits" and "misses." A "miss" sounds much less punishing than a "failure," especially when we couch it in learning-oriented terms. Use words that encourage your team to learn lessons and apply them to what's next. This is particularly important after a miss, when your people turn to you for the story. If your story revolves around negative outcomes, it will have a negative impact on your team. But if your story revolves around lessons you can carry forward, your team will understand that mistakes build successes. Misses help you home in on your target. For example, we recently overbought in a certain product style. We have more inventory than we'd like. In the aftermath, I encouraged us to ask questions like: How do we reposition ourselves? What have we learned? How do we talk about it, and how do we fix it? We made that buying decision with a particular view of the world. Now, we learn from it and use the lessons to reorient moving forward. This framing is just as important after hits as misses. Oftentimes, when junior team members report to me after hits, they describe an outcome without telling me what's next. The positive rewards of success can make us bypass the lesson-learning phase, assuming that a good result was due to a great decision. After both hits and misses, encourage reflection, lesson-learning, and future-crafting. "That's an awesome learning -- how can we push it forward? What are you going to do next?" Encourage your people to think of results -- positive and negative -- as part of a continuum, not isolated points on a graph. Use words that encourage out-of-the-box thinking. The poet Robert Kelly said, "We sleep in language if language does not come to wake us with its strangeness." I believe what he meant was that if you use the same old language, you'll get the same old results. New language, on the other hand, wakes us up. It makes us see familiar things in a new light. It prompts us to visualize a future more aligned with our values. If your language grows dull, repetitive, or is otherwise indistinguishable from your competitors' language, neither your team nor your customers will develop a personal connection with your mission. Fresh, distinct language builds a fresh, distinct culture, one whose members feel confident thinking against the status quo. Of course, different conditions call for different kinds of action. Sometimes, you have to add processes, learning to act more deliberately; other times, you have to act quickly, taking results as they come. ThirdLove has gone through periods of both. Indeed, individual departments often have different needs with regard to action versus deliberation. But whatever our circumstances, using the right language helps my team take stock, respond accordingly, and learn valuable lessons. Quelle: https://www.inc.com/heidi-zak/your-words-create-your-companys-culture-for-better-or-for-worse-take-control-with-these-tips.html
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