Overcoming obstacles in Parkinson's disease

Improved symptomatic and disease‐modifying treatments are needed for Parkinson's disease (PD). Although significant advances have been made in the understanding of PD etiology, the translation of these discoveries into novel transformative therapies has been limited as a result of systemic challenges in PD drug development. Preclinical testing lacks clear standards and prioritization criteria for advancing therapies to the clinic. Clinical testing is marked by expensive, long, and uninformative studies. In parallel to these scientific challenges, funding of late‐stage drug development has become increasingly scarce and risk averse. In this context, novel models of collaboration and funding are opening up new avenues for pursuing treatments. This review will discuss the most critical challenges in PD drug development and the innovative approaches being developed to overcome these hurdles. © 2012 Movement Disorder Society     

Finanzielle Aspekte der Gyn?kologie und Geburtshilfe

With the implementation of diagnosis-related groups (DRG) in 2004 the costs and profits for inpatient treatment have changed greatly. In gynecology and obstetrics there has been a clear reduction in treatment cases and in connection with this the average work load of the department has decreased. Under the heavy financial pressure the average case costs could be substantially reduced. Slightly increased average profits result in a clear improvement of results when calculated over all departments. Perception within hospitals is sometimes divergent and the reasons for this will be analyzed. In particular the reduced work load in individual departments is responsible because the fixed costs cannot be adequately adapted to the decreasing number of cases (minimum personnel posts, cost contingency in the delivery room etc.). The different state-based case costs also as before lead to the situation that the profits can be very different despite having the same clinical structure. The question whether valid data on costs and profits are now available to all hospitals remains to be answered.     

H?matologische Erkrankungen in der Schwangerschaft

The management of hematologic disorders in pregnancy presents diagnostic and therapeutic challenges requiring a multidisciplinary approach. Iron deficiency is the most common cause of anemia in pregnancy. Gestational thrombocytopenia is defined by mild, asymptomatic thrombocytopenia and usually requires no therapy. Autoantibody-induced idiopathic thrombocytopenia is treated with steroids and high-dose immunoglobulins in patients with platelet counts below 30,000/??l during pregnancy and below 50,000/??l before delivery. The most common hematologic neoplasias in pregnancy include Hodgkin??s disease, aggressive non-Hodgkin??s lymphomas, and acute leukemias. Cure for the mother depends on consistent intensive chemotherapy. Chemotherapy can be administered during the second and third trimester with reasonable safety, though there is an increased fetal risk. It is important to balance the potential fetal risk against the maternal risk of an untreated neoplasia.