BackgroundThe benefit of Ginkgo biloba has been discussed controversially. The aim of this review was to assess the effects of Ginkgo biloba in Alzheimer's disease as well as vascular and mixed dementia covering a variety of outcome domains.MethodsWe searched MEDLINE, EMBASE, the Cochrane databases, CINAHL and PsycINFO for controlled trials of ginkgo for Alzheimer's, vascular or mixed dementia. Studies had to be of a minimum of 12 weeks duration with at least ten participants per group. Clinical characteristics and outcomes were extracted. Meta-analysis results were expressed as risk ratios or standardized mean differences (SMD) in scores.ResultsNine trials using the standardized extract EGb761® met our inclusion criteria. Trials were of 12 to 52 weeks duration and included 2372 patients in total. In the meta-analysis, the SMDs in change scores for cognition were in favor of ginkgo compared to placebo (-0.58, 95% confidence interval [CI] -1.14; -0.01, p = 0.04), but did not show a statistically significant difference from placebo for activities in daily living (ADLs) (SMD = -0.32, 95% CI -0.66; 0.03, p = 0.08). Heterogeneity among studies was high. For the Alzheimer subgroup, the SMDs for ADLs and cognition outcomes were larger than for the whole group of dementias with statistical superiority for ginkgo also for ADL outcomes (SMD = -0.44, 95% CI -0.77; -0.12, p = 0.008). Drop-out rates and side effects did not differ between ginkgo and placebo. No consistent results were available for quality of life and neuropsychiatric symptoms, possibly due to the heterogeneity of the study populations.ConclusionsGinkgo biloba appears more effective than placebo. Effect sizes were moderate, while clinical relevance is, similar to other dementia drugs, difficult to determine.

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Digital transformation affects almost every area in societies and has consequences for incumbent companies. With qualitative research, we explore the influencing factors for digital transformation in the financial services sector. We use a PEST-model and Porter’s Five Forces as the underlying structure for our analysis. Our interviews and findings show that the financial services sector face the same current challenges, but their impact is perceived higher in the banking than in the insurance sector concerning social factors and bargaining power of buyers. The character of the current development is evolutionary rather than disruptive. Almost all incumbents currently focus on modernizing and consolidating their backend-systems. The aim is to enable them for new customer-oriented services. A primary driver for the digital transformation is the threat of a broader market entry by BigTechs. Our research provides a comprehensive overlook about the influencing factors of digital transformation using statements from experts in the field.

Highlights Italy’s political development had implications for sovereign credit and redenomination risk. Italy’s political development has affected the relationship between bank funding costs in Germany and Italy. One explanation could be implied changes to redenomination risk due to fears about Italy leaving the Euro.