Clinical‐Pharmacological Drug Information Center of Hannover Medical School: Update From a Tertiary Care University Hospital (2022–2024)

Article type: Research Article

Keywords: clinical pharmacology, drug information center, pharmacotherapy safety

Authors: Johannes Heck ⚬, Dirk O. Stichtenoth ⚬, Christoph Schröder ⚬, Ruxandra Sabau, Anna‐Leena K. Heim ⚬, Felix Koop ⚬, Thorben Pape ⚬, Sebastian Schröder ⚬, Martin Schulze Westhoff ⚬, Benjamin Krichevsky ⚬, Martin Klietz ⚬, Stephan Greten ⚬, Carsten Schumacher ⚬

Affiliations: Institute for Clinical Pharmacology Hannover Medical School Hannover Germany; Institute for General Practice and Palliative Care Hannover Medical School Hannover Germany; Department of Respiratory Medicine and Infectious Diseases Hannover Medical School Hannover Germany; Department of Psychiatry, Social Psychiatry and Psychotherapy Hannover Medical School Hannover Germany; PRACTIS Clinician Scientist Program, Dean’s Office for Academic Career Development Hannover Medical School Hannover Germany; Interdisciplinary Emergency Department University Hospital Schleswig‐Holstein Kiel Germany; Department of Neurology Hannover Medical School Hannover Germany; Center for Clinical Trials Hannover Medical School Hannover Germany

License: © 2026 The Author(s). Pharmacology Research & Perspectives published by British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics and John Wiley & Sons Ltd. CC BY 4.0 This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Article links: DOI: 10.1002/prp2.70247  |  PubMed: 41952214  |  PMC: PMC13061747

Relevance: Relevant: mentioned in keywords or abstract

Full text: PDF (827 KB)

Introduction

Drug information centers (DICs) are institutions dedicated to providing unbiased, independent, and up‐to‐date information on medications and their usage, communicating with various groups of healthcare professionals to enhance patient care and to promote rational drug use [ref. 1, ref. 2, ref. 3]. In 1962, the first DIC worldwide was established at the University of Kentucky [ref. 2, ref. 4, ref. 5], with many other DICs following in the United States (US) and Europe from the 1960s to 1980s [ref. 1, ref. 2, ref. 5, ref. 6, ref. 7]. Today, DICs exist in most countries around the globe, including emerging nations like Uganda [ref. 8], Ethiopia [ref. 9, ref. 10, ref. 11], Brazil [ref. 12], Nepal [ref. 13], and India [ref. 14, ref. 15, ref. 16, ref. 17, ref. 18].

DIC staffing and operations vary significantly between countries. In the US, DICs are typically pharmacist‐led, responding to DI queries mainly by phone [ref. 2, ref. 19, ref. 20]. European DICs are often headed by clinical pharmacologists or similarly qualified physicians, and are operated jointly by physicians and pharmacists [ref. 2, ref. 6, ref. 7, ref. 20, ref. 21]. However, numerous pharmacist‐led DICs also exist in Europe [ref. 2]. Due to their university hospital affiliations, European DICs also often involve visiting physicians and medical students [ref. 2, ref. 22]. European DICs generally offer written responses alongside verbal communication with inquirers [ref. 2, ref. 22].

A plethora of reports from DICs located in emerging countries [ref. 8, ref. 9, ref. 10, ref. 11, ref. 12, ref. 14, ref. 15, ref. 16, ref. 17, ref. 18] and Scandinavia [ref. 6, ref. 20, ref. 23, ref. 24, ref. 25, ref. 26] were published over the last few years; however, there was a notable shortage of studies from central Europe, particularly Germany [ref. 2]. The most recent data from German clinical pharmacologist‐led DICs dated back to Tröger and Meyer (2000) [ref. 27] and Schwarz et al. (1999) [ref. 28]. In 2022, to address this information gap, we analyzed 594 queries received by the clinical‐pharmacological DIC of Hannover Medical School, a tertiary care university hospital in northern Germany, between October 2018 and April 2022 [ref. 2]. We found that the majority of queries were submitted by physicians (96.1%), predominantly internists (31.1%) [ref. 2]. 82.8% of the queries were patient‐specific, as opposed to 17.2% general queries [ref. 2]. Adverse drug reactions (ADRs), indications/contraindications, and pharmacodynamic interactions (PDIs) represented the three most frequent query categories [ref. 2]. Compared to general queries, patient‐specific queries more often addressed ADRs, PDIs, and pharmacokinetic interactions (PKIs) [ref. 2].

In 1999, Schwarz and co‐workers posited that “the periodical analysis of the types and sources of enquiries may point to latent problems and needs in the medical community” [ref. 28], a statement that is still valid today. Therefore, we here provide an update from our DIC that covers the period from April 2022 to December 2024. We sought to compare the characteristics of DI queries with our previous investigation [ref. 2] and other German as well as international studies. We aimed to examine differences between patient‐specific and general queries and sought to delineate potential changes over time. Additionally, we present and discuss a curated selection of clinically complex and educational queries our DIC dealt with during the study period.

Methods

Ethics Statement

This study was approved by the Ethics Committee of Hannover Medical School (No. 11267_BO_K_2024) and adheres to the Declaration of Helsinki (1964) and its later amendments (current version dating from 2024).

Operational Procedures of the Clinical‐Pharmacological Drug Information Center of Hannover Medical School

The operational procedures of the clinical‐pharmacological DIC of Hannover Medical School were elaborated in detail in our publication from 2022 [ref. 2]. In brief, the DIC of Hannover Medical School is a specialist pharmacotherapeutic consultation service for healthcare professionals at Hannover Medical School and affiliated academic teaching hospitals. The DIC is staffed by two senior physicians (a clinical pharmacologist and an internist), a resident in clinical pharmacology, and a clinical pharmacist. Healthcare professionals submit queries to the DIC through the hospital information system SAP (Systems, Applications, and Products in Data Processing, Walldorf, Germany) or via e‐mail. The resident or clinical pharmacist handles these queries, occasionally aided by visiting physicians or medical students. If important clinical data (e.g., about the patient’s medication or comorbidities) is lacking, the inquirer is contacted for additional information. Subsequently, a thorough literature review is conducted, utilizing summaries of product characteristics (SmPCs), medical databases, current editions of standard textbooks of pharmacology and clinical pharmacology, as well as drug information and interaction software (e.g., AiDKlinik (Dosing GmbH, Heidelberg, Germany)). A written response is prepared, reviewed, countersigned by a senior physician, and delivered to the inquirer within one to three workdays. In urgent cases, a preliminary response is communicated by phone. To maintain quality standards, all queries and responses are presented and discussed at weekly pharmacotherapeutic case conferences, which are also attended by external physicians and medical students.

Data Acquisition

For the current update, all queries submitted to the clinical‐pharmacological DIC of Hannover Medical School between 1 April 2022 and 31 December 2024 were examined. Similar to our previous publication [ref. 2], the following parameters were analyzed for each query: Of note, the category “pharmacotherapy in advanced age” was not directly assigned to all queries concerning patients of chronological age ≥ 65 years, but solely to queries that explicitly addressed pharmacotherapeutical aspects in older individuals.

• Origin of the query: Hannover Medical School; academic teaching hospital; private practice; other.
• Type of query: patient‐specific (i.e., queries concerning individual patients) or general (i.e., queries of common pharmacological interest or queries concerning more broadly defined patient populations such as pregnant women).
• Age and sex of the patient (assessed solely for patient‐specific queries)
• Medical specialty of the inquiring healthcare professional.
• Query categories (assignment of more than one category per query was possible): adverse drug reaction (ADR); indication/contraindication; posology/dose adjustment (e.g., due to renal or hepatic insufficiency); therapeutic drug monitoring (TDM); pharmacogenetics; pharmacodynamic interaction (PDI); pharmacokinetic interaction (PKI); pregnancy and breastfeeding; pharmacotherapy in advanced age (i.e., patients ≥ 65 years); other.

Statistical Analysis

Descriptive statistical methods were used to summarize the data. Quantitative variables are displayed as means ± standard deviations or as medians with interquartile ranges (IQRs) for data that were not normally distributed. Categorical variables are depicted as absolute and relative frequencies. Differences between general and patient‐specific queries were analyzed with Pearson’s chi‐squared test or Fisher’s exact test, as appropriate. The latter was preferred if at least one of the four cells of a 2 × 2 contingency table had an expected frequency of less than five observations. Fundamentally, p‐values < 0.05 were considered statistically significant. To address the problem of multiple comparisons and to reduce the likelihood of type I errors, the Holm–Bonferroni correction method was applied. All statistical analyses were performed with Microsoft Excel 2019 (Redmond, Washington, USA) and IBM SPSS Statistics for Windows, version 29 (Armonk, New York, USA).

Results

Number, Type, and Origin of Queries

In total, 438 queries were received by the DIC during the study period. Of these, 85.2% were patient‐specific, whereas the remaining 14.8% were general queries (Table 1). The majority of queries were submitted by physicians (95.7%). 85.2% of queries came from healthcare professionals working at Hannover Medical School. Internists, psychiatrists, and surgeons most frequently consulted the clinical‐pharmacological DIC, submitting 28.5%, 17.6%, and 16.0% of queries, respectively.

Patient Characteristics

Age and sex of patients were documented in 82.0% (306/373) and 97.3% (363/373) of patient‐specific queries, respectively. The mean age of the patients was 54.0 ± 22.4 years (range 1 to 99 years). 60.3% (225/373) of the patients were female (male: 37.0% (138/373); sex not documented: 2.7% (10/373)). Patient‐specific queries most frequently concerned patients aged between 51 and 70 years (Figure 1).

Query Categories

Indications/contraindications, ADRs, and PDIs represented the three most frequently addressed query categories, being involved in 46.1%, 42.5%, and 41.6% of all queries, respectively (Table 2). Absolute and relative frequencies of query categories, stratified by specialties of inquiring healthcare professionals, are displayed in Table S1. In relative terms, ADRs and indications/contraindications were most frequently addressed by radiologists/radiotherapists (100% (12/12) and 66.7% (8/12) of all queries from radiologists/radiotherapists, respectively), while queries concerning posology/dose adjustments and TDM were most frequently submitted by urologists (58.5% (24/41) and 24.4% (10/41), respectively). PDIs, PKIs, and pharmacotherapy during pregnancy and breastfeeding were most commonly referred to by gynecologists (62.5% (25/40), 57.5% (23/40), and 32.5% (13/40), respectively). Pharmacogenetic topics were most frequently inquired by pediatricians (15.4% (2/13)), whereas pharmacotherapy in advanced age was referred to in approximately every third query by surgeons (31.4% (22/70)).

Comparison Between General and Patient‐Specific Queries

As compared to general queries, patient‐specific queries were more often related to ADRs (29.2% vs. 44.8%; p = 0.019), indications/contraindications (26.2% vs. 49.6%; p < 0.001), posology/dose adjustment (10.8% vs. 25.2%; p = 0.011), TDM (4.6% vs. 13.1%; p = 0.050), and PDIs (24.6% vs. 44.5%; p = 0.003) before adjusting for multiple comparisons (Table 2). By contrast, the query category “other” was more often addressed by general queries as compared to patient‐specific queries (21.5% vs. 10.5%; p = 0.011). After adjustment for multiple comparisons using the Holm–Bonferroni correction method, only the differences between general and patient‐specific queries with respect to indications/contraindications and PDIs remained statistically significant.

Examples of Clinically Complex Queries

To illustrate the clinical complexity of DI queries answered by our DIC, we present and comment on a curated selection of ten queries (Table 3). Those queries (and corresponding answers) were selected subjectively by the authors based on their potential clinical interest and educational value to readers. The selected cases are not intended to be representative of the entire sample of queries analyzed in this study; they only serve illustrative and educational purposes. Three of the ten selected queries were (primarily) related to the pharmacological treatment of rare diseases (cases no. 2, 7, and 10), two queries dealt with drug indications/contraindications (cases no. 5 and 8), two queries pertained to the management of drug interactions (cases no. 1 and 6), and one query each referred to pharmacotherapy during pregnancy (case no. 3), pharmacotherapy in advanced age (case no. 4), and pharmacogenetics (case no. 9).

Discussion

In this study, we analyzed a total of 438 queries received by the clinical‐pharmacological DIC of Hannover Medical School over a period of 33 months. Even though the sample size was around 26% smaller than in our previous investigation (study period from October 2018 to April 2022) [ref. 2], the number of queries handled per month by our DIC remained relatively constant over time (13.3 vs. 13.8 queries per month, respectively). The sample size of the present study lay within the range of other analyses in the field, which displayed sample sizes between 55 and 744 queries [ref. 3, ref. 9, ref. 10, ref. 11, ref. 13, ref. 14, ref. 15, ref. 16, ref. 17, ref. 26, ref. 28, ref. 29, ref. 30, ref. 31, ref. 32]—and was considered appropriate for an update from our DIC.

Interestingly, we found several similarities but also some notable differences between our present and previous research [ref. 2]. The proportion of patient‐specific queries was comparable (85.2% vs. 82.8% [ref. 2]), physicians were the largest group of inquiring healthcare professionals in both studies (95.7% vs. 96.1% [ref. 2]), and also the top three medical specialties that most frequently consulted our DIC (i.e., internal medicine, psychiatry and psychosomatic medicine, and surgery) remained the same. Physicians also represented the group of healthcare professionals who predominantly consulted DICs in other analyses [ref. 8, ref. 9, ref. 14, ref. 23, ref. 26, ref. 31], and internists in particular were among the main users of DICs located in Dresden [ref. 28] and Munich, Germany [ref. 32]. Consistent with our earlier research [ref. 2] but diverging from an older investigation by Tröger and Meyer (Magdeburg, Germany), we received a notable proportion of queries (16.0%) from surgeons. This substantial percentage may point to the growing interdisciplinary collaboration between medical and surgical disciplines that has developed at Hannover Medical School in recent years [ref. 33].

The elevated level of specialization at our tertiary care university hospital likely explains the consistently high proportion of patient‐specific queries (exceeding 80%). This observation is in line with an analysis by Nilsson et al. from a university hospital‐affiliated Swedish DIC jointly operated by clinical pharmacologists and pharmacists (79% patient‐specific queries) [ref. 31], but it contrasts with studies by Almazrou et al. [ref. 34] and Tefera et al. [ref. 11] conducted at pharmacist‐run Saudi Arabian and Ethiopian DICs, in which the proportions of patient‐specific queries were notably lower (44% and 53.1%, respectively). While responses to general queries typically aim to provide factual DI, responses to patient‐specific queries focus on individually tailored treatment strategies. These responses offer critical assessments of the advantages and disadvantages of specific pharmacological therapies in individual patient scenarios, considering patient‐specific factors such as age, sex, disease severity, comorbidities, and comedication. Delivering factual DI (e.g., details on drug availability, stability, compatibility, interactions, and ADRs) is a core competency of pharmacists. Conversely, evaluating the benefit–risk profile of pharmacological therapies within the context of individual patients is the domain of physicians. These professional distinctions may account for the disparities observed between the studies by Almazrou et al. [ref. 34] and Tefera et al. [ref. 11] (both pharmacist‐led) and our investigation (physician‐led). Intriguingly, a recent analysis of a university hospital pharmacy‐operated DI service in Munich, Germany, revealed proportions of patient‐specific queries and queries from physicians (91% and 95%, respectively) that were comparable to our study, but focused exclusively on ADRs [ref. 32]; other DI query categories were not assessed.

The high degree of specialization at our clinic is underscored by the queries presented and discussed in Table 3, three of which dealt with the pharmacological management of rare diseases (progressive familial intrahepatic cholestasis type 1, factor VII deficiency, and chronic Q fever). It should be noted, however, that the cases showcased in Table 3 were selected for illustrational and educational purposes only; they were not intended to be representative of the entire sample of queries analyzed in the present investigation. Timpe and Motl showed that the complexity of DI queries increased between 1995 and 2004 [ref. 35], and 70% of respondents in a survey conducted among US DICs reported an increase in the number of complex DI queries between 2003 and 2008 [ref. 19]. To this point, only a minority of researchers have showcased specific DI queries in their publications [ref. 7, ref. 16, ref. 17, ref. 22, ref. 36]. These case presentations were either in condensed form [ref. 7, ref. 22] or lacked the corresponding DIC responses [ref. 16, ref. 17]. With the exception of Lumpe et al.’s 1998 article [ref. 36] and our 2022 publication [ref. 2], our study stands out as the sole report that presents and provides commentary on a curated selection of clinically intricate DI queries, which can be regarded as a strength of our work.

Remarkably, the proportion of queries from academic teaching hospitals declined by approximately one‐half between our previous research and the current investigation (13.0% [ref. 2] vs. 6.4%). In line with a recent systematic review [ref. 37], this may point to an increasing workload in peripheral clinics (e.g., due to a shortage of physicians and nurses), leaving little time to consult external specialists during the treatment process.

Whereas the mean age of patients in our study was comparable with our previous research (54.0 ± 22.4 years and 55.6 ± 22.9 years [ref. 2]), the proportion of female patients increased (60.3% vs. 51.4% [ref. 2]). Of note, while the age distribution in our previous study showed a bimodal curve with peaks at 21–30 years and 61–70 years [ref. 2], there was a single peak in the present investigation at 51–70 years. The three most frequently addressed query categories (i.e., indications/contraindications, ADRs, and PDIs) corresponded well to the DI needs most commonly cited by healthcare professionals in a recent systematic literature review [ref. 37], and they remained stable between our previous investigation [ref. 2] and the current analysis. On the other hand, we detected certain changes in the differences between patient‐specific and general queries. As compared to general queries, patient‐specific queries were more often related to ADRs, PDIs, indications/contraindications, posology/dose adjustment, and TDM (before adjusting for multiple comparisons), whereas in our previous study, we detected differences between general queries and patient‐specific queries only with respect to ADRs, PDIs, and PKIs (also without adjustments for multiple testing). Of note, in the present investigation, only the differences between general and patient‐specific queries with regard to indications/contraindications and PDIs remained statistically significant after application of the Holm–Bonferroni correction method to address the problem of multiple comparisons and to reduce the likelihood of type I errors. These findings may be explained by the fact that general information on ADRs, indications/contraindications, posology/dose adjustment, TDM, and drug–drug interactions can be relatively easily accessed by healthcare professionals independently. A systematic literature review by Tan et al. highlighted the variety of DI sources used by healthcare professionals, the most popular of which were reference books, journals, drug databases, textbooks, and product‐specific information (e.g., SmPCs), only to name a few [ref. 37]. However, for the transfer of general clinical‐pharmacological knowledge to the treatment of individual patients, consultation and discussion with human experts (e.g., via a DIC) is still paramount. A Swedish questionnaire study revealed that 85% of responding physicians searched for DI at least weekly [ref. 38]. At the same time, healthcare practitioners often lack the time and also the expertise to address complex DI queries independently [ref. 23]. While access to scientific literature and other references has improved significantly in recent decades, mainly due to increased online search capabilities, the volume of available information on any given pharmacological topic has grown substantially [ref. 23]. Moreover, the complexity of DI queries has markedly increased in recent years [ref. 23]. Consequently, the time required to handle DI queries has not diminished significantly compared to earlier periods [ref. 23], indicating a continued need for DICs to support clinicians in their daily practice. In the present study, we did not systematically assess the time required to answer DI queries, which represents a limitation of our investigation. From our experience, typically 30–120 min are needed to answer a DI query.

Pharmacotherapy in older adults is particularly challenging due to altered pharmacokinetics and pharmacodynamics compared to younger individuals [ref. 39]. At our DIC, the proportion of queries related to pharmacotherapy in advanced age increased from 6.1% [ref. 2] to 9.1%, which may reflect Germany’s demographic shift towards an aging population: currently, over one‐fifth of Germans are 65 years or older [ref. 40], with this percentage expected to increase in the coming decades [ref. 41]. Other studies in the field did not examine pharmacotherapy in advanced age as a distinct topic [ref. 10, ref. 11, ref. 14, ref. 29, ref. 34, ref. 35, ref. 42] but similar demographic trends are anticipated in emerging nations, too [ref. 43]. Consequently, DICs in emerging nations may soon experience a comparable rise in queries related to geriatric pharmacotherapy.

The utility of clinical‐pharmacological advice on drug use during pregnancy was highlighted by Erdeljić et al., who showed that clinical pharmacologists’ assessments were more accurate than the US Food and Drug Administration classification system in predicting pregnancy outcomes after pregnancy‐related drug exposures [ref. 44]. Furthermore, in a survey of physicians who sought guidance from a Norwegian DIC on drug use during pregnancy, 9% of respondents reported that the information provided by the DIC had averted termination of an intended pregnancy [ref. 25]. Remarkably, the proportion of queries related to pregnancy or breastfeeding at our DIC rose from 3.5% [ref. 2] to 6.2%. Even though this percentage is still considerably lower than in older reports by Llerena et al. (drug use in pregnancy: 18%; drug use in breastfeeding: 4%) [ref. 3] and Schwarz et al. (drug use in pregnancy/lactation: 16%) [ref. 28], it is notably higher than in a more recent study by Tefera and colleagues (drug use in pregnancy: 2.6%) [ref. 11]. This indicates that while a general decline in DI queries related to drug use during pregnancy or breastfeeding has been observed in the last decades, presumably due to the easy and free‐of‐charge access to online databases such as Embryotox [ref. 45], Bumps (Best Use of Medicines in Pregnancy) [ref. 46], and the Drugs and Lactation Database [ref. 47], consultation with experts in clinical pharmacology is still considered useful by attending healthcare professionals, especially in clinically complex cases (e.g., case no. 3 in Table 3).

The number of queries related to pharmacogenetics and TDM in our study appeared relatively small. At Hannover Medical School, similar to the majority of university hospitals in Germany, pharmacogenetic tests and TDM are technically conducted by the Central Laboratory (which in the case of Hannover Medical School is affiliated with the Institute for Clinical Chemistry, not with the Institute for Clinical Pharmacology, at which the DIC is located). The Central Laboratory also provides explanations and interpretations of pharmacogenetic and TDM test results, which may be sufficient for healthcare professionals in most routine cases. We hypothesize that only in special, therapeutically challenging pharmacogenetic or TDM cases, the DIC is contacted by clinicians as an additional source of information and advice, potentially explaining the comparatively low number of pharmacogenetic and TDM queries in our study.

Besides its single‐center and retrospective design, the primary limitation of our study is the absence of data on patient‐related outcomes. Consequently, it was not possible to ascertain whether the consultation of the DIC by attending healthcare professionals resulted in benefits for their patients. To examine this aspect, a control group would have been necessary, which was not feasible within the constraints of this study—a drawback our investigation shares with many other DIC studies [ref. 8, ref. 9, ref. 10, ref. 11, ref. 13, ref. 14, ref. 15, ref. 16, ref. 17, ref. 18, ref. 22, ref. 26, ref. 27, ref. 28, ref. 31, ref. 32, ref. 34, ref. 42]. Moreover, the absence of data on how often the recommendations of the DIC were adhered to and implemented into clinical practice (i.e., acceptance rates), or how satisfied the inquiring healthcare professionals were with the DIC recommendations represent substantial limitations of our work. Due to the hypothesis‐generating, non‐confirmatory nature of our study, the results of the inferential statistical tests—despite adjustments for multiple comparisons—must be interpreted with considerable caution.

In summary, our study suggests that query characteristics at our DIC remained relatively stable between the time periods 2018–2022 [ref. 2] and 2022–2024, especially with respect to type of queries (> 80% patient‐specific), origin of queries (mainly from within Hannover Medical School itself), profession of inquiring healthcare professionals (> 90% physicians), medical specialties of inquirers (top three: internal medicine, psychiatry and psychosomatic medicine, surgery), and query categories (top three: indications/contraindications, ADRs, PDIs). Nonetheless, we also observed certain changes between our previous research [ref. 2] and the current investigation, most notably higher proportions of queries related to pharmacotherapy in advanced age and drug use during pregnancy or breastfeeding, as well as a unimodal instead of a bimodal age distribution curve among patient‐specific queries. Besides time‐dependent changes, fundamental differences in query characteristics across DICs may also stem from country‐specific factors, the affiliation and service area of DICs, and the composition of DIC staff (clinical pharmacologist‐led vs. pharmacist‐led) [ref. 2]. We propose that DICs can effectively contribute to high‐quality patient care and enhanced pharmacotherapy safety [ref. 2]. Future research should focus on prospective controlled studies to determine if DICs genuinely improve clinically relevant patient outcomes [ref. 2].

Author Contributions

Johannes Heck: conceptualization; data curation; investigation; methodology; formal analysis; visualization; writing – original draft; writing – review and editing. Dirk O. Stichtenoth: writing – review and editing; supervision. Christoph Schröder: writing – review and editing. Ruxandra Sabau: writing – review and editing. Anna‐Leena K. Heim: formal analysis; writing – review and editing. Felix Koop: formal analysis; writing – review and editing. Thorben Pape: formal analysis; writing – review and editing. Sebastian Schröder: formal analysis; writing – review and editing. Martin Schulze Westhoff: formal analysis; writing – review and editing. Benjamin Krichevsky: methodology; formal analysis; writing – review and editing. Martin Klietz: writing – review and editing. Stephan Greten: writing – review and editing. Carsten Schumacher: methodology; formal analysis; writing – original draft; writing – review and editing.

Funding

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

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