Introduction A considerable percentage of daily emergency calls are for nursing home residents. With the ageing of the overall European population, an increase in emergency calls and interventions in ...nursing homes (NH) is to be expected. A proportion of these interventions and hospital transfers may be preventable and could be considered as inappropriate by prehospital emergency medical personnel. The study aimed to understand Belgian emergency physicians’ and emergency nurses’ perspectives on emergency calls and interventions in NHs and investigate factors contributing to their perception of inappropriateness. Methods An exploratory non-interventional prospective study was conducted in Belgium among emergency physicians and emergency nurses, currently working in prehospital emergency medicine. Electronic questionnaires were sent out in September, October and November 2023. Descriptive statistics were used to analyze the overall results, as well as to compare the answers between emergency physicians and emergency nurses about certain topics. Results A total of 114 emergency physicians and 78 nurses responded to the survey. The mean age was 38 years with a mean working experience of 10 years in prehospital healthcare. Nursing home staff were perceived as understaffed and lacking in competence, with an impact on patient care especially during nights and weekends. General practitioners were perceived as insufficiently involved in the patient’s care, as well as often unavailable in times of need, leading to activation of Emergency Medical Services (EMS) and transfers of nursing home residents to the Emergency Department (ED). Advance directives were almost never available at EMS interventions and transfers were often not in accordance with the patient’s wishes. Palliative care and pain treatment were perceived as insufficient. Emergency physicians and nurses felt mostly disappointed and frustrated. Additionally, differences in perception were noted between emergency physicians and nurses regarding certain topics. Emergency nurses were more convinced that the nursing home physician should be available 24/7 and that transfers could be avoided if nursing home staff had more authority regarding medical interventions. Emergency nurses were also more under the impression that pain management was inadequate, and emergency physicians were more afraid of the medical implications of doing too little during interventions than emergency nurses. Suggestions to reduce the number of EMS interventions were more general practitioner involvement (82%), better nursing home staff education/competences (77%), more nursing home staff (67%), mobile palliative care support teams (65%) and mobile geriatric nursing intervention teams (52%). Discussion and conclusion EMS interventions in nursing homes were almost never seen as necessary or indicated by emergency physicians and nurses, with the appropriate EMS level almost never being activated. The following key issues were found: shortages in numbers and competence of nursing home staff, insufficient primary care due to the unavailability of the general practitioner as well as a lack of involvement in patient care, and an absence of readily available advance directives. General practitioners should be more involved in the decision to call the Emergency Medical Services (EMS) and to transfer nursing home residents to the Emergency Department. Healthcare workers should strive for vigilance regarding the patients’ wishes. The emotional burden of deciding on an avoidable hospital admission of nursing home residents, perhaps out of fear for medico-legal consequences if doing too little, leaves the emergency physicians and nurses frustrated and disappointed. Improvements in nursing home staffing, more acute and chronic general practitioner consultations, and mobile geriatric and palliative care support teams are potential solutions. Further research should focus on the structural improvement of the above-mentioned shortcomings.
We performed post hoc analyses on the utility of pretherapeutic and early interim 68Ga-DOTATOC PET tumor uptake and volumetric parameters and a recently proposed biomarker, the inflammation-based ...index (IBI), for peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumor (NET) patients treated with 90Y-DOTATOC in the setting of a prospective phase II trial. Methods: Forty-three NET patients received up to 4 cycles of 90Y-DOTATOC at 1.85 GBq/m2/cycle with a maximal kidney biologic effective dose of 37 Gy. All patients underwent 68Ga-DOTATOC PET/CT at baseline and 7 wk after the first PRRT cycle. 68Ga-DOTATOC–avid tumor lesions were semiautomatically delineated using a customized SUV threshold–based approach. PRRT response was assessed on CT using RECIST 1.1. Results: Median progression-free survival and overall survival (OS) were 13.9 and 22.3 mo, respectively. An SUVmean higher than 13.7 (75th percentile) was associated with better survival (hazard ratio HR, 0.45; P = 0.024), whereas a 68Ga-DOTATOC–avid tumor volume higher than 578 cm3 (75th percentile) was associated with worse OS (HR, 2.18; P = 0.037). Elevated baseline IBI was associated with worse OS (HR, 3.90; P = 0.001). Multivariate analysis corroborated independent associations between OS and SUVmean (P = 0.016) and IBI (P = 0.015). No significant correlations with progression-free survival were found. A composite score based on SUVmean and IBI allowed us to further stratify patients into 3 categories with significantly different survival. On early interim PET, a decrease in SUVmean of more than 17% (75th percentile) was associated with worse survival (HR, 2.29; P = 0.024). Conclusion: Normal baseline IBI and high 68Ga-DOTATOC tumor uptake predict better outcome in NET patients treated with 90Y-DOTATOC. This method can be used for treatment personalization. Interim 68Ga-DOTATOC PET does not provide information for treatment personalization.
We performed post hoc analyses on the utility of pretherapeutic and early interim
Ga-DOTATOC PET tumor uptake and volumetric parameters and a recently proposed biomarker, the inflammation-based index ...(IBI), for peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumor (NET) patients treated with
Y-DOTATOC in the setting of a prospective phase II trial.
Forty-three NET patients received up to 4 cycles of
Y-DOTATOC at 1.85 GBq/m
/cycle with a maximal kidney biologic effective dose of 37 Gy. All patients underwent
Ga-DOTATOC PET/CT at baseline and 7 wk after the first PRRT cycle.
Ga-DOTATOC-avid tumor lesions were semiautomatically delineated using a customized SUV threshold-based approach. PRRT response was assessed on CT using RECIST 1.1.
Median progression-free survival and overall survival (OS) were 13.9 and 22.3 mo, respectively. An SUV
higher than 13.7 (75th percentile) was associated with better survival (hazard ratio HR, 0.45;
= 0.024), whereas a
Ga-DOTATOC-avid tumor volume higher than 578 cm
(75th percentile) was associated with worse OS (HR, 2.18;
= 0.037). Elevated baseline IBI was associated with worse OS (HR, 3.90;
= 0.001). Multivariate analysis corroborated independent associations between OS and SUV
(
= 0.016) and IBI (
= 0.015). No significant correlations with progression-free survival were found. A composite score based on SUV
and IBI allowed us to further stratify patients into 3 categories with significantly different survival. On early interim PET, a decrease in SUV
of more than 17% (75th percentile) was associated with worse survival (HR, 2.29;
= 0.024).
Normal baseline IBI and high
Ga-DOTATOC tumor uptake predict better outcome in NET patients treated with
Y-DOTATOC. This method can be used for treatment personalization. Interim
Ga-DOTATOC PET does not provide information for treatment personalization.
SAMENVATTINGZowel in Vlaanderen als in Nederland werd de voorbije jaren sterk geïnvesteerd in preventie en interventieprogramma’s om kwetsbaarheid bij ouderen tegen te gaan. Kwetsbaarheid wordt ...doorgaans gedetecteerd door gezondheidsprofessionals. Deze studie exploreerde hoe andere professionals buiten de zorgsector zoals postbodes, winkelbediendes of apothekers een antennefunctie kunnen hebben in de detectie van kwetsbare ouderen door hen door te verwijzen naar zorg wanneer dit nodig is. Daarnaast werd nagegaan in welke situaties zij acties ondernemen en welke ondersteuning nodig is om de rol van antenneberoep op te nemen. 18 professionals werden individueel (n=12) of in focusgroep (n=6) geïnterviewd. Resultaten van dekwalitatieve analyse tonen aan dat zij veelvuldig in contact komen met kwetsbare ouderen tijdens het uitoefenen van hun beroepsactiviteit. Door in gesprek te gaan met de ouderen detecteren zij verschillende vormen van kwetsbaarheid. Zij kunnen en willen een sleutelrol opnemen om deze ouderen door te verwijzen naar zorgondersteuning maar stellen zich vragen omtrent de privacy. Een centraal meldpunt per gemeente zien zij als een oplossing. ABSTRACTBackground: When older adults have early symptoms of frailty, research indicates that an early intervention can delay or avoid adverse frailty outcomes such as hospitalization or institutionalization. Frailty is to date mostly detected in a medical setting. General practitioners or home care nurses are care professionals who are the key persons in this detection. The informal network of frail older people as well has a crucial role in avoiding the worsening of frailty and the prevention of adverse frailty outcomes. Unfortunately, not all older adults in need of care have adequate care networks. In the past years, many policies have seriously invested in prevention and intervention programs for frail older adults. Within the D-SCOPE study, the potential role of ‘non-care professionals’ is explored for detecting frail older adults without an informal network and potentially leading them to formal care. Professionals such as pharmacists, mailmen or cashiers have frequent contact with frail older adults and can be seen as “antenna professionals” given they receive considerable information from their clients or costumers. This explorative study researched (a) whether antenna professionals can detect frail communitydwellingolder adults, (b) which action they undertake when they detect a frail person andwhich barriers may occur to initiate an action and (c) which support is needed to be an antenna professional.Methods: 18 persons with different professions were interviewed: pharmacists, police inspector, bank clerk, mailmen, local business owners such as florist and grocer, manager from a hair salon or supermarket and more. Professionals who didn’t had contact with frail community-dwelling older adults during their work were excluded for an interview. Participants were asked to what extend they had contact with frail older adults who were according to them in need for help, if they everreferred them towards appropriate care, what an antenna profession meant to them, what support they need to act as one and which barriers one can expect for this kind of function. All interviews were thematically analyzed.Results: The professionals could detect frailty in numerous ways. Physical frailty was visually noticeable and by starting conversations, other psychological and social frailty became visible while practicing the profession. Not seldom older adults themselves shared tragic stories of their lives. Cognitive frailty was recognized with alert signs, for example when older adults came to buy the same item twice. These professionals regularly initiate actions that were sometimes linked to their profession such as giving advice or delivering groceries. Just listening to thestory could also be seen as an action for helping frail persons. In specific cases, situations were passed towards healthcare professionals or relatives. Barriers for referring frail older adults towards care organizations were concerns about privacy, fear of losing the continuity of the daily activities, correct estimating if one in fact needed help and finding the right balance between professional and personal life. Most participants in the study thought they could act as an antenna function for referring towards professional care although they are most concerned about the privacy regulation on this matter. One central contact point in the community for referring frail older adults was believed to be a solution to prevent frailty worsening and the question to mention this anonymously was more than once raised. More concerns of the possible antenna professionals were found in three evolutions that were analyzed across the interviews. A first was the disappearance of local business owners in the community. A second was the decline of neighborhood social capital, which makes older adults increasingly turn to neighborhood stores for social contact. A third evolution is the transformation of the social character of antenna profession in a digitized world or higher work pressure.Discussion and conclusion: The findings illustrate that professionals can have an antenna function in the detection of different types of frailty. To use the information of these professionals, their concerns should sincerely be acknowledged. Not only was correctly estimating if one effectively needs help a concern, also privacy issues were discussed. Referring a frail person with care needs anonymously is straightforward not possible according to the European Union regulation on the protection of natural persons with regard to the processing of personal data. Therefore, all professionals must have the permission of the older adult before referring him or her to a care or welfare organization. It should be noted that this study was explorative and possible other persons with an antenna function such as members from clubs or societies for older adults, neighborhood volunteers, priests or Imams were not included in this study and could have an important antenna function as well. The findings of this study however provide a basis for care or welfare organizations in the development of a policy towards the implementation of professionals with an antenna function for detecting frail community-dwelling older adults. These professionals already have valuable information that can be used to prevent frailty worsening.
To investigate the relationship between the dynamic parameters (Ki) and static image-derived parameters of 68Ga-DOTATOC-PET, to determine which static parameter best reflects underlying ...somatostatin-receptor-expression (SSR) levels on neuroendocrine tumours (NETs).
20 patients with metastasized NETs underwent a dynamic and static 68Ga-DOTATOC-PET before PRRT and at 7 and 40 weeks after the first administration of 90Y-DOTATOC (in total 4 cycles were planned); 175 lesions were defined and analyzed on the dynamic as well as static scans. Quantitative analysis was performed using the software PMOD. One to five target lesions per patient were chosen and delineated manually on the baseline dynamic scan and further, on the corresponding static 68Ga-DOTATOC-PET and the dynamic and static 68Ga-DOTATOC-PET at the other time-points; SUVmax and SUVmean of the lesions was assessed on the other six scans. The input function was retrieved from the abdominal aorta on the images. Further on, Ki was calculated using the Patlak-Plot. At last, 5 reference regions for normalization of SUVtumour were delineated on the static scans resulting in 5 ratios (SUVratio).
SUVmax and SUVmean of the tumoural lesions on the dynamic 68Ga-DOTATOC-PET had a very strong correlation with the corresponding parameters in the static scan (R²: 0.94 and 0.95 respectively). SUVmax, SUVmean and Ki of the lesions showed a good linear correlation; the SUVratios correlated poorly with Ki. A significantly better correlation was noticed between Ki and SUVtumour(max and mean) (p < 0.0001).
As the dynamic parameter Ki correlates best with the absolute SUVtumour, SUVtumour best reflects underlying SSR-levels in NETs.
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