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Jørgensen JOL, de Herder WW, Martin WA, Kolarova T, Marks M, Follin C, Geilvoet W, Melmed S. Key Device Attributes for Injectable Somatostatin Receptor Ligand Therapy in Acromegaly and Neuroendocrine Tumours. Adv Ther 2023; 40:4675-4688. [PMID: 37573277 DOI: 10.1007/s12325-023-02627-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION People living with acromegaly and neuroendocrine tumours (NETs) may be treated with injectable somatostatin receptor ligands (SRLs), administered by either a caregiver or as self-injection via a proprietary or generic device. Injection device attributes that contribute to ease of use and storage, minimise preparation requirements, and reduce injection pain are associated with improved adherence and more favourable therapeutic outcomes. The aim of this study was to assess current opinion surrounding favourable SRL device attributes for people living with acromegaly and NETs as well as that of their caregivers. METHODS Participants (healthcare professionals [HCPs] and patients/non-HCP caregivers) from 11 countries were invited to answer survey questions related to their demographic, experience, and preferences as they relate to the real-world use of injectable SRL devices. Questions were developed based on review of available literature and meetings with a Scientific Committee. RESULTS Device attributes preferred by the patient/non-HCP caregiver group (n = 211) included confidence that the correct drug amount is delivered (76%), quick administration with minimal pain/discomfort (68%), and device safety (needle-safety and low risk of contamination; 53%). Device attributes preferred by HCPs (n = 52) were quick administration with minimal pain/discomfort (69%), correct use is easy to learn, confidence in handling the device (63%), and confidence that the correct drug amount is delivered (62%). CONCLUSION The results identified key features of injection devices for SRL therapy which merit consideration for optimal management and underscore the importance of patient partnership in treatment decisions.
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Affiliation(s)
- Jens Otto L Jørgensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Wouter W de Herder
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Teodora Kolarova
- International Neuroendocrine Cancer Alliance (INCA), Boston, MA, USA
| | - Muriël Marks
- World Alliance of Pituitary Organizations (WAPO), Amsterdam, Netherlands
| | | | - Wanda Geilvoet
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Shlomo Melmed
- Pituitary Center, Dept of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Davidse K, van Staa A, Geilvoet W, van Eck JP, Pellikaan K, Baan J, Hokken-Koelega ACS, van den Akker ELT, Sas T, Hannema SE, van der Lely AJ, de Graaff LCG. We mind your step: understanding and preventing drop-out in the transfer from paediatric to adult tertiary endocrine healthcare. Endocr Connect 2022; 11:e220025. [PMID: 35521816 PMCID: PMC9175586 DOI: 10.1530/ec-22-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
Introduction Transition from paediatric to adult endocrinology can be challenging for adolescents, their families and healthcare professionals. Previous studies have shown that up to 25% of young adults with endocrine disorders are lost to follow-up after moving out of paediatric care. This poses a health risk for young adults, which can lead to serious and expensive medical acute and long-term complications. Methods In order to understand and prevent dropout, we studied electronic medical records of patients with endocrine disorders. These patients were over 15 years old when they attended the paediatric endocrine outpatient clinic (OPC) of our hospital in 2013-2014 and should have made the transfer to adult care at the time of the study. Results Of 387 adolescents, 131 had an indication for adult follow-up within our university hospital. Thirty-three (25%) were lost to follow-up. In 24 of them (73%), the invitation for the adult OPC had never been sent. We describe the failures in logistic processes that eventually led to dropout in these patients. Conclusion We found a 25% dropout during transfer from paediatric to adult tertiary endocrine care. Of all dropouts, 73% could be attributed to the failure of logistic steps. In order to prevent these dropouts, we provide practical recommendations for patients and paediatric and adult endocrinologists.
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Affiliation(s)
- Kirsten Davidse
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anneloes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Wanda Geilvoet
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Judith P van Eck
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Karlijn Pellikaan
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Janneke Baan
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anita C S Hokken-Koelega
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Dutch Growth Research Foundation, Rotterdam, the Netherlands
| | - Erica L T van den Akker
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Theo Sas
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Diabeter, National Diabetes Care and Research Centre, Rotterdam, the Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Aart Jan van der Lely
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Laura C G de Graaff
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Davidse K, Staa AL, Pellikaan K, Geilvoet W, Eck J, Baan J, Hokken-Koelega A, van den Akker E, Sas T, Hannema S, Lely AJ, Graaff-Herder L. SUN-080 We Mind Your Step: Understanding and Preventing Drop-Out in the Transition from Paediatric to Adult Tertiary Endocrine Healthcare. J Endocr Soc 2020. [PMCID: PMC7368369 DOI: 10.1210/jendso/bvaa046.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Transition from paediatric to adult endocrinology is a challenge for adolescents, their families and their healthcare professionals. Previous studies show that up to 25% of young adults with endocrine disorders are lost to follow-up once they move out of paediatric care. This poses a health risk for young adults, as lack of medical treatment and surveillance can have both psycho-social and physical consequences. Apart from absenteeism from school or work, this can lead to serious and expensive medical complications like Addison crisis. Methods In 2019 we studied electronic medical records of 387 patients who were over 15 years old when they attended the paediatric endocrine outpatient clinic (OPC) of our medical centre in 2013-2014. We collected data from medical charts, the hospital digital agenda and medical correspondence. Results Of 387 adolescents, 161 (42%) did not need adult endocrine follow-up because paediatric endocrine care was only puberty- or growth-related. Forty-six patients did not enter regular transition because they 1) participated in a pilot to improve transition (N=10), 2) had intellectual disability (ID) and transferred to ID care (N=28), or 3) died (N=8, mostly cancer-related). Hundred-and-eighty patients entered regular transition: 49 (27%) to a regional hospital and 131 (73%) within our university hospital. Of these 131 patients, 33 (25%) were lost to follow up; in 24 of them (73%), the invitation for the adult OPC had never been sent. Loss to follow up occurred when three subsequent critical steps failed: 1) the adult endocrinologist had not received or read the paediatrician’s referral letter and/or had not invited the patient; 2) the paediatrician had not checked whether the appointment was really made and received by the patient and 3) the patients and/or caregivers had not alarmed the hospital when no invitation for an appointment was received. Conclusion We found a 25% dropout during transfer from paediatric to adult tertiary endocrine care. Starting the transition process early and in a structured manner, as well as assigning a transition coordinator, can prevent part of the dropouts. However, 73% of all dropouts appeared to be attributable to failure of practical, logistic steps. In order to prevent this part of the dropouts, we provide practical recommendations for all three parties involved: 1) the adult endocrinologist should carefully read paediatricians’ letters and check whether action is required (i.e. check whether an appointment is requested) 2) the paediatrician should ascertain whether the appointment is really made and received by the patient 3) the patients and/or caregivers should be instructed to alarm the hospital when they do not receive the appointment. These actions require relatively little effort and may prevent the part of drop-outs that is caused by logistic failures.
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Affiliation(s)
| | - Anne-Loes Staa
- Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | | | - Wanda Geilvoet
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - Judith Eck
- Erasmus University Medical Center, Rotterdam, Netherlands
| | - Janneke Baan
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | | | - Theo Sas
- Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Aart-Jan Lely
- Erasmus University Medical Center, Rotterdam, Netherlands
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Franssen GJH, van Ginhoven TM, Hofland J, Feelders RA, Geilvoet W, van Lanschot JB. [Small bowel neuroendocrine tumours: to be considered in the differential diagnosis of unexplained abdominal pain and diarrhoea]. Ned Tijdschr Geneeskd 2020; 164:D4235. [PMID: 32186828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Small bowel neuroendocrine tumours (NET) are relatively rare malignancies. Due to the lack of specificity, the symptoms are usually initially attributed to irritable bowel syndrome. Frequently there is a delay of years after the onset of symptoms, before the diagnosis is made. We describe two patient cases with a small bowel NET that illustrate the typical course of the symptoms, as well as the complications of carcinoid syndrome, carcinoid heart disease, mesenteric venous congestion and arterial ischemia. On coloscopy the primary tumour can often not be reached. CT scan is the best diagnostic modality and should be considered in a patient with abdominal pain, diarrhoea, weight loss and a negative coloscopy, especially in the presence of flushing. In a non-curative situation, first-line treatment consists of a somatostatin analogue, in order to prolong progression-free survival and reduce hormonal hypersecretion. Palliative surgery can also play an important role in the management of small bowel NET.
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Affiliation(s)
- Gaston J H Franssen
- Erasmus MC, Rotterdam. Afd. Chirurgie
- Contact: Gaston J.H. Franssen (G. Franssen )
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Dulfer R, Geilvoet W, Morks A, van Lieshout EM, Smit CP, Nieveen van Dijkum EJ, in't Hof K, van Dam F, van Eijck CH, de Graaf PW, van Ginhoven TM. Impact of parathyroidectomy for primary hyperparathyroidism on quality of life: A case-control study using Short Form Health Survey 36. Head Neck 2016; 38:1213-20. [DOI: 10.1002/hed.24499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Roderick Dulfer
- Department of Surgery; Erasmus MC; Rotterdam The Netherlands
| | - Wanda Geilvoet
- Department of Surgery; Erasmus MC; Rotterdam The Netherlands
| | - Annelien Morks
- Department of Surgery; Groene Hart Ziekenhuis; Gouda The Netherlands
| | | | - Casper P.C Smit
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
| | | | - Klaas in't Hof
- Department of Surgery; Flevoziekenhuis; Almere The Netherlands
| | | | | | - Peter W. de Graaf
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
| | - Tessa M. van Ginhoven
- Department of Surgery; Reinier de Graaf Groep (RDGG) Hospital; Delft The Netherlands (retired)
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Dulfer RR, van Ginhoven TM, Geilvoet W, de Herder WW, van Eijck CHJ. Operative Treatment of Primary Hyperparathyroidism in Daycare Surgery. Scand J Surg 2014; 104:196-9. [PMID: 25384910 DOI: 10.1177/1457496914557015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 09/12/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The standard of care for primary hyperparathyroidism is surgical removal of hyperfunctional parathyroid tissue. Here, we describe 20 patients with primary hyperparathyroidism who were treated surgically in the setting of daycare surgery. DESIGN Prospective observational study. METHODS A total of 20 patients with primary hyperparathyroidism were operated between March 2005 and May 2010. The follow-up period had a median of 41 weeks (5-245 weeks). Results are presented as mean (± standard deviation) or median (minimum-maximum). RESULTS A total of 20 patients (15 women, mean age 54 ± 14 years) were included. Nine patients were provided with post-operative calcium supplementation. One of the patients visited the emergency department the next day with paresthesia and normocalcemia; this patient was sent home. Four patients, without prophylaxis, also reported themselves to the emergency department. Only one had mild hypocalcemia (2.09 mmol/L) and was supplemented. Comparing the emergency department group (n = 5) with the others, we found that pre-operative calcium levels were similar (p = 0.40); however, the emergency department group had significantly lower post-operative calcium levels (2.27 ± 0.14 vs 2.55 ± 0.25, p = 0.008) and the decrease-percentage was significantly higher (17.5% ± 5.4% vs 10.5% ± 6.4%, p = 0.21). CONCLUSION Parathyroidectomy in the daycare setting is feasible and safe. However, many patients return to the emergency department. This could be related to the strict information that is provided or due to a large decrease in their calcium levels, albeit normocalcemia. Calcium supplementation is cheap and safe, so we will provide all future patients with calcium supplementation and herewith aim to reduce the amount of emergency department visits.
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Affiliation(s)
- R R Dulfer
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T M van Ginhoven
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W Geilvoet
- Department of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - W W de Herder
- Department of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C H J van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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van Eck JP, Gobbens RJ, Beukers J, Geilvoet W, van der Lely AJ, Neggers SJCMM. Much to be desired in self-management of patients with adrenal insufficiency. Int J Nurs Pract 2014; 22:61-9. [DOI: 10.1111/ijn.12368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Judith P van Eck
- Department of Medicine, Section of Endocrinology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Robbert J Gobbens
- School of Health Care Studies; Rotterdam University of Applied Sciences; Rotterdam The Netherlands
| | - Joke Beukers
- Department of Medicine; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Wanda Geilvoet
- Department of Medicine, Section of Endocrinology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Aart-Jan van der Lely
- Department of Medicine, Section of Endocrinology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Sebastian JCMM Neggers
- Department of Medicine, Section of Endocrinology; Erasmus University Medical Center; Rotterdam The Netherlands
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van Ginhoven TM, Geilvoet W, de Herder WW, van Eijck CHJ. [Outpatient surgical treatment of primary hyperparathyroidism]. Ned Tijdschr Geneeskd 2012; 156:A4408. [PMID: 22727228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The standard of care for primary hyperparathyroidism is minimally invasive surgical removal of hyperfunctional parathyroid tissue. Abroad, this minimally invasive approach is often performed in the ambulatory setting. Patients with primary hyperparathyroidism are eligible for outpatient surgery if the risk of conducting the operation is low and various imaging techniques have confirmed the location of the parathyroid adenoma. Of 20 patients with primary hyperparathyroidism who had been treated at our hospital's day surgery department, 5 visited the emergency department the next day because of a tingling sensation; however, minor hypocalcaemia was observed in only 1 of these patients. This relatively high number of emergency-department visits may have been the result of the strict instructions given to the patients or a rapid fall in their serum calcium levels, even without this having resulted in hypocalcaemia. Calcium supplementation is affordable and safe and could reduce the number of visits to the emergency ward after outpatient treatment of hyperparathyroidism.
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