Future care:Advance care planning with older people and their families in general practice

In acute situations older people, family, doctors and nurses can struggle with making decisions regarding care. Consequently, older people may not receive the care they want or undergo unwanted diagnostics and treatments. With this thesis I aimed to contribute to improving such care for older people by gaining insight into the current state of advance care planning (ACP) with older people in the everyday general practice and in how this practice could be improved. Therefore we performed a literature review, qualitative interview studies and a focus group study with, amongst others, older people, family, GPs, primary care nurses, policy makers, and ethicists. The studies in this thesis showed that all older people should have the opportunity to prepare for future decision making, regardless of the level of mental capacity or incapacity in the future. Moreover, doctors should try to have ACP with all frail older people and their families. By ‘preparing’ we mean that older people, family and GPs understand which care may or may not be in the interest of the older person in the future and which care may or may not be possible. The studies in this thesis led to the formulation of ethical conditions, practical recommendations and an information letter and a poster for older people and family, which you can find as an appendix in this thesis. Finally, we suggest a term that better fits with this decision-making process being an open conversation all older people are entitled to: future care conversations

PET imaging in MSK infections

Musculoskeletal infections are highly feared, form a major burden on healthcare, and may lead to severe morbidity and mortality. The diagnosis may be difficult with non-specific symptoms requiring multiple diagnostic investigations. FDG-PET/CT is one of them showing good diagnostic accuracy in most musculoskeletal infections. However, one has to be aware of the non-specific FDG uptake in patients with metallic implants and in the postsurgical phase. In this chapter, the advantages and disadvantages of the use of FDG-PET/CT in musculoskeletal infections in described for several indications: infections in the peripheral bone, spine infections/spondylodiscitis, prosthetic joint infections, diabetic foot infections, and sternal bone/wound infections. Recent published guidelines and diagnostic flowcharts by delegates of the European Association of Nuclear Medicine in collaboration with delegates from other (clinical) societies, will be discussed. At the end of this chapter, recent developments in tracer and camera systems will be presented.</p

PET/CT Imaging for Personalized Management of Infectious Diseases

Positron emission tomography combined with computed tomography (PET/CT) is a nuclear imaging technique which is increasingly being used in infectious diseases. Because infection foci often consume more glucose than surrounding tissue, most infections can be diagnosed with PET/CT using 2-deoxy-2-[18F]fluoro-D-glucose (FDG), an analogue of glucose labeled with Fluorine-18. In this review, we discuss common infectious diseases in which FDG-PET/CT is currently applied including bloodstream infection of unknown origin, infective endocarditis, vascular graft infection, spondylodiscitis, and cyst infections. Next, we highlight the latest developments within the field of PET/CT, including total body PET/CT, use of novel PET radiotracers, and potential future applications of PET/CT that will likely lead to increased capabilities for patient-tailored treatment of infectious diseases