Neuroendocrine Tumour Markers

The neuroendocrine cells of the gastroenteropancreatic (GEP) axis belong to the APUD-system, because they are capable of amine precursor uptake and decarboxylation, leading to the production of amines and small peptides. Currently, over 50 peptides have been identified, secreted by more than IS different types of neuroendocrine cells scattered throughout the gut. Tumours of these cells are generally characterized by an excessive production of one or several of these peptides. The presence of peptides in tumour tissue can usually be easily identified with immunohistochemical methods, or by demonstrating their mRNA with in situ hybridization techniques . The peptides are also frequently released into the circulation, where they can exert their endocrine effects on various targets, often inducing a typical clinical syndrome of hormonal overproduction. These tumours can be called clinically jilllctioning neuroendocrine tumours. The circulating peptides can usually be measured with radioimmunologic methods, allowing them to be used as tumour markers. One tumour generally releases several amilles or peptides in the circulation. Therefore the choice of possible tumour markers is much wider than in the case of non-endocrine tumours. The situation is much more difficult in so-called clinically nonjilllctioning neuroendocrine tumours, not inducing symptoms or signs relating to hormonal hypersecretion. Sometimes, these tumours remain hormonally active, producing peptides without clinical effect, which still can be used as tumour markers. When the tumour has lost all abilities to produce hormonally active substances one has to resort to the use of non-endocrine secretion markers, such as certain enzymes or other contents of secretory granules. In the choice of an adequate tumour marker, the following criteria should be taken into account: the marker must be useful (l) to screen populations for the presence of a tumour, (2) to differentiate between the different types of neuroendocrine tumours, (3) to distinguish between benign, intermediate or malignant tumour types, (4) to provide an estimate of the tumour load, (5) to follow the course of a particular tumour over time, in order to be able to evaluate the response to therapeutic interventions, and to rapidly detect an eventual relapse, and (6) to assess the prognosis. Unfortunately none of the current tumour markers can fulfill all these goals. Therefore, the search for better markers still goes on, and is at present one of the main activities of neuroendocrine research. In addition to the use of the circulating peptides themselves, the receptors for some peptides have recently been shown to be velY valuable markers. Their presence on tumour tissue can be demonstrated in vivo by radioisotopic techniques, using radionuclide labeled peptide, which specifically binds to a specific receptor

The role of diabetes convention centres in Belgium

peer reviewedWe briefly present the modes of functioning of Diabetes Convention Centres in Belgium. In those hospital centres, patients with both type 1 or type 2 diabetes, treated by at least two insulin injections per day, benefit of an intensive educational programme by a multidisciplinary team and receive free of charge material for home blood glucose monitoring, in order to optimize diabetes management. The collaboration between convention centres and general practitioners should be reinforced (share-care), especially to improve the management of type 2 diabetic patients, who are increasingly treated with various insulin regimens

Delivering diabetes education through nurseled telecoaching : cost-effectiveness analysis

Background : People with diabetes have a high risk of developing micro-and macrovascular complications associated with diminished life expectancy and elevated treatment costs. Patient education programs can improve diabetes control in the short term, but their cost-effectiveness is uncertain. Our study aimed to analyze the lifelong cost-effectiveness of a nurse-led tele-coaching program compared to usual care in people with type 2 diabetes from the perspective of the Belgian healthcare system. Methods : The UKPDS Outcomes Model was populated with patient-level data from an 18-month randomized clinical trial in the Belgian primary care sector involving 574 participants; trial data were extrapolated to 40 years; Quality Adjusted Life Years (QALYs), treatment costs and Incremental Cost-Effectiveness Ratio (ICER) were calculated for the entire cohort and the subgroup with poor glycemic control at baseline ("elevated HbA1c subgroup") and the associated uncertainty was explored. Results : The cumulative mean QALY (95% CI) gain was 0.21 (0.13; 0.28) overall and 0.56 (0.43; 0.68) in elevated HbA1c subgroup; the respective incremental costs were (sic)1,147 (188; 2,107) and (sic)2,565 (654; 4,474) and the respective ICERs (sic)5,569 ((sic)677; (sic)15,679) and (sic)4,615 (1,207; 9,969) per QALY. In the scenario analysis, repeating the intervention for lifetime had the greatest impact on the cost-effectiveness and resulted in the mean ICERs of (sic) 13,034 in the entire cohort and (sic)7,858 in the elevated HbA1c subgroup. Conclusion : Taking into account reimbursement thresholds applied in West-European countries, nurseled telecoaching of people with type 2 diabetes may be considered highly cost-effective within the Belgian healthcare system

Patient and provider acceptance of telecoaching in type 2 diabetes : a mixed-method study embedded in a randomised clinical trial

Background: Despite advances in diagnosis and treatment of type 2 diabetes, suboptimal metabolic control persists. Patient education in diabetes has been proved to enhance self-efficacy and guideline-driven treatment, however many people with type 2 diabetes do not have access to or do not participate in self-management support programmes. Tele-education and telecoaching have the potential to improve accessibility and efficiency of care, but there is a slow uptake in Europe. Patient and provider acceptance in a local context is an important precondition for implementation. The aim of the study was to explore the perceptions of patients, nurses and general practitioners (GPs) regarding telecoaching in type 2 diabetes. Methods: Mixed-method study embedded in a clinical trial, in which a nurse-led target-driven telecoaching programme consisting of 5 monthly telephone sessions of +/- 30 min was offered to 287 people with type 2 diabetes in Belgian primary care. Intervention attendance and satisfaction about the programme were analysed along with qualitative data obtained during post-trial semi-structured interviews with a purposive sample of patients, general practitioners (GPs) and nurses. The perceptions of patients and care providers about the intervention were coded and the themes interpreted as barriers or facilitators for adoption. Results: Of 252 patients available for a follow-up analysis, 97.5 % reported being satisfied. Interviews were held with 16 patients, 17 general practitioners (GPs) and all nurses involved (n = 6). Themes associated with adoption facilitation were: 1) improved diabetes control; 2) need for more tailored patient education programmes offered from the moment of diagnosis; 3) comfort and flexibility; 4) evidence-based nature of the programme; 5) established cooperation between GPs and diabetes educators; and 6) efficiency gains. Most potential barriers were derived from the provider views: 1) poor patient motivation and suboptimal compliance with "faceless" advice; 2) GPs' reluctance in the area of patient referral and information sharing; 3) lack of legal, organisational and financial framework for telecare. Conclusions: Nurse-led telecoaching of people with type 2 diabetes was well-accepted by patients and providers, with providers being in general more critical in their reflections. With increasing patient demand for mobile and remote services in healthcare,the findings of this study should support professionals involved in healthcare policy and innovation

(Extra)Ordinary letters: A view from below on seventeenth-century Dutch

In the National Archives in Kew, London, a treasure is kept which is of great importance for the history of the Dutch language: a collection of seventeenth-century letters written by men and women from various social backgrounds. Given the fact that much of the linguistic research of seventeenth-century Dutch has been perforce based on printed texts and linguistic data produced by a relatively small number of upper-class __ usually male __ writers, not much is known with certainty about the everyday Dutch of seventeenth-century lower- and middle-class people. The letters hidden in the National Archives can change this. In this dissertation, a corpus of 595 letters written between 1664 and 1672 is examined from a sociolinguistic perspective. The topics treated are: forms of address, reflexivity and reciprocity, negation, schwa-apocope, diminutives, and the genitive and alternative constructions. The case studies show that there was still a lot of variation in seventeenth-century Dutch and that some linguistic changes had not progressed as far in the everyday Dutch of __ordinary__ people as previous research has suggested. Furthermore, it is shown that gender and social class are important factors of influence on the seventeenth-century language use, especially when interpreted in terms of education and writing experience.“Letters as loot. Towards a non-standard view on the history of Dutch”, financed by the Dutch Organisation for Scientific Research (NWO).Descriptive and Comparative Linguistic