Daugaard Dolan (piemoney51)

With the goal of designing NET clinical trials within the era of PRRT, the NET Task Force of the National Cancer Institute's GI Steering Committee held a clinical trial planning meeting (CTPM) in 2021, gathering experts across multiple disciplines including academia, the federal government, industry, and patient advocacy. For the advancement of clinical trials, the following recommendations are key: 1) re-treating patients with PRRT; 2) implementing concurrent PRRT and immunotherapy; 3) implementing concurrent PRRT and DNA damage repair inhibitor regimens; 4) addressing liver-dominant disease with novel therapies; 5) developing therapies against PRRT-resistant disease; and 6) modifying PRRT dosimetry protocols. Heart transplant patients with tricuspid regurgitation often face unfavorable prognoses. Transcatheter therapies may potentially lessen the heightened risk of surgical and postoperative complications in these susceptible patients. The institutional registry meticulously collected data on all patients with prior heart transplantation (HTX) who underwent transcatheter edge-to-edge tricuspid repair (T-TEER) in a prospective manner. Six of seven patients (five females) with heart transplants, averaging 53 years of age (range 48-64), and a median TRI-SCORE of 14 (range 7-22), received T-TEER for the treatment of symptomatic TR IV, either electively or urgently (one patient). The period between HTX and T-TEER, on average, spanned 13 years. Using a technique that proved successful in 6 of 7 (n=7) cases, two (n=4) and three (n=3) clips were implanted. A single device detachment was observed. A median 10-month echocardiographic follow-up revealed the significant and long-lasting effect of TR reduction (TR baseline versus last follow-up, P=0.003). The study further showed significant right ventricular remodeling including a reduction in right ventricular end-diastolic diameter (50mm to 36mm, P=0.002), a decrease in inferior vena cava diameter (24mm to 18mm, P=0.004), and a decrease in gamma-glutamyl-transferase activity (255 U/l to 159 U/l, P=0.004). Seven patients were monitored; four were without cardiovascular death (n=1, 267 days after T-TEER), cardiac re-operative surgery (n=1) and heart failure hospitalization (n=2), and showed no further right heart failure symptoms. Post-HTX, T-TEER's performance in reducing TR levels is considered feasible and effective, as demonstrated in the short-term follow-up. Initial outcomes might lead to a novel strategy for tackling TR in patients undergoing HTX. Within a short-term period after HTX, T-TEER treatment shows efficacy and practicality for reducing TR. Initial outcomes might establish a new path toward managing TR in HTX recipients. Older adults with multi-faceted medical needs often require rehabilitation within skilled nursing facilities to combat deconditioning stemming from their hospital stays. Skilled nursing facilities often adopt rehabilitation protocols grounded in low-intensity interventions, failing to provide sufficient challenge to skeletal muscle and thereby hindering functional improvement. A single-site pilot study of a high-intensity resistance training program (IntenSive Therapeutic Rehabilitation for Older NursinG homE Residents; i-STRONGER) led to improved physical function in skilled nursing home patients, in contrast to other methods. A comparative study using a cluster-randomized trial with a hybrid effectiveness-implementation type 1 design will assess the impact of i-STRONGER principles on patient outcomes in 16 skilled nursing facilities implementing the principles, as opposed to 16 facilities using standard care. An implementation package, encompassing a clinician training program, will equip clinicians at i-STRONGER sites to provide i-STRONGER as the standard of care. The practice of usual care will be sustained by clinicians at their respective usual care facilities. Patient physical performance, encompass