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1. Evaluation of a Palliative Care Program for Nursing Homes in 7 Countries The PACE Cluster-Randomized Clinical Trial

Author

Block, L. van den, Honinx, E., Pivodic, L., Miranda, R., Onwuteaka-Philipsen, B.D., Hout, H. van, Pasman, H.R.W., Oosterveld-Vlug, M., Koppel, M. ten, Piers, R., Noortgate, N. van den, Engels, Y., Vernooij-Dassen, M., Hockley, J., Froggatt, K., Payne, S., Szczerbinska, K., Kylanen, M., Gambassi, G., Pautex, S., Bassal, C., Buysser, S. de, Deliens, L., Smets, T., Adang, E., Andreasen, P., Baranska, I., Finne-Soveri, H., Hammar, T., Heikkila, R., Moore, C., Kijowska, V., Leppaaho, S., Mammarella, F., Mercuri, M., Kuitunen-Kaija, O., Pac, A., Paula, E.M. de, Rossi, P., Segat, I., Steen, J.T. van der, Stodolska, A., Tanghe, M., Wichmann, A.B., PACE Trial Grp, Clinical sciences, Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, End-of-life Care Research Group, Public and occupational health, APH - Aging & Later Life, APH - Quality of Care, and General practice

Subjects
Male, Advance care planning, medicine.medical_specialty, Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1], Palliative care, MEDLINE, Psychological intervention, 01 natural sciences, Article, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], law.invention, Advance Care Planning, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, 0302 clinical medicine, Randomized controlled trial, Nursing Assistants, law, Intervention (counseling), Internal Medicine, Humans, Pain Management, Medicine, 030212 general & internal medicine, Patient Comfort, 0101 mathematics, Aged, Implementation Science, Quality of Health Care, Aged, 80 and over, Terminal Care, Depression, business.industry, Palliative Care, 010102 general mathematics, Continuity of Patient Care, Nursing Homes, Clinical trial, Family medicine, Needs assessment, Dementia, Female, Nursing Staff, business, Delivery of Health Care, Needs Assessment
Abstract

Importance: High-quality evidence on how to improve palliative care in nursing homes is lacking. Objective: To investigate the effect of the Palliative Care for Older People (PACE) Steps to Success Program on resident and staff outcomes. Design, Setting, and Participants: A cluster-randomized clinical trial (2015-2017) in 78 nursing homes in 7 countries comparing PACE Steps to Success Program (intervention) with usual care (control). Randomization was stratified by country and median number of beds in each country in a 1:1 ratio. Interventions: The PACE Steps to Success Program is a multicomponent intervention to integrate basic nonspecialist palliative care in nursing homes. Using a train-the-trainer approach, an external trainer supports staff in nursing homes to introduce a palliative care approach over the course of 1 year following a 6-steps program. The steps are (1) advance care planning with residents and family, (2) assessment, care planning, and review of needs and problems, (3) coordination of care via monthly multidisciplinary review meetings, (4) delivery of high-quality care focusing on pain and depression, (5) care in the last days of life, and (6) care after death. Main Outcomes and Measures: The primary resident outcome was comfort in the last week of life measured after death by staff using the End-of-Life in Dementia Scale Comfort Assessment While Dying (EOLD-CAD; range, 14-42). The primary staff outcome was knowledge of palliative care reported by staff using the Palliative Care Survey (PCS; range, 0-1). Results: Concerning deceased residents, we collected 551 of 610 questionnaires from staff at baseline and 984 of 1178 postintervention in 37 intervention and 36 control homes. Mean (SD) age at time of death ranged between 85.22 (9.13) and 85.91 (8.57) years, and between 60.6% (160/264) and 70.6% (190/269) of residents were women across the different groups. Residents' comfort in the last week of life did not differ between intervention and control groups (baseline-adjusted mean difference, -0.55; 95% CI, -1.71 to 0.61; P =.35). Concerning staff, we collected 2680 of 3638 questionnaires at baseline and 2437 of 3510 postintervention in 37 intervention and 38 control homes. Mean (SD) age of staff ranged between 42.3 (12.1) and 44.1 (11.7) years, and between 87.2% (1092/1253) and 89% (1224/1375) of staff were women across the different groups. Staff in the intervention group had statistically significantly better knowledge of palliative care than staff in the control group, but the clinical difference was minimal (baseline-adjusted mean difference, 0.04; 95% CI, 0.02-0.05; P

Published
2020

2. Dying in long-term care facilities in Europe: the PACE epidemiological study of deceased residents in six countries

Author

Honinx, E., Dop, N. van, Smets, T., Deliens, L., Noortgate, N. van den, Froggatt, K., Gambassi, G., Kylanen, M., Onwuteaka-Philipsen, B., Szczerbinska, K., Block, L. van den, Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., Hout, H. van, Pasman, R.H.R.W., Oosterveld-Vlug, M., Piers, R., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Payne, S., Leppaaho, S., Baranska, I., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M. ten, Steen, J.T. van der, Paula, E.M. de, PACE, Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, End-of-life Care Research Group, Clinical sciences, Public and occupational health, APH - Aging & Later Life, APH - Quality of Care, and General practice

Subjects
Male, Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1], Palliative care, Social Sciences, Long-term care facility, 0302 clinical medicine, Surveys and Questionnaires, Health care, Medicine and Health Sciences, Medicine, Homes for the Aged, 030212 general & internal medicine, SCALE, Aged, 80 and over, education.field_of_study, lcsh:Public aspects of medicine, 3. Good health, Death, Europe, Policy, End-of-life care, Cohort, Female, BURDEN, Research Article, medicine.medical_specialty, Population, Nursing homes, 030209 endocrinology & metabolism, NURSING-HOMES, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, PEOPLE, Humans, QUALITY, education, Aged, business.industry, Public health, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, ADVANCED DEMENTIA, Long-Term Care, LIFE, Long-term care, Epidemiologic Studies, Biostatistics, business, Demography
Abstract

Background: By 2030, 30% of the European population will be aged 60 or over and those aged 80 and above will be the fastest growing cohort. An increasing number of people will die at an advanced age with multiple chronic diseases. In Europe at present, between 12 and 38% of the oldest people die in a long-term care facility. The lack of nationally representative empirical data, either demographic or clinical, about people who die in long-term care facilities makes appropriate policy responses more difficult. Additionally, there is a lack of comparable cross-country data; the opportunity to compare and contrast data internationally would allow for a better understanding of both common issues and country-specific challenges and could help generate hypotheses about different options regarding policy, health care organization and provision. The objectives of this study are to describe the demographic, facility stay and clinical characteristics of residents dying in long-term care facilities and the differences between countries.Methods: Epidemiological study (2015) in a proportionally stratified random sample of 322 facilities in Belgium, Finland, Italy, the Netherlands, Poland and England. The final sample included 1384 deceased residents. The sampled facilities received a letter introducing the project and asking for voluntary participation. Facility manager, nursing staff member and treating physician completed structured questionnaires for all deaths in the preceding 3 months.Results: Of 1384 residents the average age at death ranged from 81 (Poland) to 87 (Belgium, England) (p p Conclusions: The population dying in long-term care facilities is complex, displaying multiple diseases with cognitive and functional impairment and high levels of dementia. We recommend future policy should include integration of high-quality palliative and dementia care.

Published
2019

4. No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia:a pre-planned subgroup analysis of the seven-country PACE trial

Author

Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., PACE, on behalf of, Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., and PACE, on behalf of

Abstract

Background: ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and

Published
2021

5. No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia : a pre-planned subgroup analysis of the seven-country PACE trial

Author

Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., PACE, on behalf of, Miranda, R., Smets, T., Van Den Noortgate, N., van der Steen, J.T., Deliens, L., Payne, S., Szczerbińska, K., Pautex, S., Van Humbeeck, L., Gambassi, G., Kylänen, M., Van den Block, L., Gatsolaeva, Y., Pivodic, L., Honinx, E., Tanghe, M., van Hout, H., Froggatt, K., Onwuteaka-Philipsen, B., Pasman, H.R.W., Piers, R., Baranska, I., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Hammar, T., Heikkilä, R., Moore, D.C., Kijowska, V., ten Koppel, M., de Paula, E.M., and PACE, on behalf of

Abstract

Background: ‘PACE Steps to Success’ is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents’ comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying–End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (− 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (− 0.6; p = 0.741), non-advanced and

Published
2021

9. Agreement of Nursing Home Staff With Palliative Care Principles: A PACE Cross-sectional Study Among Nurses and Care Assistants in Five European Countries

Author

Honinx, E., Smets, T., Piers, R., Deliens, L., Payne, S., Kylanen, M., Baranska, I., Pasman, H.R.W., Gambassi, G., Block, L. van den, Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., Hout, H. van, Noortgate, N. van den, Froggatt, K., Onwuteaka-Philipsen, B., Szczerbinska, K., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppaaho, S., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M., Steen, J.T. van der, Paula, E.M. de, PACE, European Assoc Palliative Care VZW, European Forum Primary Care Age Pl, Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, End-of-life Care Research Group, Clinical sciences, General practice, Public and occupational health, APH - Aging & Later Life, and APH - Quality of Care

Subjects
Cross-Cultural Comparison, medicine.medical_specialty, Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1], Palliative care, Cross-sectional study, Attitude of Health Personnel, Nursing(all), Clinical Neurology, Context (language use), Opinions, 03 medical and health sciences, 0302 clinical medicine, Belgium, Medicine, Humans, 030212 general & internal medicine, care homes, General Nursing, Pace, Netherlands, Quality of Health Care, Terminal Care, business.industry, Palliative Care, Odds ratio, Nursing Homes, Anesthesiology and Pain Medicine, Cross-Sectional Studies, England, Italy, 030220 oncology & carcinogenesis, Family medicine, Attitudes, Health Care Surveys, Care assistants, Hospice and Palliative Care Nursing, Nursing Staff, Neurology (clinical), Spiritual care, Poland, business, Nursing homes
Abstract

Contains fulltext : 215538.pdf (Publisher’s version ) (Open Access) CONTEXT: To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. OBJECTIVES: To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. METHODS: This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). RESULTS: Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09-0.43, P = 0.003), nurses (0.59; 95% CI: 0.43-0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08-0.34, P = 0.002). CONCLUSIONS: The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed.

Published
2019

10. Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework

Author

Oosterveld-Vlug, M., Onwuteaka-Philipsen, B., Koppel, M. Ten, Hout, H. van, Smets, T., Pivodic, L., Tanghe, M., Noortgate, N. Van Den, Hockley, J., Payne, S., Moore, D.C., Kijowska, V., Szczerbinska, K., Kylanen, M., Leppaaho, S., Mercuri, C., Rossi, P., Mercuri, M., Gambassi, G., Bassal, C., Paula, E.M. de, Engels, Y., Deliens, L., Block, L. Van den, Pasman, H. R. W., Oosterveld-Vlug, M., Onwuteaka-Philipsen, B., Koppel, M. Ten, Hout, H. van, Smets, T., Pivodic, L., Tanghe, M., Noortgate, N. Van Den, Hockley, J., Payne, S., Moore, D.C., Kijowska, V., Szczerbinska, K., Kylanen, M., Leppaaho, S., Mercuri, C., Rossi, P., Mercuri, M., Gambassi, G., Bassal, C., Paula, E.M. de, Engels, Y., Deliens, L., Block, L. Van den, and Pasman, H. R. W.

Abstract

Contains fulltext : 215612.pdf (publisher's version ) (Open Access), BACKGROUND: The PACE 'Steps to Success' programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. METHODS: The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. RESULTS: The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. CONCLUSIONS: The imple

Published
2019

11. Agreement of Nursing Home Staff With Palliative Care Principles:A PACE Cross-sectional Study Among Nurses and Care Assistants in Five European Countries

Author

Honinx, E., Smets, T., Piers, R., Deliens, L., Payne, S., Kylänen, M., Barańska, I., Pasman, H.R.W., Gambassi, G., Van den Block, L., Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., van Hout, H., Van Den Noortgate, N., Froggatt, K., Onwuteaka-Philipsen, B., Szczerbińska, K., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M.T., van der Steen, J.T., Morgan de Paula, E., Honinx, E., Smets, T., Piers, R., Deliens, L., Payne, S., Kylänen, M., Barańska, I., Pasman, H.R.W., Gambassi, G., Van den Block, L., Gatsolaeva, Y., Miranda, R., Pivodic, L., Tanghe, M., van Hout, H., Van Den Noortgate, N., Froggatt, K., Onwuteaka-Philipsen, B., Szczerbińska, K., Oosterveld-Vlug, M., Wichmann, A.B., Engels, Y., Vernooij-Dassen, M., Hockley, J., Leppäaho, S., Pautex, S., Bassal, C., Mammarella, F., Mercuri, M., Rossi, P., Segat, I., Stodolska, A., Adang, E., Andreasen, P., Kuitunen-Kaija, O., Moore, D.C., Pac, A., Kijowska, V., Koppel, M.T., van der Steen, J.T., and Morgan de Paula, E.

Abstract

Context: To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. Objectives: To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. Methods: This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). Results: Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09–0.43, P = 0.003), nurses (0.59; 95% CI: 0.43–0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08–0.34, P = 0.002). Conclusions: The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed.

Published
2019

13. Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the 'PACE Steps to Success' intervention in seven countries

Author

Smets, T., Onwuteaka-Philipsen, B.B.D., Miranda, R., Pivodic, L., Tanghe, M., Hout, H. van, Pasman, R., Oosterveld-Vlug, M., Piers, R., Noortgate, N. Van Den, Wichmann, A.B., Engels, Y., Vernooij-Dassen, M.J.F.J., Hockley, J., Froggatt, K., Payne, S., Szczerbinska, K., Kylanen, M., Leppaaho, S., Baranska, I., Gambassi, G., Pautex, S., Bassal, C., Deliens, L., Block, L. Van den, Smets, T., Onwuteaka-Philipsen, B.B.D., Miranda, R., Pivodic, L., Tanghe, M., Hout, H. van, Pasman, R., Oosterveld-Vlug, M., Piers, R., Noortgate, N. Van Den, Wichmann, A.B., Engels, Y., Vernooij-Dassen, M.J.F.J., Hockley, J., Froggatt, K., Payne, S., Szczerbinska, K., Kylanen, M., Leppaaho, S., Baranska, I., Gambassi, G., Pautex, S., Bassal, C., Deliens, L., and Block, L. Van den

Abstract

Contains fulltext : 190893.pdf (publisher's version ) (Open Access), BACKGROUND: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries. METHODS: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). SECONDARY OUTCOMES: resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework. DISCUSSION: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national clu

Published
2018

14. Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the 'PACE Steps to Success' intervention in seven countries

Author

Smets, T, Onwuteaka-Philipsen, Bbd, Miranda, R, Pivodic, L, Tanghe, M, van Hout, H, Pasman, Rhrw, Oosterveld-Vlug, M, Piers, R, Van Den Noortgate, N, Wichmann, Ab, Engels, Y, Vernooij-Dassen, M, Hockley, J, Froggatt, K, Payne, S, Szczerbinska, K, Kylanen, M, Leppaaho, S, Baranska, I, Gambassi, G, Pautex, S, Bassal, C, Deliens, L, Van den Block, L, Gambassi, G (ORCID:0000-0002-7030-9359), Smets, T, Onwuteaka-Philipsen, Bbd, Miranda, R, Pivodic, L, Tanghe, M, van Hout, H, Pasman, Rhrw, Oosterveld-Vlug, M, Piers, R, Van Den Noortgate, N, Wichmann, Ab, Engels, Y, Vernooij-Dassen, M, Hockley, J, Froggatt, K, Payne, S, Szczerbinska, K, Kylanen, M, Leppaaho, S, Baranska, I, Gambassi, G, Pautex, S, Bassal, C, Deliens, L, Van den Block, L, and Gambassi, G (ORCID:0000-0002-7030-9359)

Abstract

Background: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries.Methods: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey). Secondary outcomes: resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs).Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework.Discussion: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluste

Published
2018

27. Posters * Early Pregnancy

Author

Christiansen, O., primary, Dahl, M., additional, Nielsen, H. S., additional, Kolte, A. M., additional, Larsen, E. C., additional, Hviid, T. V., additional, Pike, J., additional, Ellis, J., additional, Johnson, S., additional, Shaw, R., additional, Parkinson, P., additional, Perry, P., additional, Kuji, N., additional, Okumura, N., additional, Takano, M., additional, Ogawa, S., additional, Yamada, M., additional, Hamatani, T., additional, Yoshimura, Y., additional, Kawakami, M., additional, Hirayama, A., additional, Tomita, M., additional, Shaw, J. L. V., additional, Wills, G. S., additional, McClure, M. O., additional, Horner, P. J., additional, Colgan, A., additional, Jabbour, H. N., additional, Critchley, H. O. D., additional, Entrican, G., additional, Horne, A. W., additional, Dosen, M., additional, Vlaisavljevic, V., additional, Kovacic, B., additional, Horlbeck, S., additional, Kirschfink, M., additional, Ziegler, A., additional, Strowitzki, T., additional, Eggert-Kruse, W., additional, Lambers, M. J., additional, Groeneveld, E., additional, Hoozemans, D. A., additional, Schats, R., additional, Hompes, P. G. A., additional, Lambalk, C. B., additional, Wu, F., additional, Aghai, Z., additional, Steffensen, R., additional, van Halteren, A. G. S., additional, Spierings, E., additional, Christiansen, O. B., additional, Miklos, D., additional, Goulmy, E., additional, Seki, T., additional, Sugawara, N., additional, Maeda, M., additional, Manome, T., additional, Araki, Y., additional, Farquharson, R., additional, Dawood, F., additional, Leylek, O., additional, Uner, O., additional, Ozcil, M. D., additional, Baltaci, V., additional, Andersen, D., additional, Lossl, K., additional, Andersen, A. N., additional, Furbringer, J., additional, Bach, H., additional, Simonsen, J., additional, McCartney, J., additional, Dutton, P., additional, Brady, B. M., additional, Oriol, B., additional, Giles, J., additional, Bronet, F., additional, Ruiz, A., additional, Pellicer, A., additional, Garcia-Velasco, J. A., additional, Scarpellini, F., additional, Sbracia, M., additional, Rossi, G., additional, Lam, K. K. W., additional, Chiu, P. C. N., additional, Lee, C. L., additional, Yeung, W. S. B., additional, Ho, P. C., additional, van den Boogaard, E., additional, Cohn, D. M., additional, Korevaar, J. C., additional, Middeldorp, S., additional, Goddijn, M., additional, Farquharson, R. G., additional, Papanikolaou, E., additional, Werpoest, W., additional, Fatemi, H., additional, Polyzos, N., additional, Humaidan, P., additional, Tarlatzis, B., additional, Devroey, P., additional, Tournaye, F., additional, Li, W., additional, Laird, S., additional, Li, T. C., additional, Lathi, R. B., additional, Massie, J., additional, O'leary, K., additional, Druzin, M., additional, Chi, H. B., additional, Ma, C. H., additional, Qiao, J., additional, Du, X. G., additional, Yang, R., additional, Hamilton, C., additional, Brandes, M., additional, Verzijden, J. C. M., additional, de Weys, N. P. C., additional, de Bruin, J. P., additional, Bots, R. S. G. M., additional, Nelen, W. L. D. M., additional, Kremer, J. A. M., additional, Kuhn-Beck, F., additional, Moutel, G., additional, Weingertner, A. S., additional, Kohler, M., additional, Mager, C., additional, Kohler, A., additional, Hunsinger, M. C., additional, Neumann, M., additional, Bouffet, N., additional, Tanghe, M., additional, and Favre, R., additional

Published
2010
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28. Use ofZ-scores to select a fetal biometric reference curve

Author

Sananes, N., primary, Guigue, V., additional, Kohler, M., additional, Bouffet, N., additional, Cancellier, M., additional, Hornecker, F., additional, Hunsinger, M. C., additional, Kohler, A., additional, Mager, C., additional, Neumann, M., additional, Schmerber, E., additional, Tanghe, M., additional, Nisand, I., additional, and Favre, R., additional

Published
2009
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31. Nuchal translucency and cystic hygroma colli in screening for fetal major congenital heart defects in a series of 12,910 euploid pregnancies.

Author

Sananes N, Guigue V, Kohler M, Bouffet N, Cancellier M, Hornecker F, Hunsinger MC, Kohler A, Mager C, Neumann M, Schmerber E, Tanghe M, Nisand I, Favre R, Sananes, N, Guigue, V, Kohler, M, Bouffet, N, Cancellier, M, and Hornecker, F

Abstract

Objective: Many studies have shown that an increased nuchal translucency (NT) may be a good marker of fetal heart malformation, but the extent to which NT is suitable for identifying the population at risk remains unclear. We aimed to determine the value of NT measurement and of the presence of cystic hygroma colli in the screening of euploid fetuses for congenital heart defects (CHD). Methods: We carried out a retrospective analysis of 12 910 euploid pregnancies examined between January 1995 and August 2007 at our institution. The screening performance of NT measurements in identifying fetuses with CHD was assessed, with comparison between the use of cut-offs defined as absolute values, multiples of the median (MoM) and percentiles. The presence of cystic hygroma colli was also assessed in the prediction of CHD. Results: The incidence of major CHD was 3.4 per thousand (44/12 910). The sensitivity of NT measurement in screening for major CHD was 54.5% if the threshold was set at the 95(th) percentile, 45.4% if it was set at 3 mm, 27.3% for 3.5 mm, 50.0% for 1.5 MoM and 45.5% for 1.75 MoM. The false-positive rates for these thresholds were 8.4, 6.6, 1.7, 8.9 and 6.3%, respectively. The incidence of major CHD was 1.2% (10/813) in cases of thick NT (> 95(th) centile) and 4.3% (13/304) in cases of hygroma colli. Conclusions: NT measurement during the first trimester is potentially useful for screening for fetal major CHD. Screening performance is consistent whether NT values are expressed as MoMs, percentiles or absolute values. The incidence of major CHD seems to be higher in cases of cystic hygroma colli. [ABSTRACT FROM AUTHOR]

Published
2010
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33. Enquête bij reders en scheepsjongens in de Belgische zeevisserij: het ‘Fonds voor Scheepsjongens’; de visserij, nu en in de nabije toekomst

Author

Tanghe, M.

Abstract

In 1976 the Fund for Apprentice Fishermen, created in 1971 on a voluntary owners' contribution base, has been converted by legal provision into a new Fund, to which all ship owners must contribute for at least 50 % of all salary expenditure; administrative costs are for the account of the State. Apart from the financial aids granted, the Government is now directly engaged in the management of the Fund.The aim of this inquiry was to obtain some relevant information about the opinions of both ship owners and apprentice fishermen concerning aforesaid Fund. Subsequently it was also the intention to know their opinion about the fisherman's training, his job, his career, his prospects, in view of the considerable changes in the structure of the fishing fleet, and of the technological, vocational and socio-economic changes within the industry. Data were collectedin 1977 by questionnaire and interview. Furthermore use has been made of some existing information. Another major objective was to know the reasons which underlie the differences in earnings among apprentices (Fund salary, percent of gross returns, "poundage", etc.).This paper discusses the latent uneasiness in the fisherman's mind, that sometimes is roused to vigorous opinions, views and attitudes. The interviews were based on two questionnaires, one for the ship owners and an other one for the trainees. However, it was eventually the intention to hold a rather non-structured conversation on a broad and deep level. This, of course, provided more spontaneity in the utterances and replies.It may be concluded that the study provides adequate data for drawing up some guidelines for further improvements in the crew problem policy. An outstanding feature is undoubtedly the fact that the trainees are still recruited from the traditional fishing community, despite the many attempts of attracting youngsters from outside of that community. It is believed, both by the owners and by the trainees, that the Fund has a positive effect on the crew problem. However, it is felt that additional measures are needed to reach a decisive solution of this complex problem.

Published
1977

34. Ecological amplitude in Silene nutans in relation to allozyme variation at the western margin of its distribution

Author

Meerts, P., Van Rossum, F., Tanghe, M., and Gratia, E.

Subjects
ECOLOGY, BIOLOGICAL variation, SPECIES distribution
Abstract

At the western border of its geographical range, Silene nutans (Caryophyllaceae) has evolved two groups of parapatric populations showingdistinct allozyme patterns and apparently occurring on different bedrock types. This study tests the hypothesis that these groups represent edaphic ecotypes. With this in view, the ecological amplitude of 36 populations of Silene nutans from Belgium was investigated and their synecology specified using vegetation composition and soil parameters; Ellenberg indicator values were used for ecological interpretation of the vegetation analyses. The results provide evidence that allozyme and habitat variations are correlated, the two groups occurring on contrasting soil with distinct vegetation types. One group is restricted to alkaline soils and typically occurs in open calcareous grasslands, fringes and scrub. The other group is characterized by wider autecological and synecological ranges with a bimodal pH-distribution,occurring on two kinds of siliceous soils: (1) neutral soils, supporting vegetation with a high species richness comprising many mesophilous species, and (2) CaCO3-free bedrocks characterized by acidophilous, species-poor, open dry grasslands and woodlands. It also appears that factors not related to soil chemistry, such as microclimate, are involved in the ecological specialization of the two ecotypes. It is argued that these ecotypes. exemplify adaptive radiation and parapatric speciation at the margin of a species distribution area. [ABSTRACT FROM AUTHOR]

Published
1999

35. Comparing Symptom Ratings by Staff and Family Carers in Residents Dying in Long-Term Care Facilities in Three European Countries, Results From a PACE Survey.

Author

Tanghe M, Van Den Noortgate N, Deliens L, Smets T, Onwuteaka-Philipsen B, Finne-Soveri H, Van den Block L, and Piers R

Subjects
Belgium, Europe, Humans, Long-Term Care, Netherlands, Nursing Homes, Caregivers, Terminal Care
Abstract

Context: Symptom management is essential in the end-of-life care of long-term care facility residents., Objectives: To study discrepancies and possible associated factors in staff and family carers' symptom assessment scores for residents in the last week of life., Methods: A postmortem survey in Belgium, The Netherlands, and Finland: staff and family carers completed the End-of-Life in Dementia-Comfort Assessment in Dying scale, rating 14 symptoms on a one-point to three-point scale. Higher scores reflect better comfort. We calculated mean paired differences in symptom, subscale, and total scores at a group level and inter-rater agreement and percentage of perfect agreement at a resident level., Results: Mean staff scores significantly reflected better comfort than those of family carers for the total End-of-Life in Dementia-Comfort Assessment in Dying (31.61 vs. 29.81; P < 0.001) and the physical distress (8.64 vs. 7.62; P < 0.001) and dying symptoms (8.95 vs. 8.25; P < 0.001) subscales. No significant differences were found for emotional distress and well-being. The largest discrepancies were found for gurgling, discomfort, restlessness, and choking for which staff answered not at all, whereas the family carer answered a lot, in respectively, 9.5%, 7.3%, 6.7%, and 6.1% of cases. Inter-rater agreement κ ranged from 0.106 to 0.204, the extent of perfect agreement from 40.8 for lack of serenity to 68.7% for crying., Conclusion: There is a need for improved communication between staff and family and discussion about symptom burden in the dying phase in long-term care facilities., (Copyright © 2020. Published by Elsevier Inc.)

Published
2020
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36. Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework.

Author

Oosterveld-Vlug M, Onwuteaka-Philipsen B, Ten Koppel M, van Hout H, Smets T, Pivodic L, Tanghe M, Van Den Noortgate N, Hockley J, Payne S, Moore DC, Kijowska V, Szczerbińska K, Kylänen M, Leppäaho S, Mercuri C, Rossi P, Mercuri M, Gambassi G, Bassal C, de Paula EM, Engels Y, Deliens L, Van den Block L, and Pasman HR

Subjects
Cluster Analysis, Europe, Humans, Long-Term Care, Health Plan Implementation methods, Nursing Homes standards, Palliative Care methods, Process Assessment, Health Care methods, Program Evaluation methods, Quality Improvement
Abstract

Background: The PACE 'Steps to Success' programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries., Methods: The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis., Results: The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified., Conclusions: The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination., Trial Registration: The PACE study was registered at www.isrctn.com-ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.

Published
2019
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37. Opioid, antipsychotic and hypnotic use in end of life in long-term care facilities in six European countries: results of PACE.

Author

Tanghe M, Van Den Noortgate N, Pivodic L, Deliens L, Onwuteaka-Philipsen B, Szczerbinska K, Finne-Soveri H, Collingridge-Moore D, Gambassi G, Van den Block L, and Piers R

Subjects
Aged, Aged, 80 and over, Belgium, Cross-Sectional Studies, England, Female, Finland, Humans, Italy, Male, Netherlands, Poland, Retrospective Studies, Analgesics, Opioid administration & dosage, Antipsychotic Agents administration & dosage, Hypnotics and Sedatives administration & dosage, Long-Term Care statistics & numerical data, Palliative Care statistics & numerical data, Terminal Care statistics & numerical data
Abstract

Background: Opioids, antipsychotics and hypnotics are recommended for comfort care in dying. We studied their prescription during the last 3 days in residents deceased in the long-term care facility (LTCF)., Methods: In a retrospective, cross-sectional survey in Belgium, England, Finland, Italy, the Netherlands and Poland, LTCFs, selected by proportional stratified random sampling, reported all deaths over the previous 3 months. The nurse most involved in the residents' care reviewed the chart for opioid, antipsychotic and hypnotic prescription, cause of death and comorbidities. Multivariable logistic regression was performed to adjust for resident characteristics., Results: Response rate was 81.6%. We included 1079 deceased residents in 322 LCTFs. Opioid prescription ranged from 18.5% (95% CI: 13.0-25.8) of residents in Poland to 77.9% (95% CI: 69.5-84.5) in the Netherlands, antipsychotic prescription from 4.8% (95% CI: 2.4-9.1) in Finland to 22.4% (95% CI: 14.7-32.4) in Italy, hypnotic prescription from 7.8% (95% CI: 4.6-12.8) in Finland to 47.9% (95% CI: 38.5-57.3) in the Netherlands. Differences in opioid, antipsychotic and hypnotic prescription between countries remained significant (P < 0.001) when controlling for age, gender, length of stay, cognitive status, cause of death in multilevel, multivariable analyses. Dying from cancer showed higher odds for receiving opioids (OR 3.51; P < 0.001) and hypnotics (OR 2.10; P = 0.010)., Conclusions: Opioid, antipsychotic and hypnotic prescription in the dying phase differed significantly between six European countries. Further research should determine the appropriateness of their prescription and refine guidelines especially for LTCF residents dying of non-cancer diseases.

Published
2019
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38. Integrating palliative care in long-term care facilities across Europe (PACE): protocol of a cluster randomized controlled trial of the 'PACE Steps to Success' intervention in seven countries.

Author

Smets T, Onwuteaka-Philipsen BBD, Miranda R, Pivodic L, Tanghe M, van Hout H, Pasman RHRW, Oosterveld-Vlug M, Piers R, Van Den Noortgate N, Wichmann AB, Engels Y, Vernooij-Dassen M, Hockley J, Froggatt K, Payne S, Szczerbińska K, Kylänen M, Leppäaho S, Barańska I, Gambassi G, Pautex S, Bassal C, Deliens L, and Van den Block L

Subjects
Belgium, Delivery of Health Care standards, England, Finland, Humans, Italy, Netherlands, Poland, Quality Improvement standards, Surveys and Questionnaires, Switzerland, Palliative Care methods, Skilled Nursing Facilities standards, Skilled Nursing Facilities trends
Abstract

Background: Several studies have highlighted the need for improvement in palliative care delivered to older people long-term care facilities. However, the available evidence on how to improve palliative care in these settings is weak, especially in Europe. We describe the protocol of the PACE trial aimed to 1) evaluate the effectiveness and cost-effectiveness of the 'PACE Steps to Success' palliative care intervention for older people in long-term care facilities, and 2) assess the implementation process and identify facilitators and barriers for implementation in different countries., Methods: We will conduct a multi-facility cluster randomised controlled trial in Belgium, Finland, Italy, the Netherlands, Poland, Switzerland and England. In total, 72 facilities will be randomized to receive the 'Pace Steps to Success intervention' or to 'care as usual'. Primary outcome at resident level: quality of dying (CAD-EOLD); and at staff level: staff knowledge of palliative care (Palliative Care Survey)., Secondary Outcomes: resident's quality of end-of-life care, staff self-efficacy, self-perceived educational needs, and opinions on palliative care. Economic outcomes: direct costs and quality-adjusted life years (QALYs). Measurements are performed at baseline and after the intervention. For the resident-level outcomes, facilities report all deaths of residents in and outside the facilities over a previous four-month period and structured questionnaires are sent to (1) the administrator, (2) staff member most involved in care (3) treating general practitioner, and (4) a relative. For the staff-level outcomes, all staff who are working in the facilities are asked to complete a structured questionnaire. A process evaluation will run alongside the effectiveness evaluation in the intervention group using the RE-AIM framework., Discussion: The lack of high quality trials in palliative care has been recognized throughout the field of palliative care research. This cross-national cluster RCT designed to evaluate the impact of the palliative care intervention for long-term care facilities 'PACE Steps to Success' in seven countries, will provide important evidence concerning the effectiveness as well as the preconditions for optimal implementation of palliative care in nursing homes, and this within different health care systems., Trial Registration: The study is registered at www.isrctn.com - ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) Registration date: July 30, 2015.

Published
2018
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39. A quantitative indicator diagram for lytic polysaccharide monooxygenases reveals the role of aromatic surface residues in HjLPMO9A regioselectivity.

Author

Danneels B, Tanghe M, Joosten HJ, Gundinger T, Spadiut O, Stals I, and Desmet T

Subjects
Chromatography, Ion Exchange, Genetic Vectors, Mixed Function Oxygenases chemistry, Mixed Function Oxygenases genetics, Mixed Function Oxygenases isolation & purification, Mutagenesis, Site-Directed, Pichia genetics, Mixed Function Oxygenases metabolism, Polysaccharides metabolism
Abstract

Lytic polysaccharide monooxygenases (LPMOs) have changed our understanding of lignocellulosic degradation dramatically over the last years. These metalloproteins catalyze oxidative cleavage of recalcitrant polysaccharides and can act on the C1 and/or C4 position of glycosidic bonds. Structural data have led to several hypotheses, but we are still a long way from reaching complete understanding of the factors that determine their divergent regioselectivity. Site-directed mutagenesis enables the investigation of structure-function relationship in enzymes and will be of major importance in unraveling this intriguing matter. In this context, it is crucial to have an enzyme assay or screening approach with a direct correlation with the desired functionality. LPMOs render this search extra challenging due to their insoluble substrates, complex pattern of reaction products and lack of synthetic standards of most oxidized products. Here, we describe a regioselectivity indicator diagram based on the time-course of only 2 HPAEC-PAD signals. The diagram was successfully used to confirm the hypothesis that aromatic surface residues influence the C1/C4 oxidation ratio in Hypocrea jecorina LPMO9A. Consequently, the diagram should become a valuable tool in the search towards better understanding and engineering of regioselectivity in LPMOs.

Published
2017
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40. Disulfide bridges as essential elements for the thermostability of lytic polysaccharide monooxygenase LPMO10C from Streptomyces coelicolor.

Author

Tanghe M, Danneels B, Last M, Beerens K, Stals I, and Desmet T

Subjects
Enzyme Stability, Hot Temperature, Bacterial Proteins chemistry, Disulfides chemistry, Mixed Function Oxygenases chemistry, Models, Molecular, Software, Streptomyces coelicolor enzymology
Abstract

Lytic polysaccharide monooxygenases (LPMOs) are crucial components of cellulase mixtures but their stability has not yet been studied in detail, let alone been engineered for industrial applications. In this work, we have evaluated the importance of disulfide bridges for the thermodynamic stability of Streptomyces coelicolor LPMO10C. Interestingly, this enzyme was found to retain 34% of its activity after 2-h incubation at 80°C while its apparent melting temperature (Tm) is only 51°C. When its three disulfide bridges were broken, however, irreversible unfolding occurred and no residual activity could be detected after a similar heat treatment. Based on these findings, additional disulfide bridges were introduced, as predicted by computational tools (MOdelling of DIsulfide bridges in Proteins (MODiP) and Disulfide by Design (DbD)) and using the most flexible positions in the structure as target sites. Four out of 16 variants displayed an improvement in Tm, ranging from 2 to 9°C. Combining the positive mutations yielded additional improvements (up to 19°C) but aberrant unfolding patterns became apparent in some cases, resulting in a diminished capacity for heat resistance. Nonetheless, the best variant, a combination of A143C-P183C and S73C-A115C, displayed a 12°C increase in Tm and was able to retain and was able to retain no less than 60% of its activity after heat treatment., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Published
2017
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