Deinococcus glutaminyl-tRNA synthetase is a chimer between proteins from an ancient and the modern pathways of aminoacyl-tRNA formation

Glutaminyl-tRNA synthetase from Deinococcus radiodurans possesses a C-terminal extension of 215 residues appending the anticodon-binding domain. This domain constitutes a paralog of the Yqey protein present in various organisms and part of it is present in the C-terminal end of the GatB subunit of GatCAB, a partner of the indirect pathway of Gln-tRNA(Gln) formation. To analyze the peculiarities of the structure–function relationship of this GlnRS related to the Yqey domain, a structure of the protein was solved from crystals diffracting at 2.3 Å and a docking model of the synthetase complexed to tRNA(Gln) constructed. The comparison of the modeled complex with the structure of the E. coli complex reveals that all residues of E. coli GlnRS contacting tRNA(Gln) are conserved in D. radiodurans GlnRS, leaving the functional role of the Yqey domain puzzling. Kinetic investigations and tRNA-binding experiments of full length and Yqey-truncated GlnRSs reveal that the Yqey domain is involved in tRNA(Gln) recognition. They demonstrate that Yqey plays the role of an affinity-enhancer of GlnRS for tRNA(Gln) acting only in cis. However, the presence of Yqey in free state in organisms lacking GlnRS, suggests that this domain may exert additional cellular functions

Palliatieve inpatients in general hospitals : a one day observational study in Belgium

Background: Hospital care plays a major role at the end-of-life. But little is known about the overall size and characteristics of the palliative inpatient population. The aim of our study was to analyse these aspects. Methods: We conducted a one-day observational study in 14 randomly selected Belgian hospitals. Patients who met the definition of palliative patients were identified as palliative. Then, information about their sociodemographic characteristics, diagnoses, prognosis, and care plan were recorded and analysed. Results: There were 2639 in-patients on the day of the study; 9.4% of them were identified as “palliative”. The mean age of the group was 72 years. The primary diagnosis was cancer in 51% of patients and the estimated life expectancy was shorter than 3 months in 33% of patients and longer than 1 year in 28% of patients. The professional caregivers expected for most of the patients (73%), that the treatment would improve patient comfort rather than prolong life. Antibiotics, transfusions, treatments specific to the pathology, and artificial nutrition were administered in 90%, 78%, 57% and 50% of the patients, respectively, but were generally given with a view to controlling the symptoms. Conclusions: This analysis presents a first national estimate of the palliative inpatient population. Our results confirm that hospitals play a major role at the end-of-life, with one out of ten inpatients identified as a “palliative” patient. These data also demonstrate the complexity of the palliative population and the substantial diversity of care that they can require

Can we import quality tools? a feasibility study of European practice assessment in a country with less organised general practice

<p>Abstract</p> <p>Background</p> <p>Quality is on the agenda of European general practice (GP). European researchers have, in collaboration, developed tools to assess quality of GPs. In this feasibility study, we tested the European Practice Assessment (EPA) in a one-off project in Belgium, where general practice has a low level of GP organisation.</p> <p>Methods</p> <p>A framework for feasibility analysis included describing the recruiting of participants, a brief telephone study survey among non-responders, organisational and logistic problems. Using field notes and focus groups, we studied the participants' opinions.</p> <p>Results</p> <p>In this study, only 36 of 1000 invited practices agreed to participate. Co-ordination, administrative work, practice visits and organisational problems required several days per practice. The researchers further encountered technical problems, for instance when entering the data and uploading to the web-based server. In subsequent qualitative analysis using two focus groups, most participant GPs expressed a positive feeling after the EPA procedure. In the short period of follow-up, only a few GPs reported improvements after the visit. The participant GPs suggested that follow-up and coaching would probably facilitate the implementation of changes.</p> <p>Conclusion</p> <p>This feasibility study shows that prior interest in EPA is low in the GP community. We encountered a number of logistic and organisational problems. It proved attractive to participants, but it can be augmented by coaching of participants in more than a one-off project to identify and achieve targets for quality improvement. In the absence of commitment of the government, a network of universities and one scientific organisation will offer EPA as a service to training practices.</p

Evidence based post graduate training. A systematic review of reviews based on the WFME quality framework

<p>Abstract</p> <p>Background</p> <p>A framework for high quality in post graduate training has been defined by the World Federation of Medical Education (WFME). The objective of this paper is to perform a systematic review of reviews to find current evidence regarding aspects of quality of post graduate training and to organise the results following the 9 areas of the WFME framework.</p> <p>Methods</p> <p>The systematic literature review was conducted in 2009 in Medline Ovid, EMBASE, ERIC and RDRB databases from 1995 onward. The reviews were selected by two independent researchers and a quality appraisal was based on the SIGN tool.</p> <p>Results</p> <p>31 reviews met inclusion criteria. The majority of the reviews provided information about the training process (WFME area 2), the assessment of trainees (WFME area 3) and the trainees (WFME area 4). One review covered the area 8 'governance and administration'. No review was found in relation to the mission and outcomes, the evaluation of the training process and the continuous renewal (respectively areas 1, 7 and 9 of the WFME framework).</p> <p>Conclusions</p> <p>The majority of the reviews provided information about the training process, the assessment of trainees and the trainees. Indicators used for quality assessment purposes of post graduate training should be based on this evidence but further research is needed for some areas in particular to assess the quality of the training process.</p

Sex differences in circulating proteins in heart failure with preserved ejection fraction

Background Many patients with heart failure with preserved ejection fraction (HFpEF) are women. Exploring mechanisms underlying the sex differences may improve our understanding of the pathophysiology of HFpEF. Studies focusing on sex differences in circulating proteins in HFpEF patients are scarce. Methods A total of 415 proteins were analyzed in 392 HFpEF patients included in The Metabolic Road to Diastolic Heart Failure: Diastolic Heart Failure study (MEDIA-DHF). Sex differences in these proteins were assessed using adjusted logistic regression analyses. The associations between candidate proteins and cardiovascular (CV) death or CV hospitalization (with sex interaction) were assessed using Cox regression models. Results We found 9 proteins to be differentially expressed between female and male patients. Women expressed more LPL and PLIN1, which are markers of lipid metabolism; more LHB, IGFBP3, and IL1RL2 as markers of transcriptional regulation; and more Ep-CAM as marker of hemostasis. Women expressed less MMP-3, which is a marker associated with extracellular matrix organization; less NRP1, which is associated with developmental processes; and less ACE2, which is related to metabolism. Sex was not associated with the study outcomes (adj. HR 1.48, 95% CI 0.83–2.63), p = 0.18. Conclusion In chronic HFpEF, assessing sex differences in a wide range of circulating proteins led to the identification of 9 proteins that were differentially expressed between female and male patients. These findings may help further investigations into potential pathophysiological processes contributing to HFpEF

Kinésithérapie : quelques ingrédients pour une bonne prescription

118-120Cet article résume la littérature scientifique relative aux traitements de kinésithérapie pour cinq affections fréquentes : l’accident vasculaire cérébral (AVC), la bronchiolite du nourrisson, la rééducation à la marche chez la personne âgée, la prothèse de genou et l’entorse de la cheville

Development of a position paper for chronic care in Belgium : Appendix

219 p.Ill

Organisation of care for chronic patients in Belgium : development of a position paper

VI, 166 p.Ill.SCIENTIFIC REPORT 11 -- 1. THE CHALLENGE OF CHRONIC CARE 11 -- 1.1. CHRONIC CARE: A GROWING BURDEN FOR THE HEALTH CARE SYSTEMS. 11 -- 1.2. OBJECTIVE: DEVELOPMENT OF A POSITION PAPER FOR CHRONIC CARE IN BELGIUM 11 -- 1.3. SCOPE: FROM “CHRONIC DISEASE” TO “CHRONIC CARE BASED ON THE PATIENT’S NEEDS” 13 -- 1.3.1. Chronic disease: official definitions based on a listing of diseases 13 -- 1.3.2. The patient with “chronic disease”: frequently in the plural 13 -- 1.3.3. Chronic care as an answer to the patient’s needs 13 -- 1.3.4. on care (versus primary prevention and “health in all policies”) 15 -- 1.4. EPIDEMIOLOGY AND COSTS OF CHRONIC DISEASES 15 -- 1.4.1. Epidemiology 15 -- 1.4.2. Costs 16 -- 2. HIGHLIGHTS FROM THE INTERNATIONAL PERSPECTIVE 18 -- 2.1. VIEWPOINTS OF THE EUROPEAN UNION, THE UNITED NATIONS AND THE WORLD HEALTH ORGANIZATION 18 -- 2.1.1. Data sources 18 -- 2.1.2. International frameworks: calls for integrated care 18 -- 2.1.3. Shift towards integrated care: advocacy for organizational changes 21 -- 2.1.4. Role of primary care: hub of coordination 22 -- 2.1.5. Summary and conclusions 24 -- 2.2. CHRONIC CARE MODEL 26 -- 2.2.1. Elements of the chronic care model 26 -- 2.2.2. Evidence underlying the chronic care model 27 -- 2.3. HIGHLIGHTS FROM 4 COUNTRIES 28 -- 2.3.1. Methods 28 -- 2.3.2. Stakeholder collaboration: shared vision and leadership 29 -- 2.3.3. Information technologies and performance measurement. 31 -- 2.3.4. Engaging consumers 31 -- 2.3.5. Improving Health Care delivery: translation of the national/regional strategy at local level 32 -- 2.3.6. Aligning finance /insurance: incentives 32 -- 2.3.7. Outcomes 33 -- 2.3.8. Barriers in redesigning chronic care management 33 -- 2.3.9. Key points: lessons learned 33 -- 3. REASONING FRAMEWORK FOR A HEALTH SYSTEM ORIENTED TOWARDS CHRONIC CARE 34 -- 3.1. OBJECTIVE OF THIS CHAPTER 34 -- 3.2. DEVELOPMENT OF A VISION FOR A REFORM OF CHRONIC CARE IN BELGIUM 35 -- 3.2.1. General shape of the vision or root definition 35 -- 3.2.2. Core purpose 36 -- 3.2.3. Additional qualifications 36 -- 3.2.4. Expanded vision/root definition 38 -- 3.3. CONCEPTUAL MODEL: FUNCTIONAL ACTIVITIES REQUIRED FOR A CHRONIC CARE SYSTEM 39 -- 3.3.1. Plan, provide and co-ordinate routine care 40 -- 3.3.2. Provide acute episode response and specialized services 41 -- 3.3.3. Conduct early identification 42 -- 3.3.4. Support patient/informal caregiver empowerment (including self-management) 43 -- 3.3.5. Conduct health promotion and prevention activities 44 -- 3.3.6. Implement and follow-up a dynamic care model 45 -- 3.3.7. Six requirements for each activity 45 -- 3.4. CONCLUDING REMARKS 47 -- 4. CHRONIC CARE INITIATIVES IN BELGIUM 48 -- 4.1. OBJECTIVE OF THIS CHAPTER 48 -- 4.2. METHODS 48 -- 4.2.1. Data sources 48 -- 4.2.2. Data collection 48 -- 4.2.3. Inclusion and exclusion criteria 48 -- 4.3. NATIONAL PLAN: “PRIORITY TO CHRONIC PATIENTS!” 49 -- 4.4. DESCRIPTION OF THE INITIATIVES FROM THE FEDERAL PUBLIC SERVICE HEALTH, FOOD CHAIN SAFETY AND ENVIRONMENT AND FROM THE SICKNESS FUNDS 49 -- 4.4.1. Inventory of initiatives that target patients with a chronic illness 49 -- 4.4.2. Discussion: initiatives from the Federal Public Service Health, Food Chain Safety and environment and from the Sickness Funds 55 -- 4.5. DESCRIPTION OF INITIATIVES FROM THE NATIONAL INSTITUTE FOR HEALTH AND DISABILITY INSURANCE 56 -- 4.5.1. Health care system level 56 -- 4.5.2. Plan, provide and coordinate care in the primary care setting 57 -- 4.5.3. Self-empowerment of the patients 63 -- 4.6. KEY POINTS: CHRONIC CARE INITIATIVES IN BELGIUM 64 -- 5. RECOMMENDATIONS IN RELATION TO CHRONIC CARE: ANALYSIS OF KCE REPORTS 65 -- 5.1. OBJECTIVE OF THIS CHAPTER 65 -- 5.2. METHODS 65 -- 5.3. TAILORED DELIVERY SYSTEM DESIGN 65 -- 5.3.1. Strengthening primary care: illustration of type 2 diabetes care 66 -- 5.3.2. Organizational models that streamline transition between primary, secondary and tertiary care 67 -- 5.3.3. Organization of services for the older persons 67 -- 5.3.4. Organization of Palliative care services 69 -- 5.3.5. Organization of Mental Health Care Services 70 -- 5.3.6. Organization of rehabilitation services 70 -- 5.4. APPROPRIATE WORKFORCE 71 -- 5.4.1. Physician workforce planning 71 -- 5.4.2. Attractiveness, recruitment and retention of the GP profession 71 -- 5.4.3. Differentiated Nursing Practice 72 -- 5.4.4. The right function for the right health professional: physiotherapists and pharmacists 72 -- 5.4.5. Important role for the occupational physician and the advisory physician from the sickness funds 73 -- 5.4.6. Role for informal caregivers 73 -- 5.4.7. Curricula and continuous education based on needs 73 -- 5.5. APPROPRIATE FINANCING 74 -- 5.5.1. Financial accessibility 74 -- 5.5.2. Financing system for home care nursing 75 -- 5.5.3. Comparison of two financing systems for primary health care 76 -- 5.5.4. Financial initiatives for quality 76 -- 5.6. QUALITY PROCESSES 77 -- 5.7. DECISION SUPPORT 78 -- 5.7.1. Seamless care with regard to medications 79 -- 5.7.2. Self-empowerment in chronic dialysis 79 -- 5.8. CLINICAL INFORMATION SYSTEMS 79 -- 5.9. KEY POINTS: EVIDENCE AND RECOMMENDATIONS FROM KCE REPORTS 80 -- 6. FOCUS ON PATIENT EMPOWERMENT AND NEW PROFILES/ FUNCTIONS IN THE FIRST LINE OF CARE 82 -- 6.1. OBJECTIVE OF THIS CHAPTER 82 -- 6.2. METHODS 82 -- 6.3. HOW TO FOSTER THE PATIENT SELF-EMPOWERMENT ? INSIGHTS FROM A SYSTEMATIC REVIEW OF THE LITERATURE 82 -- 6.3.1. Scope of the literature review 83 -- 6.3.2. Methods 84 -- 6.3.3. Results of the search strategy 84 -- 6.3.4. Effectiveness of the interventions: results by disease 88 -- 6.3.5. Summary of the findings: analysis by type of intervention 94 -- 6.3.6. Conclusion: what elements make up successful interventions? 97 -- 6.3.7. Strengths of this review 98 -- 6.3.8. Caveats in the interpretation of results 98 -- 6.3.9. Key points: interventions to foster patient empowerment 99 -- 6.4. NEW PROFILES AND FUNCTIONS IN THE HEALTH CARE SYSTEM 99 -- 6.4.1. Objective: analysis of the possible changes within the workforce to tackle the future challenges of chronic care 99 -- 6.4.2. Methods 100 -- 6.4.3. New roles in health care: examples from the UK, Canada and The Netherlands 100 -- 6.4.4. Situation in Belgium 110 -- 6.4.5. Discussion: implementation of new functions and professions in the Belgian health care system 114 -- 6.4.6. Key points: new functions and roles in primary health care 115 -- 7. ORGANIZATION OF CHRONIC CARE IN BELGIUM: STAKEHOLDERS’ ANALYSIS 116 -- 7.1. OBJECTIVE OF THIS CHAPTER 116 -- 7.2. METHODS: CONSULTATION OF STAKEHOLDERS FROM DIFFERENT LEVELS 116 -- 7.2.1. Micro and meso levels: four brainstorming sessions and semi-structured interviews 116 -- 7.2.2. Macro level: two meetings with stakeholders 117 -- 7.3. RESULTS: STAKEHOLDERS’ VIEWS ON THE ORGANIZATION OF CHRONIC CARE IN BELGIUM 118 -- 7.3.1. Theme 1: continuum of care within lines of care and between lines of care calls for coordination 118 -- 7.3.2. Theme 2: Redefining the roles of health professionals and training 121 -- 7.3.3. Theme 3: Empowerment and support of the patient and his/her informal caregiver 124 -- 7.3.4. Theme 4: Payment system influences care 125 -- 7.3.5. Theme 5: Clinical information systems and e-Data 127 -- 7.3.6. Theme 6: Accessibility of care 129 -- 7.3.7. Strengths and limitations of this SWOT analysis 130 -- 7.4. KEY POINTS: HIGHLIGHTS FROM THE SWOT ANALYSIS WITH STAKEHOLDERS 131 -- 7.4.1. Lack of efficiency 131 -- 7.4.2. Coordination at micro level: a multidisciplinary primary care team is at the centre of a system designed for people with chronic care needs 131 -- 7.4.3. Coordination at the meso level: mid-level scale initiatives to improve seamless care between hospital and home care 131 -- 7.4.4. Task delegation and new functions in the health care system: the added value of medical assistants and qualified nurses 131 -- 7.4.5. Preventing institutionalization: importance of respite care and coaching the informal caregivers 132 -- 7.4.6. Patients and Informal care givers. Roles of their organizations 132 -- 7.4.7. Balancing payment systems 132 -- 7.4.8. Information systems 132 -- 7.4.9. Accessible care 133 -- 8. ANALYSIS OF COORDINATION STRUCTURES AND PROGRAMMES IN BELGIUM 134 -- 8.1. OBJECTIVE OF THIS CHAPTER 134 -- 8.2. BACKGROUND: HEALTH CARE SYSTEM, A COMPLEX ADAPTIVE SYSTEM 135 -- 8.3. COORDINATION STRUCTURES AND PROGRAMMES IN HEALTH CARE 135 -- 8.3.1. Coordination structures 135 -- 8.3.2. Coordination programmes 136 -- 8.4. KEY FEATURES OF COORDINATION STRUCTURES AND PROGRAMMES 136 -- 8.4.1. Coordination structures at micro level 136 -- 8.4.2. Need for a geographically integrated system at meso level 138 -- 8.4.3. Towards a uniform vision at macro level 138 -- 8.5. EVOLUTION OF COORDINATION STRUCTURES IN BELGIUM 139 -- 8.5.1. Micro level: from single-handed practices towards more collaboration 139 -- 8.5.2. Meso level: from home care coordinating centres (SIT/CCSSD) to Integrated Primary Care Systems (GDT/SISD) 140 -- 8.6. CARE PROGRAMMES: FIT WITHIN “MICRO” OR “MESO” HORIZONTAL STRUCTURES 142 -- 8.6.1. Local multidisciplinary Networks 143 -- 8.6.2. Alternative forms of care for older persons 143 -- 8.6.3. Palliative care platforms and teams 143 -- 8.7. FROM LESSONS LEARNED TO FUTURE PERSPECTIVES 144 -- REFERENCES 14

Blood pressure during adolescence : a study among Belgian adolescents selected from a high cardiovascular risk population

Abstract. Introduction: the Belgian province of Luxembourg has a high incidence of cardiovascular (CV) disease according to the MONICA register. Surveys conducted in adults and children have also found high CV risk factor levels in this province. Design: cross-sectional study. Objective of the present study: to collect data about blood pressure (BP) and its determinants in adolescents from this high CV risk population and to analyse their relationship. Participants: 1526 adolescents (12-17 years) in 24 secondary schools of the province. Results: mean systolic BP levels were 125 mmHg (sd= 12 mmHg) and 122 mmHg (sd= 11 mmHg) for boys an girls, respectively. Mean diastolic BP was equal to 74 mmHg (sd = 10 mmHg) in both genders. Systolic BP increased with age and differed significantly between genders from 15 years onwards. Body fatness indices increased with age except waist-to-hip ratio in girls and triceps skinfold in boys. Regression models including age, anthropometric indices and physical activity explained a small percentage of BP variance (for systolic BP, r²= 0.21 and 0.12 for boys and girls, respectively). Weight was the first parameter related to BP in correlation with regression analyses. Conclusions: this study showed high BP and body fatness indices in adolescents fom a high CV risk population. The model under study showed a moderate relationship between body fatness and BP. This finding suggests other influences as genetic component to account for the high levels observed