Facing the challenges of PROM implementation in Dutch dialysis care:Patients' and professionals' perspectives

BACKGROUND: Patient Reported Outcome Measures (PROMs) are increasingly used in routine clinical practice to facilitate patients in sharing and discussing health-related topics with their clinician. This study focuses on the implementation experiences of healthcare professionals and patients during the early implementation phase of the newly developed Dutch set of dialysis PROMs and aims to understand the process of early implementation of PROMs from the users' perspectives. METHODS: This is a qualitative study among healthcare professionals (physicians and nursing staff: n = 13) and patients (n = 14) of which 12 were receiving haemodialysis and 2 peritoneal dialysis. Semi-structured interviews were used to understand the barriers and facilitators that both professionals and patients encounter when starting to implement PROMs. RESULTS: The early PROM implementation process is influenced by a variety of factors that we divided into barriers and facilitators. We identified four barriers: patient´s indifference to PROMs, scepticism on the benefits of aggregated PROM data, the limited treatment options open to doctors and organizational issues such as mergers, organizational problems and renovations. We also describe four facilitators: professional involvement and patient support, a growing understanding of the use of PROMs during the implementation, quick gains from using PROMs such as receiving instant feedback and a clear ambition on patient care such as a shared view on patient involvement and management support. CONCLUSIONS: In this qualitative study carried out during the early implementation phase of the Dutch dialysis PROM set, we found that patients did not yet consider the PROM set to be a useful additional tool to share information with their doctor. This was despite the professionals' primary reason for using PROMs being to improve patient-doctor communication. Furthermore, the perceived lack of intervention options was frustrating for some of the professionals. We found that nurses could be important enablers of further implementation because of their intensive relationship with dialysis patients.</p

Desulfotomaculum carboxydivorans sp.nov., a novel sulfate-reducing bacterium capable of growth at 100% CO

A moderately thermophilic, anaerobic, chemolithoheterotrophic, sulfate-reducing bacterium, strain CO-1-SRBT, was isolated from sludge from an anaerobic bioreactor treating paper mill wastewater. Cells were Gram-positive, motile, spore-forming rods. The temperature range for growth was 30¿68 °C, with an optimum at 55 °C. The NaCl concentration range for growth was 0¿17 g l¿1; there was no change in growth rate until the NaCl concentration reached 8 g l¿1. The pH range for growth was 6·0¿8·0, with an optimum of 6·8¿7·2. The bacterium could grow with 100 % CO in the gas phase. With sulfate, CO was converted to H2 and CO2 and part of the H2 was used for sulfate reduction; without sulfate, CO was completely converted to H2 and CO2. With sulfate, strain CO-1-SRBT utilized H2/CO2, pyruvate, glucose, fructose, maltose, lactate, serine, alanine, ethanol and glycerol. The strain fermented pyruvate, lactate, glucose and fructose. Yeast extract was necessary for growth. Sulfate, thiosulfate and sulfite were used as electron acceptors, whereas elemental sulfur and nitrate were not. A phylogenetic analysis of 16S rRNA gene sequences placed strain CO-1-SRBT in the genus Desulfotomaculum, closely resembling Desulfotomaculum nigrificans DSM 574T and Desulfotomaculum sp. RHT-3 (99 and 100 % similarity, respectively). However, the latter strains were completely inhibited above 20 and 50 % CO in the gas phase, respectively, and were unable to ferment CO, lactate or glucose in the absence of sulfate. DNA¿DNA hybridization of strain CO-1-SRBT with D. nigrificans and Desulfotomaculum sp. RHT-3 showed 53 and 60 % relatedness, respectively. On the basis of phylogenetic and physiological features, it is suggested that strain CO-1-SRBT represents a novel species within the genus Desulfotomaculum, for which the name Desulfotomaculum carboxydivorans is proposed. This is the first description of a sulfate-reducing micro-organism that is capable of growth under an atmosphere of pure CO with and without sulfate. The type strain is CO-1-SRBT (=DSM 14880T=VKM B-2319T

Effect of methanogenic substrates on anaerobic oxidation of methane and sulfate reduction by an anaerobic methanotrophic enrichment

Anaerobic oxidation of methane (AOM) coupled to sulfate reduction (SR) is assumed to be a syntrophic process, in which methanotrophic archaea produce an interspecies electron carrier (IEC), which is subsequently utilized by sulfate-reducing bacteria. In this paper, six methanogenic substrates are tested as candidate-IECs by assessing their effect on AOM and SR by an anaerobic methanotrophic enrichment. The presence of acetate, formate or hydrogen enhanced SR, but did not inhibit AOM, nor did these substrates trigger methanogenesis. Carbon monoxide also enhanced SR but slightly inhibited AOM. Methanol did not enhance SR nor did it inhibit AOM, and methanethiol inhibited both SR and AOM completely. Subsequently, it was calculated at which candidate-IEC concentrations no more Gibbs free energy can be conserved from their production from methane at the applied conditions. These concentrations were at least 1,000 times lower can the final candidate-IEC concentration in the bulk liquid. Therefore, the tested candidate-IECs could not have been produced from methane during the incubations. Hence, acetate, formate, methanol, carbon monoxide, and hydrogen can be excluded as sole IEC in AOM coupled to SR. Methanethiol did inhibit AOM and can therefore not be excluded as IEC by this study

Biomethanation potential of biological and other wastes

Anaerobic technology has been traditionally applied for the treatment of carbon rich wastewater and organic residues. Anaerobic processes can be fully integrated in the biobased economy concept for resource recovery. After a brief introduction about applications of anaerobic processes to industrial wastewater treatment, agriculture feedstock and organic fraction of municipal solid waste, the position of anaerobic processes in biorefinery concepts is presented. Integration of anaerobic digestion with these processes can help in the maximisation of the economic value of the biomass used, while reducing the waste streams produced and mitigating greenhouse gases emissions. Besides the integration of biogas in the existing full-scale bioethanol and biodiesel production processes, the potential applications of biogas in the second generation lignocellulosic, algae and syngas-based biorefinery platforms are discussed.(undefined

Generalized Temporal Verification Diagrams

. Verification diagrams are a succinct and intuitive way of representing proofs that reactive systems satisfy a given temporal property. We present a generalized verification diagram that allows representation of a proof of any property expressible by a temporal formula. We show that representation of a proof by generalized verification diagram is sound and complete. 1 Introduction Verification diagrams are a succinct and intuitive way of representing proofs that reactive systems satisfy a given temporal property. Verification diagrams were first introduced for this purpose in [MP94] (see also [MP95]). In that paper, diagrams dedicated to particular classes of properties were presented, e.g., wait-for diagrams for precedence properties, chain and ranked diagrams for response properties. In this paper we present generalized verification diagrams, which allow the representation of a proof of any property expressible by a temporal formula. The method of proof by verification diagram, ca..

THE PHOSPHOLIPASE-C ACTIVATING P-2U PURINOCEPTOR ALSO INHIBITS CYCLICAMP FORMATION IN DDT1 MF-2 SMOOTH-MUSCLE CELLS

The P-2U purinoceptor mediated effect on cellular cAMP was investigated in DDT1 MF-2 smooth muscle cells. Stimulation of these receptors by ATP or UTP caused a pronounced decrease of about 50% in cellular cAMP levels in forskolin or isoprenaline pretreated cells. This action of the nucleotides was concentration dependent with an IC50 of 9.4 +/- 0.2 mu M and 29.0 +/- 0.5 mu M for UTP and ATP, respectively and was inhibited by the P-2-purinoceptor antagonist suramin. The cAMP level appeared to be modified by intracellular Ca2+, represented by an initial decline in cAMP. Neither inactivation of protein kinase C by staurosporine nor elevated cytoplasmic Ca2+ concentrations interfered with the sustained decrease in cAMP levels induced by ATP or UTP, showing that this effect is not mediated via the phospholipase C pathway known to be activated after P-2U purinoceptor stimulation in DDT1 MF-2 cells. Pertussis toxin inhibited the action of these nucleotides on the cellular cAMP level. It can be concluded that the P-2U purinoceptor in DDT1 MF-2 cells is coupled to different G-proteins, activating phospholipase C and inhibiting adenylyl cyclase activity