Factors Associated With Changes in Patient-Centered Care in Undergraduate Nursing Students.

AIM: The purpose of this study was to examine active listening, self-awareness, and empathy and how they relate to changes in patient-centered care (PCC) in undergraduate nursing students. BACKGROUND: PCC is associated with better patient outcomes, but the level of PCC has been found to be low in nursing students. METHOD: This secondary analysis used baseline and follow-up data at two time points from 50 undergraduate nursing students. RESULTS: Changes in self-awareness were associated with changes in PCC directly (Follow-Up 1) or directly and indirectly through the effects on changes in empathy (Follow-Up 2), controlling for age, experience, and intervention. Changes in active listening were associated with changes in PCC only indirectly through the effect on changes in empathy only at Follow-Up 2. CONCLUSION: Changes in self-awareness and active listening need to be the first targets of interventions to improve PCC in undergraduate nursing students.

Self-paced polling increases medical student engagement in recorded lectures and improves examination performance.

Engaging preclinical medical students in the curriculum is challenging. To address this challenge, the investigators developed and implemented self-paced polling with recorded lectures, in which students answered audience response questions at their own pace. In 2021, we retrospectively assigned second-year medical students (N = 165) as Active or Inactive based on their answered polling questions. We subdivided the Active group into two groups, a Live group who predominantly responded to polling in live classes and a Self-paced group who predominantly used polling with recorded lectures. Outcomes were academic performance on customized National Board of Medical Examiners (NBME) examinations and engagement. Compared with the Inactive group, the Self-paced group performed better on the customized NBME examination after extensive self-paced polling. Students answered a significantly larger proportion of questions correctly in self-paced polling compared with live polling. Students who used self-paced polling reported a positive experience and indicated they had emotional, behavioral, or cognitive engagement with the curriculum. This study introduces self-paced polling with recorded lectures, which medical educators can potentially use to enhance student engagement and academic performance.NEW & NOTEWORTHY More medical students utilize recorded lectures than live lectures. Self-paced polling questions allow students to participate while watching recorded lectures. Second-year medical students performed significantly better on examination after actively using the self-paced polling compared with inactive students. They also reported emotional, behavioral, and cognitive engagement with the course material while using the self-paced polling.

Interactive retrieval practice in renal physiology improves performance on customized National Board of Medical Examiners examination of medical students.

Retrieval practice improves long-term retention. Use of interactive retrieval practice in large group, in-person and online live classes, in combination with outside resources, is unreported for medical physiology classes. The primary study purpose was to compare student cohorts' performance with or without retrieval practice in renal physiology classes, relative to the national average on customized national examinations in renal physiology, nonphysiology, and all questions. The secondary purpose was to examine the students' educational experience. For the primary purpose, we used a nonequivalent group, posttest-only design. For the secondary purpose, we used cross-sectional and qualitative designs. We analyzed examination results of 684 students in four academic years. For renal physiology questions, students performed significantly better in years with retrieval practice compared with years without it (P < 0.001). There was no change in nonphysiology scores over the four years. Performance in all questions, too, significantly improved (P < 0.001). A large majority (86%) of students indicated retrieval practice helped them learn renal physiology. Student ratings of quality in online classes, which featured interactive retrieval practice, were higher than that of in-person classes (P < 0.001). Qualitative analysis revealed students found interactive retrieval practice, scaffolding, outside resources, and the instructor's teaching style helpful. Educators in medical physiology classes can use our findings to implement interactive retrieval practice.

Predictors of 10-Year Stent-Related Adverse Outcomes after Coronary Drug-Eluting Stent Implantation: The Importance of Stent Size.

INTRODUCTION: The predictors of stent treatment failure and their importance 10 years after treatment with drug-eluting stents (DESs) have not been reported in detail. METHODS: Data were retrieved from the SORT-OUT II database encompassing 2,849 non-left main coronary lesions in 2,073 unselected all-comer patients treated with first-generation DES and followed clinically for 10 years. Stent treatment failure (STF) was defined as definite or probable stent thrombosis, target lesion revascularization (TLR), or >70% restenosis left untreated. Target lesion failure (TLF) was defined as cardiac death, target vessel myocardial infarction, or TLR. Characteristics predicting higher hazard ratios (HRs) were identified by the multivariate Cox regression analysis. RESULTS: A stent diameter ≤2.5 versus ≥3.5 mm had STF 23.3 versus 11.8% and TLF 27.9 versus 18.8%. Stent length <20 versus >40 mm had STF 13.0 versus 29.0% and TLF 18.7 versus 34.6%. In multivariate analysis, decreasing stent diameter (HR: 1.24 [3.0 mm] to 2.12 [2.25 mm], reference ≥3.5 mm) and increasing stent length (HR: 1.15 [20-30 mm] to 2.07 [>40 mm], reference <20 mm) predicted STF together with diabetes (HR: 1.31), previous revascularization (HR: 1.31), restenotic (HR: 2.25), bifurcation (HR: 1.45), and chronically occluded lesions (HR: 1.54). A predictive score (PS) was calculated for each lesion from the HRs for the predictors present. The 10-year rates of STF were 10% in lesions with a PS ≤ 1.5 and 37% in those with PS ≥ 3.5. CONCLUSIONS: Ten-year outcomes show large variations depending on the stent size and a few patient and lesion characteristics. The calculation of a PS from these unambiguous variables may be used to improve the risk estimate in individual lesions and patients.

SuPAR is associated with death and adverse cardiovascular outcomes in patients with suspected coronary artery disease.

BACKGROUND: The inflammatory biomarker soluble urokinase plasminogen activator receptor (suPAR) is associated with presence and severity of coronary artery disease (CAD) and incident death and myocardial infarction (MI). We sought to validate this finding in a further cohort of patients with suspected CAD. METHODS: Plasma suPAR was available in 1635 patients (73% with CAD) undergoing coronary angiography at a single regional Danish hospital between 2003 and 2005. Patients were followed for adverse cardiovascular outcomes of death, cardiac death and MI over a median follow-up of 4.2 years. RESULTS: In multivariate Cox models, adjusted for established cardiovascular risk factors, the biomarkers C-reactive protein, troponin-T and N-terminal-pro brain natriuretic peptide and the number of stenotic vessels, suPAR was independently associated with the combined endpoint of death/MI, hazard ratio (HR) 1.88; cardiovascular death, HR 2.01; and non-fatal MI, HR 1.53; (all p ≤ .037) per doubling of suPAR concentration. A plasma cutoff for suPAR ≥ 3.5 ng/mL was also significantly associated with death/MI, HR 1.51; p = .005. The C-statistic for the multivariate model predicting death/MI improved from 0.712 to 0.730 (p for difference .008) after inclusion of suPAR. However, suPAR was not associated with presence or extent of CAD (p > .05). CONCLUSION: These results validate previous findings that demonstrate suPAR to be an independent predictor of death/MI in patients with suspected or known CAD, however suPAR was not associated with presence or extent of CAD in our cohort. Probably because suPAR reflects end organ damage rather than the degree of atherosclerosis. BRIEF SUMMARY: We demonstrate that the inflammatory biomarker soluble urokinase plasminogen activator receptor is an independent predictor of death/myocardial infarction in patients with suspected or known coronary artery disease, but is not associated with the presence or severity of coronary artery disease.

Simulating Four Essential Conversations with Hematology/Oncology Trainees: a Qualitative Evaluation.

Hematologists/oncologists have a crucial responsibility to effectively communicate with patients. However, they have been criticized for ineffective communication with patients. To develop effective communication behaviors that meet the needs of patients and families, trainees need practice and feedback about their performance. Medical faculties frequently teach communication skills using simulation-based curricula; however, they often include only general communication skills, without tailored approaches for specialties. This study examined Hematology/Oncology trainees' qualitative perceptions about the value of and techniques used for simulations of specialty specific, essential conversations with patients and families, and debriefing sessions. Results demonstrate a highly effective curriculum and positive learner experiences. While most reports on this topic take place within major academic cancer centers, outcomes from a mid-sized Hematology/Oncology training program are unknown. The study confirms feasibility for implementing a simulation-based communications program in a mid-sized Hematology/Oncology program and describes simulation techniques that were effective.

Similar five-year outcome with paclitaxel- and sirolimus-eluting coronary stents.

OBJECTIVE: Millions of patients were treated with the sirolimus-eluting Cypher™ and the paclitaxel-eluting Taxus™ coronary stents with potential late-occurring increase in event rates. Therefore, the long-term outcome follow-up is of major clinical interest. DESIGN: In total, 2.098 unselected patients with ST-segment elevation myocardial infarction (STEMI), non-STEMI, stable or unstable angina pectoris were randomized to receive Cypher™ (n = 1.065) or Taxus™ (n = 1.033) stents and were followed for 5 years. RESULTS: The primary end-point; the composite of cardiac death, myocardial infarction and target vessel revascularization (major adverse cardiac event, MACE), occurred in 467 patients (22.3%); Cypher™ n = 222 (20.8%), Taxus™ n = 245 (23.7%), ns. Definite and probable stent thrombosis occurred in 107 patients (5.1%); Cypher™ n = 51 (4.8%), Taxus™ n = 56 (5.4%), ns. No statistically significant differences were found in the elements of the primary end-point or in other secondary end-points between the two stent groups. After one year, the annual rates of stent thrombosis and MACE remained constant. CONCLUSIONS: During 5-year follow-up, the Cypher™ and the Taxus™ coronary stents had similar clinical outcome with no signs of increasing rates of adverse events over time.

Summer undergraduate biomedical research program for underrepresented minority students in a rural, low-income state.

Introduction: Diversity can enhance the agenda and quality of biomedical research, but a dearth of underrepresented minorities and women serve as biomedical researchers. The study purpose was to examine the impact of the a summer undergraduate research program on self-efficacy in research, scientific communication, and leadership as well as scientific identity, valuing objectives of the scientific community, and intent to pursue a biomedical research career. Methods: Underrepresented minority and female undergraduate students participated in a mentored research experience in a rural, low-income state. Results: Students' self-efficacy in research, scientific communication, and leadership as well as scientific identity, valuing objectives of the scientific community, and intent to pursue a biomedical research career increased post-program compared to pre-program. Conclusion: This study supports implementation of a biomedical summer undergraduate research program for URM and women in a poor, rural, settings.

Interprofessional Naloxone Student Training to Manage Suspected Opioid Overdose.

PURPOSE: The study purpose was to examine the effect of interprofessional naloxone training on students' knowledge, confidence, and interprofessional collaboration competency. The overarching goal was to decrease mortality related to opioid overdoses. DESIGN/METHODS: A training session for interprofessional students consisted of a lecture presentation, demonstration, and hands-on practice regarding appropriate administration of naloxone for suspected opioid overdose. A questionnaire elicited baseline and change in knowledge, confidence, and interprofessional collaboration competency scores at pretraining and posttraining. In addition, changes in knowledge and confidence were also measured 3 weeks after the training. Thematic analysis explored training components that students perceived as valuable or needing improvement. RESULTS: Participants (N = 100) were nursing (n = 33), physician assistant (n = 37), and pharmacy (n = 30) students. Pretraining and posttraining comparison demonstrated increased knowledge (P < .001), confidence (P < .001), and collaboration scores (P < .001). At 3 weeks, knowledge and confidence remained higher than pretraining (P < .001). Knowledge was trending downward compared with posttraining (P = .09). Thematic analysis identified 4 themes: (a) indications for administration of different naloxone types, (b) learning modalities, (c) knowledge application, and (d) improvements. CONCLUSIONS: An interprofessional naloxone administration training resulted in increased knowledge, confidence, and interprofessional teamwork. Educators can adapt this training for a variety of future or current healthcare professionals to improve immediate intervention and outcomes in suspected opioid overdoses.

Hematology/Oncology Fellowship Programs' Participation in the Quality Oncology Practice Initiative.

PURPOSE: In the first decade of this millennium, ASCO pioneered a quality measurement tool, the Quality Oncology Practice Initiative (QOPI). Despite an Accreditation Council for Graduate Medical Education (ACGME) requirement since 2012 for oncology fellows to participate in quality improvement (QI) projects, the uptake of QOPI remains modest. METHODS: This study examined reasons for low QOPI participation by surveying participating and nonparticipating HemOnc Fellowship Programs. The survey elicited views toward QI and QOPI as well as ideas about making the program more helpful. RESULTS: Among 69 fellowship programs, only 39% (n = 27) participated in QOPI. Other findings were that (1) the majority of programs considered their fellows' QI projects beneficial but were not fulfilling the ACGME standard for all fellows' QI participation; (2) nonparticipating programs were unfamiliar with but interested in QOPI; (3) participating programs tended to view QI as easier to conduct and more beneficial than nonparticipating programs; and (4) programs that withdrew from QOPI and participating programs alike were dissatisfied with the educational benefit and data abstraction burden for fellows. CONCLUSION: Academic oncology programs generally valued QI but many have not fully engaged in it. Fellows in programs participating in QOPI may have had less difficulty conducting QI and their projects may have been more beneficial than that of nonparticipating programs. However, perceived lack of educational benefits for fellows and the burden of manual data abstraction from the electronic medical record are impediments to satisfaction with the program. Higher faculty involvement and longitudinal reports for each fellow may significantly increase participation.

Identification of 8-methyladenosine as the modification catalyzed by the radical SAM methyltransferase Cfr that confers antibiotic resistance in bacteria.

The Cfr methyltransferase confers combined resistance to five different classes of antibiotics that bind to the peptidyl transferase center of bacterial ribosomes. The Cfr-mediated modification has previously been shown to occur on nucleotide A2503 of 23S rRNA and has a mass corresponding to an additional methyl group, but its specific identity and position remained to be elucidated. A novel tandem mass spectrometry approach has been developed to further characterize the Cfr-catalyzed modification. Comparison of nucleoside fragmentation patterns of A2503 from Escherichia coli cfr+ and cfr- strains with those of a chemically synthesized nucleoside standard shows that Cfr catalyzes formation of 8-methyladenosine. In addition, analysis of RNA derived from E. coli strains lacking the m(2)A2503 methyltransferase reveals that Cfr also has the ability to catalyze methylation at position 2 to form 2,8-dimethyladenosine. The mutation of single conserved cysteine residues in the radical SAM motif CxxxCxxC of Cfr abolishes its activity, lending support to the notion that the Cfr modification reaction occurs via a radical-based mechanism. Antibiotic susceptibility data confirm that the antibiotic resistance conferred by Cfr is provided by methylation at the 8 position and is independent of methylation at the 2 position of A2503. This investigation is, to our knowledge, the first instance where the 8-methyladenosine modification has been described in natural RNA molecules.

Training nurses in the treatment of tobacco use and dependence: pre- and post-training results.

AIM: This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. BACKGROUND: Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. METHOD: A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. RESULTS: Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. CONCLUSION: Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.

Comparison of PubMed and Google Scholar literature searches.

BACKGROUND: Literature searches are essential to evidence-based respiratory care. To conduct literature searches, respiratory therapists rely on search engines to retrieve information, but there is a dearth of literature on the comparative efficiencies of search engines for researching clinical questions in respiratory care. OBJECTIVE: To compare PubMed and Google Scholar search results for clinical topics in respiratory care to that of a benchmark. METHODS: We performed literature searches with PubMed and Google Scholar, on 3 clinical topics. In PubMed we used the Clinical Queries search filter. In Google Scholar we used the search filters in the Advanced Scholar Search option. We used the reference list of a related Cochrane Collaboration evidence-based systematic review as the benchmark for each of the search results. We calculated recall (sensitivity) and precision (positive predictive value) with 2 x 2 contingency tables. We compared the results with the chi-square test of independence and Fisher's exact test. RESULTS: PubMed and Google Scholar had similar recall for both overall search results (71% vs 69%) and full-text results (43% vs 51%). PubMed had better precision than Google Scholar for both overall search results (13% vs 0.07%, P < .001) and full-text results (8% vs 0.05%, P < .001). CONCLUSIONS: Our results suggest that PubMed searches with the Clinical Queries filter are more precise than with the Advanced Scholar Search in Google Scholar for respiratory care topics. PubMed appears to be more practical to conduct efficient, valid searches for informing evidence-based patient-care protocols, for guiding the care of individual patients, and for educational purposes.

Randomized Controlled Simulation Trial to Compare Transfer Procedures for Emergency Cesarean.

OBJECTIVE: To test the hypothesis that capping intravenous and epidural lines would reduce time to transfer women in labor to the operating room and time to readiness for general anesthesia for emergency cesarean. The secondary purpose was to identify latent threats to patient safety. DESIGN: Mixed methods analysis of a randomized, controlled, in situ simulation trial. SETTING: Labor and delivery unit at high-risk referral center. PARTICIPANTS: Fifteen interprofessional teams that included labor and delivery nurses and anesthesiology residents. METHODS: Immediately before simulation, we randomized bedside nurses and anesthesiology residents to one of two groups: usual transfer or the cap and run procedure. Simulation scenarios started with fetal heart rate decelerations that necessitated position changes followed by emergency cesarean. An embedded simulated obstetrician announced the decision for cesarean; completion of an OR checklist confirmed team readiness to induce general anesthesia. Postsimulation debriefing was focused on teamwork and opportunities to improve safety, and we used qualitative analysis to synthesize results. RESULTS: We found no statistically significant difference in the overall time from decision for cesarean to readiness for general anesthesia between the two groups (usual transfer median = 445 seconds [interquartile range, 425-465] vs. cap and run 390 seconds [interquartile range, 383-443], p = .12). The time in the operating room was less in the cap and run group than in the usual transfer group (median = 300 seconds vs. 250 seconds, p = .038). Qualitative analysis of the debriefing data indicated advantages of the capping procedure, including better bed maneuverability and fewer tangled lines. CONCLUSION: We found no evidence of decreased overall time from decision for cesarean to readiness for general anesthesia based on whether the nurse capped the intravenous and epidural lines or pushed the intravenous pole alongside the bed. However, nurses perceived improved patient safety with the cap and run procedure.

Community-Engaged Development, Implementation, and Evaluation of an Interprofessional Education Workshop on Gender-Affirming Care.

Background: Transgender/nonbinary (trans/NB) patients face stigma in health care settings. Health care professionals' training on trans/NB issues has historically been lacking. Interprofessional education (IPE) provides an opportunity to improve knowledge and attitudes across health care professions. The purpose of this study was to: (a) describe the development and implementation of an IPE workshop on gender-affirming care through a trans/NB community-academic partnership and (b) examine the impact of the workshop on student knowledge and attitudes. Methods: The workshop included a slide presentation on basic terminology and concepts, video clips of trans/NB patient-provider interactions, facilitated discussions of affirming practices, and a trans/NB panel. Nonparametric statistical analysis of pre- and post-survey data from 58 workshop participants measured changes in student knowledge and attitudes. Findings: Students demonstrated statistically significant improvements in knowledge (t=-12.72; p<0.01) and interpersonal comfort (t=-2.06; p<0.05) as well as sex and gender beliefs (t=-3.06; p<0.05) on subscales from the Transgender Attitudes & Beliefs Scale. The results demonstrated no differences on the human value subscale (t=-0.69; p=0.49) or on health care professional questions (t=-1.23; p=0.23). Conclusions: A community-academic partnership developed and implemented this brief interactive educational intervention, which can improve both knowledge and attitudes about trans/NB individuals' health among health professional students.

Use of decision rules for osteoporosis prevention and treatment: implications for nurse practitioners.

PURPOSE: To describe the current literature regarding the benefits of bone mineral density (BMD) screening and to discuss clinical decision rules for BMD screening. DATA SOURCES: Extensive review of the scientific literature regarding osteoporosis, BMD screening, and current clinical decision rules. CONCLUSIONS: Osteoporosis is a disease characterized by deterioration of bone and increased susceptibility to fractures, crippling, and disfigurement. BMD testing is the best predictor for osteoporosis and associated fractures; however, routine global BMD testing is cost-prohibitive. A need exists for a selective and practical clinical decision rule for referral for testing. IMPLICATIONS FOR PRACTICE: Several effective clinical decision rules are presented, and their uses and applications are described. The osteoporosis self-assessment tool is recommended by the authors because of its predictive power and ease of use.

Patient- and Family-Centered Care in the Preoperative Setting: Simulation Cases Featuring Standardized Patients for Anesthesia Residents.

INTRODUCTION: Evidence links patient-centered care to improvements in allocation of health care resources, patient satisfaction, chronic disease self-management, morbidity, and mortality. Support from families, too, can improve patients' health and well-being. However, patient- and family-centered care (PFCC) in the preoperative setting is challenging due to short-term relationships with patients, time constraints, and lack of training. METHODS: This module uses simulations with standardized patients. Groups of residents are divided into pairs, and each resident in a pair alternately participates in, or observes via live camera feed, a simulation case. The pair participates in both debriefing sessions. Two simulation cases are run. The first features a Jehovah's Witness who wants lifesaving blood but does not want her accompanying daughter to know. Despite excruciating pain, analgesia is being withheld because surgery consent has not been obtained. The second features a patient with HIV who does not want her accompanying pastor to know. The operating room nurse calls for a resident to bring her to surgery, but the patient wants to talk to her mother, who has yet to arrive. The purpose of the curriculum is for anesthesia residents to apply PFCC when having difficult preoperative conversations with patients and their families and obtaining anesthesia consent. RESULTS: Participants rated the training environment, faculty, debriefing, clinical application, and contribution of standardized patients highly. Participants' perceived self-efficacy for each core principle of PFCC improved postsimulation compared to presimulation. DISCUSSION: We believe this curriculum can contribute to improvement in PFCC and subsequent improvement in the quality and safety of health care.

Use of Baby Isao Simulator and Standardized Parents in Hearing Screening and Parent Counseling Education.

PURPOSE: The primary purpose of this study was to test the effect of the combined use of trained standardized parents and a baby simulator on students' hearing screening and parental counseling knowledge and skills. METHOD: A one-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills and satisfaction of the educational experience with standardized parents and a baby simulator. The mean age of the 14 audiology students participating in this study was 24.79 years (SD = 1.58). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Six students (2 students in each scenario) volunteered to participate in the infant hearing screening and counseling scenarios, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each of 3 scenarios. After the last scenario, participants were asked to complete a satisfaction survey of their learning experience using simulation and standardized parents. RESULTS: Overall, the pre- and post-simulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels regarding knowledge and skills. The mean difference between pre- and postevent scores was 0.52 (p < .01). The mean satisfaction level was 4.71 (range = 3.91-5.00; SD = 0.30) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied. CONCLUSIONS: The results of this novel educational activity demonstrate the value of using infant hearing screening and parental counseling simulation sessions to enhance student learning. In addition, this study demonstrates the use of simulation and standardized parents as an important pedagogical tool for audiology students. Students experienced a high level of satisfaction with the learning experience.

Linking climate change mitigation and coastal eutrophication management through biogas technology: Evidence from a new Danish bioenergy concept.

The interest in sustainable bioenergy solutions has gained great importance in Europe due to the need to reduce GHG emissions and to meet environmental policy targets, not least for the protection of groundwater and surface water quality. In the Municipality of Solrød in Denmark, a novel bioenergy concept for anaerobic co-digestion of food industry residues, manure and beach-cast seaweed has been developed and tested in order to quantify the potential for synergies between climate change mitigation and coastal eutrophication management in the Køge Bay catchment. The biogas plant, currently under construction, was designed to handle an annual input of up to 200,000 t of biomass based on four main fractions: pectin wastes, carrageenan wastes, manure and beach-cast seaweed. This paper describes how this bioenergy concept can contribute to strengthening the linkages between climate change mitigation strategies and Water Framework Directive (WFD) action planning. Our assessments of the projected biogas plant indicate an annual reduction of GHG emissions of approx. 40,000 t CO2 equivalents, corresponding to approx. 1/3 of current total GHG emissions in the Municipality of Solrød. In addition, nitrogen and phosphorous loads to Køge Bay are estimated to be reduced by approx. 63 t yr.(-1) and 9 tyr.(-1), respectively, contributing to the achievement of more than 70% of the nutrient reduction target set for Køge Bay in the first WFD river basin management plan. This study shows that anaerobic co-digestion of the specific food industry residues, pig manure and beach-cast seaweed is feasible and that there is a very significant, cost-effective GHG and nutrient loading mitigation potential for this bioenergy concept. Our research demonstrates how an integrated planning process where considerations about the total environment are integrated into the design and decision processes can support the development of this kind of holistic bioenergy solutions.