BackgroundThe increased international focus on improving patient outcomes, safety and quality of care has led stakeholders, policy makers and healthcare provider organizations to adopt standardized processes for evaluating healthcare organizations. Accreditation and certification have been proposed as interventions to support patient safety and high quality healthcare. Guidelines recommend accreditation but are cautious about the evidence, judged as inconclusive. The push for accreditation continues despite sparse evidence to support its efficiency or effectiveness.MethodsWe searched MEDLINE, EMBASE and The Cochrane Library using Medical Subject Headings (MeSH) indexes and keyword searches in any language. Studies were assessed using the Cochrane Risk of Bias Tool and AMSTAR framework. 915 abstracts were screened and 20 papers were reviewed in full in January 2013. Inclusion criteria included studies addressing the effect of hospital accreditation and certification using systematic reviews, randomized controlled trials, observational studies with a control group, or interrupted time series. Outcomes included both clinical outcomes and process measures. An updated literature search in July 2014 identified no new studies.ResultsThe literature review uncovered three systematic reviews and one randomized controlled trial. The lone study assessed the effects of accreditation on hospital outcomes and reported inconsistent results. Excluded studies were reviewed and their findings summarized.ConclusionAccreditation continues to grow internationally but due to scant evidence, no conclusions could be reached to support its effectiveness. Our review did not find evidence to support accreditation and certification of hospitals being linked to measurable changes in quality of care as measured by quality metrics and standards. Most studies did not report intervention context, implementation, or cost. This might reflect the challenges in assessing complex, heterogeneous interventions such as accreditation and certification. It is also may be magnified by the impact of how accreditation is managed and executed, and the varied financial and organizational healthcare constraints. The strategies hospitals should impelment to improve patient safety and organizational outcomes related to accreditation and certification components remains unclear. Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0933-x) contains supplementary material, which is available to authorized users.

Progression through the mammalian cell cycle is facilitated by cyclin-cyclin-dependent kinase (cdk) complexes, which are activated at specific points during the cell cycle. Alteration in cyclin-cdk complexess may lead to altered cell cycle and tumorigenesis. In this study, we analyzed expression of cyclins A, D1, D3 and E in tumor tissue from 170 patients with primary invasive breast carcinomas. Immunohistochemical methods were used to detect protein expression of these cyclins. We detected positive immunoreactivity in 55 (32% Cyclins are groups of proteins that play a relevant role in cell-cycle progression. According to their sequence motif, pattern of expression and activity, they exert a regulatory function in the control of transitional stages of the cell cycle 1 and are grouped as cyclins of the G 1 , S and G 2 /M phases. The phase activity of cyclins contributes to phosphorylation of specific substrates, such as cyclin-dependent kinases and retinoblastoma protein (pRB), required for progression through G 1 , the beginning of the different phases and the completion of the cell cycle. 2 Among the G 1 cyclins, ectopic expression of cyclins D1 and E in mammalian fibroblasts shortens G 1 and reduces the serum dependence for S-phase entry. 3-7 Unlike G 1 -phase cyclins, A and B family cyclins achieve maximal levels later in the cycle. Cyclin A, which is synthesized during DNA replication and G 2 /M transition, is involved in cellular activities that promote both replication and transcription. 8,9 The activities of the B cyclins are essential for G 2 transition and mitosis. 6,10 -13 Loss of restriction point control is a common event in malignancies. Several studies reveal that deregulation of both cyclins and the pRB pathway is involved in human carcinogenesis. 14 -16 Expression of cyclins and pRB also reportedly represents alternative mechanisms by which tumor cells may escape the G 1 restriction point. 17 Deregulated expression of cyclins has been found in different types of cancer. Several mechanisms, e.g., chromosomal translocation, amplification of cyclin genes and deregulation by post-transcriptional mechanisms, play a role in deregulated expression in various types of human carcinoma. 15 Also, cyclin A may contribute to the regulation of genes involved in cell growth and in the transformed phenotype. 11,14,18,19 However, the prognostic value of cyclin A over-expression in clinical material has yet to be studied. Our present aim was to evaluate the prognostic value of expression of cyclins A, D1, D3 and E in tumor tissue from patients with primary invasive breast carcinomas. MATERIAL AND METHODSMaterial was obtained from 170 patients with primary breast carcinoma admitted to the Central Hospital of Akershus and to Ullevål Hospital from 1988 to 1993. Mean age at diagnosis was 60 years (range 28 -88). Fifteen (9%) were classified as invasive lobular, 131 as invasive ductal (77%) and 15 (9%) as other types. For 9 patients, no information about tumor classification was available. Lymph node dissection was...

BackgroundQuestionnaires are commonly used to collect patient, or user, experiences with health care encounters; however, their adaption to specific target groups limits comparison between groups. We present the construction of a generic questionnaire (maximum of ten questions) for user evaluation across a range of health care services.MethodsBased on previous testing of six group-specific questionnaires, we first constructed a generic questionnaire with 23 items related to user experiences. All questions included a "not applicable" response option, as well as a follow-up question about the item's importance. Nine user groups from one health trust were surveyed. Seven groups received questionnaires by mail and two by personal distribution. Selection of core questions was based on three criteria: applicability (proportion "not applicable"), importance (mean scores on follow-up questions), and comprehensiveness (content coverage, maximum two items per dimension).Results1324 questionnaires were returned providing subsample sizes ranging from 52 to 323. Ten questions were excluded because the proportion of "not applicable" responses exceeded 20% in at least one user group. The number of remaining items was reduced to ten by applying the two other criteria. The final short questionnaire included items on outcome (2), clinician services (2), user involvement (2), incorrect treatment (1), information (1), organisation (1), and accessibility (1).ConclusionThe Generic Short Patient Experiences Questionnaire (GS-PEQ) is a short, generic set of questions on user experiences with specialist health care that covers important topics for a range of groups. It can be used alone or with other instruments in quality assessment or in research. The psychometric properties and the relevance of the GS-PEQ in other health care settings and countries need further evaluation.

Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.