Managers' perceptions of the effects of a national mandatory accreditation program in Danish hospitals. A cross-sectional survey.

OBJECTIVE: This study aimed to examine and compare middle and senior hospital managers' perceptions of the effects of a mandatory accreditation program in Denmark, the Danish Healthcare Quality Program (Den Danske Kvalitetsmodel [DDKM]) after it was terminated in 2015. DESIGN: A cross-sectional online questionnaire survey. SETTING: All 26 somatic and psychiatric public hospitals in Denmark. PARTICIPANTS: All senior and middle managers. METHODS: A questionnaire with open and closed response (five-point Likert scale) questions. Quantitative data were analyzed descriptively and through ordered logistic regression by management level. Qualitative data were subjected to a software-assisted content analysis. RESULTS: The response rate was 49% (533/1059). In both the qualitative and quantitative data sets, participants perceived the DDKM as having: led to an increased focus on registration, documentation and additional and unnecessary procedures. While the DDKM was perceived as increasing a focus on quality, the time required for accreditation was at the expense of patient care. There were significant differences by management level, with middle managers having more negative perceptions of the DDKM related to time spent on documentation and registration. CONCLUSION: While the DDKM had some perceived benefits for quality improvement, it was ultimately considered time-consuming and outdated or having served its purpose. Including managers, particularly middle managers, in refinements to the new quality improvement model could capitalize on the benefits while redressing the problems with the terminated accreditation program.

The effect of an attachment-oriented couple intervention for breast cancer patients and partners in the early treatment phase: A randomised controlled trial.

OBJECTIVE: Patients and partners both cope individually and as a dyad with challenges related to a breast cancer diagnosis. The objective of this study was to evaluate the effect of a psychological attachment-oriented couple intervention for breast cancer patients and partners in the early treatment phase. METHODS: A randomised controlled trial including 198 recently diagnosed breast cancer patients and their partners. Couples were randomised to the Hand in Hand (HiH) intervention in addition to usual care or to usual care only. Self-report assessments were conducted for both patients and partners at baseline, postintervention (5 months), and follow-up (10 months), assessing cancer-related distress, symptoms of anxiety and depression, and dyadic adjustment. Patients' cancer-related distress was the primary outcome. RESULTS: Cancer-related distress decreased over time in both patients and partners, but the intervention did not significantly affect this decrease at postintervention (P = .08) or follow-up (P = .71). A significant positive effect was found on dyadic adjustment at follow-up for both patients (P = .04) and partners (P = .02). CONCLUSIONS: There was no significant effect of the HiH intervention cancer-related distress. The results suggest that most couples can cope with cancer-related distress in the context of usual care. However, the positive effect on dyadic adjustment implies that the HiH intervention benefitted both patients and partners. Future studies should investigate how to integrate a couple focus in usual cancer care to improve dyadic coping in the early treatment phase.

Hereditary orotic aciduria: results of a screening survey.

Urine from 1,358 mentally retarded subjects was screened for the presence of elevated concentrations of orotic acid and orotidine. This survey was conducted in search of occult variants of hereditary orotic aciduria which might be associated with mental retardation. Although no homozygous variants were detected, 9 subjects with persistently abnormal urinary screening tests were discovered. Assays of erythrocyte orotidylate decarboxylase and phosphoribosyltransferase enzymes showed deficient activities for 2 of these subjects typically found in red cells of persons heterozygous for hereditary orotic aciduria. The same studies were conducted on urine and blood samples from the families of the affected subjects, and additional family members were also found to be affected. Detection of two unrelated heterozygotes among so small a screened population suggests, as previously noted, a higher frequency of the abnormal gene than that indicated by the extreme rarity of the homozygous condition. This study demonstrates the usefulness of the urinary screening test mass surveys and indicates the need for further study of the prevalence of the mutant gene.

Epidermal growth factor rapidly stimulates prolactin gene transcription.

Epidermal growth factor (EGF) was originally characterized as a growth factor for various cell types1,2 and was subsequently shown to affect a number of cellular and molecular processes3,4, of which many might be considered as a part of the pleiotropic growth response (enhanced uptake of glucose, uridine and amino acids and stimulated synthesis of protein, RNA and DNA). Very early responses to EGF, such as increased sodium fluxes5 and stimulation of tyrosine phosphorylation6, have been proposed to mediate some or all of EGF's effects. In a number of tissues, EGF has been shown to increase the synthesis of specific proteins7-10. We have investigated the effects of EGF on prolactin synthesis in the GH4 rat pituitary cell line to gain further insight into the mechanism of EGF's actions on cellular functions. Addition of EGF to GH4 cells results in a three- to sixfold stimulation of prolactin synthesis, as well as a partial inhibition of cell growth7,8. In this report, we demonstrate that the increased prolactin synthesis appears to be the result of a rapid stimulation of prolactin gene transcription by EGF. It is tempting to speculate that very early transcription by EGF. It is tempting to speculate that very early transcriptional effects on specific genes, such as reported here in te case of the prolactin gene in GH4 cells, may mediate some or all of the later effects of EGF on cell cycle regulation in those cells for which it serves as a growth factor.

Thyrotropin-releasing hormone exerts rapid nuclear effects to increase production of the primary prolactin mRNA transcript.

This report directly documents that a polypeptide hormone can regulate specific gene expression as a consequence of increasing the levels of a primary genomic transcript. The regulation and expression of the prolactin gene was studied in a cell line (GH4) derived from a rat pituitary tumor. These cells respond to addition of the hypothalamic tripeptide, thyrotropin-releasing hormone (TRH; thyroliberin), by elevation of the levels of mature prolactin mRNA and increase in prolactin biosynthesis. The message induction is preceded by, and apparently consequential to, a comparable rapid increase in the nuclear prolactin RNA precursors, including the putative primary transcript.

Nucleoside transport in cells and membrane vesicles from Escherichia coli K12.

Osmotic shock treatment of cells of Escherichia coli K12 caused a reduction in the transport of nucleosides into the cells. The strains used carried mutations in the nucleoside catabolizing enzymes. This indicated that the decrease in transport capacity was not due to loss of these enzymes during the shock treatment. Membrane vesicles, prepared from the same strains, showed a limited transport of cytidine, deoxycytidine, and uridine. Transport of purine nucleosides and of thymidine was very low in vesicles lacking the appropriate nucleoside phosphorylases and no significant stimulation was observed if the nucleoside phosphorylases were present in the membrane vesicles. These results all indicate that components outside the cytoplasmic membrane are important for nucleoside transport. Selection for resistance to fluorodeoxycytidine yielded mutants which were unable to transport any nucleoside, even when the nucleoside phosphorylases were present in high amounts. This finding is consistent with a requirement for a specific transport process prior to the initial enzymatic attack on the incoming nucleoside.