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At least 1,621 records · Page 90Linked to original sources
PubMedDate not supplied

[Stroke-specific quality of life scale (ECVI-38): an evaluation of its acceptance, reliability and validity].

INTRODUCTION AND AIMS: Health-related quality of life (HRQL) is currently essential in the evaluation of stroke-related clinical trials. Existing stroke-specific scales were developed in English-speaking countries and most of them do not satisfy the necessary standards of validity. In consequence, the first Spanish-language scale for evaluating the quality of life (QL) of stroke survivors was developed (ECVI-38). In this work the psychometric properties of this summary measure were assessed. PATIENTS AND METHODS: A group of 63 stroke patients were studied, between 2 months and 2 years after the event, to evaluate the acceptability, reliability and validity of the ECVI-38, using standardised psychometric methods. RESULTS: The ECVI-38 proved to have an important degree of acceptability; only three elements showed a high percentage of data loss due to the age of the patients in the sample; the floor and ceiling effects were within the accepted limits. The scale displayed good internal consistency (Cronbach's alpha 0.79-0.97, correlations between elements 0.53-0.90) and good stability in the test-retest trial (intraclass correlation coefficients 0.89-0.98). As regards its construct validity (total correlations among correct domains, convergent r = 0.57-0.90, discriminating r = 0.19-0.39), the results were very good, as were the findings of the studies of validity vs. external criteria (difference between groups with a known neurological status, and convergence validity). CONCLUSIONS: The ECVI-38 is a measure that is acceptable, reliable and valid for evaluating QL in patients who have had a stroke. Further tests are needed to evaluate its sensitivity and to explore its value in both clinical and research practice.

Activities of Daily Living↗
PubMed2003

Validation of the archimedes diabetes model.

OBJECTIVE: To validate the Archimedes model of diabetes and its complications for a variety of populations, organ systems, treatments, and outcomes. RESEARCH DESIGN AND METHODS: We simulated a variety of randomized controlled trials by repeating in the model the steps taken for the real trials and comparing the results calculated by the model with the results of the trial. Eighteen trials were chosen by an independent advisory committee. Half the trials had been used to help build the model ("internal" or "dependent" validations); the other half had not. Those trials comprise "external" or "independent" validations. RESULTS: A total of 74 validation exercises were conducted involving different treatments and outcomes in the 18 trials. For 71 of the 74 exercises there were no statistically significant differences between the results calculated by the model and the results observed in the trial. Considering only the trials that were never used to help build the model-the independent or external validations-the correlation was r = 0.99. Including all of the exercises, the correlation between the outcomes calculated by the model and the outcomes seen in the trials was r = 0.99. When the absolute differences in outcomes between the control and treatment groups were compared, the correlation coefficient was r = 0.97. CONCLUSIONS: The Archimedes diabetes model is a realistic representation of the anatomy, pathophysiology, treatments, and outcomes pertinent to diabetes and its complications for applications that involve the populations, treatments, outcomes, and health care settings spanned by the trials.

Clinical Trials as Topic↗
PubMed1988

Further analysis of learned helplessness in rheumatoid arthritis using a "Rheumatology Attitudes Index".

A Rheumatology Attitudes Index (RAI) has been modified from the Arthritis Helplessness Index to assess the psychological construct of learned helplessness. The validity of the RAI was established in comparisons to the Arthritis Helplessness Index. The external criterion validity of the RAI was established by identification of statistically significant correlations between RAI scores and physical measures of disease status, including joint count, grip strength, walking time, and button test, as well as with questionnaire self-report scores for difficulty, dissatisfaction and pain in activities of daily living (ADL). Any variation in RAI scores which could be explained by available disease status measures was explained entirely by ADL self-report scores, with no additional explanation by traditional physical measures. Responses to individual RAI statements were significantly correlated with either questionnaire or physical measures of disease status for only 6 of the 15 RAI statements.

Activities of Daily Living↗
PubMed2006

A validated quantitative assay to detect occult micrometastases by reverse transcriptase-polymerase chain reaction of guanylyl cyclase C in patients with colorectal cancer.

PURPOSE: Guanylyl cyclase C (GCC), a receptor for bacterial diarrheagenic enterotoxins, may be a prognostic and predictive marker to detect occult micrometastases in patients undergoing staging for colorectal cancer. However, quantification of GCC expression in tissues by the quantitative reverse transcription-PCR (qRT-PCR) has not undergone analytic and clinicopathologic validation. EXPERIMENTAL DESIGN: A technique to quantify GCC mRNA in tissues employing RT-PCR was developed and validated employing external calibration standards of RNA complementary to GCC. RESULTS: GCC qRT-PCR exhibited reaction efficiencies >92%, coefficients of variations <5%, linearity >6 orders of magnitude, and a limit of quantification of >25 copies of GCC cRNA. This assay confirmed that GCC mRNA was overexpressed by colorectal tumors from 41 patients, which correlated with increased GCC protein quantified by immunohistochemistry. Analyses obtained with 164 lymph nodes from patients free of cancer and 15 nodes harboring metastases established a threshold for metastatic disease of approximately 200 GCC mRNA copies/mug total RNA, with a sensitivity of 93% and specificity of 97%. GCC mRNA above that threshold was detected in 76 of 367 (approximately 21%) nodes free of disease by histopathology from 6 of 23 (26%) patients, suggesting the presence of occult micrometastases. CONCLUSIONS: Quantifying GCC mRNA in tissues by RT-PCR employing external calibration standards is analytically robust and reproducible, with high clinicopathologic sensitivity and specificity. This validated assay is being applied to approximately 10,000 lymph nodes in a prospective trial to define the sensitivity of GCC qRT-PCR for staging patients with colorectal cancer.

Adult↗
PubMed1992

The theoretical application of inclined hinges with the Ilizarov external fixator for simultaneous angulation and rotation correction.

The mathematical concepts of single-cut osteotomies for simultaneous correction of angulation and rotation have been adapted and simplified for gradual distraction-osteogenic correction with the Ilizarov external fixator. Validation studies were performed analytically, using a solid modeling analysis, and experimentally with an Ilizarov external fixator mounted on a wood dowel. The resultant equations have been simplified and are easy to use. Starting from the hinge which would correct the angulation, the axis must be reoriented in the horizontal plane by half the rotation deformity (R/2) and given an inclination slope equal to the rotation divided by the angulation (R/A).

Biomechanical Phenomena↗
PubMed2002

[Validity of death certificate variables in cases of death from external causes, Brazil].

OBJECTIVE: To validate variables other than the basic cause of death on death certificates from external causes of residents younger than 20 years old living in Recife, Brazil, in 1995. METHODS: A survey of death records of the Institute of Forensic in Recife was carried out in order to validate death certificate variables included in official mortality registries. Agreement analysis was performed using Kappa indexes and sensitivity. As a result of the methodology used, the study data was considered to be more consistent and therefore regarded as standard. RESULTS: Those variables forensic specialists indicated as their direct responsibility showed an excellent (gender, age, and category of violence) and good (type of accident) agreement. However, there were significant discrepancies in those variables seen as either of indirect or no forensic responsibility, such as locality and area where death took place, medical care provided and accident location. CONCLUSIONS: Data reveal a dissociation between the reasons for including some variables in death certificates and the obtaining strategy and their social purpose.

Adolescent↗
PubMed2006

Severe and persistent mental illness: a useful definition for prioritizing community-based mental health service interventions.

OBJECTIVE: There is a lack of consensus on the identification of seriously mentally ill patients (SMI). This study investigates the external and predictive validity of an operationalized definition for the severity and persistency of mental illness applied to a sample of service users attending a community mental health service. METHOD: The definition is based on the fulfilment of dysfunction (GAF < or = 50) and illness duration (> or = 2 yrs) criteria. The study was conducted with a two-year longitudinal design. External and predictive validity of the SMI definition were assessed against the diagnosis of psychosis. RESULTS: Our data show evidence for an overall high predictive and external validity of the SMI definition and high sensitivity in predicting those with high burden of mental illness. CONCLUSIONS: In order to identify people with high levels of psychiatric burden, the SMI working definition seems to be more useful than that simply based on diagnostic criteria.

Adult↗
PubMedDate not supplied

[Psychometric characteristics of questionnaires designed to assess the knowledge, perceptions and practices of health care professionals with regards to alcoholic patients].

UNLABELLED: Failure of the French health care services to diagnose and manage problem drinkers has been established on many occasions. This results from a relative lack of knowledge of the basics of alcoholism and the low level of involvement of health care professionals in the management of these patients. In response to this inadequacy, the French Public Health Ministry promoted the development of managed care and coordination of care for these patients. Teams in charge of coordinating care for problem drinkers have been implanted in 96 French hospitals since 1996. These teams aim to provide support to health care providers caring for problem drinkers. For this purpose, they have delivered continuing medical education designed to prepare health care providers to identify and manage these patients in various settings. However, no formal assessment of the impact of these interventions on the knowledge, perceptions, and practices of health care professionals has been planned. The assessment of these interventions can rely on qualitative methods such as observation, focus groups, or individual interviews. However, qualitative methods require specific skills, are time-consuming, and cannot be implemented on a large scale. In contrast, quantitative methods using survey questionnaires or standardized instruments appear to be more appropriate for large scale or repeated evaluations. However, the accuracy of ratings provided by these instruments can be affected by many methodological factors, including the quality of the instrument in terms of validity, reliability, and sensitivity to changes. The aim of this paper is to describe the properties of French and English language questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients. METHODS: The instruments were retrieved by searching the Medline, Pascal, and Sudoc computerized bibliographic databases from January 1964 to December 2002. The following medical Subject Headings (MeSH) and text words were used: "*alcoholism/psychology/therapy", "questionnaire", "healthy care surveys", "attitude of health personnel", and "*knowledge/attitude/practice". In addition, the table of contents of the French journals devoted to alcoholism that were not indexed in electronic bibliographic databases were examined (Alcoologie et addictologie, Alcoologie). The bibliographies of relevant articles were also examined for additional citations. Finally, a phone survey of 34 professionals caring for alcoholic patients located in French university hospitals was carried out to retrieve unpublished questionnaires. Two authors independently extracted data from each study using a standard date abstract form. Disagreements were resolved through consensus. They extracted information on the development process and properties of validity, reliability, and sensitivity to changes. Validity is a concept concerned with the extent to which an instrument actually measures what it is supposed to measure. It is assessed through different facets (content, construct, criterion, discriminant, and predictive validity). Reliability reflects the amount of error inherent in any measurement. Sensitivity to change corresponds to the property of an instrument to identify small but clinically significant changes in attitude or practice. RESULTS: A total of 57 relevant publications involving 39 original instruments were identified. Eighty questionnaires were not available, despite the solicitation of their developers. Overall, the study included 21 instruments. Of these, 20 were English-language questionnaires and one was in French. The conceptual frameword was specified for only two questionnaires: "the Addiction Belief Scale" and "the Alcohol and Alcohol Problems Perception Questionnaire". The number of items ranged from 9 to 122. Items were derived from qualitative surveys in only two cases. In the other cases, they were derived from the literature, expert panels, or form unknown sources. The internal construct validity of eight questionnaires was assessed using principal component analysis, factor analysis, or cluster analysis. We considered that external construct validity was analyzed by testing empirical hypotheses derived from the literature for 15 of the instruments studied. Predictive validity cas evidenced for only one questionnaire. Internal consistency was documented for seven instruments, using Cronbach's coefficient. Test-retest or inter-rater reliability was assessed for none of the instruments. The sensitivity to change of two instruments was analyzed. The response rate to the instruments ranged from 46% to 93%. DISCUSSION: The main finding of this study is that properties of validity, reliability, and sensitivity of questionnaires designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are neglected. Moreover, these questionnaires generally lack a theoretical background. Hence, the interpretation of responses to these questionnaires may be misleading. The present study has several limitations. The search strategy could be criticized for searching only a small number of databases, and selecting French and English language questionnaires. However, given the large range of journals included, it was unlikely that the strategy has limited the generality of the results. In addition, we identified no additional relevant articles by contacting professionals working with alcoholic patients in French university hospitals. Articles reporting instruments designed to assess the knowledge, perceptions, and practices of health care professionals with regards to alcoholic patients are incomplete. Journals should require minimum evidence of validity, reliability, and sensitivity when reporting results of surveys, development of questionnaires or standardized instruments. CONCLUSION: The psychometric characteristics of French language questionnaires were given very little attention. In order to evaluate the effectiveness of their continuing medical education programs, the teams that train French medical staff caring for alcoholic patients should either develop a standardized survey questionnaire following a strict methodology or translate an English language instrument, which would also require a cross-cultural validation.

Alcoholism↗
PubMed2002

Substantial evidence of effect.

Pressures for rapid drug development, especially for treatments that may affect public health significantly, drive a need to reconsider what is necessary to establish the "substantial evidence" of efficacy and safety required for regulatory approval. The concept of substantial evidence of effect can be stated fairly simply in principle, but its application to the evaluation of findings from real clinical drug development programs can be quite complicated and depend on circumstances relating to the population studied and the condition being treated. This paper discusses a number of considerations that arise in attempting to address this issue. These include confirmation of efficacy/safety as opposed to replication of results, the use of surrogates for the clinical outcome, ethical considerations, the use of trials aimed at demonstrating equivalence or noninferiority instead of superiority of a new drug, and the balance between benefits and risks. Recent developments such as the International Conference on Harmonization (ICH) guidelines dealing with statistical principles and choice of control group, and Food and Drug Administration (FDA) guidances interpreting the 1998 Modernization Act identify useful alternative definitions of substantial evidence and also identify when a single study can be enough to demonstrate a clinically important effect. The primary difficulty with the use of noninferiority trials is the need to demonstrate assay sensitivity or validity, i.e., that the trial would have demonstrated the superiority of the active control treatment to placebo had the trial included a placebo group. Failure to demonstrate a significant difference between the presumed active treatments and an inactive control precludes a definitive conclusion of assay validity, but external evidence, e.g., from trials demonstrating the activity of the active control, may yet justify concluding that the trial was assay valid. Issues of interpretation of important unexpected findings are illustrated in the recent experience with the alpha- and beta-blocker carvedilol, where there was a significant reduction in mortality among patients on carvedilol relative to placebo, but a treatment effect could not be demonstrated for the primary outcome. Experience with trials of thrombolytic agents illustrates alternative strategies for demonstrating substantial evidence of effect. Finally, meta-analyses can contribute to the substantial evidence by synthesizing the findings from separate trials to provide a perspective on drug performance in a heterogeneous population of patients that no single trial could provide.

Carbazoles↗
PubMed2001

Parametric oesophageal multiple swallow scintigraphy for validation of dysphageal symptoms during external beam irradiation of mediastinal tumours.

The aim of the study was to evaluate dysphageal symptoms and to measure the effect of local analgesic treatment using parametric oesophageal multiple swallow scintigraphy (PES) during external beam irradiation of the mediastinal region. Fifteen patients (most with lung cancer) with dysphagia grade II underwent PES during external beam radiotherapy of the mediastinum before and after application of local analgesics. Dynamic parametric condensed images were recorded. The intensity of clinical symptoms was correlated with the emptying rate at 10 s (ER-10 s) and the mean transit time (MTT). Visual analysis of the images was performed and the results were correlated with the fields of irradiation portals. Of the 15 patients, 12 showed a correlation between irradiation portals and the region of oesophageal motility disorder. Concordant results of clinical symptoms and PES data were found. In nine patients with a decrease in dysphagia following local analgesia, an increase in mean ER-10 s and a decrease in MTT were observed. In three patients with deterioration in clinical symptoms after analgesic treatment, a similar decrease in mean ER-10 s was found, though MTT remained constant. In three patients with normal values, motility disorders were detected in the dynamic study. In conclusion, PES was found to be a sensitive tool for the validation of dysphageal symptoms in patients during external beam irradiation of mediastinal tumours and for the evaluation and quantification of the efficacy of local analgesic treatment. Additional visual analysis of the dynamic study is helpful in diagnosing minimal disorders.

Adult↗
PubMed2005

Chemotherapy-induced anaemia during adjuvant treatment for breast cancer: development of a prediction model.

BACKGROUND: At present, oncologists prescribe chemotherapy according to standard dose schedules, and as a result many patients develop serious, dose-limiting toxic effects such as anaemia. We aimed to develop a prediction model for anaemia in patients with breast cancer who were receiving adjuvant chemotherapy. METHODS: We reviewed medical records of 331 patients who had received adjuvant chemotherapy for breast cancer. Patients were divided randomly into a derivation sample (n=221) and internal-validation sample (n=110). An external sample of 119 patients enrolled onto the control group of a randomised trial of epoetin alfa was used to validate the model further. Multivariable logistic regression was applied to develop the initial model. We then developed a risk-scoring system, ranging from 0 (low risk) to 50 (high risk), based on the final regression variables. A receiver operating characteristic (ROC) curve analysis was done to measure the accuracy of the scoring system when applied to both validation samples. FINDINGS: The risk of anaemia increased as the pretreatment haemoglobin concentration decreased and was reduced with successive chemotherapy cycles. Risk was also predicted by a platelet count of 200x10(9) cells/L or less before chemotherapy, age 65 years or older, type of adjuvant chemotherapy, and use of prophylactic antibiotics. ROC analysis had acceptable areas under the curve of 0.88 for the internal-validation sample and 0.84 for the external validation sample. A risk score of > or = 24 to < 25 before chemotherapy was identified as the optimum cut-off for maximum sensitivity (83.5%) and specificity (92.3%) of the prediction model. INTERPRETATION: The application and continued refinement of this prediction model will help oncologists to identify patients at risk of developing anaemia during chemotherapy for breast cancer, and might enhance patient-centred care by the application of anaemia treatment in a proactive and appropriate way.

Aged↗
PubMed1993

Validation of target values in external quality assessment schemes for peptide hormones and tumour markers.

Consensus means are tacitly assumed to provide correct target values in many external quality assessment schemes EQAS for peptide hormones and tumour markers. We suggest, however, that such targets should not be used without some evidence of their validity. Comparison of the expected and found increments in the target value on adding known quantities of International Standards to serum pools can provide confirmation of the correctness of target values or, in some cases, identify clearly incorrect targets. Validation of targets is important if EQAS are to stimulate use of correctly calibrated assays, rather than those that simply agree with the most commonly used method(s).

Biomarkers, Tumor↗
PubMed2005

Three-dimensional structure-activity relationships of nonsteroidal ligands in complex with androgen receptor ligand-binding domain.

We studied the three-dimensional quantitative structure-activity relationships (3D QSAR) of 70 structurally and functionally diverse androgen receptor (AR) binding compounds using the comparative molecular similarity indices analysis (CoMSIA) method. The compound set contained 67 nonsteroidal analogues of flutamide, nilutamide, and bicalutamide whose binding mode to AR was unknown. Docking was used to identify the preferred binding modes for the nonsteroidal compounds within the AR ligand-binding pocket (LBP) and to generate the ligand alignment for the 3D QSAR analysis. The alignment produced a statistically significant and predictive model, validated by random group cross-validation and external test sets (q(2)(LOO) = 0.656, SDEP = 0.576, r(2) = 0.911, SEE = 0.293; q(2)(10) = 0.612, q(2)(5) = 0.571; pred-r(2) = 0.800). Additional model validation comes from the CoMSIA maps that were interpreted with respect to the LBP structure. The model takes into account and links the AR LBP structure, docked ligand structures, and the experimental binding activities. The results provide valuable information on intermolecular interactions between nonsteroidal ligands and the AR LBP.

Anilides↗
PubMed1996

Pilot study of the introduction of the J95 health data collection system.

J95 is a health data collection system aimed at gathering information on the weight of health problems facing the Army in order to allow rational and effective prioritization. Before implementing the system Army-wide, a pilot study has been undertaken to validate the J95 ICD 9-based classification system, to test the practical problems encountered with operating the system and its practical value to decision-makers. Both internal and external coding validity were tested in terms of agreement with a "gold standard' and in terms of repeatability and they scored highly. A number of problems were identified analysing discordances and using the comments raised by the participants. A final shortened version of the classification was developed accordingly. The report also contains a number of examples of the potential of the system which is due to be implemented by 1 January 1996.

Humans↗
PubMed2003

A liquid chromatographic-tandem mass spectrometric method for the analysis of serotonin and related indoles in human whole blood.

This paper describes a high-performance liquid chromatographic-tandem mass spectrometric (HPLC-MS-MS) method for the determination of serotonin (5-HT) and the related indoles tryptophan (TRP), 5-hydroxyindoleacetic acid (5-HIAA), indole-3-acetic acid (IAA), and indole-3-proprionic acid (IPA) in whole blood. Ionization was achieved by atmospheric pressure chemical ionization (APCI). The method uses a solvent gradient to achieve baseline separation of all analytes. Linearity was established for all components from 10 to 500 ng/mL, with the exception of TRP, which was calibrated from 0.4 to 20 microg/mL. Limits of quantitation were established that were well below the normal endogenous concentrations of 5-HT and its related indoles. Recoveries of 5-HT, TRP, 5-HIAA, IAA, and IPA were 95%, 91%, 98%, 79%, and 65%, respectively, from whole blood matrix and varied less than 2%. Serotonin, TRP, and IAA results were verified by cross-validation with an external laboratory using a previously validated HPLC method with fluorometric detection. A regression analysis of the two data sets resulted in correlation coefficients of 0.981, 0.964, and 0.987 for 5-HT, TRP, and IAA, respectively.

Chromatography, High Pressure Liquid↗
PubMed2006

Prognosis following severe head injury: Development and validation of a model for prediction of death, disability, and functional recovery.

BACKGROUND: A prognostic model for head trauma patients is useful only if it predicts clinically relevant outcomes accurately on new subjects in various settings. Most existing models consider only dichotomous outcome and have not been tested externally. We developed and validated a rule for prediction of three functional outcome states after severe head injury, using information from day 1. METHODS: The model was developed in a cohort of 304 adults who were admitted to a Dutch trauma center and had survived and remained comatose for >24 hours following severe head injury. We used ordinal logistic regression analysis to predict the extended Glasgow Outcome Scale after > or =12 months, merged into three categories. We preselected five known predictors of outcome and used bootstrapping techniques to avoid statistical overfitting. The performance of the model was subsequently tested in a cohort of 122 patients from an unrelated hospital. RESULTS: The model contained age (p < 0.0001), best motor response on day 1 (p = 0.002), pupil response after resuscitation (p = 0.005), computed tomography findings (p = 0.004), and presence of arterial hypotension (p = 0.37) as predictor variables. In the external validation cohort, the model showed adequate agreement between observed and predicted outcome probabilities (calibration). The model had a good ability to discriminate patients with different outcomes (c-statistic 0.808). The predictive accuracy was 66% when the model was used to classify patients across the three outcome categories. CONCLUSIONS: We have developed a practical model for predicting the probability of death, survival with major disability, and functional recovery in patients who are comatose 24 hours after severe head injury. The model performed well in an external setting, indicating that measures to avoid statistical overfitting were successful.

Adult↗
PubMed2002

[Spanish version of a scale for the assessment of mania: validity and reliability of the Young Mania Rating Scale].

BACKGROUND: The Young Mania Rating Scale is the most widely used tool for the assessment of the intensity of manic symptoms. Unfortunately, to date, there was no Spanish validated version available. This study validated the Spanish version of the YMRS. PATIENTS AND METHOD: A sample of 541 DSM-IV manic or hypomanic bipolar patients were recruited in 56 different psychiatric settings in Spain and assessed with the YMRS by 112 clinicians specifically trained in its use on days 1, 7, 14, 30, 45 and at 3 and 6 months. The mania subscale of the Clinical Global Impression for Bipolar Disorders was also performed in order to have a standard measure to compare our results. Feasibility, reliability, validity and sensitivity of the YMRS were analysed. RESULTS: The YMRS Spanish version showed reliability index of 0.88 (internal consistency) and 0.76 (test-retest reliability), and good internal validity and external (p < 0.001) when compared to the mania subscale of the Modified Clinical Global Impression. The results also showed good sensitivity and feasibility. CONCLUSIONS: The YMRS Spanish Version is a useful, valid and reliable tool for the assessment of manic symptoms.

Bipolar Disorder↗
PubMed2001

Quality programmes, accreditation and certification in Switzerland.

PURPOSE: To report on current quality initiatives in health care in the context of accreditation and certification in Switzerland. SOURCE OF INFORMATION: A review from the Swiss Accreditation Service, the Swiss Medical Association and the University of Zurich. SETTING: In Switzerland, health care providers and health insurers are obliged by law to sign contracts on quality of care. The law texts and related ordinances do not state explicitly the content and format of quality contracts between providers and costs payers. Finding adequate practical solutions is the responsibility of the partners involved. Six different possibilities of quality initiatives are studied and discussed in this report. These include initiatives to create independent certification or inspection bodies for health care organizations accredited by the national accreditation body. FINDINGS: So far, there is only one established standardized system with clear requirements. This accreditation and certification model is an adaptation of the International Standards Organization but so far it has not been used often in the public domain. Each of the other five approaches are more frequently applied but none of them lead to full external peer review certification including medical outcome yet. CONCLUSIONS: A lot of harmonization work still has to be done and clear branch specific requirements need to be agreed upon. Practicability and validity of external peer review schemes may also need further evaluation and improvement to reach the goals of health care systems in the future.

Accreditation↗