Quality assurance of medical education in the Netherlands: programme or systems accreditation?

Accreditation is an instrument that is used worldwide to monitor, maintain and improve the quality of medical education. International standards have been defined to be used in reviewing and evaluating the quality of education. The organization and the process of accreditation of medical education programmes in the Netherlands and in Flanders are described in some detail. Accreditation can be based on the results of a detailed assessment of an educational programme or on an evaluation of the educational system and the organization of the institution in question. The Flemish-Dutch accreditation organization (NAO) is moving from programme accreditation towards a combination of programme and systems accreditation. The pros and cons of these two approaches are discussed

Angiogenic profile of breast carcinoma determines leukocyte infiltration

To study the relationship between the angiogenic profile and leukocyte infiltration of tumors, single cell suspensions of archival frozen medullary and ductal breast cancer tissues were analyzed by flow cytometry. The amount of leukocytes and endothelial cells was measured, as well as the expression of intercellular adhesion molecule-1 (ICAM-1) on the endothelial cell fraction. A significantly higher number (3.2-fold) of infiltrating leukocytes was observed in medullary carcinoma. The composition of this infiltrate was similar to that seen in ductal carcinomas. The more intense infiltrate was explained by the approximately 3-fold enhanced endothelial ICAM-1 expression in medullary carcinoma. The angiogenic profile of all tumors was assessed by quantitative real-time reverse transcription-PCR analysis. Vascular endothelial growth factor (VEGF)-C and VEGF-D, but not VEGF-A, basic fibroblast growth factor, placental growth factor, and angiopoietins 1, 2, and 3 showed a relatively higher level of expression in ductal carcinoma than in medullary carcinoma. In vitro, both VEGF-C and VEGF-D were found to decrease endothelial ICAM-1 expression in the presence of basic fibroblast growth factor. These data suggest that in vivo angiogenic stimuli prevent the formation of an effective leukocyte infiltrate in tumors by suppressing endothelial ICAM-1 expression