A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]

BACKGROUND: Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. METHODS/DESIGN: To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. DISCUSSION: The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.Jeffrey Braithwaite, Johanna Westbrook, Marjorie Pawsey, David Greenfield, Justine Naylor, Rick Iedema, Bill Runciman, Sally Redman, Christine Jorm, Maureen Robinson, Sally Nathan and Robert Gibber

Long-term valproate treatment increases brain neuropeptide Y expression and decreases seizure expression in a genetic rat model of absence epilepsy

The mechanisms by which valproate, one of the most widely prescribed anti-epileptic drugs, suppresses seizures have not been fully elucidated but may involve up-regulation of neuropeptide Y (NPY). We investigated the effects of valproate treatment in Genetic Absence Epilepsy Rats from Strasbourg (GAERS) on brain NPY mRNA expression and seizure control. GAERS were administered either valproate (42 mg.kg(−1) hr(−1)) or saline continuously for 5 days. Electroencephalograms were recorded for 24 hrs on treatment days 1, 3 and 5 and the percentage of time spent in seizure activity was analysed. NPY mRNA expression was measured in different brain regions using qPCR. Valproate treatment suppressed seizures by 80% in GAERS (p<0.05) and increased NPY mRNA expression in the thalamus (p<0.05) compared to saline treatment. These results demonstrate that long-term valproate treatment results in an upregulation of thalamic expression of NPY implicating this as a potential contributor to the mechanism by which valproate suppresses absence seizures

NPY mRNA expression is increased in the thalamus of valproate treated GAERS.

<p>Representative coronal pictures of dissected tissue from SCx (A); Thal (B); Arc (C). (D) NPY mRNA expression (relative to 18S mRNA expression) was significantly increased in the thalamus of valproate treated GAERS (black bars n = 6) compared to saline treated GAERS (white bars n = 6). Data shown as mean±SEM. *p<0.05 compared to saline controls (two tailed Mann Whitney U test). Thal - thalamus; SCx - Somatosensory cortex; Arc -arcuate nucleus.</p

Five days of valproate treatment suppresses seizures in GAERS.

<p>(A) Representative EEG trace from a GAERS rat showing the characteristic spike-and-wave discharge of an absence seizure. GAERS were given valproate (black bars n = 6; 42 mg.kg-1 hr-1) or saline (white bars n = 6) continuously for 5 days. 24 hour EEG data were collected and the percent of time spent in seizure activity (B), number of seizures per hour (C) and seizure duration (D) was quantified for each animal. A two-tailed Mann Whitney U test at each time point shows that the percentage of time spent in seizure activity (B) and the number of seizures per hour (C) was significantly reduced only after five days of treatment. Data shown as mean±SEM *p<0.05 valproate treatment compared to saline control.</p

Valproate does not affect food intake in GAERS.

<p>Food intake in saline (white bars n = 6) and valproate (black bars n = 6) treated GAERS at baseline and over the 5 day treatment period. There was no significant difference in food intake between GAERS receiving valproate compared to GAERS receiving saline treatment on each day of treatment (p>0.05, two-tailed Mann Whitney U test). Data shown as mean±SEM.</p