Management of evidence and conflict of interest in guidelines on early childhood allergy prevention and child nutrition: study protocol of a systematic synthesis of guidelines and explorative network analysis [version 2; peer review: 2 approved]

Background With the rising prevalence of allergic diseases in children, prevention of childhood allergies becomes an important public health issue. Recently, a paradigm shift is taking place in the approach to preventing allergies, and clinical practice guidelines (CPG) and food-based dietary guidelines (FBDG) play an important role in providing practitioners with the latest evidence and reliable guidance. However, concern about the methodological quality of the development of FBDGs and CPGs, including limitations in the systematic reviews, lack of transparency and unmanaged conflicts of interest (COI), reduce the trust in these guidelines. Methods We aim to synthesize the available guidance on early childhood allergy prevention (ECAP) through a systematic search for national and international CPGs and FBDGs concerning ECAP and child nutrition (CN) and to assess the quality of the guidelines and management of COI. Additionally, we will analyse the content and the evidence base of the recommendation statements. We aim to quantify the COI in guideline panellists and explore possible associations between COI and recommendations. Through a social network analysis, we expect to elucidate ties between panellists, researchers, institutions, industry and other sponsors. Guidelines are an important tool to inform healthcare practitioners with the newest evidence, but quality and reliability have to be high. This study will help identify potential for further improvement in the development of guidelines and the management of COI. If the social network analysis proves feasible and reveals more information on COI in comparison to disclosed COI from the previous analyses, the methodology can be developed further to identify undisclosed COIs in panelists. Ethics and dissemination This research does not require ethical approval because no human subjects are involved. Results will be published in international peer-reviewed open access journals and via presentations at scientific conferences

How do parents access, appraise, and apply health information on early childhood allergy prevention? A focus group and interview study

BackgroundWhen parents want to make health-related decisions for their child, they need to be able to handle health information from a potentially endless range of sources. Early childhood allergy prevention (ECAP) is a good example: recommendations have shifted from allergen avoidance to early introduction of allergenic foods. We investigated how parents of children under 3 years old access, appraise and apply health information about ECAP, and their respective needs and preferences.MethodsWe conducted 23 focus groups and 24 interviews with 114 parents of children with varied risk for allergies. The recruitment strategy and a topic guide were co-designed with the target group and professionals from public health, education, and medicine. Data were mostly collected via video calls, recorded and then transcribed verbatim. Content analysis according to Kuckartz was performed using MAXQDA and findings are presented as a descriptive overview.ResultsParents most frequently referred to family members, friends, and other parents as sources of ECAP information, as well as healthcare professionals (HCPs), particularly pediatricians. Parents said that they exchanged experiences and practices with their peers, while relying on HCPs for guidance on decision-making. When searching for information online, they infrequently recalled the sources used and were rarely aware of providers of “good” health information. While parents often reported trying to identify the authors of information to appraise its reliability, they said they did not undertake more comprehensive information quality checks. The choice and presentation of ECAP information was frequently criticized by all parent groups; in particular, parents of at-risk children or with a manifested allergy were often dissatisfied with HCP consultations, and hence did not straightforwardly apply advice. Though many trusted their HCPs, parents often reported taking preventive measures based on their own intuition.ConclusionOne suggestion to react upon the many criticisms expressed by parents regarding who and how provides ECAP information is to integrate central ECAP recommendations into regular child care counseling by HCPs—provided that feasible ways for doing so are identified. This would assist disease prevention, as parents without specific concerns are often unaware of the ECAP dimension of issues such as nutrition

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Content validity of a culturally adapted checklist for self-assessment of critical incident reporting system audit teams in a Swiss university hospital

Background: Critical Incident Reporting Systems (CIRS) support the analysis of critical incidents and foster quality improvement in healthcare. The analysis of CIRS reports by designated CIRS teams enable organizational learning. To maintain a constructive work flow CIRS teams should be able to self-assess their work. We adapted the checklist used by the Dutch Healthcare Inspectorate to judge the quality of sentinel event analysis reports provided by hospitals.Method: The 26 items of the Dutch checklist were translated into German and culturally adapted to be used in a Swiss university hospital. Relevance and comprehensibility were rated by experts applying the Content Validity Index on item level (I-CVI) and on the checklist level (S-CVI). Five CIRS team members tested the usefulness of the revised checklist and provided feedback which we used to further revise the checklist.Results: Comprehensibility of the 19 items ranged from 58.3 % to 100 %, and the I-CVI ranged between 0.17 and 1.0. The S-CVI achieved a good 0.80. For reasons of clarity we modified, deleted and added items. CIRS team members regarded this further adapted 15-item checklist to be of limited utility.Discussion: The adapted checklist for self-assessment of the CIRS teams' work flow received good ratings for content validity but its usefulness for CIRS teams was found to be limited. The checklist may benefit from further development

What Skills Do Addiction-Specific School-Based Life Skills Programs Promote? A Systematic Review

In school-based addiction prevention, life skills programs (LSPs) have been established since the 1990s. The scientific evidence regarding program effectiveness is in parts unclear. This review links life skills not to behavioral outcomes but to three facets of the self: the affective evaluative, the dispositional & dynamic, and the cognitive descriptive facet of the self. This complements the evidence on behavioral outcomes. In a systematic literature search we have identified drug-specific life skills programs in German language and their evaluation studies. We have mapped the instruments used to assess effectiveness of the LSP on three facets of the self, which are site of action of intrapersonal skills. We identified six comparable life skills programs that have been evaluated at least once. In five of these programs, different facets of life skills have been assessed with a total of 38 different measurement instruments. We found that improvements in affective evaluative and dispositional & dynamic facets of the self could be stimulated by LSPs, complementing previous evidence focusing on behavioral outcomes. Conclusion: Numerous instruments have been used that are not directly comparable but can be categorized by facets of the self. As a result, it is found that life skills programs can have an impact on building attitude and the shaping of intrapersonal skills. Interpersonal competencies such as communication skills and empathy have not been measured. Furthermore, a consensus on measurement instruments for life skills should be found

Clinical effectiveness and cost-effectiveness of central venous catheters treated with Minocycline and Rifampicin in preventing bloodstream infections in intensive care patients [Medizinische Wirksamkeit und Kosteneffektivität von Minocyclin/Rifampicin-beschichteten zentralvenösen Kathetern zur Prävention von Blutbahninfektionen bei Patienten in intensivmedizinischer Betreuung]

[english] The use of central venous catheters coated with antibiotics can avoid bloodstream infections with intensive care patients. This is the result of a scientific examination which has been published by the DIMDI. Costs could be also saved in this way. However, according to the authors, the underlying studies do not allow absolutely valid statements.<br>[german] Der Einsatz bestimmter Antibiotika-beschichteter Venenkatheter kann bei Intensivpatienten Blutbahninfektionen vermeiden. So das Ergebnis einer wissenschaftlichen Untersuchung, die das DIMDI veröffentlicht hat. Auch ließen sich damit Kosten einsparen. Allerdings erlauben, laut den Autoren, die zugrunde gelegten Studien keine uneingeschränkt gültigen Aussagen

Cross-sectional relationship of perceived familial protective factors with depressive symptoms in vulnerable youth

Abstract Background There are multiple negative consequences associated with heavy episodic drinking and close associations between substance abuse and depression, alcohol-intoxicated adolescents (AIA) represent a vulnerable group. We aim to add to the current literature by investigating the cross-sectional relationship of perceived familial protective factors with depressive symptoms in AIA in hospitals, with respect to sex. Depression is among the 10 leading causes of disabilities during childhood and adolescence, with girls being more vulnerable than boys. Considerable evidence reveals a strong association between depression and alcohol abuse. The family provides the possibility to positively influence depressive symptoms. Methods We present cross-sectional data of a German multisite, epidemiological cohort study on AIA. By using youth’s self-reports, we assessed sociodemographic data, as well as data on perceived familial protective factors and depressive symptoms using items of the Communities that Care Youth Survey instrument. We performed descriptive and multigroup analyses to evaluate the measurement invariance of the used instruments. Moreover, to investigate the relationships between the constructs, we used structural equation modelling. Results The study sample comprised 342 AIA, with a mean age of 15.5 years (SD = 1.2; 48.1% girls). The final structural equation model achieved an acceptable model fit of χ2 (69, 342) = 110.056; p = .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.046; SRMR = 0.042, and the rewards for prosocial involvement in the family context correlated significantly negatively with present depressive symptoms, (ß = − 0.540, p <  0.001). The effects were stronger in boys (ß = − 0.576, p <  0.001) than in girls (ß = − 0.519, p <  0.001). Conclusion In vulnerable youth in Germany, depressive symptoms are correlated to good experiences within the family. Future research should assess whether interventions that enhance parental support reduce the risk of depressive symptoms in AIA. Our findings highlight the need for family-based prevention programmes, particularly for AIA with an increased risk of depression

Ranking hospitals for outcomes in total hip replacement - administrative data with or without additional patient surveys? - Part 1: Administrative data

Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part I of the publication, we present the results of the approach based on administrative data. Methods: We used administrative data from the AOK-Lower Saxony of the years 2000, 2001 and 2002. The study population comprised all beneficiaries, who received total hip replacement in the years 2000 or 2001. Performance indicators used where “critical incident (Mortality or revision)” and “number of revisions” within the first year. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries in each of the two years. Multivariate modelling (logistic and poisson regression) was used to estimate the performance indicators by case-mix variables (age, sex, co-diagnoses) and hospital characteristics (hospital size, surgical volume). The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or SMR respectively with respect to a pre-selected reference hospital. The resulting rankings were compared with each other, with regard to temporal stability, and the impact of case-mix variables.Results: About 4500 beneficiaries received total hip replacement in each year (n2000: 4482; n2001: 4579). The ranking included 65 hospitals. Comparing the years 2000 and 2001, the temporal stability of the rankings based on a single performance indicator was low (Spearman rang correlation coefficients 0.158 and 0.191). The agreement of rankings based on different performance indicators in the same year was high (Spearman: 0.80 and 0.85). Including case-mix variables improved the model fit remarkably. Odds ratios for hospitals varied from 0.0 to 10.0 (critical incident) and SMRs from 0.0 to 6.1 (number of revisions). Conclusions: Using data of two adjacent years together improves the reliability of hospital rankings. Adding the administrative data derived patient variables improves the explanation of the performance indicators. Whether this is sufficient to account for case-mix can not be determined at this point. If the case-mix was addressed properly, the rankings showed large differences in the quality of care, raising the need for action. In the second part of the publication, we will discuss, whether administrative data are good enough to provide information on relevant health outcomes and case-mix, or if hospital rankings should be based on additional information from patient surveys