Assessing the quality and completeness of reporting in health systems guidance for pandemics using the AGREE-HS tool.

Background: During health emergencies, leading healthcare organisations, such as the World Health Organization (WHO), the European Centre for Disease Control and Prevention (ECDC), and the United States Centers for Disease Control and Prevention (CDC), provide guidance for public health response. Previous studies have evaluated clinical practice guidelines (CPGs) produced in response to epidemics or pandemics, yet few have focused on public health guidelines and recommendations. To address this gap, we assessed health systems guidance (HSG) produced by the WHO, the ECDC, and the CDC for the 2009 H1N1 and COVID-19 pandemics. Methods: We extracted HSG for the H1N1 and COVID-19 pandemics from the organisations' dedicated repositories and websites. After screening the retrieved documents for eligibility, five assessors evaluated them using the Appraisal of Guidelines Research & Evaluation - Health Systems (AGREE-HS) tool to assess the completeness and transparency of reporting according to the five AGREE-HS domains: "Topic", "Participants", "Methods", "Recommendations", and "Implementability". Results: Following the screening process, we included 108 HSG in the analysis. We observed statistically significant differences between the H1N1 and COVID-19 pandemics, with HSG issued during COVID-19 receiving higher AGREE-HS scores. The HSG produced by the CDC had significantly lower overall scores and single-domain scores compared to the WHO and ECDC. However, all HSG scored relatively low, under the median of 40 total points (range = 10-70), indicating incomplete reporting. The HSG produced by all three organisations received a median score <4 (range = 1-7) for the "Participants", "Methods", and "Implementability" domains. Conclusions: There is still significant progress to be made in the quality and completeness of reporting in HSG issued during pandemics, especially regarding methodological approaches and the composition of the guidance development team. Due to their significant impact and importance for healthcare systems globally, HSG issued during future healthcare crises should adhere to best reporting practices to increase uptake by stakeholders and ensure public trust in healthcare organisations.

Tool to assess recognition and understanding of elements in Summary of Findings Table for health evidence synthesis: a cross-sectional study.

of Findings (SoF) tables concisely present the main findings of evidence synthesis of health evidence, but how users navigate it to understand and interpret the presented information is not clear. We quantified the interaction of medical students with an SoF table while answering a knowledge quiz. Read&Learn tool was used to measure the number of target and non-target table cells visited for each question and the time spent on these cells. Students positively identified target elements for quiz questions and answered simpler questions, but struggled with critical thinking and understanding study outcomes. The question on outcomes with the largest improvement post-intervention had the fewest correct answers, the longest interaction with table cells and the most opened cells before answering. Students spent a median of 72% of the time reading target table cells. A heatmap of the interactions showed that they were mostly answer-oriented. Further development of the tool and metrics is needed to use the tool and the metrics to study the cognitive processes during the assessment of health evidence.

Trends and Predictors of Pediatric Negative Appendectomy Rates: A Single-Centre Retrospective Study.

BACKGROUND: Appendectomy is still the standard treatment for acute appendicitis in the majority of centers. Despite all available diagnostic tools, the rates of negative appendectomies are still relatively high. This study aimed to determine negative appendectomy rates and to analyze the demographic and clinical data of the patients whose histopathology report was negative. METHODS: All patients younger than 18 years who underwent appendectomy for suspected acute appendicitis in the period from 1 January 2012 to 31 December 2021 were included in the single-center retrospective study. Electronic records and archives of histopathology reports were reviewed for patients with negative appendectomy. The primary outcome of this study was a negative appendectomy rate. Secondary outcomes comprehended the rate of appendectomies and the association of age, sex, body mass index (BMI), values of laboratory markers, scoring systems, and ultrasound reports with negative histopathology reports. RESULTS: During the study period, a total of 1646 appendectomies for suspected acute appendicitis were performed. In 244 patients, negative appendectomy was reported regarding the patients' pathohistology. In 39 of 244 patients, other pathologies were found, of which ovarian pathology (torsion and cysts) torsion of greater omentum and Meckel's diverticulitis were the most frequent. Finally, the ten-year negative appendectomy rate was 12.4% (205/1646). The median age was 12 years (interquartile range, IQR 9, 15). A slight female predominance was noted (52.5%). A significantly higher incidence of negative appendectomies was noted in girls, with a peak incidence between the ages of 10 and 15 years (p < 0.0001). Male children whose appendectomy was negative had significantly higher BMI values compared to female patients (p = 0.0004). The median values of white blood cell count, neutrophil count, and CRP in the patients with negative appendectomy were 10.4 × 109/L, 75.9%, and 11 mg/dL, respectively. The median of Alvarado's score was 6 (IQR 4; 7.5), while the median of the AIR score was 5 (IQR 4, 7). The rate of children with negative appendectomy who underwent ultrasound was 34.4% (84/244), among which 47 (55.95%) concluded negative reports. The rates of negative appendectomies were not homogenous in terms of distribution regarding the season. The incidence of negative appendectomies was more frequent during the cold period of the year (55.3% vs. 44.7%; p = 0.042). CONCLUSIONS: The majority of negative appendectomies were performed in children older than 9 years and most frequently in female children aged 10 to 15 years. In addition, female children have significantly lower BMI values compared to male children with negative appendectomy. An increase in the utilization of auxiliary diagnostic methods such as computed tomography could affect the reduction in the pediatric negative appendectomy rate.

Croatian mothers were 11 times more likely to give their newborn infants formula in hospital if they had used it for their older children.

AIM: We determined the prevalence and predictors of formula supplementation for healthy, term newborn infants in hospital. METHODS: A cross-sectional study was conducted from 1 June to 21 October 2020 among Croatian women who gave birth to healthy newborn infants of ≥37 weeks gestation and birth weight of ≥2500 g at the University Hospital of Split, Croatia. The mothers completed a questionnaire on hospital infant feeding practices and breastfeeding self-efficacy. Multinomial logistic regression investigated associations between perinatal factors and formula supplementation. RESULTS: We approached 392 mothers, and 355 (90.6%) were included: 286 (80.6%) said their newborn infant received formula in hospital and it was at their request in 173/286 (60.5%) of cases. The adjusted analyses identified factors associated with increased odd ratios (OR) and 95% confidence intervals (CI) for formula supplementation: no previous breastfeeding experience (OR 9.42, 95% CI 3.51-25.28), breastfeeding difficulties in hospital (OR 9.12, 95% CI 3.46-24.09) and older children who received formula during their birth hospitalisation (OR 11.51, 95% CI 4.4-30.1). Mothers were not routinely notified of the risks. CONCLUSION: An unacceptably high proportion of healthy newborn infants received formula in hospital.