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Objectives The aims of this study were to develop a German version of the Early Childhood Oral Health Impact Scale (ECOHIS), a measure of oral health-related quality of life in preschool age children, and to assess the instrument's reliability and validity. Methods The original English version of the ECOHIS questionnaire was translated into German (ECOHIS-G) by a forwardbackward translation method. A total of 336 children aged 0 to 5 years and their caregivers who were recruited at the Department of Paediatric Dentistry in Vienna, Austria, participated in this study. The caregivers completed the ECOHIS-G and their children were clinically examined for the presence of dental caries and plaque accumulation. Reliability of ECOHIS was investigated in a subsample of 59 subjects after 3 weeks. Results Questionnaire summary score test-retest reliability was 0.81 (intraclass correlation coefficient, 95% confidence interval (CI) ranging from 0.68 to 0.89) and internal consistency was 0.83 (Cronbach's alpha, lower limit of the 95% CI 0.80). Validity of the ECOHIS-G questionnaire was supported by correlation coefficients with global ratings of oral health of − 0.42 (95% CI − 0.45 to − 0.35) and overall well-being of − 0.29 (95% CI − 0.34 to − 0.22) which met the expectations. Mean ECOHIS-G scores were statistically significantly higher in children with caries compared with caries-free children. Conclusions The German version of the ECHOHIS was found to be reliable and valid in children aged 0 to 5 years. Clinical relevance These findings enable assessments of oral health-related quality of life in German-speaking preschool children. Keywords Oral health-related quality of life (OHRQoL). Early Childhood Oral Health Impact Scale (ECOHIS). Psychometric properties. Reliability. Validity

Objectives: Value-based healthcare (VBHC) aims at improving patient outcomes while optimizing the use of hospitals' resources among medical personnel, administrations, and support services through an evidence-based, collaborative approach. In this article, we present a blueprint for the implementation of VBHC in hospitals, based on our experience as members of the European University Hospital Alliance. Methods:The European University Hospital Alliance is a consortium of 9 large hospitals in Europe and aims at increasing the quality and efficiency of care to ultimately drive better outcomes for patients. Results:The blueprint describes how to prepare hospitals for VBHC implementation; analyzes gaps, barriers, and facilitators; and explores the most effective ways to turn patient pathways into a process that results in high-value care. Using a patientcentric approach, we identified 4 core minimum components that must be established as cornerstones and 7 organizational enablers to waive the barriers to implementation and ensure sustainability. Conclusion:The blueprint guides through pathway implementation and establishment of key performance indicators in 6 phases, which hospitals can tailor to their current status on their way to implement VBHC.

Oral health‐related quality of life (OHRQoL) is an important dental patient‐reported outcome which is commonly based on 4 dimensions, namely Oral Function, Orofacial Pain, Orofacial Appearance and Psychosocial Impact. The Oral Health Impact Profile (OHIP) is the most used OHRQoL instrument designed for adults; nevertheless, it is used off‐label for children as well. Our aim was to describe the OHRQoL impact on children measured by OHIP and map the information to the 4‐dimensions framework of OHRQoL. A systematic literature review following the PRISMA statement was conducted to include studies assessing OHRQoL of children ≤ 18 years using OHIP. The OHIP seven‐domain information was converted to the OHRQoL 4‐dimension scores accompanied by their means and 95% confidence interval. Risk of bias was assessed using a six‐item modified version of quality assessment tool for prevalence studies. We identified 647 articles, after abstracts screening, 111 articles were reviewed in full text. Twelve articles were included, and their information was mapped to the 4‐dimensional OHRQoL. Most included studies had low risk of bias. OHRQoL highest impact was observed for Oral Function, Orofacial Pain, and Orofacial Appearance for children with: Decayed‐Missing‐Filled‐Surface (DMFS) of ≥10, anterior tooth extraction without replacement and untreated fractured anterior teeth, respectively. Across all oral health conditions, Psychosocial Impact was less affected than the other three dimensions. OHIP has been applied to a considerable number of children and adolescents within the literature. One instrument and a standardised set of 4‐OHRQoL dimensions across the entire lifespan seem to be a promising measurement approach in dental and oral medicine.

Key findings: Despite clear scope, most guidelines for SARS CoV-2 infections and for other care in the context of COVID-19 fell short of basic methodological standards. Only 4% were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). Patients were included in the development of one guideline. A process for regular updates was described in 14%. What this adds to what is known: Our study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. What is the implication/what should change now: An insufficient consideration of appropriate methodologies in the guideline development process could lead to misleading information, uncertainty among the professionals, and potentially harmful actions for patients. This paper provides an important benchmark for the future assessment of the quality of COVID-19 guidelines. Abstract Objective: The number of published clinical practice guidelines related to COVID-19 has rapidly increased. This study explored if basic methodological standards of guideline development have been met in the published clinical practice guidelines related to COVID-19. Study Design and Setting: Rapid systematic review from February 1 st until April 27 th , 2020 using MEDLINE [PubMed], CINAHL [Ebsco], Trip and manual search, including all types of healthcare workers providing any kind of healthcare to any patient population in any setting. Results: There were 1342 titles screened and 188 guidelines included. The highest average AGREE II domain score was 89% for scope and purpose , the lowest for rigor of development (25%). Only eight guidelines (4%) were based on a systematic literature search and a structured consensus process by representative experts (classified as the highest methodological quality). The majority (156; 83%) was solely built on an informal expert consensus. A process for regular updates was described in 27 guidelines (14%). Patients were included in the development of only one guideline. Conclusion: Despite clear scope, most publications fell short of basic methodological standards of guideline development. Clinicians should use guidelines that include up-to-date information, were informed by stakeholder involvement, and employed rigorous methodologies.

Objectives The aims of this study were to develop a German version of the Child Perceptions Questionnaire for children aged 8 to 10 years (CPQ-G8-10), a measure of oral health-related quality of life, and to assess the instrument's reliability and validity. Methods The original English version of the CPQ8-10 questionnaire was translated into German (CPQ-G8-10) by a forwardbackward translation method. A total of 409 8-to 10-year-old children who were recruited at the Department of Paediatric Dentistry in Vienna, Austria, participated in this study. The children self-completed the CPQ-G8-10 and were clinically examined for the presence of dental caries and plaque accumulation. Reliability of CPQ-G8-10 was investigated in a subsample of 58 children after 3 weeks. Results Questionnaire summary score test-retest reliability was 0.85 (intraclass correlation coefficient, 95% confidence interval (CI) ranging from 0.75 to 0.91) and internal consistency was 0.88 (Cronbach's alpha, lower limit of the 95% CI: 0.87). Validity of the CPQ-G8-10 questionnaire was supported by correlation coefficients with global ratings of oral health of − 0.40 (95% CI − 0.49 to − 0.31) and overall well-being of − 0.26 (95% CI − 0.33 to − 0.13) which met the expectations. Mean CPQ-G8-10 scores were statistically significantly higher in children with caries (dmft+DMFT > 0) compared with caries-free children (p = 0.02). Conclusions The German version of the CPQ8-10 was found to be reliable and valid in children aged 8 to 10 years. Clinical relevance These findings enable assessments of oral health-related quality of life in German speaking 8-to 10-year-old children.

BackgroundIt is estimated that 50–70% of patients with rheumatoid arthritis (RA) are non-adherent to their recommended treatment. Non-adherent patients have a higher risk of not reaching an optimal clinical outcome. We explored factors associated with nonadherence from the patient’s perspective.MethodsFour hundred and fifty-nine RA patients (346 (75.4%) females; mean age 63.0 ± 14.8 years) who failed to attend follow-up visits in two rheumatology centres were eligible to participate in a qualitative interview study. We used this strategy to identify patients who were potentially non-adherent to medicines and/or non-pharmacological interventions. By means of meaning condensation analysis, we identified new and some already well known insights to factors associated with non-adherence. We used the capability, opportunity, and motivation model of behaviour (COM-B) model as a frame of reference to classify the factors.ResultsForty-three of 131 patients (32.8%) who agreed to participate in the qualitative interviews were found to be non-adherent. New insights on factors associated with non-adherence included strong opinions of patients, such as pain being considered as an indicator of hard work and something to be proud of, or inflammation being a natural process that should not be suppressed; feeling not to be in expert’s hands when being treated by a physician/health professional; the experience of excessive self-control over the treatment; and rheumatologists addressing only drugs and omitting non-pharmacological aspects. The COM-B model comprehensively covered the range of our findings.ConclusionsThe new insights on factors associated with non-adherence allow a better understanding of this phenomenon and can substantially enhance patient care by helping to develop targeted interventions.Electronic supplementary materialThe online version of this article (10.1186/s13075-018-1732-7) contains supplementary material, which is available to authorized users.

Background Limited evidence exists for intergenerational interventions to promote health and well-being in older adults and preschool children. We therefore aimed to evaluate the implementation, feasibility and outcome of an intergenerational health promotion program based on psycho-motor activity. Methods A multicenter mixed-methods study with preschool children and older adults as equivalent target-groups, and professionals and parents as additional informants was conducted in Austria. The study included a needs assessment, a pilot phase with a formative process evaluation and a subsequent rollout phase to evaluate the outcome and the adapted processes of the intervention program. To analyze the qualitative data, a modified form of the framework method was applied. Quantitative data were collected with a time-sampling method and were analyzed using descriptive and inferential statistical procedures. Results One hundred ninety-six participants (93 older adults [54 to 96 years old, 83% female], 78 children [2 to 7 years old, 58% female], 13 professionals and 12 parents) from 16 institutions (eight kindergartens and eight geriatric facilities) were included in the study. The qualitative process evaluation revealed several aspects for improvement of the intervention program. Well-being as measured by observing spontaneous intergenerational contacts ( p < 0.001) and facial expressions (effect size r = 0.34; p < 0.001) showed a significant increase between the rollout baseline and follow-up assessments. Conclusions Professionals in geriatric institutions and kindergartens could facilitate interactions between members of the different generations by offering an intergenerational intervention program based on psycho-motor activities in the future. Electronic supplementary material The online version of this article (10.1186/s12889-019-6572-0) contains supplementary material, which is available to authorized users.