María Fabiana Ossorio

Evaluación de la producción científica en la residencia de pediatría

INTRODUCTION Despite the impact that training in research could have in postgraduate programs, certain specific knowledge of the trainees may increase their scientific production. We described the scientific production of a pediatric residency, and evaluated its association with specific knowledges and activities. METHODS We developed a cross-sectional study, by self-administered survey to pediatric residents. The number of participations in research projects was registered, as well as certain specific knowledges and activities (informatics, English language, research methodology, university teaching positions). This association was assessed by logistic regression. RESULTS We interviewed 122 pediatric residents (first year: 22.1%, second year: 23.1%, third year: 19.1%, fourth year: 24.6%, chiefs residents: 9%, instructors: 3.3%). A total of 311 participations in research were registered (there could be more than 1 author in them). From them, 105 were presented at scientific meetings and 16 were published. Length of service and having a university teaching position were independent predictors for presentation (OR= 6.3 and 2.8, respectively) and publication (OR= 4.2 and 6.5, respectively). CONCLUSION Scientific production reached presentation at meetings in 33% of participations and publication, in 5%. Having a university teaching position was significantly associated with scientific production.

Validación de una herramienta de predicción clínica simple para la evaluación de la gravedad en niños con síndrome bronquial obstructivo

INTRODUCTION Acute lower respiratory infection in children usually causes Bronchial Obstructive Syndrome, which could include hipoxemia. Although pulse oximetry (SaO2) is the gold standard to evaluate hipoxemia, it is usually estimated from a clinical score not yet validated. We aimed to validate the respiratory distress score used in Argentina and to compare its performance with the one used in Chile. METHODS We included 200 children aged under 2 years, with Bronchial Obstructive Syndrome. On admission SaO2 and, Argentinean and Chilean scores components (respiratory rate, heart rate, wheezing, chest indrawing, cyanosis) were assessed. We evaluated the score components ability to predict hipoxemia (SaO2 < or = 95 and SaO2 < or = 91) by logistic regression. Correlation between Argentinean score and SaO2 was estimated. The best threshold of both scores to predict hipoxemia was calculated by ROC curve. Sensitivity, specificity, predictive values and likelihood ratios of both scores to predict hipoxemia were calculated. RESULTS Chest indrawing was an independent predictor of hipoxemia (SaO2 < or = 95 and SaO2 < or = 91) (OR: 3.1 IC95%:1.6-5.9 and OR: 13.8 IC95%:1.8-105.4, respectively). The Argentinean score showed acceptable correlation with SaO2 (Spearman: -0,492; p< 0,0001). On SaO2 < or = 91 the Argentinean score showed the best diagnostic performance (auc= 0.904). An Argentinean score > or = 5 was the best threshold to predict hipoxemia (Sensitivity= 100%, specificity= 54.3%). The Chilean score was also evaluated, showing a performance slightly worst than the Argentinean. CONCLUSION An Argentinean score > or = 5 points was sensitive enough to predict hipoxemia (SaO2 < or = 91). This score only allowed identifying children who does not benefit from supplementary oxygen.

Evaluación de dos métodos estandarizados de interpretación de radiografías de tórax en niños con neumonía

OBJECTIVE To evaluate the accuracy of World Health Organization (WHO) method of interpreting chest radiographs on identifying young children with bacterial pneumonia, and to compare its accuracy with other method. METHODS Chest radiographs from children aged under 5 years old hospitalized for pneumonia, with microbiological evidence of bacterial or viral infection, were evaluated by 3 observers blinded to other data (pediatrician [P], pulmonologist [N], radiologist [R]) according to WHO and Khamapirad scores. A WHO score=1 and a Khamapirad score >2 were selected as the thresholds suggesting bacterial pneumonia. The relationship between radiographic scores and etiology was evaluated using chi square. Sensitivity (Se), specificity (Sp), positive (PPV) and negative (NPV) predictive values for predicting bacterial pneumonia were calculated. Interobserver agreement (P vs. N vs. R) was calculated (kappa). RESULTS 108 chest radiographs were evaluated (87 viral, 21 bacterial). WHO score= 1 was associated with bacterial pneumonia (p <0.001; OR= 6.4; CI 95%= 1.629.7), achieving a Se= 85%, Sp= 51%, PPV= 30%, NPV= 93%. Khamapirad score >2, evaluated by P, was also associated with bacterial pneumonia (p <0.0008; OR= 6.31; CI 95%= 1.8-24.4), achieving a Se= 80%, Sp= 59%, PPV= 32% NPV= 92%. Interobserver agreement was slightly better using WHO score (P vs. N= 0.82, P vs. R= 0.69, N vs. R= 0.85) than Khamapirad score (P vs. N= 0.48, P vs. R= 0.69, N vs. R= 0.82). CONCLUSIONS Both methods showed similar accuracy in order to identify bacterial pneumonia. WHO score is simpler than Khamapirad score and showed a better interobserver agreement.

Eficacia y seguridad de una regla de decisión para orientar el tratamiento en niños con neumonía vacunados contra neumococo: Un ensayo clínico controlado

INTRODUCTION Although most cases of pneumonia in children younger than 5 years old have a viral nature, in everyday practice, they are frequently treated with antibiotics. A clinical decision rule (BPS:Bacterial Pneumonia Score) proved to be effective for identifying which children with pneumonia required antibiotics, but its performance has not been assessed in the population vaccinated against pneumococcal disease. Our objective was to assess whether using the BPS would allow to reduce antibiotic use compared to routine management of children with community acquired pneumonia vaccinated against pneumococcal disease. MATERIAL AND METHODS Randomized, controlled, partially-blinded clinical trial with parallel groups comparing two approaches in the management of children aged 3-60 months old in an outpatient setting because of pneumonia, who had been vaccinated with the pneumococcal conjugate vaccine.The BPS group received antibiotics with a BPS >4 points; while the control group was administered antibiotics at the discretion of the treating physician. The estimated sample size was calculated as, at least, 30 patients per group. The rate of antibiotic use and the clinical course were compared in both groups. RESULTS Sixty-five patients (33 in the BPS group and 32 in the control group) were included; their average age was 17.5 months old. Antibiotic use was significantly higher in the control group than in the BPS group (21/32 versus 9/33; OR: 5.09; 95% CI: 1.57-16.85; p= 0.001). Seven patients had an unfavorable course (three in the BPS group, and four in the control group). CONCLUSION The use of the BPS allowed to reduce antibiotic use in the initial management of patients with pneumonia vaccinated against pneumococcal disease, without increasing the probability of an unfavorable course of the disease.

Seguridad de una regla de predicción para el manejo inicial de niños con neumonía tratados en forma ambulatoria

INTRODUCTION: Despite many cases of pneumonia in children are due to viruses, initial management includes antibiotics. To avoid unnecessary antibiotic use, a clinical rule to predict etiology in children hospitalized for pneumonia was developed (BPS: Bacterial Pneumonia Score), but it performance in ambulatory settings has not been yet tested. We aimed to evaluate the safety of using BPS in children with pneumonia in an ambulatory setting. METHODS: This cohort study included children aged 3-60 months, assisted for pneumonias as outpatients. BPS (range: -3 to 15 points) was calculated in all of them, and only those with ≥ 4 points received antibiotics. Clinical outcome was evaluated 1, 2, 3, 5, 7, and 10 days after the first visit. RESULTS: 108 patients were included, aged 25.3 ± 16.5 months. From them, 48 (44.4%) showed BPS ≥ 4, and received antibiotics. After 10 days, there were no differences in clinical outcome between groups (with and without antibiotics) (p = 0.5; RR: 0.39; IC 95%: 0.01-5.74). Only 3 patients showed unsatisfactory clinical outcome; 1 of them had not received antibiotics. CONCLUSIONS: Using BPS was safe for initial management of children with pneumonia in an outpatient setting.

Seasonality of respiratory syncytial virus in Buenos Aires. Relationship with global climate change.

INTRODUCTION Global climate change circulation pattern respiratory syncytial virus (RSV). We assessed whether RSV season has changed over the past 20 years and its correlation with mean annual temperature. METHODS Cross-sectional study that included records of RSV and temperatures from Buenos Aires (1995-2014). RSV season onset, offset and duration, and its correlation with mean annual temperature were described for each year. RESULTS A total of 8109 RSV infections were identified. The duration of RSV season reduced significantly (1995: 29 weeks vs. 2014: 17 weeks; R: 0.6; p < 0.001) due to an early ending (1995: week 45 vs. 2014: week 33; R: 0.6; p < 0.001). No correlation was observed between mean annual temperature and RSV season start, end and duration. CONCLUSIONS Over the past 20 years, RSV season shortened significantly, but no correlation with temperature was observed.

Evaluación de una prueba para valorar el razonamiento clínico en diferentes niveles de capacitación médica

Background: MATCH (Measuring Analytical Thinking in Clinical Health Care) is an instrument to evaluate clinical reasoning. Aim: To assess MATCH performance in professionals and students with different training in pediatrics. Material and Methods: MATCH was administered to medical students (S), frst (R1) and third (R3) year residents and staff physicians (P). We evaluated the score and time required to achieve it, according to training level in pediatrics. Results: Eighty fve subjects were included (23 S, 28 R1, 17 R3 y 17 P), achieving 37.4 ± 6.0 points, in 25.2 ± 8.5 minutes. There were significant differences in score and time, according to training level. There was a positive correlation between training level and score (Rho = 0.515; p < 0.001), and a negative one between training level and time (Rho = -0.589; p < 0.001). Conclusions: More experienced and trained professionals had a better performance in a clinical analytical thinking test.

Changes in PubMed affiliation indexing improved publication identification by country

Publications are often used to estimate the biomedical scientific production of an institution or country. Through its “affiliation” filter PubMed is a useful open-access tool for this purpose. In 2013 this filter was modified, beginning to include all authors. To estimate the impact of this modification we carried out the same search strategy before and after the change took place. We evaluated publications in PubMed from the 2010–2012 and 2014–2016 periods. Using the “affiliation” filter, we identified publications from three countries from different continents, with similar income level and number of scientific publications: Argentina, Thailand, and South Africa. We compared the slopes of both periods for each country and for the total references in PubMed. Regarding the number of publications, Argentina, Thailand and South Africa showed a significantly steeper slope in the 2014–2016 period versus 2010–2012 period, while the slopes of the total number of publications in PubMed showed no difference between periods. The inclusion of all authors in affiliation indexing by PubMed significantly impacts the evaluation of the scientific production of countries, reducing under-registration.

Aplicación del Examen Clínico Objetivo Estructurado en la residencia de Pediatría de la Ciudad de Buenos Aires

INTRODUCTION The Objective Structured Clinical Examination (OSCE) is considered the reference standard for competence evaluation, but its use in Latin America is limited. The City of Buenos Aires Government (CBAG) administers a Paediatric residency system that includes 400 residents distributed in 13 hospitals, sharing an admission system and education program. We aim to describe the experience of administering an OSCE for evaluating all the Paediatric residents of the CBAG. SUBJECTS AND METHOD Descriptive study, including all paediatric residents of the CBAG, belonging to 13 hospitals (2 paediatric and 11 general), ending their first year of training. The OSCE included 10 stations. RESULTS Eighty-five residents participated in the OSCE, and 88.2% (95% CI 79.7-93.5) passed the examination. There were no significant differences in the pass rate between residents from paediatric hospitals and from general hospitals (89.5 vs. 85.7%; OR=1.4; 95% CI 0.4-5.5; P=.8). CONCLUSIONS In 2015, the OSCE was administered to all paediatric residents of the CBAG for the first time. This experience allowed identifying weaknesses in the education system, in order to develop strategies to overcome them.

Publicación de trabajos presentados en los Encuentros Nacionales de Investigación Pediátrica de la Sociedad Argentina de Pediatría: factores involucrados

OBJECTIVE To estimate the proportion of abstracts presented at National Pediatric Research Meetings that are fully-published and describe their design and factors that influence nonpublication. METHODS Descriptive and analytical study including all abstracts presented at National Pediatric Research Meetings (1998-2011). One author per study was identified and asked to complete a survey on its design, publication and factors associated with non-publication. RESULTS Out of 746 abstracts that were submitted, the authors of 522 (70%) completed the survey. Among these, 84.3% were observational studies and 15.7%, experimental; 34% had received funding. Two hundred and seventeen abstracts were published subsequently (41.5%, 95% confidence interval [CI]: 37.3-45.9). Funded studies had better chances of being published (odds ratio [OR]: 2, 95% CI: 1.4-2.9, p 〈 0.001). Lack of time, insufficient sample size, and problems with funding were referred as the most common reasons for failure to publish. CONCLUSIONS Among allabstracts presented at National Pediatric Research Meetings, 41.5% were fully published. Lack of time was the most common reason for unpublished studies.