Pediatric Emergency Medicine Training: A Survey of Current Status in Latin America.

Pediatric emergency medicine (PEM) is a relatively new and rapidly evolving subspecialty in many countries. The purposes of this study were to describe the characteristics and to find common/shared practices in current available PEM fellowship programs across Latin America. METHODS: An electronic, multicenter survey was created and stored on Google forms. The survey was in Spanish language and included 30 questions about the characteristics of the pediatric emergency program, history of the program, and support expected from the Latin American Pediatric Emergency Society. RESULTS: A total of 11 PEM programs in 6 countries were acknowledged in Latin America. All programs are placed in pediatric tertiary care hospitals. All PEM programs were approved by the local universities and the Ministries of Health in each country. Difficulties to start a PEM program included a lack of physicians properly trained in PEM who could direct the program, physician instructors in specific topics, places to complete rotations of the future fellows, and getting the local health authorities to acknowledge the importance of the program. With regard to the duration of the program, 72.7% (8) have a 2-year curriculum and 27.3% (3) have a 1-year curriculum. Four (36.4%) program directors mentioned an admission examination as a requirement, 4 (36.4%) needed an examination plus an interview, 3 (27.3%) mentioned that it is necessary just like an interview, and 2 (18.2%) mentioned that the physicians are admitted with a scholarship. With regard to the structure of the programs and rotations included, most of the programs have rotations that are compulsory in different pediatric subspecialties. In 80% of the programs, fellows are evaluated based on different technical skill procedures that they need to learn and perform during PEM fellowship training. The PEM fellowship is recognized by different societies in emergency medicine and pediatrics, except in Dominican Republic where it is only recognized by the Ministry of Health and the university. After completion of the program in 90% (10) of the programs, graduates are not guaranteed a job, and in half, there is no mechanism implemented for recertification of the pediatric emergency physicians by the local medical council. CONCLUSIONS: In Latin America, postgraduate programs in pediatric emergencies are a response to a need for health systems. Being an innovative specialty, it surpassed each country's own challenges, until it was able to reach an internationally standardized level, with a great diversity of pedagogical methodology, which the product has been to offer a high quality of emergency care to children.

Relación de la industria farmacéutica con los médicos residentes de la República Dominicana / Relationship of the Pharmaceutical Industry with the Medical Residences of the Dominican Republic

Introducción: las relaciones médicas con la industria farmacéutica son cada vez más complejas y los desafíos éticos que plantea son reales. Objetivo: conocer la relación que existe entre la industria farmacéutica con los médicos residentes del país y el impacto que pudiera tener esta relación. Material y Métodos: estudio descriptivo transversal mediante encuesta electrónica anónima. Se consideró la participación si confirmaban el llenado de la encuesta, que estuvo disponible durante abril y mayo de 2019. Se realizó un análisis descriptivo y se aseguró la confidencialidad y el anonimato de los datos. Resultados: se encuestaron 77 médicos residentes del país; 55.8 % recibe semanalmente visita del representante farmacéutico. Al menos cinco veces al año recibieron obsequio (49.4 %), participaron en comida, cena u otro eventosocial (48.1 %), participó en charla financiada por empresa farmacéutica (57.1 %). 40.3 % recibieron una vez al año el pago por parte de la industria farmacéutica, de inscripción/ viaje a algún evento (congreso, jornada, etc.). Están de acuerdo en que los regalos/propuestas de la industria farmacéutica influyen en la prescripción de los medicamentos (20.8 %), considera bien aceptar pago de eventos (45.4 %), refirieron que en su residencia se suelen aceptar regalos y ofertas y no ha tenido un espacio formativo sobre relaciones con la industria farmacéutica (89.6 %). Conclusión: existe un alto nivel de contacto de los médicos residentes con la industria farmacéutica, es necesario más y mejor formación en manejo de conflictos de intereses en la práctica profesional.

Introduction: Medical relationships with the pharmaceutical industry are increasingly complex and the ethical challenges it poses are real. Objective: To know the relationship that exists between the pharmaceutical industry and the resident doctors of the country and the impact that this relationship could have. Material and Methods: Cross-sectional descriptive study, through anonymous electronic survey participation was considered if they confirmed the completion of the survey that was available during April and May 2019. A descriptive analysis was conducted and the confidentiality and anonymity of the data was ensured. Results: 77 resident physicians of the country were surveyed; 55.8% receive a weekly visit from the pharmaceutical representative. At least 5 times a year they received a gift (49.4%), participated in a meal, dinner or other social event (48.1%), participated in a talk funded by a pharmaceutical company (57.1%). 40.3% received once a year the payment by the FI, of registration / trip to an event (congress, day, etc.). They agree that the gifts / proposals of the pharmaceutical industry influence the prescription of the medicines (20.8%), consider accepting payment of events (45.4%), they said that in their residence they usually accept gifts and offers of the pharmaceutical industry and has not had a training space on relations with the pharmaceutical industry (89.6%). Conclusion: There is a high level of contact of resident physicians with the Pharmaceutical Industry, it is necessary more and better training in handling conflicts of interest in professional practice

Consenso de Recomendaciones Para El Traslado Interhospitalario de pacientes sospechosos/confirmados con COVID-19: Grupo de trabajo de Transporte De La Sociedad Latinoamericana de Emergencias Pediátricas (SLEPE)

RESUMEN El transporte del paciente pediátrico en estado crítico en tiempos de COVID 19 representa un desafío, especialmente en un entorno de recursos limitados. Es posible que los hospitales regionales en muchas partes del mundo no estén completamente equipados para tratar a niños con necesidades médicas complejas y en casos de infección por coronavirus. En muchos casos, los equipos de transporte deben tomar decisiones complejas durante todo el proceso, desde la llamada inicial al hospital receptor y la atención del paciente. Los niños en un entorno de recursos limitados tienen un mayor riesgo de eventos adversos y deterioro clínico. El objetivo de este documento es estandarizar aspectos relacionados con el transporte de pacientes sospechosos / confirmados de COVID-19, a fin de reducir el riesgo de transmisión durante el proceso, proteger al personal de salud, evitar el deterioro fisiológico de los pacientes durante el transporte y el posterior contagio de otros pacientes que puedan ser trasladados en la ambulancia.

ABSTRACT Transporting the critically ill pediatric patient in times of COVID 19 is challenging, especially in a resource-limited setting. Regional hospitals in many parts of the world may not be fully equipped to treat children with complex medical needs and coronavirus infection. In many cases, transportation teams must make complex decisions throughout the care process, from the initial call at the receiving hospital to all aspects of caring for the patient. Children in a resource-limited setting are at increased risk for adverse events and clinical decline. The purpose of this document is to standardize aspects related to the transport of suspected / confirmed COVID-19 patients, in order to reduce transmission risk during the process, protect health-care personnel, avoid clinical deterioration of patients during transport and prevent subsequent virus transmission to other patients who may later be transferred in the same ambulance.