Validation of an instrument for the evaluation of exchange transfusion (INEXTUS) via an OSCE.

INTRODUCTION: Exchange transfusion is the treatment of choice for patients with severe hyperbilirubinemia who do not respond to phototherapy. This procedure is highly complex and requires substantial expertise to perform, however it´s not done frequently enough to guarantee adequate training. Traditional learning scenarios do not have a space reserved for teaching this procedure or an instrument that fully and objectively evaluates the skills that a professional must acquire.  OBJECTIVES: The purpose was to construct and evaluate the INEXTUS instrument´s validity evidence relevant to internal structure, in a simulated scenario through the performance of an objective structured clinical exam (OSCE).  MATERIALS AND METHODS: The Delphi consensus methodology was utilized to design the instrument; six experts participated through three rounds using the Google Forms platform. The categories and items previously obtained were subjected to validation by nine experts through a dichotomous survey. Prior to data collection, the evaluators were trained through a pilot test with 10 medical students. Subsequently, all residents of a paediatric programme were evaluated through the OSCE methodology in a simulated scenario, with 6 stations, of a clinical case of a new-born with an explicit need for exchange transfusion. During their participation in the scenario, the residents were first evaluated with the instrument developed. Additionally, audio and video filming of all students who participated was performed with the aim of conducting a second evaluation two weeks after the first four evaluators participated. RESULTS: The final INEXTUS instrument consists of 46 subitems grouped into 23 items divided into 6 categories, demonstrating an inter-rater intraclass correlation coefficient of 0.96 (95% CI 0.94, 0.98 p-value < 0.001). For the Fleiss Kappa of the 23 items evaluated, concordance was evaluated for 14 items but could not be determined for the 9 remaining items because all the ratings were equal, either because the items were not performed or they were all performed adequately. Of the 14 items, 9 good scores were obtained (95% CI 0.61 to 0.8; p value < 0.001), and 5 very good scores were obtained (95% CI 0.81 to 1; p value < 0.001). CONCLUSIONS: The INEXTUS instrument evaluates exchange transfusion skills in medical personnel in training in simulated scenarios using the OSCE methodology; it has high validity and reliability and is a high-impact educational tool.

[Precision medicine for the diagnosis of neonatal sepsis: systematic review and meta-analysis]. / Medicina de precisión para el diagnóstico de sepsis neonatal: Revisión sistemática y metaanálisis.

BACKGROUND: Current biomarkers for the diagnosis of neonatal sepsis llave limited accuracy. The development of precision medicine based on omic's technologies offer an opportunity to improve the diagnosis of neonatal sepsis. AIM: To evalúate the sensitivity and specificity of tests based on omic technologies (metabolomics, proteomics and genomics) for the diagnosis of neonatal sepsis. METHODS: A systematic review was carried out in electronic databases. Observational studies and clinical trials evaluating tests based on omic technologies in neonates compared to culture for the diagnosis of neonatal sepsis were included. For the meta-analysis, a random effects model and an evaluation of heterogeneity were proposed through a subgroup analysis by omic test, gestational age and time of establishment of sepsis. RESULTS: Differential expression of the genome, proteome and metabolome is observed between neonates with and without sepsis, identifying different biomarkers. The meta-analysis showed a pooled summary measure for sensitivity of0.88 (95% CI 0.72, 0.96), specificity of0.76 (95% CI 0.62, 0.85). CONCLUSION: Omics-based tests have a high sensitivity, with the best performing ones being those based on genomics / transcriptomics. The studies have high heterogeneity.

Unexpected low genetic variation in the South American hystricognath rodent Lagostomus maximus (Rodentia: Chinchillidae).

The South American plains vizcacha, Lagostomus maximus inhabits primarily the Pampean and adjoining Espinal, Monte and Chaquenean regions of Argentina. In order to study the population genetic structure of L. maximus, a fragment of 560 bp of the mitochondrial DNA hypervariable region 1from 90 individuals collected from the 3 subspecies and 8 groups along Argentina was amplified and analyzed. We found 9 haplotypes. The haplotype network did not show an apparent phylogeographical signal. Although low levels of genetic variation were found in all the subspecies and groups analyzed, a radiation of L. maximus would have occurred from the North and Center of the Pampean region toward the rest of its geographic range in Argentina. Low levels of genetic diversity, the existence of a single genetically distinct population in Argentina and changes of its effective size indicate that metapopulation processes and changes in human population dynamics during the late-Holocene were important factors shaping the population genetic structure of L. maximus in Argentina.

Medicina de precisión para el diagnóstico de sepsis neonatal: revisión sistemática y metaanálisis / Precision medicine for the diagnosis of neonatal sepsis: systematic review and meta-analysis

ANTECEDENTES: Los biomarcadores actuales para el diagnóstico de sepsis neonatal tienen una exactitud limitada. El desarrollo de la medicina de precisión basada en tecnologías ómicas ofrece una oportunidad para mejorar el diagnóstico de la sepsis neonatal. OBJETIVOS: Evaluar la sensibilidad y especificidad de las pruebas basadas en tecnologías ómicas (metabolómica, proteómica y genómica/transcriptómica) para el diagnóstico de sepsis neonatal. METODOLOGÍA: Se realizó una revisión sistemática en bases de datos electrónicas. Se incluyeron estudios observacionales y ensayos clínicos que evaluaran las pruebas basadas en tecnologías ómicas en neonatos comparado con el cultivo para el diagnóstico de sepsis neonatal. Dos revisores independientes realizaron la evaluación de la calidad de los estudios y la extracción de los datos. Para el metaanálisis se realizó un modelo de efectos aleatorios y se planeó una evaluación de la heterogeneidad a través de un análisis de subgrupos por prueba ómica, edad gestacional y tiempo de establecimiento de la sepsis. RESULTADOS: Se observa expresión diferencial del genoma, proteoma y metaboloma entre los neonatos con y sin sepsis, identificando diferentes biomarcadores. El metaanálisis mostró una medida de resumen combinada para la sensibilidad de 0,88 (IC 95% 0,72-0,96), especificidad de 0,76 (IC 95% 0,62-0,85). CONCLUSIÓN: Las pruebas basadas en ómicas tienen una alta sensibilidad, siendo las de mejor rendimiento las basadas en genómica/transcriptómica. Los estudios tienen alta heterogeneidad.

BACKGROUND: Current biomarkers for the diagnosis of neonatal sepsis llave limited accuracy. The development of precision medicine based on omic's technologies offer an opportunity to improve the diagnosis of neonatal sepsis. AIM: To evalúate the sensitivity and specificity of tests based on omic technologies (metabolomics, proteomics and genomics) for the diagnosis of neonatal sepsis. METHODS: A systematic review was carried out in electronic databases. Observational studies and clinical trials evaluating tests based on omic technologies in neonates compared to culture for the diagnosis of neonatal sepsis were included. For the meta-analysis, a random effects model and an evaluation of heterogeneity were proposed through a subgroup analysis by omic test, gestational age and time of establishment of sepsis. RESULTS: Differential expression of the genome, proteome and metabolome is observed between neonates with and without sepsis, identifying different biomarkers. The meta-analysis showed a pooled summary measure for sensitivity of0.88 (95% CI 0.72, 0.96), specificity of0.76 (95% CI 0.62, 0.85). CONCLUSION: Omics-based tests have a high sensitivity, with the best performing ones being those based on genomics / transcriptomics. The studies have high heterogeneity.

Caracterización sobre la toma de decisiones éticas en las unidades de cuidado neonatal por parte de pediatras y neonatólogos / Characterization of making ethical decisions in neonatal care units by pediatricians and neonatologists / Caracterização em relação à deliberação ética nas unidades de cuidados neonatais por pediatras e neonatologistas

Introducción: Ha aumentado la sobrevida de los neonatos críticamente enfermos, lo que ha llevado a los profesionales encargados del cuidado de estos bebés a enfrentar frecuentemente decisiones éticas. En el presente trabajo se plantea el objetivo de caracterizar las situaciones éticas que enfrentan, el criterio que utilizan y la forma en que se toman las decisiones en los dilemas éticos por parte de los pediatras y neonatólogos. Métodos: Se realizó un estudio de corte transversal. Se invitaron a participar 87 neonatólogos y/o pediatras que quisieran contestar de forma voluntaria la encuesta para la caracterización y trabajaran en unidades neonatales de Chía y Bogotá entre el 1 de octubre de 2014 y 31 de enero de 2015, de los cuales aceptaron participar 45 profesionales (51.7%). Se realizó un análisis exploratorio de los datos, utilizando estadística descriptiva. Resultados: De los profesionales que contestaron la encuesta, el 100.0% se ha enfrentado a problemas éticos, el 60.0% han recibido algún tipo de capacitación en bioética, 33.0% se apoya en comités de ética, 98.0% tienen algún límite de viabilidad para iniciar reanimar y el 93.0% ha limitado el esfuerzo terapéutico; el 98.0% incluye a los padres en las decisiones y registra la decisión en la historia clínica. Conclusiones: Son frecuentes los conflictos éticos en la unidad neonatal. La mayoría cuenta con capacitación y comité de ética para la toma de decisiones. Entre los especialistas hay opiniones heterogéneas sobre ciertos problemas éticos en las unidades neonatales.

The survival of critically ill neonates has increased, which has led to professional caregivers of these babies to face ethical decisions about it. This paper outlines the aim of characterizing ethical situations that caregivers face, the criterion they use and how decisions on ethical dilemmas are taken by Pediatricians and Neonatologists. Methodology: A cross-sectional study was performed. 87 neonatologists and/or Pediatricians, who work in neonatal care units in Chia and Bogota between October 1 of 2014 and January 31 of 2015, were invited to participate and answer a characterization survey voluntarily, but only 45 professionals (51.7%) agreed to take part in it. An exploratory data analysis was performed by using descriptive statistics. Results: Professionals who answered the survey, 100.0% of them has faced ethical problems, 60.0% of them has received some training in bioethics, 33.0% relies on ethics committee, 98.0% has a viability limit to start reanimating and 93.0% has limited the therapeutic effort; 98.0% includes parents in decisions and registers the decision in the medical record. Conclusions: Ethical conflicts in the neonatal care unit are frequent. Most professionals have training and an ethics committee for decision-making. Among the specialists there are heterogeneous views on certain ethical problems in neonatal care units.

Introdução: O aumento da sobrevivência de recém-nascidos criticamente doentes, o que levou a cuidadores profissionais para esses bebês muitas vezes enfrentam decisões éticas. Objetivo: Neste trabalho é caracterizar as situações éticas e os critérios utilizados por pediatras e neonatologistas no jeito como tomam as decisões, frente aos dilemas éticos surgidos. Métodos: O estudo realizado foi de tipo transversal. De 87 neonatologistas e / ou pediatras convidados a participar no estudo realizado entre 01 de outubro de 2014 e 31 de janeiro de 2015, 45 profissionais (51,7%), que trabalham nas unidades neonatais de Chia e Bogotá (Colȏmbia), aceitaram livremente responder as perguntas. Os dados foram estudados por meio de estatística descritiva. Resultados: As respostas da pesquisa mostraram que 100,0% dos professionais tem enfrentado problemas éticos, 60,0% receberam alguma preparação em bioética, 33,0% se apoia na comissão de ética, 98,0% têm um limite de viabilidade para começar a reanimação e 93,0% tem limitado o esforço terapêutico; 98,0% inclui os pais nas decisões e o registra no prontuário. Conclusões: Os conflitos éticos são frequentes na unidade neonatal. A maioria tem formação e conta com a comissão de ética para tomar as decisões. Entre os especialistas há pontos de vista heterogêneos sobre certos problemas éticos nas unidades neonatais.