Overuse of bronchodilators and steroids in bronchiolitis of different severity: bronchiolitis-study of variability, appropriateness, and adequacy.

BACKGROUND: In the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings. METHODS: This is a cross-sectional, descriptive study of 5647 cases of acute bronchiolitis in 91 Spanish hospitals and primary care centres. We classified the appropriateness of the treatments according to the recommendations of a consensus conference. RESULTS: There was an inappropriate use of treatments in 58.3% of the cases during the acute phase and in 45.4% during the maintenance phase. There was a generalised use of inhaled beta 2 agonists, regardless of the severity of the patients (hospitalised patients 69.3%, emergency care 63.2% and ambulatory 64.1%). Adrenaline was used in 30.1% of hospitalised cases and in 80.2% of intensive care patients. Systemic corticosteroids were not only used in one-third of hospitalised patients but also in 25.8% of ambulatory cases. CONCLUSIONS: In acute bronchiolitis in Spain there is a wide use of treatments that are not recommended by the available clinical practice guidelines. Beta 2 agonist bronchodilators and corticosteroids are widely used and maintained, regardless of the severity of the patients.

[From medical school to paediatric residency, stopping of at the MIR exam: something must change? A survey of fourth year pediatric residents]. / De las facultades de Medicina a la residencia de Pediatría, pasando por el examen de médico interno residente: ¿algo debe cambiar? Resultados de una encuesta en residentes de Pediatría de cuarto año.

INTRODUCTION: The Spanish medical education system has made a great contribution to the development of the National Health Service, but a need for an overall assessment process still remains. AIM: Evaluate several issues of under- and postgraduate (MIR) medical education of Spanish residents in Paediatrics. METHOD: An anonymous questionnaire with coded answers administered to 61 paediatric residents in the fourth year of specialty. RESULTS: Two thirds of residents think that the Medicine curriculum must change, with less theoretical education. Similarly a proportion of residents believes that the MIR Exam should introduce items on skills and abilities in addition to the current items. Resident tutors are considered positively in 90% of cases, but 35% of them failed in their assessment. Concepts related to evidence-based medicine are being introduced into undergraduate medical education (48% of answers) and postgraduate (69%), but we still found several areas for improvement: bibliographic information searching and critical appraisal of scientific documents. CONCLUSIONS: The quality of medical education (undergraduate and postgraduate) shows several issues that must change, mainly related to two current paradigms: the European Higher Education Area (EEHA) and Evidence-Based Medicine (EBM).

[Level of knowledge of Quality Commitment Campaign and of "do not do" recommendations amongst general practitioners, pediatricians and nurses Primary Care]. / Grado de conocimiento de la campaña Compromiso por la Calidad y de las recomendaciones no hacer entre médicos de familia, pediatras y enfermería de Atención Primaria.

BACKGROUND: To evaluate if the Quality Commitment Campaign (QCC) was sufficiently known among primary care professionals (PC), and second, to evaluate the knowledge about certain recommendations of what should not be done in PC. METHODS: A observational study was conducted. General practitioners (GP), pediatricians (PED) and nursing (NUR) participated. A direct question was asked about whether QCC was known and a set of dichotomous questions based on the "do not do" recommendations to assess their knowledge. A sample size of 288 professionals from each group was the minimum required for a sampling error of 5%, 95% confidence level and p=0.75. The field study was conducted with the collaboration of health services and professional and scientific organizations. Data were described by frequencies and mean (standard deviation), and compared by means of ?2/Fisher or ANOVA and t-test. RESULTS: A total of 1,904 professionals (936 GP, 682 PED and 286 NUR) answered. The QCC initiative was known by 828 (43.5%) professionals: 524 (56.0%) GP, 234 (34.3%) PED and 70 (24.5%) NUR (p<0.001). All the questions were correctly answered by 652 (69.7%) GP, 631 (92.5%) PED and 116 (40.6%) NUR. Significantly more mistakes (p<0.001) were made by those who did not know the QCC, worked in the private sector or were not considered responsible for overuse. Despite not knowing the QCC, 60% GP and 90% PED answered all the questions of the test correctly. CONCLUSIONS: NUR and GP could benefit from a greater diffusion of the QCC. As could those working in the private sector and those who believe that professionals have little responsibility for unnecessary overuse.

[Evaluation of formal elements of Spanish pediatrics journals]. / Evaluación de los aspectos formales de las revistas pediátricas españolas.

INTRODUCTION: Standardization of scientific journals is indispensable for accurate transmission of knowledge, since it guarantees the universality and reproducibility of research. The objective of this study was to evaluate the formal elements of Spanish pediatrics journals. MATERIAL AND METHODS: In 2005, we studied the characteristics of Spanish biomedical journals with special emphasis on Spanish pediatrics journals. The form used for the selection of journals for inclusion in the database Indice Médico Español (IME) was employed to evaluate 65 distinct characteristics in each journal. The parameters were grouped in the following five categores: journal presentation, presentation of the articles, scientific and editorial committees, content characteristics, and dissemination parameters. RESULTS: The journals with the highest overall scores were Anales de Pediatría (63 points out of a maximum of 82), followed by Pediatría de Atención Primaria (53 points), Acta Pediátrica Española and Cirugía Pediátrica (55 points each), Pediatrika (53 points), and Revista Española de Pediatría (48 points). The score obtained by Anales de Pediatría places this journal in the top 10 Spanish journals included in IME. CONCLUSIONS: Spanish pediatrics journals meet most of the formal elements required of biomedical journals, although some aspects could be improved, such as deficiencies in the frequency and regularity of publication, mention of the dates of manuscript receipt and acceptance, the lack of a clear description of the editorial process of manuscript selection and peer review, the absence of committee members' institutional affiliations, and the absence of articles by non-Spanish authors.

[Usefulness of procalcitonin as an early diagnostic test of neonatal sepsis in newborns with risk factors for infection]. / Utilidad de la procalcitonina como prueba diagnóstica precoz de sepsis neonatal en recién nacidos con factores de riesgo de infección.

OBJECTIVE: To investigate the reliability of serum procalcitonin (PCT) as an early diagnostic test (within the first 12 hours of life) of neonatal sepsis in newborns with maternal or neonatal risk factors for infection. MATERIAL AND METHODS: We performed a prospective study of 123 newborns consecutively admitted to neonatal unit over a 2-year period with at least one risk factor for infection. We constructed a 2x2 table between the validated test (serum PCT by semi-quantitative assay, with several cut-off points: 0.5, 2 and 10 ng/ml) and the reference assay (blood culture or clinical, laboratory and microbiological confirmation of sepsis). The validity (sensitivity, specificity), safety [positive predictive value (PPV) and negative predictive value (NPV)] and likelihood ratios (LR+ and LR-) of the test were calculated. RESULTS: Serum PCT was measured within the first 12 hours of life in 95% of the patients (mean and median=6 hours). The best cut-off point for serum PCT was 2 ng/ml, and, taking subsequent clinical-laboratory-microbiological confirmation of sepsis as the best reference assay, showed a sensitivity of 100% (95% CI 65-100), specificity of 82% (95% CI 74-88), PPV of 25% (95% CI 13-44), NPV of 100% (95% CI 96-100), LR+ of 5.5 (95% CI 3.7-8.1), and LR- of 0. CONCLUSIONS: Serum PCT levels<2 ng/ml within the first 6-12 hours of life in newborns with risk factors for infection are useful as a screening assay to rule out neonatal sepsis with a sensitivity of 100% (false negatives=0% and NPV=100%). However, for subsequent confirmation a more specific assay (with a low false positive rate and high PPV) should be used, such as C-reactive protein. The higher cost of the serum PCT test should be weighed against shorter admissions as a result of its use.

[Survey on scientific research activity in Spanish neonatal divisions between 2000 and 2004]. / Encuesta sobre la actividad investigadora en los servicios de neonatología en España en el período 2000-2004.

Research is an essential activity in neonatology. Following the recommendation of the Spanish Neonatal Society (SEN), a questionnaire on the state of research activity was sent to all Spanish neonatal divisions belonging to all public and private institutions with structured neonatal activity. The following items were included: (i) clinical level of the units; (ii) academic degrees and professional qualifications of the staff members; (iii) characteristics of the scientific activity performed, and (iv) financial and technical aid supporting research. Of a total of 115 eligible hospitals, 86 hospitals (74.8 %), including most of the referral centers, participated in the survey. Notable among the positive results were the findings that a significant number of neonatologists have doctoral degrees (17.4 %), are active members of the SEN (74.9 %), and wish to participate in scientific research (100 %). In addition, the presence of epidemiologists (100 %), research support units (85 %) and ethical committees (93 %) in the hospitals is widespread. Negative aspects include the lack of a specific budget to initiate research (74 %), lack of protected time even with research grants (86 %), and lack of interrelation with other groups of basic or clinical researchers (43 %). Analysis of scientific production revealed that most of the abstracts presented are restricted to Spanish national meetings, and only a small number of consolidated groups publish regularly in peer-reviewed international journals with impact factor. Measures that could help to improve the current situation are the formation of multi-hospital groups, participation in comprehensive databases (SEN 1500), and joint meetings for basic and clinical scientists, among others. The results of this survey were presented at the Congress of Perinatal Medicine held in Las Palmas (November, 2005).

[Biomedical publications in Spain on debate (I): state of neurological journals]. / Las publicaciones biomédicas en España a debate (I): estado de las revistas neurológicas.

INTRODUCTION: Bibliometric studies belong to the so-called 'social studies of science', and science policy constitutes one of its main applied fields, providing objective and useful tools for evaluating the results of scientific activity. Neurological sciences are very important in the bibliometric map of Spain about biomedicine and health sciences, from a quantitative (second thematic area in productivity, only after biology-biochemical) and a qualitative (high health costs and morbimortality) point of view. DEVELOPMENT: In Spain we can found about 360 biomedical journals, 18 of them related to the area of neurological sciences. In 2005, only 17 biomedical Spanish journals were in the Science Citation Index database, three of them in the field of neurosciences: Neurologia (impact factor = 0.57), Revista de Neurologia (0.39) and Neurocirugia (0.23), and these journals have also very good Latindex criteria about formal aspects. But it is important to mention that the impact factor specifically measures visibility and diffusion of the works published by these journals rather than their scientific quality. We search the answer to some questions about the present and future of biomedical journals in general and neurological journals in particular: paper or electronic publication?, free access or open access?, scientific journal or scientific article?, English or Spanish publication? CONCLUSIONS: The Acuerdo de Buenos Aires is an initiative to promote scientific neurological papers of high quality in Spanish. The current status of neurological journals in the bibliometric context of our country is good and open to the advantages of electronic and free access.

[Biomedical publications in Spain on debate (II): the on-going 'revolutions' and their application to neurological journals]. / Las publicaciones biomédicas en España a debate (II): las 'revoluciones' pendientes y su aplicación a las revistas neurológicas.

AIM AND DEVELOPMENT: To debate about the application of on-going 'revolutions' in medical knowledge to Spanish neurological journals in the 21st century. This article reviews the current status of five revolutions in the field of health sciences, in general, and in neurological sciences, in particular: 1) the knowledge revolution: to translate the scientific investigation to the patient, with knowledge needs-driven research agenda with founder commissioning research to answer questions posed by clinicians, managers and patients, and systematic and critical appraisal reviews as the creator of quality improved knowledge; 2) the evidence based medicine revolution: the pyramid information of '4S', with systems (guidelines and computerized decision support systems), synopses (secondary journals), syntheses (systematic reviews and meta-analysis) and studies (original studies published in journals); 3) the web revolution: the possibility of dissemination of biomedical documentation by means of the Internet network are producing changes in the traditional way of conceiving scientific publication; the Internet represents a great advantage for investigation and also for clinical practice, since it permits free, universal access to databases and the interchange of texts, images and videos; 4) the open access revolution: to take full control over all operations related to the process of publish (to create, publish, communicate, distribute, reproduce and transform) with no need of any intermediaries, and to transform fundamental aspects concerning the circulation of knowledge, its use and availability; and 5) the librarian revolution: the project of a Virtual Health Library in Spain as a tool to access and disseminate scientific and technical knowledge on health through the Internet.

[Gender analysis of papers published in Revista de Neurología (2002-2006)]. / Análisis de género de los artículos publicados en Revista de Neurología durante el quinquenio 2002-2006.

INTRODUCTION: There is an ongoing interest in the society in promoting gender equality and in women integration in research activities. The purpose of this work is to identify from a gender perspective the bibliometric characteristics of articles published in Revista de Neurología journal during the 2002-2006 period. MATERIALS AND METHODS: Records were obtained from Science Citation Index database of ISI-Thomson platform. The following indicators were determined, disaggregated by gender: year of publication, type of document, number and order of signatures, number of collaborators, signature/papers index and in the institutional and geographical level. RESULTS: 4527 authors were identified, 2614 (57.74%) men and 1913 (42.,26%) women. The highest women's participation took place in original articles (39.01% of signatures). 44.5% of authors with one published article were women, while 'big women producers' (those with more than 9 articles) only were 16.67%. A greater productivity in men and a greater rate of collaboration in women has been detected. CONCLUSIONS: Scientific activity studies disaggregated by gender give an essential information in order to establish the basis of a scientific policy for promoting the woman as researcher. The evolution in the number of female authors in Revista de Neurología journal does not present an aiming growth to reach the parity in the next years. A low presence of women in positions of high productivity has been detected, whose causes should be identified.

[Analysis of citations and national and international impact factor of Farmacia Hospitalaria (2001-2005)]. / Análisis de citas y factor de impacto nacional e internacional de Famacia Hospitalaria (2001-2005).

OBJECTIVE: The objective of this study is to analyse the citation patterns and impact and immediacy indicators of the Farmacia Hospitalaria journal during the period 2001-2005. METHOD: An analysis of citations chosen from 101 Spanish health science journals was carried out in order to determine the citing and cited journals and the national and international impact and immediacy indicators. A similar methodology used by Thomson ISI in Science Citation Index (SCI) and Journal Citation Reports (JRC) was applied. RESULTS: Farmacia Hospitalaria made 1,370 citations to 316 different journals. The percentage of self-citations was 9%. The national impact factor increased from 0.178 points in 2001 to 0.663 points in 2005 while the international impact factor increased from 0.178 to 0.806 for the same period. CONCLUSIONS: The analysis of citation patterns demonstrates the multidisciplinary nature of Farmacia Hospitalaria and a significant growth in the impact indicators over recent years. These indicators are higher than those of some other pharmacy journals included in Journal Citation Reports. Self-citation was not excessive and was similar to that of other journals.

[Methylphenidate in the treatment of attention-deficit/hyperactivity disorder: are we achieving an adequate clinical practice?]. / Metilfenidato en el tratamiento del trastorno por déficit de atención e hiperactividad: realizamos una práctica clínica adecuada?

INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is the most frequent behavioural disorder in infancy and methylphenidate is the most widely used medication. AIM. To analyze if the use of methylphenidate allows a good clinical practice in ADHD in terms of efficacy, effectiveness, efficiency and safety. MATERIALS AND METHODS: Systematic review of the articles about therapeutic management of ADHD with methylphenidate published in secondary and primary publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. RESULTS: The main secondary information is found in the Cochrane Library, but we also detect relevant articles in Pubmed, mainly published in Journal of the American Academy of Child and Adolescent Psychiatry and Pediatrics. There are many randomized clinical trials with methylphenidate (immediate-release and extended-release methylphenidate) and some systematic review and/or meta-analysis, but these trials have some limitations (in relation to patients, interventions and outcomes) and publication bias. CONCLUSIONS: From the evidence-based analysis (and from the experience) we detect good scientific evidence that methylphenidate improve target outcomes in ADHD in the short and half-term in children (mainly 6-12 years). The treatment algorithm advises to start with methylphenidate (immediate or extended-release methylphenidate, in relation to cost-benefit parameters); when there is not response (between 10-30% of patients) or evidence of relevant secondary effects, we could consider the use of atomoxetine. There are many questions to solve based on better clinical trials: the efficacy and safety of methylphenidate in very young children and adolescents, long-term effects and the duration of the treatment.

[Consistency of clinical practice with the scientific evidence in the management of febrile seizures]. / Adecuación de la práctica clínica a la evidencia científica en el tratamiento de las convulsiones febriles.

INTRODUCTION: An important inconsistency exists between the evidence available about the management of febrile seizures (FC) and its application in real practice. AIM. To value the degree of appropriateness of current management of FC. MATERIALS AND METHODS: Structured review of the articles on appropriateness published in biomedical literature. Methodological analysis and qualitative synthesis. RESULTS: The evidence available on the diagnosis and treatment of the FC is little. Except for the related to the preventive treatment of recurrences of FC, the rest of the evaluation criteria is based on the opinion of experts or methods of consensus. Eight articles have been identified that reflect the following problems: insufficient or excessive use of antiepileptic drugs during the seizures, unnecessary accomplishment of lumbar puncture, sanguineous analysis, neuroimage studies or electroencephalograms, and prescription of preventive treatments in simple FC. The methodological quality of the reviewed papers is little and its heterogeneity prevents the quantitative synthesis. CONCLUSIONS: The management of FC must be reviewed since an important part of the decisions of the clinical practice is not always sustained in a valid scientific evidence. We only have sufficient evidence on the effectiveness and security of the anticonvulsant treatments to the prevention of the recurrences.

[What can we expect of Collaborative Review Groups of Cochrane Collaboration in neuropaediatrics?]. / Qué podemos esperar de los Grupos Colaboradores de Revisión de la Colaboración Cochrane en neuropediatría?

INTRODUCTION: Cochrane Collaboration (CC) contains detailed, critical and up-to-date systematic reviews (SR) of the best scientific evidence available. AIM: To analyse the bibliometric characteristics of the SR related to paediatric neurology published in the 50 Collaborative Review Groups (CRG) of the CC. MATERIALS AND METHODS: Bibliometric analysis of the Database of Systematic Reviews in Cochrane Library, Issue 2, 2005 (n = 2.231 SR). The variables recorded were: number of SR and protocols in any CRG, authors and clusters of secondary research, dates (late review and update), type of study, critical review of the SR and conclusions. RESULTS: Nine published SR about neuropaediatrics: the Epilepsy Group (24 SR), the Neuromuscular Disease Group (16), the Neonatal Group (16), the Developmental, Psychosocial and Learning Problems Group (10), the Pain, Palliative Care and Supportive Care Group (4), the Movement Disorders Group (3), the Injuries Group (3), the Infectious Disease Group (3) and the Acute Respiratory Infections Group (2). The three main thematic areas were treatment of epilepsy (pharmacologic and non-pharmacologic), neonatal neurology (mainly intraventricular haemorrhage and perinatal asphyxia) and miscellanea (autism spectrum disorder, headache, cerebral palsy, myasthenia gravis, Guillain-Barre syndrome, Bell's palsy and bacterial meningitis). All the SR were about treatment interventions. CONCLUSIONS: Paediatric neurology SR are infrequent (3.6% of the 2.231 SR published in CC), and helps an evidence-based decision-making in a few areas: pharmacologic treatment of epilepsy, management of intraventricular haemorrhage of preterm infants and bacterial meningitis. Many therapies in paediatric neurology persist with no supporting evidence, and we detected no SR about important neurological issues in childhood as attention-deficit hyperactivity disorder, mental retardation and hypotonia.

[Rational management of antibiotherapy in ORL infections in children: critical review of the best scientific evidences]. / Manejo racional de la antibioterapia en las infecciones otorrinolaringológicas en la infancia: revisión crítica de las mejores pruebas científicas.

INTRODUCTION: Upper respiratory tract infections are the more prevalent infections in childhood and it is important to know the use and overuse of antibiotics. The objective of this article is to make a systematic and critical review of the best scientific evidence in bibliography in order to use antibiotics rationally in otorhinolaryngology (ORL) infections. MATERIAL AND METHODS: Systematic and structured review of the articles regarding antibiotherapy in ORL infections (pharyngitis, tonsillitis, otitis, sinusitis and laryngitis) in childhood published in secondary (Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc.) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). DATA SELECTION: study design, population, intervention, outcomes, main results and applicability in clinical practice. RESULTS: The main secondary information is found in The Cochrane Library and in Clinical practice guideline clearinghouses. The documents in Cochrane Library are, basically, clinical trials, systematic reviews and/or meta-analysis, mainly about otitis (13 documents), sinusitis/rhinosinusitis (6), pharyngitis/tonsillitis (3) and nasopharyngitis (3). We found 17 guidelines, mainly for otitis (8 guidelines), pharyngitis/tonsillitis (5), sinusitis (3) and laryngitis (1). Also, we found some relevant articles in Pubmed database, complementary to secondary publications. CONCLUSIONS: There are a high number of quality scientific studies who support an evidence-based decision making in clinical practice about the rational use of antibiotics in ORL infections in childhood, mainly in otitis, tonsillitis and sinusitis. Every decision in this field will have to be based on a systematic appraisal of the best evidence available in the context of the prevailing values and resources available. Doctor's knowledge (mainly in otorhinolaryngologists and pediatricians) of systematic and critical review of the current literature can help to modify prescribing habits about overuse and misuse of antibiotics in ORL infections.

[Continuum, the continuing education platform based on a competency matrix]. / Continuum, la plataforma de Formación Basada en Competencias.

Competency-Based Education is a learning method that has changed the traditional teaching-based focus to a learning-based one. Students are the centre of the process, in which they must learn to learn, solve problems, and adapt to changes in their environment. The goal is to provide learning based on knowledge, skills (know-how), attitude and behaviour. These sets of knowledge are called competencies. It is essential to have a reference of the required competencies in order to identify the need for them. Their acquisition is approached through teaching modules, in which one or more skills can be acquired. This teaching strategy has been adopted by Continuum, the distance learning platform of the Spanish Paediatric Association, which has developed a competency matrix based on the Global Paediatric Education Consortium training program. In this article, a review will be presented on the basics of Competency-Based Education and how it is applied in Continuum.

[Consistency of clinical practice with the scientific evidence in the management of childhood asthma]. / Adecuación de la práctica clínica a la evidencia científica en el manejo del asma.

INTRODUCTION: There is substantial inconsistency between the evidence available on the management of childhood asthma and its application in practice. OBJECTIVE: To evaluate the degree of appropriateness of current management of childhood asthma. MATERIAL AND METHODS: We performed a structured review of the articles published on appropriateness in the recent biomedical literature (last 5 years). Methodological analysis and qualitative synthesis were performed. RESULTS: Twenty-three articles were identified that reflected the following problems: insufficient documentation on trigger factors, evolution of pulmonary function and symptoms, inadequate guidelines on the treatment of exacerbations, inadequate use of inhaler devices, insufficient use of anti-inflammatory drugs, unjustified heterogeneity in the selection of anti-inflammatory drugs, lack of correlation between severity and level of treatment, lack of written guidelines on customized self-management, unjustified use of antibiotics, and lack of pulmonary function testing devices. CONCLUSIONS: The management of childhood asthma should be reviewed since a large number of decisions made in clinical practice are not always based on valid scientific evidence.

[Neonatal neurology decision-making starting from systematic reviews of Cochrane Collaboration]. / Toma de decisiones en Neurología neonatal a través de las revisiones sistemáticas de la Colaboración Cochrane.

INTRODUCTION: Cochrane Collaboration (CC) provides growing and readily accessible resource to help that decision-making care is based on detailed, critical, and current reviews of the best available evidence. There are many clinical questions for which there is no good evidence on which to base clinical practice. AIM: To analyse the bibliometric characteristics of the systematic reviews (SR) about neonatal neurology published in Neonatal CC. MATERIALS AND METHODS: Bibliometric analysis of The Cochrane Database Systematic Reviews in Neonatal CC, Issue 1, 2004 (n = 169 SR). The dependent variable registered in each SR was subject area of study (mainly neurology subject area) and the rest of variables were considered independent: authors (number and country), dates (late review and update), characteristics of included clinical trials (number and type), characteristics of the newborns included (number and gestational age), reviewer's conclusions and potential conflicts of interest. RESULTS: Neurology was the third most important subject area in Neonatal CC (13 SR), after the subject area of respiratory (73 SR) and gastroenterology-nutrition (26 RS). We identified three selective clusters of secondary investigation in neonatal neurology SR: intraventricular haemorrhage (4 SR), perinatal asphyxia (4 SR) and opiate withdrawal syndrome (2 SR). The number of clinical trials (median 4), patients (median 193), update (46%), sufficient conclusion (54%) and potential conflicts of interest (8 %) in each SR is similar to the rest of SR in Neonatal CC; the only difference we found is less preterm infants (15%) in this SR. All the SR are about interventions for the treatment or prevention of diseases, and we don't found any review about diagnostic tests. CONCLUSIONS: At the moment, the neonatal neurology SR published in Neonatal CC are infrequent and almost half of them the reviewer's conclusions are insufficient for inferring probable effects in clinical practice. Many therapies in neonatal neurology persist without supportive evidence, and some common therapies may actually be harmful, and these are the conclusions found in SR about intraventricular haemorrhage. We detected no SR about important neuropediatric themes in neonatal period: hypoxic-ischemic encephalopathy, periventricular leukomalacia, neonatal seizures, hypotonia, etc.

[Generic drugs in the treatment of epilepsy]. / Fármacos genéricos en el tratamiento de la epilepsia.

AIM: We discuss some controversial aspects with prescription of generic drugs (GD) and the problems concerning bioequivalence, mainly in the case of drugs with non-linear pharmacokinetics and/or narrow therapeutic rank, like the antiepileptic drugs (AED). DEVELOPMENT: There is considerable debate about GD in the treatment of epilepsy, with clearly advantages (cost saving) and disadvantages (loss of seizure control or drug toxicity) in prescribing generics anticonvulsants. We make a systematic review of the literature in primary (PubMed) and secondary (Tripdatabase and Cochrane Library) bibliographic databases in relation to GD and AED. The main information is about classical AED (phenytoin, carbamazepine, valproic acid and primidone) and we don't found studies in this area about the new AED. The level of evidence is, generally, weak, based on case-series and expert opinion without explicit critical appraisal (except in phenytoin with level of evidence moderate, based on some analytical studies). In Spain, at this moment, there are only two generic AED, one-classical (carbamazepine) and one-new (gabapentin). CONCLUSION: The American Academy of Neurology and Epilepsy Foundation maintains that the individual and physician should be notified and give their consent before a switch in antiepileptic medications is made, whether it involves generic substitution for brand name products, or generic to generic substitutions.

[Controversies in the therapeutical management of congenital diaphragmatic hernia: update by means of evidence-based medicine]. / Controversias en el manejo terapéutico de la hernia diafragmática congenita: actualización a través de la medicina basada en pruebas.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is one of the high-risk diseases in neonatal surgery. The aim of this article is to make an update of the controversies about the therapeutic management (time of surgery and modalities of medical stabilization) of CDH, by means of a systematic and critical review of the best scientific evidence in bibliography. METHODS: Systematic and structured review of the articles about therapeutic management of CDH (surgery, mechanical ventilation, inhaled nitric oxide, extracorporeal membrane oxygenation, surfactant, etc) published in secondary (TRIPdatabase, systematic review in Cochrane Collaboration, clinical practice guidelines, health technology assessment database, etc) and primary (bibliographic databases, biomedical journals, books, etc) publications and critical appraisal by means of methodology of the Evidence-Based Medicine Working Group. We selected the publications with the main scientific evidence in therapeutical articles (clinical trial, systematic review, meta-analysis and clinical practice guideline). RESULTS: The main secondary information is found in The Cochrane Library: 3 systematic review in the Neonatal Group (one specific about the time of surgery, and two related to the use of nitric oxide and extracorporeal membrane oxygenation in neonatal severe respiratory failure). But we found the main relevant articles in Pubmed database, mainly published in Journal Pediatric Surgery and with some clusters of investigation (Congenital Diaphragmatic Hernia Study Group in Texas University and Buffalo Institute of Fetal Therapy in New York University). CONCLUSIONS: From the evidence-based analysis, the results of CDH management between immediate versus delayed surgery were unclear, but delayed surgical (with pre-operative stabilization) has become preferred approach in many centers, and foetal surgery is not better than neonatal one. Opinion regarding the time of surgery has gradually shifted from early repair to a policy of stabilization and delayed repair. Because of associated persistent pulmonary hypertension and/or pulmonary hypoplasia in CDH, medical therapy is focused toward optimizing oxygenation while avoiding barotrauma, using gentle ventilation and permissive hypercarbia. High frequency oscillatory ventilation, inhaled nitric oxide and extracorporeal membrane oxygenation are used in severe cases, but these treatments do not clearly improve the outcome in neonates with CDH. The usefulness of surfactant and partial liquid ventilation are based in animal model experimentation, because the clinical trials in newborns are little and non-conclusive. Challenges for the future in this thematic area include the need for bigger and better trials of therapy in this field, with long-term outcomes among surviving children.

[Open availability of articles and raw research data in Spanish pediatrics journals]. / Disponibilidad en abierto de los artículos y de los datos brutos de investigación en las revistas pediátricas españolas.

INTRODUCTION: The open Access to publications and the raw data allows its re-use and enhances the advancement of science. The aim of this paper is to identify these practices in Spanish pediatrics journals. METHOD: We reviewed the author's instructions in 13 Spanish pediatrics journals, identifying their open access and deposit policy. RESULTS: Eight journals allow open access without restriction, and 5 provide information on the ability to re-use and depositing data in repositories or websites. CONCLUSIONS: Most of the journals have open access, but do not promote the deposit of additional material or articles in repositories or websites.