Reporting guidelines and a touch of critical appraisal.

The biomedical research process must follow certain quality criteria in its design and development to ensure that the results are credible and reliable. Once completed, the time comes to write an article for publication. The article must present in sufficient detail, and in a clear and transparent manner, all the information on the research work that has been carried out. In this way, readers, after a critical reading of the published content, will be able to judge the validity and relevance of the study and, if they so wish, make use of the findings. In order to improve the description of the research process for publication, a series of guidelines have been developed which, in a simple and structured way, guide authors in the preparation of a manuscript. They are presented in the form of a list, flowchart, or structured text, and are an invaluable aid when writing an article. This article presents the reporting guidelines for the most common designs along with the corresponding checklists.

Guías para la elaboración de manuscritos y unas pinceladas de lectura crítica / Reporting guidelines and a touch of critical appraisal

El proceso de investigación biomédica debe seguir unos criterios de calidad en su diseño y elaboración que garanticen que los resultados son creíbles y fiables. Una vez finalizado, llega el momento de escribir un artículo para su publicación. Este debe presentar con suficiente detalle, y de forma clara y transparente, toda la información del trabajo de investigación realizado. De esta forma, los lectores, tras una lectura crítica de lo publicado, podrán juzgar la validez y la relevancia del estudio, y si lo consideran, utilizar los hallazgos. Con el objetivo de mejorar la descripción del proceso de investigación para su publicación, se han desarrollado una serie de guías que, de forma sencilla y estructurada, orientan a los autores a la hora de elaborar un manuscrito. Se presentan en forma de lista, diagrama de flujo, o texto estructurado, y son una ayuda inestimable a la hora de escribir un artículo. Este artículo presenta las guías de elaboración de manuscritos de los diseños más habituales, con sus listas de verificación.(AU)

The biomedical research process must follow certain quality criteria in its design and development to ensure that the results are credible and reliable. Once completed, the time comes to write an article for publication. The article must present in sufficient detail, and in a clear and transparent manner, all the information on the research work that has been carried out. In this way, readers, after a critical reading of the published content, will be able to judge the validity and relevance of the study and, if they so wish, make use of the findings. In order to improve the description of the research process for publication, a series of guidelines have been developed which, in a simple and structured way, guide authors in the preparation of a manuscript. They are presented in the form of a list, flowchart, or structured text, and are an invaluable aid when writing an article. This article presents the reporting guidelines for the most common designs along with the corresponding checklists.(AU)

Incidence of retained biopsy specimens after esophagogastroduodenoscopy and colonoscopy.

Background and study aims In gastrointestinal endoscopy, biopsies must transit through the accessory channel and cap, presenting an opportunity for loss of tissue. We sought to determine the incidence of specimen retention in the accessory channel or cap and identify procedure characteristics associated with specimen retention. Patients and methods After completion of standard endoscopic procedures in which biopsies were obtained, the biopsy cap and accessory channel were inspected, brushed, and irrigated for any retained biopsy specimens according to a standard protocol. For controls, the same protocol was applied to procedures in which biopsies were not obtained. Specimen bottles from the recovery protocol were sent for pathological examination regardless of whether any visible tissue was present. Results A total of 216 outpatient procedures were included: 55 esophagogastroduodenoscopies (EGDs) and 50 colonoscopies in which biopsies were obtained and 56 EGDs and 55 colonoscopies in the control group. Retained specimens were found in either the cap or channel in 50 of 105 (48%). In 20 of 105 (19%), retained specimens were found just in the cap, in six of 105 (5.7%), retained specimens were found just in the channel, while in 24 of 105 (23%), retained specimens were found in both the cap and channel. Retained specimens were more likely to be found in EGDs compared to colonoscopies (58% vs. 36%, P = 0.031). No retained specimens were found in the control group. Conclusions Retained specimens are startingly common in standard gastrointestinal endoscopic procedures and could potentially change diagnoses and management. Quality improvement measures should be instituted to monitor prevalence of retained biopsies and methods to prevent them should be developed.

Entrustable Professional Activities for the Training of Postgraduate Primary Care Pediatricians.

PROBLEM: Competency-based training is a model of medical education program that uses an organized framework of competencies to develop entrustable professional activities (EPAs) for each specialty. Implementation of EPAs varies by medical specialty and country. Although national models for primary care pediatrics have been suggested in the past, standardized EPAs have not been established. APPROACH: The authors, all members of the curriculum working group of the European Confederation of Primary Care Paediatricians, describe the development and design of a training model based on EPAs specifically for pediatricians in primary care. The objective was to facilitate and disseminate a training model that standardizes and improves training in primary care pediatrics. They aimed to make the model flexible enough so that it can be adapted to different training models and different European health systems. OUTCOMES: Between May 2017 and December 2019, the authors developed a framework that includes 7 domains of competencies for the training in pediatric primary care and a set of 11 core EPAs to guide the learning process. They structured each EPA as follows: title, activity profile, domains of competence, competencies within each domain, required knowledge and skills, learning objectives described in terms of outcomes, and a 3-stage rating supervision scale to evaluate the level of performance. NEXT STEPS: The next step is the progressive implementation of these EPAs into the postgraduate primary care pediatrics training programs of European health systems. To support this implementation, the authors intend to develop training videos to assist in daily teaching of the EPAs. The authors will also develop a pan-European online resident forum designed specifically to facilitate EPA learning by sharing and discussing clinical cases. They plan to launch a pilot study on the use of the EPAs in primary care health centers in 6 European countries.

COVID-19 en pediatría: valoración crítica de la evidencia / COVID-19: Critical appraisal of the evidence

Presentamos el resumen de un documento de valoración crítica de la evidencia disponible sobre la COVID-19, elaborado con formato de guía de práctica clínica siguiendo la metodología GRADE. El documento trata de dar respuestas a una serie de preguntas clínicas estructuradas, con definición explícita de la población, intervención/exposición, comparación y resultado, y una jerarquización de la importancia clínica de las medidas de efecto valoradas. Realizamos revisiones sistemáticas de la literatura para responder a las preguntas, agrupadas en 6 capítulos: epidemiología, clínica, diagnóstico, tratamiento, prevención y vacunas. Valoramos el riesgo de sesgo de los estudios seleccionados con instrumentos estándar (RoB-2, ROBINS-I, QUADAS y Newcastle-Ottawa). Elaboramos tablas de evidencia y, cuando fue necesario y posible, metaanálisis de las principales medidas de efecto. Seguimos el sistema GRADE para realizar síntesis de la evidencia, con valoración de su calidad y, cuando se consideró apropiado, emitir recomendaciones jerarquizadas en función de la calidad de la evidencia, los valores y preferencias, el balance entre beneficios, riesgos y costes, la equidad y la factibilidad. (AU)

We present the summary of a critical appraisal document of the available evidence on COVID-19, developed with a clinical practice guide format following GRADE methodology. The document tries to provide answers to a series of structured clinical questions, with an explicit definition of the population, intervention/exposure, comparison and outcome, and a rating of the clinical relevance of the outcome measures. We conducted a systematic review of the literature to answer the questions, grouped into six chapters: epidemiology, clinical practice, diagnosis, treatment, prevention, and vaccination. We assessed the risk of bias of the selected studies with standard instruments (RoB-2, ROBINS-I, QUADAS and Newcastle-Ottawa). We constructed evidence tables and, when necessary and possible, meta-analysis of the of the most relevant outcome measures. We followed the GRADE system to synthesize the evidence, assessing its quality, and, when appropriate, giving recommendations, rated according to the quality of the evidence, the values and preferences, the balance between benefits, risks and costs, equity and feasibility. (AU)

COVID-19: Critical appraisal of the evidence.

We present the summary of a critical appraisal document of the available evidence on COVID-19, developed with a clinical practice guide format following GRADE methodology. The document tries to provide answers to a series of structured clinical questions, with an explicit definition of the population, intervention / exposure, comparison and outcome, and a rating of the clinical relevance of the outcome measures. We conducted a systematic review of the literature to answer the questions, grouped into six chapters: epidemiology, clinical practice, diagnosis, treatment, prevention, and vaccination. We assessed the risk of bias of the selected studies with standard instruments (RoB-2, ROBINS-I, QUADAS and Newcastle-Ottawa). We constructed evidence tables and, when necessary and possible, meta-analysis of the of the most relevant outcome measures. We followed the GRADE system to synthesise the evidence, assessing its quality, and, when appropriate, giving recommendations, rated according to the quality of the evidence, the values and preferences, the balance between benefits, risks and costs, equity and feasibility.

Descripción y evaluación de la rotación de estudiantes de Medicina por Pediatría de Atención Primaria / Description and assessment of medical student rotation in Primary Care Paediatrics

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[COVID-19: Critical appraisal of the evidence]. / COVID-19 en pediatría: valoración crítica de la evidencia.

We present the summary of a critical appraisal document of the available evidence on COVID-19, developed with a clinical practice guide format following GRADE methodology. The document tries to provide answers to a series of structured clinical questions, with an explicit definition of the population, intervention/exposure, comparison and outcome, and a rating of the clinical relevance of the outcome measures. We conducted a systematic review of the literature to answer the questions, grouped into six chapters: epidemiology, clinical practice, diagnosis, treatment, prevention, and vaccination. We assessed the risk of bias of the selected studies with standard instruments (RoB-2, ROBINS-I, QUADAS and Newcastle-Ottawa). We constructed evidence tables and, when necessary and possible, meta-analysis of the of the most relevant outcome measures. We followed the GRADE system to synthesize the evidence, assessing its quality, and, when appropriate, giving recommendations, rated according to the quality of the evidence, the values and preferences, the balance between benefits, risks and costs, equity and feasibility.

Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review.

AIM: The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. METHODS: MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. RESULTS: Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. CONCLUSION: According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.

El uso inapropiado de antibióticos en las bronquitis agudas predispone a su mal uso futuro / The inappropriate use of antibiotics in acute bronchitis predisposes to its future misuse

CONCLUSIONES DE LOS AUTORES DEL ESTUDIO: la prescripción inapropiada de antibióticos para un episodio de bronquitis aguda se relaciona con la prescripción de antibióticos para subsecuentes bronquitis. COMENTARIO DE LOS REVISORES: una incorrecta prescripción de antibiótico en un primer proceso de bronquitis aguda puede condicionar la prescripción de antibiótico en procesos de bronquitis posteriores. Los profesionales debemos ser cuidadosos con la prescripción de antibióticos y limitarlos a los procesos en los que están indicados

AUTHORS' CONCLUSIONS: inappropriate antibiotic prescribing for a child's initial acute bronchitis episode predicted likelihood of antibiotic prescribing for subsequent acute bronchitis episodes. REVIEWERS' COMMENTARY: an incorrect antibiotic prescription in a first process of acute bronchitis can condition the antibiotic prescription in later processes of bronchitis. Professionals must be careful with the prescription of antibiotics and limit them to the processes in which they are indicated

Repercusión de la desfinanciación de la vacuna antineumocócica en una población con recursos bajos / Impact of the underfunding of the pneumococcal vaccine in a low income population

Introducción: en junio de 2010, la Comunidad de Madrid incluyó en el calendario vacunal infantil la vacuna neumocócica conjugada tridecavalente. Por razones presupuestarias, se retiró de la financiación en julio de 2012 y hasta enero de 2015. Nuestro objetivo fue evaluar cómo influyó este hecho en la cobertura vacunal y en la incidencia de enfermedad neumocócica invasiva, neumonía y otitis media aguda en una población de recursos económicos bajos y compararlo con los mismos datos publicados para el conjunto de la región. Material y métodos: estudio de cohortes retrospectivo de los casos de enfermedad neumocócica y cobertura vacunal en los niños nacidos entre mayo de 2012 y octubre de 2014 del centro de salud Entrevías (Madrid, España). Resultados: se encuentra una menor cobertura vacunal (66%; IC 95: 57,3 a 71,4) respecto a la media de la Comunidad de Madrid (77%). No hubo casos de enfermedad neumocócica invasiva y la incidencia de neumonías y otitis fue independiente del estado vacunal. El único factor asociado a la incidencia de otitis fue la asistencia a guardería. Conclusiones: la desfinanciación de la vacuna neumocócica conjugada condicionó la disminución de la cobertura vacunal por debajo de la media regional en una población de bajos recursos. No se encontró aumento de incidencia de enfermedad neumocócica, probablemente debido a la persistencia del efecto rebaño o a un tamaño muestral insuficiente (AU)

Introduction: since June 2010 the Community of Madrid included in the childhood vaccination schedule the conjugate vaccine against thirteen pneumococcal serotypes. By budgetary reasons, it was with-drawn from the financing public system in July 2012 to March 2015. Our goal was to evaluate how it influenced vaccination coverage and the incidence of acute otitis media, pneumonia and invasive pneumococcal disease in a low-income population, and compare them with published data for the whole region. Methods and materials: retrospective cohort study of pneumococcal disease and vaccination rate in children born between May 2012 and October 2014, who are patients in the Health Center of Entrevias. Results: there has been a reduction in the vaccination coverage (66%, 95% CI: 57.3 to 71.4%) compared to the average of the Community of Madrid (77%). There were no cases of invasive pneumococcal disease, and the incidence of pneumonia and acute otitis media was independent of immunization status. The only factor associated to the incidence of acute otitis was the attendance to daycare center. Conclusions: the defunding of the conjugate vaccine against thirteen pneumococcal serotypes caused a decrease of vaccination coverage in children a low-income population. In this study we found no increased incidence of pneumococcal disease, a fact that may be due to the persistence of the herd effect or to an insufficient sample size (AU)

La introducción precoz del huevo y el cacahuete parece disminuir el riesgo de alergia / Early egg and peanut introduction appears to reduce allergy risk

Los autores de esta revisión sistemática concluyen que la introducción precoz del huevo o el cacahuete en la dieta infantil se asocia a una disminución del riesgo de alergia a dichos alimentos, aunque se deben tener en cuenta las limitaciones de los estudios primarios. Respecto a otros alimentos estudiados (pescado, leche de vaca, gluten) no se encontró evidencia de ningún efecto. Probablemente no haya justificación para retrasar la introducción de algunos alimentos como el huevo y el cacahuete con el fin de prevenir la alergia a los mismos e incluso esta recomendación sea perjudicial. Falta evidencia para hacer una recomendación sobre el momento más adecuado de introducirlos (AU)

The authors of this systematic review conclude that the early introduction of egg or peanut in the infant diet was associated with lower risk of developing egg or peanut allergy, although these findings should be considered in the context of limitations in the primary studies. Regarding other foods studied (fish, cow’s milk, gluten), no evidence of any effect was found. There is probably no justification for the delay in the introduction of some foods such as eggs and peanuts to prevent allergy to them. This recommendation can even be harmful. There is no evidence to make a recommendation on the most appropriate time to introduce them (AU)

Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada / Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis

Background: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. Aim: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. Material and Methods: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Results: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Conclusions: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Dudas sobre la utilidad del cribado masivo con electrocardiograma en deportistas para prevenir la muerte súbita / Doubts about the usefulness electrocardiogram mass screening in identifying sudden death in athletes

Conclusiones de los autores del estudio: el uso selectivo del electrocardiograma (ECG) en los exámenes previos a la participación de atletas jóvenes proporciona una alta tasa de detección de cardiopatías. Se debe demostrar que la implantación del ECG como cribado tiene una mayor eficiencia para la prevención de la muerte súbita que su uso selectivo, antes de valorar su implantación generalizada. Comentario de los revisores: las deficiencias metodológicas de este estudio hacen que sus resultados no condicionen ningún cambio en las actuales directrices respecto a los exámenes preparticipación de atletas jóvenes. Las directrices europeas y españolas en estos momentos aconsejan el uso de ECG como cribado en las evaluaciones preparticipación (AU)

Athors´ conclusions: due to the methodological shortcomings of this study, the results don’t make any change to current guidelines regarding preparticipation athletic evaluations among youths. Current European and Spanish guidelines advise using ECG screening in preparticipation athletic evaluations. Reviewers´ commentary: selective ECG use for preparticipation athletic evaluations has a high rate of identification of cardiac disease. Adoption of a mass ECG screening program would need to prove to be more efficient at identifying diseases associated with sudden cardiac death than a selective approach (AU)

[Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis]. / Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada.

BACKGROUND: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. AIM: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. MATERIAL AND METHODS: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. RESULTS: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. CONCLUSIONS: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

Antivacunas: un reto para el pediatra / Anti-vaccination: a challenge for the pediatrician

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Crecemos en Europa / We grow in Europe

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