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OBJECTIVE: To evaluate the effectiveness of a new model, Case Analysis and Translation to Care in Hospital (CATCH), for the review of pediatric inpatient cases when an adverse event or "close call" had occurred. STUDY DESIGN: The curricular intervention consisted of an introductory podcast/workshop, mentorship of presenters, and monthly CATCH rounds over 16 months. The study was conducted with 22 pediatricians at a single tertiary care center. Intervention assessment occurred using participant surveys at multiple intervals: pre/post the intervention, presenter experience (post), physicians involved and mentors experience (post), and after each CATCH session. Paired t-tests and thematic analysis were used to analyze data. Time required to support the CATCH process was used to assess feasibility. RESULTS: Our overall experience and data revealed a strong preference for the CATCH model, high levels of engagement and satisfaction with CATCH sessions, and positive presenter as well as physicians-involved and mentor experiences. Participants reported that the CATCH model is feasible, engages physicians, promotes a safe learning environment, facilitates awareness of tools for case analysis, and provides opportunities to create "CATCH of the Day" recommendations to support translation of learning to clinical practice. CONCLUSIONS: The CATCH model has significant potential to strengthen clinical case rounds in pediatric hospital medicine. Future research is needed to assess the effectiveness of the model at additional sites and across medical specialities.

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RESUMEN Introducción: La otitis media aguda se define como infección del oído medio y/o mastoides con efusión retrotimpánica, constituye una de las causas más comunes de consulta médica pediátrica y la primera causa de prescripción de antibióticos en la infancia. Objetivo: Describir los principales aspectos clínicos y epidemiológicos de la otitis media aguda en pacientes menores de 5 años ingresados en el servicio de Neumología del Hospital Pediátrico Provincial Docente "Pepe Portilla" durante el año 2020. Método: Se realizó una investigación descriptiva y transversal. El universo estuvo constituido por 96 niños menores de 5 años con diagnóstico de otitis media catarral ingresados en dicho servicio en el periodo antes mencionado. Se recolectaron de las historias clínicas variables, como: edad, sexo, factores de riesgo, manifestaciones clínicas y tratamiento antimicrobiano. Resultados: El 47,7 % de los pacientes con diagnóstico de otitis media catarral fueron menores de 1 año, con franco predominio del sexo masculino (60,4 % vs. 39,6 %). El factor de riesgo más frecuente fue la escasa o nula lactancia materna en los primeros 6 meses de vida, presente en el 86,5 % de la serie estudiada. La fiebre resultó el síntoma más representativo (91,7 %) y la ceftriaxona el antimicrobiano más prescrito (54,2 %). Conclusiones: La otitis media aguda es motivo frecuente de hospitalización en menores de 2 años. Los niños del sexo masculino, con escasa o nula lactancia materna y antecedentes de atopia tienen riesgo incrementado para dicha entidad.

ABSTRACT Introduction: Acute otitis media is defined as an infection of the middle ear and/or a mastoiditis infection with retrotympanic effusion. It´s one of the most common diseases attended in pediatric consultations and the first cause of antibiotic prescription in childhood. Objective: To describe the main clinical and epidemiological aspects of acute otitis media in patients under 5 years old admitted to the Pneumology Department at the Hospital Provincial Docente Pediátrico "Pepe Portilla", Pinar del Rio, in 2020. Method: A descriptive and cross-sectional study was carried out. A total of 96 children less than 5 (as studied universe) were involved in the study with a diagnosis of catarrhal otitis media admitted to the Pneumology department during the aforementioned period. Variables such as age, sex, risk factors, clinical manifestations and antimicrobial treatment were collected from medical records. Results: The 47.7% of patients diagnosed with catarrhal otitis media were less than 1 year, and male sex was cleared predominant (60.4% vs. 39.6%). The most frequent risk factor was little or no breastfeeding in the first 6 months of life, present in 86.5% of the group studied. Fever was the most representative symptom (91.7%) and ceftriaxone the most prescribed antimicrobial medicine (54.2%). Conclusions: Acute otitis media is a frequent reason for hospitalization in children under 2 years of age. Male children with little or no breastfeeding and a history of atopy are at increased risk.

RESUMO Introdução: A otite média aguda é definida como uma infecção da orelha média e/ou mastóide com derrame retrotimpânico, é uma das causas mais comuns de consulta médica pediátrica e a primeira causa de prescrição de antibióticos na infância. Objetivo: Descrever os principais aspectos clínicos e epidemiológicos da otite média aguda em pacientes menores de 5 anos internados no serviço de Pneumologia do Hospital Universitário Pediátrico "Pepe Portilla" durante o ano de 2020. Método: Investigação descritiva e transversal foi realizado. O universo foi constituído por 96 crianças menores de 5 anos com diagnóstico de otite média catarral admitidas no referido serviço no referido período. Foram coletadas variáveis dos prontuários, como: idade, sexo, fatores de risco, manifestações clínicas e tratamento antimicrobiano. Resultados: 47,7% dos pacientes diagnosticados com otite média catarral eram menores de 1 ano, com clara predominância do sexo masculino (60,4% vs. 39,6%). O fator de risco mais frequente foi pouca ou nenhuma amamentação nos primeiros 6 meses de vida, presente em 86,5% das séries estudadas. A febre foi o sintoma mais representativo (91,7%) e a ceftriaxona o antimicrobiano mais prescrito (54,2%). Conclusões: A otite média aguda é motivo frequente de hospitalização em crianças menores de 2 anos. Crianças do sexo masculino, com pouca ou nenhuma amamentação e história de atopia apresentam risco aumentado para esta entidade.

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INTRODUCTION: This study evaluates the performance of individual and combinations tests used for pediatric tuberculosis diagnosis at a reference center. MATERIALS AND METHODS: Diagnostic test outcomes from children with presumed pulmonary tuberculosis evaluated from January 2005 - July 2010 were compared to a standard diagnosis made by an expert panel of physicians. RESULTS: Presence of at least one sign/symptom, history of contact, or abnormal chest X-ray (aCXR) individually showed the highest sensitivity (85.7%). While the combination of history of contact, at least one sign/symptom, positive tuberculin skin test, and aCXR had low sensitivity of 20%, but the specificity and a positive predictive value were 100%, respectively. The combination of tests used in the International Union Against Tuberculosis and Lung Disease and the Brazilian Ministry of Health systems showed sensitivity of 28.6% and 71.4% and specificity of 95.8% and 97.0%, respectively. CONCLUSIONS: In the absence of a gold standard, the combination of clinical history, tuberculin skin test, and aCXR, as well as the Brazilian scoring system serve as simple, low-cost approach that can be used for pediatric TB diagnosis by first-contact care providers.

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Resumen Introducción: Los programas de optimización de uso de antimicrobianos (PROA) se enfocan en el uso apropiado de antimicrobianos para ofrecer mejores resultados clínicos y menores riesgos de eventos adversos. Objetivos: Comparar consumo y costos de antimicrobianos antes y después de instauración de un programa de regulación de antimicrobianos y describir la proporción de resistencia de bacterias prioritarias. Métodos: Estudio cuasi-experimental, retrospectivo y prospectivo, descriptivo y analítico, que comparó el consumo y costo de antimicrobianos en un período pre- intervención (2007-2010) y un período post-intervención (2011-2017). Se realizó análisis descriptivo de resistencias bacterianas prioritarias. Resultados: El consumo de gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem disminuyó significativamente en el período post-intervención comparado con el período pre-intervención (p < 0,05), mientras que el consumo de amikacina, piperacilina/tazobactam, cefepime y levofloxacina en el período post-intervención mostró un aumento significativo. La reducción de costos no fue significativa para gentamicina, vancomicina, meropenem, cefotaxima, ceftazidima e imipenem. Para amikacina, cefepime, piperacilina/tazobactam y levofloxacina el aumento de costos no fue significativo. Los aislamientos de Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus y Enterococcus faecalis disminuyeron durante el período post-intervención. Conclusión: el PROA demostró disminución en consumo y costos de algunos antimicrobianos.

Abstract Background: Antimicrobial Stewardship Programs (ASP) focus in the appropriate use of antimicrobials to improve clinical results and minimize risk of adverse events. Aims: To compare consumption and costs of antimicrobials before and after the establishment of an antimicrobial stewardship program and to describe the resistance proportion of priority bacteria. Methods: Quasi-experimental, retrospective and prospective, descriptive and analytical study, to compare consumption and costs of antimicrobials in a pre- intervention period (2007-2010) and a post- intervention period (2011-2017). Additionally, a descriptive analysis of bacterial resistance from 2010 was performed. Results: Gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem consumption decreased significantly in the post-intervention period compared to the pre-intervention period (p < 0.05) while consumption of amikacin, piperacillin/tazobactam, cefepime and levofloxacin increased significantly in the post-intervention period. The reduction in costs was not significant for gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem, meanwhile, costs increased for amikacin, piperacillin/tazobactam, cefepime and levofloxacin, but this was not significant. The isolation of Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis decreased during the post-intervention period. Conclusion: The ASP showed a decrease in consumption and costs of some antimicrobials.

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Resumen: Objetivo: Determinar la relación entre el clima ético organizacional y la Cultura de Seguridad del Paciente en el personal de enfermería del Hospital Regional de Alta Especialidad del Niño "Dr. Rodolfo Nieto Padrón". Material y Métodos: Estudio cuantitativo, descriptivo, correlacional y transversal, los instrumentos utilizados para medir el clima ético hospitalario, la encuesta de Linda Olsón (1988) y la cultura de seguridad del paciente, el cuestionario el MOSPS (2011). La muestra la constituyeron 168 profesionales de enfermería. Resultados: El índice global de clima ético hospitalario de 56.29, las enfermeras percibieron un clima de seguridad global de 8 (57.1%), en una escala del 0 al 10. Los eventos notificados en un año fueron de 0 incidentes por escrito (88.7%). Se encontró que existe una asociación positiva y significativa (rs=.404; p=.000) entre el clima ético y los eventos adversos, así comodel clima ético con la seguridad (rs=.231; p=.003) y del clima ético hospitalario y la percepción de seguridad del paciente (rs=.636; p=.000). Conclusiones: El clima ético hospitalario percibido, se orienta a un ambiente positivo y de confianza en el trabajo colaborativo entre profesionales y pacientes, en contraste con los hallazgos de desconfianza y subordinación que son desfavorables para el ejercicio profesional en otras disciplinas, la relación con los jefes y con el hospital.

Abstract: Objetive: To determine the relationship between the organizational ethical climate and the Safety Culture of the Patient in the nursing staff of the Regional Hospital of High Specialty of the Child "Dr. Rodolfo Nieto Padrón ". Materials and methods: Quantitative, descriptive, correlational and transversal study, the survey of Linda Olsón (1988) and the culture of patient safety, the questionnaire MOSPS (2011) used as instruments to measure the hospital ethics climate. The sample consisted of 168 nursing professionals. Results: The global index of hospital ethical climate of 56.29, nurses perceived a climate overall security of 8 (57.1%), on a scale of 0 to 10. Events reported in one year were 0 incidents in writing (88.7%). It was found that there is a positive and significant association (rs = .404; p = .000) between the ethical climate and the adverse events, as well as the ethical climate with safety (rs = .231; p = .003) and the hospital's ethical climate and the perception of patient safety (rs = .636; p = .000). Conclusions: The perceived hospital ethical climate is oriented towards a positive and reliable environment in the collaborative work between professionals and patients, in contrast to the findings of distrust and subordination that are unfavorable for professional practice with other disciplines, the relationship with the chiefs and with the hospital.

Resumo: Objetivo: Determinar a relaçâo entre o clima ético organizacional e a cultura de segurança do doente na equipe de enfermagem do Hospital Regional de Alta Especialidade da Criança "Dr. Rodolfo NietoPadrón ". Materiais e métodos: Estudo quantitativo, descritivo, correlacional e transversal, os instrumentos utilizados para medir o clima ético hospitalar foram a pesquisa de Linda Olsón (1988) e a cultura de segurança do doente, o questionário MOSPS (2011). A amostra foi composta por 168 profissionais de enfermagem Resultados: O índice global do clima ético hospitalar é de 56,29, os enfermeiros perceberam um clima de segurança global de 8 (57,1%), numa escala de 0 a 10. Os eventos notificados por escrito num ano sao de 0 incidentes (88,7% ). Verificou-se a existência de uma associaçâo positiva e significativa (rs = 0,404, p = 0,000) entre o clima ético e os eventos adversos, bem como o clima ético com a segurança (rs = 0,231; p = 0,003) e o clima ético hospitalar e a percepçao da segurança do doente (rs = 0,636; p = 0,000). Conclusao: O clima ético hospitalar percebido orienta-se num ambiente positivo e de confiança no trabalho colaborativo entre profissionais e doentes, em opsiçao aos dados de desconfiança e subordinaçao que sao desfavoráveis para a prática profissional com outras disciplinas, as relaçoes com os chefes e com o hospital.

Résumé: Objectif: Déterminer la relation entre le climat éthique organisationnel et la culture de sécurité du patient parmi le personnel infirmier de l'Hôpital régional de haute spécialité de l'enfant "Dr. Rodolfo Nieto Padrón ". Matériel et méthodes: Étude quantitative, descriptive, corrélationnelle et transversale, instruments utilisés pour mesurer le climat éthique en milieu hospitalier, enquête Linda Olsón (1988) et culture sur la sécurité des patients, questionnaire MOSPS (2011). L'échantillon comprenait 168 professionnels infirmiers. Résultats: Indice global du climat hospitalier éthique de 56,29, les infirmières ont perçu un climat de sécurité global de 8 (57,1%) sur une échelle de 0 à 10. Les événements rapportés au cours d'une année sont de 0 incidents écrits (88,7%). Il a été constaté qu'il existe une association positive et significative (rs=0,404, p=0,000) entre le climat éthique et les événements indésirables, ainsi que le climat éthique avec sécurité (rs= 0,231; p = 0,003) et le climat éthique hospitalier et perception de la sécurité des patients (rs = 0,636; p=0,000). Conclusions: Le climat éthique hospitalier perçu est orienté vers un environnement positif et digne de confiance dans le travail collaboratif entre professionnels et patients, contrairement aux conclusions de méfiance et de subordination défavorables à la pratique professionnelle avec d'autres disciplines, la relation avec les chefs. et avec l'hôpital.

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OBJECTIVE: To conduct a scoping review of the literature to describe current conceptualization and measurement of socioeconomic status in pediatric health research. STUDY DESIGN: Four databases were used to identify relevant studies, followed by selection and data extraction. Inclusion criteria for studies were the following: enrolled subjects <18 years old, included a health-related outcome, published from 1999 to 2018, and explicitly measured socioeconomic status (SES). RESULTS: Our literature search identified 1768 publications and 1627 unique records. After screening for duplication and relevance, 228 studies satisfied the inclusion criteria, with 75% (n = 170) published since 2009. There were 52 unique singular measures and an additional 20 composite measures. Income-related measures were used in 65% of studies (n = 147) and measures of education in 42% (n = 95). The majority of studies using census-derived variables or insurance status were conducted within the previous 10 years. CONCLUSIONS: Pediatric studies use a variety of SES measures, which limits comparisons between studies. Few studies provide an evidenced-based rationale that connects the SES indicator to the health outcome, but the majority of studies do find a significant impact of SES on outcomes. SES should be comprehensively studied so that meaningful measures can be used to identify specific SES mechanisms that impact child health.

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Se realizó un estudio descriptivo y retrospectivo de 65 pacientes menores de 19 años atendidos en el Servicio de Hematología del Hospital Infantil Docente Sur Dr. Antonio María Béguez César de Santiago de Cuba en el período 2001-2005, pero seguidos evolutivamente hasta diciembre de 2015, con el objetivo de describir algunos parámetros relacionados con la supervivencia de este grupo poblacional, para lo cual se analizaron algunas variables de interés de las historias clínicas individuales. En la serie predominaron el grupo etario de 1-4 años (43,1 %), el sexo masculino (55,4 %), la variante morfológica L1 (96,9 %) y las recaídas tempranas. En general, la alta supervivencia alcanzada estuvo relacionada con la aplicación de protocolos de tratamientos modernos e integracionistas; mientras que las muertes ocurrieron mayormente por las recaídas y en la fase de inducción.

A descriptive and retrospective study of 65 patients under 19 years assisted in the Hematology Service of Dr. Antonio María Béguez Caesar Teaching Southern Pediatric Hospital in Santiago de Cuba was carried out in the period 2001-2005, but with continued follow-up to December, 2015, with the objective of describing some parameters related to the survival of this populational group, for which some variables of interest for the individual medical records were analyzed. The age group 1-4 years (43.1 %), male sex (55.4 %), morphological variant L1 (96.9 %) and early relapses prevailed in the series. In general, the high survival was related to the use of modern treatments and comprehensive protocols; while the deaths took place mostly due to relapses and during the induction phase.

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Se realizó un estudio descriptivo transversal de 1 819 pacientes con fiebre y serología reactiva, ingresados en el Hospital Infantil Dr Antonio María Béguez César de Santiago de Cuba por diagnóstico presuntivo de dengue, desde enero de 2015 hasta diciembre de 2016, de quienes se extrajeron muestras de suero en el Departamento de Microbiología de la mencionada institución, las cuales fueron enviadas al laboratorio del Instituto de Medicina Tropical Dr Pedro Kourí de La Habana para su procesamiento y posible confirmación. En la casuística se obtuvo una positividad de 54,3 por ciento, así como predominio de los niños mayores de 5 años con 1 451, de los procedentes del municipio de Santiago de Cuba con 1 651, de la fiebre en 847 y de la ocurrencia de la infección durante el trimestre octubre-noviembre en 864.

A descriptive cross-sectional study of 1 819 patients with fever and reactive serology, admitted in Dr Antonio María Béguez Caesar Pediatric Hospital in Santiago de Cuba was carried out through presumptive diagnosis of dengue from January, 2015 to December, 2016, from whom samples of serum were obtained in the Microbiology Department of the above-mentioned institution, which were sent to the laboratory of Dr Pedro Kourí Tropical Medicine Institute in Havana for their processing and possible confirmation. A 54,3 percent of positive cases was obtained in the case material, as well as the prevalence of children older than 5 years with 1 451, those coming from Santiago de Cuba municipality were 1 651, those with fever were 847 and those with occurrence of the infection during the trimester October-November were 864.

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Se realizó un estudio descriptivo y transversal de 54 pacientes con infecciones asociadas a la asistencia sanitaria en el Hospital Infantil Sur Docente Dr Antonio María Béguez César de Santiago de Cuba, que abarcó desde enero de 2015 hasta diciembre de 2016. Las variables analizadas incluyeron edad, sexo, tipo de infección, resultado de los cultivos, microorganismo aislado y servicio de procedencia. Todas las muestras de los cultivos efectuados fueron procesadas en el Departamento de Microbiología de la mencionada institución. En la casuística predominaron el grupo etario de 5-17 años, el sexo masculino, la infección en la herida quirúrgica, la positividad de los cultivos, el aislamiento de la Escherichia coli y la Unidad de Cuidados Intensivos. Solo fallecieron 2 de los lactantes de 0-11 meses, para 3,7 por ciento.

A descriptive and cross-sectional study of 54 patients with infections associated with the health care in Dr Antonio María Béguez César Southern Teaching Pediatric Hospital was carried out in Santiago from Cuba, from January, 2015 to December, 2016. The analyzed variables included age, sex, infection type, result of the cultures, isolated organism and origin service. All the culture samples were processed in the Microbiology Department of the institution. The age group 5-17 years, male sex, infection in the surgical wound, the positivity of the cultures, isolation of Escherichia coli and the Intensive Care Unit prevailed in the case material. Only 2 of the infants with 0-11 months died, for 3,7 percent.

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Se realizó una investigación descriptiva, observacional y longitudinal en el Servicio de Otorrinolaringología del Hospital Infantil Sur Dr. Antonio María Béguez César de Santiago de Cuba, que abarcó desde enero de 2015 hasta diciembre de 2017, con el objetivo de caracterizar a los 341 niños y adolescentes atendidos en el cuerpo de guardia por presentar cuerpos extraños aerodigestivos. En la casuística primaron el grupo etario de menores de 5 años (62,5 por ciento), el sexo masculino (52,8 por ciento), la procedencia urbana (65,1 por ciento), los cuerpos extraños orgánicos (67,4 por ciento), la fosa nasal como localización anatómica, la obstrucción nasal como síntoma principal y la extracción manual a través de rinoscopia anterior. En 11,1 por ciento de los exámenes radiográficos se observó el cuerpo extraño. Solo falleció un paciente durante el estudio

A descriptive, observational and longitudinal investigation in the Otolaryngology Service of Dr. Antonio María Béguez César Southern Children Hospital was carried out in Santiago de Cuba from January, 2015 to December, 2017, aimed at characterizing the 341 children and adolescents assisted in the emergency room because they presented aerodigestive foreign bodies. In the case material There was a prevalence of under 5 age group (62.5 percent), male sex (52.8 percent), urban origin (65.1 percent), organic foreign bodies (67.4 percent), the nasal cavity as anatomical localization, nasal obstruction as main symptom and the manual extraction through previous rhinoscopy. In 11.1 percent of the radiographic exams the foreign body was observed. Just a patient died during the study

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