Factors associated with attrition among residents in pediatrics: A mixed-method study in a single center in the Philippines

@#<p style="text-align: justify;"><strong>Background.</strong> Attrition in residency training can lead to lower workplace morale and increased costs. Finding associated factors can help revise admissions criteria or identify at-risk residents.</p><p style="text-align: justify;"><strong>Objective.</strong> We aimed to determine factors associated with attrition among residents in pediatrics.</p><p style="text-align: justify;"><strong>Methods.</strong> We applied a mixed cross-sectional (survey) and retrospective cohort (records review) study design. Residents who began training in the Philippine General Hospital in 2012-2018 were included. Our primary outcomes were non-completion of training within three years (attrition), completion beyond three years or ongoing training at a delayed year level (off-cycle), and the composite of attrition or off-cycle. Fisher's exact probability test and t-test were used to compare the non-attrition group versus the attrition group, and the non-attrition group versus the attrition or off-cycle group.</p><p style="text-align: justify;"><strong>Results.</strong> The overall attrition rate and off-cycle rate among 162 residents were 7.41% and 4.32%, respectively. The survey response rate was 73.00%. Four factors were significantly associated with attrition: higher age at entry into the program (p = 0.030), advanced degree (p = 0.009), longer interval from internship completion to start of residency training (p = 0.017), and a lower case presentation score (p = 0.048). The proportion of respondents older than 29 years was significantly higher in the attrition group than the non-attrition group (40.00% vs 0.94%, p = 0.031). Higher age at entry was also significantly associated with the composite outcome (attrition or off-cycle).</p><p style="text-align: justify;"><strong>Conclusion.</strong> Older age at entry, advanced degree, a longer interval from internship, and lower-case presentation scores were associated with attrition among residents in pediatrics from a single center.</p>

Validation of the Filipino translated questionnaire on parent attitudes about childhood vaccines

@#<p style="text-align: justify;"><strong>OBJECTIVE: </strong>To determine the content validity and test-retest reliability of the Filipino Translated Questionnaire on Parent Attitudes About Childhood Vaccines.</p><p style="text-align: justify;"><strong>METHODOLOGY:</strong> Eligible parents of patients seen at the Pediatric Outpatient Department, Pediatric Emergency Room and Pediatric Wards of the Philippine General Hospital were recruited into the study. The original survey tool was translated to Filipino by the Sentro ng Wikang Filipino. A focus group of four experts in the field of vaccination rated the content of each item on the questionnaire based on its relevance. Ten Filipino speaking participants were then recruited to check its face validity. This was then implemented to 67 Filipino speaking participants to check its test-retest reliability.</p><p style="text-align: justify;"><strong>RESULTS: </strong>The overall item content validity index of the questionnaire was computed to be 0.95. All items had a 100% rating in terms of clarity and simplicity. The high intraclass correlation coefficient of 0.970 supports the tool's test-retest reliability. However, the test had a low Cronbach's ? coefficient of 0.687 which could be increased to 0.711 with the removal of one item from the question pool.</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>The Filipino Translated Questionnaire on Parent Attitudes About Childhood Vaccines has face and content validity with an acceptable internal consistency. This can serve as a framework for future researches on vaccine hesitancy.</p>

Antibiotic prescribing patterns of pediatric residents: Do the results of blood cultures make a difference?

Abstract@#The diagnosis of bacteremia relies on the isolation and identification of the bacteria from blood cultures, whether they are community-acquired or nosocomial in origin. However, studies have shown that, in the Philippines alone, physicians have been found to underutilize these laboratory examinations. @*Objectives@#The goal of this study was to determine the influence of positive blood cultures and sensitivity test results on the antibiotic choices of pediatrics residents at the University of the Philippines – Philippine General Hospital (UP-PGH). @*Methods@#A chart review of patients with positive blood cultures, who were 18 years old and below, and admitted initially at the UP-PGH Pediatric Emergency Room (UP-PGH PER) from August 1, 2004 to July 31, 2005 was performed. Excluded were patients who died before the release of the blood culture reports or discharged per request or against medical advice, post-operative patients, patients with presumed polymicrobial sepsis, and patients with contaminated blood cultures. Results: One hundred twenty two (122) patients with positive blood cultures were included: 87 or 71.3% of the isolates were community-acquired, the most common pathogens of which were gram-positive bacteria, Staphylococcus epidermidis (18.3%), followed by gram-negative Salmonella (11.5%). Among the patients diagnosed with bacteremia at the UP-PGH PER, Staph. epidermidis was also the most common pathogen; with 34% of all isolates acquired nosocomially. Other significant isolates included Pseudomonas putida, Pseudomonas aeruginosa, and Klebsiella sp. Prior to the release of the blood culture and sensitivity results, 45 of the 122 patients were already discharged. Therapy at the time of discharge was of questionable efficacy, accounting to 73.3%. Of the 77 patients discharged after the release of blood culture and sensitivity (CS) results, only 21(27%) of the antibiotic therapies were modified, and 56 (73%) were not modified at all. It is imperative to know, however, that 50% of the antibiotic therapies were modified a day after the corresponding blood culture and sensitivity (CS) results came out for patients who presented with nosocomial infection. @*Conclusion@#In general, blood culture and sensitivity test results have a limited effect on the antibiotic choices of pediatric residents at the UP-PGH (University of the Philippines – Philippine General Hospital).