Validation of entrustable professional activities for use in neonatal care residency programs.

OBJECTIVE: Define and develop a set of entrustable professional activities (EPAs) to link clinical training and assessment of the hospital components of neonatal care in neonatology medical residency programs. METHODS: An exploratory study was conducted in two phases using a modified Delphi approach. In the first phase, a committee of five neonatology residency program coordinators drafted an initial set of EPAs based on the national matrix of competencies and on EPAs defined by international organizations. In the second phase, a group of neonatal care physicians and medical residents rated the indispensability and clarity of the EPAs and provided comments and suggestions. RESULTS: Seven EPAs were drafted by the coordinators´ committee (n = 5) and used in the content validation process with a group (n = 37) of neonatal care physicians and medical residents. In the first Delphi round, all EPAs reached a content validity index (CVI) above 0.8. The coordinators´ committee analyzed comments and suggestions and revised the EPAs. A second Delphi round with the revised EPAs was conducted to validate and all items maintained a CVI above 0.8 for indispensability and clarity. CONCLUSION: Seven entrustable professional activities were developed to assess residents in the hospital components of neonatal care medicine. These EPAs might contribute to implementing competency-based neonatology medical residency programs grounded in core professional activities.

The use of reverse transcription-polymerase chain reaction (RT-PCR) for the rapid detection and identification of dengue virus in an endemic region: a validation study.

Dengue is the most important arboviral disease worldwide. Dengue diagnosis is usually made by serology, but serological techniques do not identify the infecting strain, and are only useful late in the course of infection. Several reverse transcription-polymerase chain reaction (RT-PCR) protocols have been described for dengue diagnosis but none of them has been used on a regular basis. We conducted a validation study of PCR-based diagnosis in an area (in Brazil) where dengue-1 virus has been circulating at a low incidence rate. Viral detection by RT-PCR was evaluated using the sera of 253 patients with clinical diagnosis of dengue, and the results were compared to those obtained by IgM capture enzyme-linked immunosorbent assay (MAC-ELISA) and virus isolation. Out of 75 IgM-positive samples, 17 were RT-PCR positive, and only 2 were positive for virus isolation. Through enzymatic digestion of PCR amplicons, we were able to differentiate the 2 dengue serotypes circulating in Brazil (dengue-1 and dengue-2), and to determine that dengue-1 was the virus responsible for the infections. We show with this study that RT-PCR is more sensitive than virus isolation on clinical samples and allows for a rapid detection of dengue infections and for a straightforward identification of the circulating serotype.