Jornal de pediatria最新文献_第5页

Access to genetic evaluation of 1463 individuals with orofacial cleft in Brazil 对巴西 1463 名口面裂患者进行基因评估。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-22 DOI: 10.1016/j.jped.2024.07.002

Isabela Mayá Wayhs Silva , Milena Atique Tacla , Erlane Marques Ribeiro , Elaine Lustosa-Mendes , Agnes Cristina Fett-Conte , Têmis Maria Félix , Ana Carolina Xavier , Isabella Lopes Monlleó , Vera Lúcia Gil-da-Silva-Lopes

Objective

The current study delves into the accessibility of genetic evaluations for individuals with orofacial clefts (OC), comparing data between genetics and treatment centers across Brazil.

Methods

This cross-sectional retrospective study analyzed primary data from 1463 OC individuals registered in the Brazilian Database of Craniofacial Anomalies (BDCA) between 2008 and 2018 without age or sex selection. Diagnostic exam results stemming from research projects until 2023 were considered.

Results

Of the 1463 individuals with typical OC, 987 were non-syndromic, 462 were syndromic (SOC), 10 presented atypical forms, and three were not specified OC cases. The average age for accessing laboratory diagnosis was 8.5 years among SOC individuals. Notably, more SOC cases were registered in genetics centers than treatment and rehabilitation centers (37.1 % vs. 29 %, p = 0.0015). Those originating from genetics centers accessed diagnosis at an average age of 7.3 years, while those from treatment and rehabilitation centers experienced delays with an average age of 10.7 years (p = 0.0581).

Conclusions

Irrespective of the center of origin, the data highlight delayed diagnosis and challenges in accessing genetic tests for the syndromic group. Given the widespread reliance on the public health system by most of the Brazilian population, disseminating this data can significantly contribute to shaping an informed perspective on healthcare access. These insights can improve public policies tailored to the unique needs of individuals with OC.

研究目的本研究通过比较巴西各地遗传学中心和治疗中心的数据，深入研究口面裂（OC）患者接受遗传学评估的可及性：这项横断面回顾性研究分析了2008年至2018年期间在巴西颅面畸形数据库（BDCA）登记的1463名OC患者的原始数据，未对年龄或性别进行选择。研究还考虑了截至2023年的研究项目中的诊断检查结果：在1463例典型OC患者中，987例为非综合征，462例为综合征（SOC），10例为非典型OC，3例为未指定OC病例。在 SOC 患者中，获得实验室诊断的平均年龄为 8.5 岁。值得注意的是，在遗传学中心登记的 SOC 病例多于治疗和康复中心（37.1% 对 29%，P = 0.0015）。来自遗传学中心的病例平均年龄为 7.3 岁，而来自治疗和康复中心的病例平均年龄为 10.7 岁（p = 0.0581）：无论来自哪个中心，这些数据都突显了综合征群体在诊断方面的延迟和在获得基因检测方面的挑战。鉴于大多数巴西人普遍依赖公共卫生系统，传播这些数据可极大地促进人们对医疗服务的了解。这些见解可以改善公共政策，满足 OC 患者的独特需求。

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引用次数: 0

Different immunological patterns of Down syndrome patients with and without recurrent infections 唐氏综合征患者反复感染和未反复感染的不同免疫模式。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-22 DOI: 10.1016/j.jped.2024.06.007

Kamila Rosa Martins , Flavia Araujo Alves , Luiz Roberto da Silva , Lauren Olivia Alves da Silva , Gesmar Rodrigues Silva Segundo

Objective

Individuals with Down Syndrome (DS) exhibit a higher susceptibility to infections, suggesting potential immunological alterations within this population. Consequently, this study aims to assess the immune response profile in children with DS to identify potential immune dysfunctions associated with recurrent infections.

Methods

The authors conducted a retrospective analysis involving 49 DS patients, examining various epidemiological, clinical, cytogenetic, and laboratory variables. The studyʼs sample comprised patients aged 2–20 years, with a predominance of males. These patients were categorized into two groups based on the presence or absence of recurrent infections, as indicated by the Jeffrey Modell Foundation alert signs.

Results

Immunoglobulin (Ig) A, G, and M levels were deemed normal, although individuals with DS experiencing recurrent infections exhibited significantly lower IgA levels. Additionally, CD3, CD4, CD8, and CD19 lymphocyte counts were found to be within normal ranges, with no significant differences between the two groups. While overall data indicated normal seroconversion levels of pneumococcal polysaccharide antibodies, a notable impairment in seroconversion was observed among DS patients with recurrent infections compared to those without such infections.

Conclusion

The deficiency of anti-polysaccharide antibodies in individuals with DS may constitute an important immunological comorbidity. Therefore, it warrants further investigation, particularly among individuals with recurrent infections.

目的：唐氏综合征（DS）患者对感染的易感性较高，这表明该人群中存在潜在的免疫学改变。因此，本研究旨在评估唐氏综合征患儿的免疫反应谱，以确定与反复感染有关的潜在免疫功能障碍：作者对 49 名 DS 患者进行了回顾性分析，检查了各种流行病学、临床、细胞遗传学和实验室变量。研究样本包括 2-20 岁的患者，男性居多。根据杰弗里-莫德尔基金会（Jeffrey Modell Foundation）的警戒体征，这些患者根据有无反复感染被分为两组：免疫球蛋白（Ig）A、G和M水平均正常，但反复感染的DS患者的IgA水平明显较低。此外，CD3、CD4、CD8 和 CD19 淋巴细胞计数均在正常范围内，两组之间无明显差异。虽然总体数据显示肺炎球菌多糖抗体的血清转换水平正常，但与无反复感染的患者相比，有反复感染的DS患者的血清转换能力明显下降：结论：DS 患者抗多糖抗体缺乏可能是一种重要的免疫合并症。结论：DS 患者抗多糖抗体缺乏可能是一种重要的免疫合并症，因此值得进一步研究，尤其是在反复感染者中。

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引用次数: 0

Estimation of standing height in spina bifida: model development and validation 脊柱裂患者站立高度的估算：模型开发与验证。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-16 DOI: 10.1016/j.jped.2024.06.005

Fabio Bertapelli, Marisa Maia Leonardi-Figueiredo, Emanuela Juvenal Martins, Cyntia Rogean de Jesus Alves de Baptista, Ana Claudia Mattiello-Sverzut

Objective

Childhood standing height has been estimated from arm span-related (height_AS) models. The authors aimed to develop and cross-validate a height_AS model in individuals with spina bifida (SB) and examine the accuracy of existing height_AS models.

Methods

Participants were individuals with sacral and low-lumbar SB (n = 14) and non-SB (n = 83), 7–16 years old. Arm span, age, sex, and group (SB vs. non-SB) were candidate height predictors. Sequential regression and leave-one-out cross-validation approaches were used for the model development (M1) and cross-validation (M1–M5). Existing models were: an SB-specific model from Polfuss et al. (M2) and non-SB specific models from Gauld et al. (M3), Mulu et al. (M4), and Zverev et al. (M5) studies.

Results

Arm span and group explained 95 % of the variance in height (R² = 0.95; p < 0.001; SEE = 3.666 cm) and were included in the M1. Mean differences between actual and estimated height were 0.0 cm (M1), 0.4 cm (M2), and 0.5 cm (M5), all not significant (p > 0.05). However, Bland-Altman analysis revealed some variability in the predictability of the models across participants with limits of agreement ranging from 7.4 to 10.9 cm. Considerable errors were observed with M3 (mean diff: −5.58 cm, 95 % CI: −1.6, −20.2 cm), and M4 (mean diff: 10.5 cm, 95 % CI: −13.8, −27.3 cm).

Conclusions

Models (M1, M2 and M5) may accurately estimate standing height in groups of children with SB. However, due to the wide limits of agreement, caution is recommended when applying these models for individual height estimations.

目的：儿童期的站立身高是通过臂展相关（heightAS）模型估算的。作者旨在开发并交叉验证脊柱裂（SB）患者的身高AS模型，并检查现有身高AS模型的准确性：参与者为 7-16 岁的骶椎和低腰椎脊柱裂患者（14 人）和非脊柱裂患者（83 人）。臂展、年龄、性别和组别（骶骨骨折与非骶骨骨折）是预测身高的候选因素。在模型开发（M1）和交叉验证（M1-M5）中采用了顺序回归和留一交叉验证方法。现有模型包括：Polfuss 等人的 SB 特定模型（M2）以及 Gauld 等人（M3）、Mulu 等人（M4）和 Zverev 等人（M5）的非 SB 特定模型：臂展和组别解释了 95% 的身高变异（R2 = 0.95; p 0.05）。然而，布兰德-阿尔特曼分析表明，不同参与者的模型预测能力存在一定差异，差异范围从 7.4 厘米到 10.9 厘米不等。M3（平均差异：-5.58 厘米，95 % CI：-1.6，-20.2 厘米）和 M4（平均差异：10.5 厘米，95 % CI：-13.8，-27.3 厘米）的误差较大：结论：模型（M1、M2 和 M5）可以准确估计 SB 儿童群体的站立身高。结论：模型（M1、M2 和 M5）可准确估计 SB 儿童群体的站立身高，但由于一致性限制较大，建议在应用这些模型估计个体身高时谨慎行事。

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引用次数: 0

Association between type of feeding at hospital discharge and nutritional status of Brazilian very preterm infants: a multicenter study 出院时的喂养方式与巴西早产儿营养状况的关系：一项多中心研究

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-15 DOI: 10.1016/j.jped.2024.06.006

Betina Soldateli , Rita C. Silveira , Renato S. Procianoy , Erika M. Edwards , Mandy B. Belfort

Objectives

To examine trends over time in diet and size of very preterm infants, and associations of diet with size at hospital discharge/transfer.

Methods

The authors studied 4062 surviving very preterm infants born < 32 weeks’ gestational age and < 1500 g between January 2012 and December 2020 from 12 Brazilian Neonatal Intensive Care Units. Diet type at discharge/transfer was classified as exclusive human milk, exclusive formula, or mixed. Outcomes were weight and head circumference at hospital discharge and the change in each from birth to discharge. The authors used linear regression to estimate adjusted associations of diet type with infant size, overall, and stratified by fetal growth category (small vs. appropriate for gestational age). The authors also examined trends in diet and infant size at discharge over the years.

Results

Infants’ mean gestational age at birth was 29.3 weeks, and the mean birth weight was 1136 g. Diet at discharge/transfer was exclusive human milk for 22 %, mixed for 62 %, and exclusive formula for 16 %. Infant size in weight and head circumference were substantially below the growth chart reference for all diets. Infants fed human milk and mixed diets were lighter and had smaller heads at discharge/transfer than infants fed formula only (weight z: −2.0, −1.8, and −1.5; head z: −1.3, −1.2 and −1.1 for exclusive human milk, mixed and exclusive formula respectively).

Conclusion

Results suggest high human milk use but gaps in nutrient delivery among hospitalized Brazilian very preterm infants, with little evidence of improvement over time.

方法作者研究了 2012 年 1 月至 2020 年 12 月间巴西 12 家新生儿重症监护病房的 4062 名胎龄 32 周、体重 1500 克的存活早产儿。出院/转院时的饮食类型分为纯母乳、纯配方奶或混合饮食。研究结果包括出院时的体重和头围，以及从出生到出院期间这两项指标的变化情况。作者使用线性回归估算了饮食类型与婴儿体型的调整关联，包括总体关联和按胎儿生长类别（小于胎龄与适合胎龄）分层的关联。作者还研究了出院时的饮食和婴儿体型在过去几年中的变化趋势。结果婴儿出生时的平均胎龄为 29.3 周，平均出生体重为 1136 克。出院/转院时的饮食中，22% 为纯母乳喂养，62% 为混合喂养，16% 为纯配方喂养。在所有饮食中，婴儿的体重和头围都大大低于生长图表的参考值。与只喂配方奶粉的婴儿相比，喂人奶和混合饲料的婴儿出院/转院时体重较轻，头围较小（体重 z：-2.0、-1.8 和-1.5；头部 z：-结论结果表明，在住院的巴西极早产儿中，人奶的使用率很高，但在营养素的输送方面却存在差距，而且随着时间的推移，几乎没有改善的迹象。

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引用次数: 0

Head growth trajectories as a window into neurodevelopment in preterm infants 作为早产儿神经发育窗口的头部生长轨迹。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-09 DOI: 10.1016/j.jped.2024.07.001

引用次数: 0

Evaluation of the level of information of pediatricians about the diagnosis and management of cryptorchidism 评估儿科医生对隐睾症诊断和治疗的了解程度。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-09 DOI: 10.1016/j.jped.2024.06.002

Objective

Evaluate the level of information of pediatricians about the diagnosis and management of cryptorchidism.

Method

A cross-sectional observational study was conducted using a form via the "Google Forms" platform. The study population included pediatricians and pediatric residents associated with the Brazilian Society of Pediatrics. Seven hundred twenty-eight responses were recorded and analyzed using IBM SPSS v21.

Results

728 valid responses were obtained. Of these answers, only 20.5 % answered that the physical examination was sufficient for the diagnosis, and 79.4 % responded that they requested ultrasound as the best test to aid in diagnosing cryptorchidism. When questioned about the ideal age for referring a patient with cryptorchidism, the survey recorded 56.3 % of the responses defending the correct age as six months old, 30.2 % shortly after birth, and 13.2 % at two years old. Other topics were addressed in the form, such as the frequency of evaluation of testicular position and investigation for DDS, among others. Still, the answers to these questions were compatible with current manuals and guidelines on cryptorchidism.

Conclusion

It is evident that the understanding of the professionals consulted about the diagnosis and management of cryptorchidism needs to be updated with the current practices adopted and that pediatricians, in general, must maintain periodic programs on this subject. Therefore, this topic should be part of a continuing education program with pediatric surgery.

目的：评估儿科医生对隐睾症诊断和治疗的了解程度：评估儿科医生对隐睾症诊断和治疗的了解程度：采用 "谷歌表格 "平台上的表格进行横断面观察研究。研究对象包括与巴西儿科学会有联系的儿科医生和儿科住院医师。记录了 728 份回复，并使用 IBM SPSS v21 进行了分析：结果：共获得 728 条有效回复。在这些回答中，只有 20.5% 的人认为体格检查足以做出诊断，79.4% 的人认为超声波是帮助诊断隐睾症的最佳检查方法。当被问及隐睾症患者的理想转诊年龄时，调查记录显示 56.3% 的回答将正确年龄定义为六个月大，30.2% 的回答将正确年龄定义为出生后不久，13.2% 的回答将正确年龄定义为两岁。调查表中还涉及了其他一些问题，如评估睾丸位置的频率和 DDS 调查等。尽管如此，这些问题的答案与目前有关隐睾症的手册和指南是一致的：很明显，接受咨询的专业人员对隐睾症的诊断和处理的理解需要根据当前采用的方法进行更新，而且儿科医生必须定期开展有关这一主题的课程。因此，该主题应成为小儿外科继续教育课程的一部分。

{"title":"Evaluation of the level of information of pediatricians about the diagnosis and management of cryptorchidism","authors":"","doi":"10.1016/j.jped.2024.06.002","DOIUrl":"10.1016/j.jped.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the level of information of pediatricians about the diagnosis and management of cryptorchidism.</div></div><div><h3>Method</h3><div>A cross-sectional observational study was conducted using a form via the \"Google Forms\" platform. The study population included pediatricians and pediatric residents associated with the Brazilian Society of Pediatrics. Seven hundred twenty-eight responses were recorded and analyzed using IBM SPSS v21.</div></div><div><h3>Results</h3><div>728 valid responses were obtained. Of these answers, only 20.5 % answered that the physical examination was sufficient for the diagnosis, and 79.4 % responded that they requested ultrasound as the best test to aid in diagnosing cryptorchidism. When questioned about the ideal age for referring a patient with cryptorchidism, the survey recorded 56.3 % of the responses defending the correct age as six months old, 30.2 % shortly after birth, and 13.2 % at two years old. Other topics were addressed in the form, such as the frequency of evaluation of testicular position and investigation for DDS, among others. Still, the answers to these questions were compatible with current manuals and guidelines on cryptorchidism.</div></div><div><h3>Conclusion</h3><div>It is evident that the understanding of the professionals consulted about the diagnosis and management of cryptorchidism needs to be updated with the current practices adopted and that pediatricians, in general, must maintain periodic programs on this subject. Therefore, this topic should be part of a continuing education program with pediatric surgery.</div></div>","PeriodicalId":14867,"journal":{"name":"Jornal de pediatria","volume":"100 6","pages":"Pages 640-645"},"PeriodicalIF":2.8,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141599830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparing the clinical characteristics and outcomes of septic shock children with and without malignancies: a retrospective cohort study 比较患有和未患有恶性肿瘤的脓毒性休克患儿的临床特征和预后：一项回顾性队列研究。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-03 DOI: 10.1016/j.jped.2024.06.003

Objective

There is an amelioration in mortality rates of septic shock patients with malignancies over time, but it remains uncertain in children. Therefore, the authors endeavored to compare the clinical characteristics, treatment needs, and outcomes of septic shock children with or without malignancies.

Methods

The authors retrospectively analyzed the data of children admitted to the PICU due to septic shock from January 2015 to December 2022 in a tertiary pediatric hospital. The main outcome was in-hospital mortality.

Results

A total of 508 patients were enrolled. The proportion of Gram-negative bacteria and fungal infections in children with malignancies was significantly higher than those without malignancies. Septic shock children with malignancies had a longer length of stay (LOS) in the hospital (21 vs. 11 days, p<0.001). However, there were no statistically significant differences in the LOS of PICU (5 vs. 5 days, p = 0.591), in-hospital mortality (43.0 % vs. 49.4 %, p = 0.276), and 28-day mortality (49.2 % vs. 44.7 %, p = 0.452). The 28-day survival analysis (p = 0.314) also showed no significant differences.

Conclusion

Although there are significant differences in the bacterial spectrum of infections, the septic shock children with or without malignancies showed a similar mortality rate. The septic shock children with malignancies had longer LOS of the hospital.

目的：随着时间的推移，患有恶性肿瘤的脓毒性休克患者的死亡率有所下降，但儿童患者的死亡率仍不确定。因此，作者试图比较有无恶性肿瘤的脓毒性休克患儿的临床特征、治疗需求和预后：作者回顾性分析了一家三级儿科医院2015年1月至2022年12月因脓毒性休克入住PICU的患儿数据。主要结果是院内死亡率：结果：共有508名患者入院。恶性肿瘤患儿的革兰氏阴性菌和真菌感染比例明显高于非恶性肿瘤患儿。患有恶性肿瘤的脓毒症休克患儿的住院时间（LOS）更长（21 天对 11 天，p）：虽然感染的细菌谱存在明显差异，但患有或未患有恶性肿瘤的脓毒性休克患儿的死亡率相似。患有恶性肿瘤的脓毒性休克患儿的住院时间更长。

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引用次数: 0

Inference of stature using segmental measures in comparison with directly measured height in children and adolescents: an analytical cross-sectional study 使用分段测量法推断儿童和青少年的身高与直接测量身高的比较：一项横断面分析研究。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-02 DOI: 10.1016/j.jped.2024.05.004

Objectives

In the clinical routine of pediatricians, height is the most reliable indicator for assessing growth. However, there are situations where it is not possible to measure this parameter directly, making the estimation of height or length a useful alternative. The main goal of this study is to identify which segmental measure, including upper arm length (UAL), tibial length (TL), and knee-heel length (KHL), provides the stature estimate that most closely approximates directly measured height in the study participants.

Methods

Analytical cross-sectional study of the anthropometric and segmental measures of 248 participants, aged 0 to 14 years old, using Stevenson's and Kihara's equations to estimate indirectly measured height.

Results

The segmental measure that provided a measurement that deviated the least from the actual height was the KHL, followed by TL, both calculated using Stevenson's equations.

Conclusion

The use of segmental measures to infer a child's stature is valuable in clinical practice, particularly in bedridden and incapacitated patients. Based on the present findings, the KHL and TL segments yielded more accurate results than the UAL

目的：在儿科医生的临床日常工作中，身高是评估生长情况的最可靠指标。然而，在某些情况下无法直接测量这一参数，因此身高或身长的估算成为一种有用的替代方法。本研究的主要目的是确定上臂长度（UAL）、胫骨长度（TL）和膝跟长度（KHL）等哪种分段测量方法能提供最接近直接测量身高的身材估计值：对 248 名 0 至 14 岁参与者的人体测量和节段测量进行分析性横断面研究，使用史蒂文森和木原方程估算间接测量的身高：结果：测量结果与实际身高偏差最小的节段测量值是 KHL，其次是 TL，两者均使用史蒂文森方程计算：结论：使用节段测量法推断儿童的身材在临床实践中很有价值，尤其是对于卧床不起和丧失劳动能力的患者。根据目前的研究结果，KHL和TL节段比UAL得出的结果更准确。

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引用次数: 0

Corrigendum to 对......的更正

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-07-02 DOI: 10.1016/j.jped.2024.06.004

引用次数: 0

Validation of entrustable professional activities for use in neonatal care residency programs 验证新生儿护理住院医师培训计划中使用的可委托专业活动。

IF 2.8 4区医学 Q1 PEDIATRICS

Jornal de pediatria

Pub Date : 2024-06-29 DOI: 10.1016/j.jped.2024.05.003

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.

目的定义并制定一套可委托的专业活动（EPAs），将新生儿科住院医师培训项目中新生儿护理的临床培训和医院部分的评估联系起来：采用改良德尔菲法，分两个阶段进行探索性研究。在第一阶段，由五名新生儿科住院医师培训项目协调员组成的委员会根据国家能力矩阵和国际组织定义的 EPA，起草了一套初步的 EPA。在第二阶段，一组新生儿护理医师和住院医师对 EPA 的不可或缺性和清晰度进行了评分，并提出了意见和建议：结果：协调员委员会（n = 5）起草了七份 EPA，并与一组（n = 37）新生儿护理医师和住院医师进行了内容验证。在第一轮德尔菲讨论中，所有 EPA 的内容效度指数 (CVI) 均高于 0.8。协调员委员会分析了意见和建议，并对 EPA 进行了修订。对修订后的 EPA 进行了第二轮德尔菲验证，所有项目的不可或缺性和清晰度的 CVI 均保持在 0.8 以上：结论：制定了七项可委托的专业活动，用于评估住院医师在新生儿护理医学中的医院部分。这些EPAs可能有助于实施以核心专业活动为基础的能力本位新生儿科住院医师培训项目。

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引用次数: 0