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There was a widespread discontinuation of simulation programs during and after the COVID-19 pandemic. The objective is to explore how to facilitate greater integration of simulation in healthcare organizations. A literature review was conducted in PubMed, MEDES, IBECS and DOCUMED databases. Twenty-three articles published after the pandemic were selected, categorized in seven themes and critically reviewed. In order to consistently and fully integrate simulation into the organizational culture it is recommended to prioritize the development of new strategies that enhance the efficiency and safety of healthcare delivery. And also strategies that enhance the satisfaction and well-being of all stakeholders., (Copyright © 2023 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In situ simulation facilitates training in clinical settings under similar emotional pressure that occurs in real life situations. The objective of the present study was to assess the feasibility, implementation, facilitators self-confidence and teaching challenges of a training program of cardiopulmonary resuscitation through an in situ simulation plan., Method: A training program was designed for the facilitators. The number of professionals trained and in situ simulations performed were recorded, as well as the logistical challenges. An ad hoc survey was designed to assess facilitators self-confidence and educational challenge which were classified using the debriefing assessment for simulation in healthcare©., Results: During a period of 3 years, 95 trained facilitators implemented 378 in situ simulations that allowed to train 1281 nursing professionals working at inpatient units. Integration of in situ simulations with daily activities and availability of facilitators were the main logistical challenges. Stablishing and maintaining a stimulating learning environment and structuring the debriefing in an organized way were the main educational challenges., Conclusions: In situ simulation helps to train the coordination of nursing teams taking care of patients in cardiorespiratory arrest and to identify the risks that may affect patient safety. Identifying the educational challenges during the implementation of in situ simulation facilitates the design of specific educational and monitoring strategies., (Copyright © 2021 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Debriefing Assessment for Simulation in Healthcare (DASH) is an instrument to assist in developing and evaluating faculty debriefing and instructional skills that, in the context of trained raters, yields reliable data and internal consistency. Support for its validity is grounded in both its content and the scores arising from its use. The utilization of this and other assessment tools, guidelines, and protocols is expanding internationally, but most of them are available only in English and there is not a single established methodology for translation. The objectives of this study were to demonstrate a translation technique and conduct a linguistic validation of the translation of the DASH from English to Spanish and to demonstrate and conduct a cultural validation across 8 Spanish-speaking countries., Methods: A forward translation and review of the DASH score sheets and Rater's Handbook defined the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the translators to produce the approved harmonized version. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 5 monolingual subjects from 8 Spanish-speaking countries., Results: During the forward translation, 16 discrepancies were detected in the Spanish DASH. Sixty-two participants were sent the Spanish cultural questionnaire and 48% responded. A total of 82 different interpretations and 57 extra recommendations (42% terms, 16% concepts, and 42% syntax) were made. Twenty-seven percent of them were applied., Conclusions: The translated DASH has undergone a linguistic validation into Spanish, and a cultural validation across 8 Spanish-speaking countries. It may be used to assess debriefings in healthcare settings in these countries. The methodology used is applicable for translating and assessing a cross-cultural validation of assessment instruments., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Society for Simulation in Healthcare.)

Cumulating evidence indicates that dysregulation of microRNAs (miRNAs) plays a central role in the initiation, progression, and drug resistance of cancer cells. However, the specific miRNAs contributing to drug resistance in ovarian cancer cells have not been fully elucidated. Aimed to identify potential miRNAs involved in platinum resistance, we performed a miRNA expression profile in cisplatin-sensitive and cisplatin-resistant ovarian cancer cells, and we found several differentially abundant miRNAs in the pair of cell lines. Notably, miR-18a-5p (miR-18a), a member of the oncogenic associated miR-17-92 cluster, was decreased in cisplatin-resistant as compared with cisplatin-sensitive cells. Real-time PCR analysis confirmed these findings. We then studied the biological, molecular, and therapeutic consequences of increasing the miR-18a levels with oligonucleotide microRNA mimics (OMM). Compared with a negative control OMM, transient transfection of a miR-18a-OMM reduced cell growth, cell proliferation, and cell invasion. Intraperitoneal injections of miR-18a-OMM-loaded folate-conjugated liposomes significantly reduced the tumor weight and the number of nodules in ovarian cancer-bearing mice when compared with a control-OMM group. Survival analysis using the Kaplan-Meier plotter database showed that ovarian cancer patients with high miR-18a levels live longer in comparison to patients with lower miR-18a levels. Bioinformatic analyses, real-time-PCR, Western blots, and luciferase reporter assays revealed that Matrix Metalloproteinase-3 (MMP-3) is a direct target of miR-18a. Small-interfering RNA (siRNA)-mediated silencing of MMP-3 reduced cell viability, cell growth, and the invasiveness potential of cisplatin-resistant ovarian cancer cells. Our study suggests that targeting miR-18a is a plausible therapeutic strategy for cisplatin-resistant ovarian cancer., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Quiñones-Díaz, Reyes-González, Sánchez-Guzmán, Conde-Del Moral, Valiyeva, Santiago-Sánchez and Vivas-Mejía.)

Background and Objective: There is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment., Methods: A working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution., Results: The following supplies are produced: 1) devices that help protect providers: face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas., Conclusions: 3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To describe the use of simulation as a tool to support the strategic management of change in the Cantabrian Regional Health Service in Spain., Methods: A working group was created to: 1) define the strategic areas of innovation and change; 2) establish criteria for the selection of proposals that can be addressed with simulation; 3) analyse and select the proposals; 4) design and implement the simulation programs, and 5) evaluate results., Results: The constantly changing needs of the regional health system enabled 6 strategic areas to be identified during 2017-208: 1) efficient use of resources; 2) implementation of health plans of interest in the community; 3) patient safety improvement; 4) management of health personnel; 5) development of new professional skills, and 6) selection and implementation of new technology., Conclusions: Clinical simulation is a useful tool to promote innovation strategies in healthcare, facilitating the adaptation of professionals and patients to change., (Copyright © 2020 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Objective: Malnourishment can be caused by either a lack of food or an excess of low-nutrient foods. Due to several factors, this predisposes children to academic failure. The objective of this study is to estimate the prevalence of school children with eating problems, study their nutrition level, food quality in the diet, and level of physical activity., Material and Methods: The study involved the school children between 3 months and 16.5 years of age in the municipalities of Centelles, Hostalets de Balenyà and Sant Martí de Centelles. Personal, age, nutrition and physical activity data were collected for the descriptive and bivariate analyses., Results: A total of 1,374 children were included, of which 122 were under 3 years of age (8.9%). Obesity was recorded in 2.5%, while 17.2, 15.6 and 64.8% were overweight, underweight and of normal weight, respectively. The remaining 1,252 children were over 3 years of age (91.1%), and obesity was recorded in 8.1%, while 26.1, 11.0 and 62.9% were overweight, underweight and of normal weight, respectively. Adherence to the Mediterranean diet decreased significantly with increasing age. The maintenance of body weight was significantly correlated to the consumption of carbohydrates for breakfast before going to school, daily fruit consumption, and not having a need for care from the social services. The differences in physical activity and a sedentary lifestyle proved significant between males and females., Conclusion: Being underweight and overweight are factors related to eating habits and dependency upon the social services., (Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Although tacrolimus therapy is not the first-line therapy for childhood nephrotic syndrome, it is often used instead of cyclosporine to ameliorate the side effects. The pharmacokinetics (PK) of tacrolimus (Tac) can be influenced by many conditions, and it has a high plasma protein binding. The Tac PK during relapse and remission of childhood nephrotic syndrome has not been well described., Methods: We performed 14 PK profiles (with measurements before intake and 0.5, 1, 2, 4, and 12 hours postintake) in 7 children with steroid-resistant nephrotic syndrome at week 1 (all nephrotic) and week 16 after Tac therapy (all in remission). These data were compared with historical PK data of 161 PK profiles in 87 pediatric renal transplant recipients with measurements before intake and 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 12 hours postintake. Tac levels were measured using the Abbott Tacro II assay. We used descriptive statistics to generate percentiles and compared these with those of patients with steroid-resistant nephrotic syndrome., Results: The median age of patients with nephrotic syndrome was 3.2 years (range 2.5, 17.2), male gender 71.4%, significantly younger than the control group. Median Tac dose was similar during both PK profiles (0.11 mg·kg·d at week 1 versus 0.13 mg·kg·d at week 16, P = 0.81). There were no statistically significant differences in median dose-normalized area-under-the-time-concentration profiles, peak concentration, time to reach peak concentration, and Tac trough levels. Individual dose-normalized Tac levels for each time point during the PK profile were also not different (P = 0.81)., Conclusions: We conclude that Tac PK profiles are unaltered during relapse of nephrotic syndrome.

Unlabelled: Finasteride 1 mg, one of the main treatments for male androgenetic alopecia (MAGA), may produce sexual dysfunction, but young men with MAGA could experience high psychosocial impairment because of changes in body image. Dissatisfaction with body image has been linked to an increase in problems with sexual function. To date no study has considered the possible effect of psychological impairment on sexual function of men with MAGA. Aim of our study was to explore the effect of psychosocial impairment produced by hair loss on the sexual function of men with MAGA., Patients and Methods: Cross-sectional design. In total, 190 men with MAGA ranging 18-40 years old were recruited from an Internet online community. Participants completed an online survey comprising the SKINDEX-29 and the Massachusetts General Hospital Sex Functioning Questionnaire. Individuals with MAGA and moderate to severe psychosocial impairment had a higher risk of sexual dysfunction - adjusted odds ratio 2.1 (1.2-4.0; P=0.02) - compared with subjects with mild to absent impairment. Sexual desire and sexual arousal were the most affected elements of sexual response, but an increase in erectile dysfunction and reduced global satisfaction were also reported. We present the first study exploring the influence of MAGA psychosocial impairment on sexual function. Men between 18 and 40 years of age with moderate to severe MAGA psychosocial morbidity were found to have an increased risk of sexual dysfunction. Assessment of psychological morbidity and sexual function could be critical in patients with MAGA, particularly when considering treatment with finasteride.

Introduction: We analyzed the impact of simulation-based training on clinical practice and work processes on teams caring for patients with possible Ebola virus disease (EVD) in Cantabria, Spain., Methods: The Government of Spain set up a special committee for the management of EVD, and the Spanish Ministry of Health and foreign health services created an action protocol. Each region is responsible for selecting a reference hospital and an in-house care team to care for patients under investigation. Laboratory-confirmed cases of EVD have to be transferred to the Carlos III Health Institute in Madrid. Predeployment training and follow-up support are required to help personnel work safely and effectively. Simulation-based scenarios were designed to give staff the opportunity to practice before encountering a real-life situation. Lessons learned by each team during debriefings were listed, and a survey administered 3 months later assessed the implementation of practice and system changes., Results: Implemented changes were related to clinical practice (eg, teamwork principles application), protocol implementation (eg, addition of new processes and rewriting of confusing parts), and system and workflow (eg, change of shift schedule and rearrangement of room equipment)., Conclusions: Simulation can be used to detect needed changes in protocol or guidelines or can be adapted to meet the needs of a specific team.

Statement: Five principles of magic are described that directly relate to enhancing participant engagement in the healthcare simulation setting. The principles discussed are the following: reality is in the mind of the participant, attention is easily misdirected, perception can be manipulated, various cognitive biases can be exploited, and focus must be captured. Using these principles in a healthcare simulation can help fill gaps in fidelity and bring a participant to a point where the situation and events make sense to them, they feel that they are in an appropriate environment, and they are willing to forgive the natural flaws of the simulation itself. Misuse of illusions beyond the purpose of filling fidelity gaps can break trust with the teacher and lead to disengagement of the participant.