Simulation Exercise Research Articles

Developing a competency assessment framework for pharmacists in primary health care settings in India.

Competency frameworks in the pharmacy profession define the necessary practice standards and establish benchmarks for work accountability and career progression. Pharmacists are integral to primary healthcare, and assessing their competencies is essential for improving the performance of primary healthcare services. Although several countries have developed competency frameworks for pharmacists in primary healthcare, such frameworks are currently lacking in India. This study aimed to develop a competency assessment framework for in-service pharmacists in Indian public primary healthcare settings. For which, a five-stage consultative process was followed. In the first stage, the systematic literature review was conducted to identify pharmacist competencies in the primary healthcare setting. After that, an expert consultation was organized to develop consensus among experts on competencies and its behaviours. Competency assessment tools were then developed based on the literature and later finalized through experts' agreements during consultation. Finally, the tools were tested in one of the public primary healthcare facilities. In stage one, the systematic literature review identified 20 competencies and 175 associated behaviors distributed across four domains: Pharmaceutical Health, Pharmaceutical Care, Organization and Management, and Professional/Personal. Expert consultations resulted in the consensus on 11 roles as domains of pharmacists in Indian primary healthcare settings during stage 2. During the expert consultation, each one of 11 pharmacist's role and competencies and behaviours was discussed and consensus was arrived on 26 competencies and 107 behaviours. For which, under the role of pharmacy management, one of the critical competency for primary health care pharmacist is the knowledge about the layout and infrastructure of the pharmacy/store and how to adapt it to optimize pharmacy services. For this competency, one of the behaviour is assessment of the existing infrastructure and identifying gaps and opportunities for improvement. After that in stage 3, a competency assessment tool was developed, and consensus was made on it in stage 4 during expert consultation. The developed tool contains instruments such as a questionnaire to assess knowledge and attitude, and observational checklist, mini-clinical exercises for specific conditions, and simulation exercises to assess skills. This study successfully developed a competency assessment framework for in-service pharmacists in Indian public primary healthcare settings. The framework encompasses 24 competencies and associated behaviors, covering 11 roles of pharmacists in Indian primary healthcare settings. For example, under the pharmacy management role, some of the competencies include planning and procurement, inventory management, storage conditions, digital literacy to handle supply chain-led IT Systems, NSQ Medical Products Management, etc. The developed competency assessment tool assessing knowledge, attitude and skills provides a comprehensive framework for assessing pharmacist competencies and identifying competency gaps. The framework can be used to capacitate pharmacists and improve their performance. It improves their performance in primary healthcare settings, and enhance the delivery of healthcare services in India. Additionally, it fills a critical gap in the existing literature and can serve as a valuable resource for policymakers, educators, and healthcare professionals involved in pharmacy practice in primary care settings.

Integration of mind mapping and In-Situ Simulation training to enhance the implementation of sepsis Hour-1 Bundle treatment

BackgroundSepsis is one of the most challenging and complex clinical states, with persistently high mortality rates. Guidelines recommend the early identification of sepsis patients and immediate initiation of the Hour-1 Bundle treatment to reduce mortality from sepsis. Emergency nurses play a vital role in the early screening of sepsis. Studies indicate that mind mapping and In-Situ Simulation (ISS) training not only aid healthcare professionals in reinforcing theoretical knowledge retention but also enhance skills in coordination, task management, and communication during simulation exercises. This, in turn, promotes the effective implementation of various treatments during resuscitation. The combination of theoretical and practical training methods is more effective than a single training approach. In June 2023, our hospital's emergency department conducted training for emergency nurses on sepsis mind mapping combined with ISS.ObjectiveTo explore the effect of mind mapping combined with ISS training in promoting the emergency nurses' implementation of the Hour-1 Bundle in sepsis patients.MethodsUsing mind mapping and ISS training methods, 24 emergency nurses were divided into 6 groups for a 12-week training period. The study compared their pre- and post-training knowledge of sepsis, identification and diagnostic time, Hour-1 Bundle treatment completion rate, and non-technical skill scores. Post-training, the emergency nurses evaluated the effectiveness of the training.ResultsThe scores for sepsis knowledge among emergency nurses before and after training were 44.17 ± 9.21 and 60.42 ± 5.29, respectively. The identification and diagnostic times (hours) were 0.63 ± 0.18 and 0.49 ± 0.13, respectively. The Hour-1 Bundle treatment completion rates were 58.33% and 85.7%, respectively. There was a significant increase in all non-technical skill scores, with statistical significance (P < 0.05, P < 0.001). After two ISS trainings, the SET-M scores progressively increased, indicating a high satisfaction rate among nurses with the mind mapping and ISS training.ConclusionThe combination of mind mapping and ISS training enables emergency nurses to identify sepsis earlier and promotes the effective implementation of the Hour-1 Bundle treatment in sepsis patients, while also enhancing their cognitive understanding of sepsis and non-technical skills.

On the subject of an ATC simulator exercise in the training of air traffic controllers at Civil Aviation Educational Institutions

On the subject of an ATC simulator exercise in the training of air traffic controllers at Civil Aviation Educational Institutions

The Role of Health and Safety Training in Enhancing Medical Staff Safety in Pediatric Surgery

Pediatric surgery presents unique challenges and risks, necessitating robust health and safety training for medical staff. The delicate nature of surgical procedures involving children requires not only technical proficiency but also a profound understanding of the physiological and psychological differences between paediatric and adult patients. This journal explores the critical role of such training in enhancing the safety of medical personnel engaged in pediatric surgical procedures. The importance of comprehensive health and safety training cannot be overstated. For instance, paediatric patients often present with conditions that are rare in adults, requiring surgical teams to be well-versed in specialised techniques and protocols. A study conducted by the American Academy of Pediatrics highlights that hospitals with rigorous training programmes report significantly lower rates of surgical complications. This correlation demonstrates that well-trained staff are better equipped to anticipate and manage potential risks, thus protecting both the patient and themselves. Moreover, the psychological aspect of working with children cannot be ignored. Medical staff must be trained to communicate effectively with both young patients and their families, alleviating fears and building trust. For example, a case study involving a paediatric cardiac surgery team revealed that pre-surgery consultations, facilitated by trained staff, led to a marked decrease in pre-operative anxiety among children. This not only improved the overall experience for families but also contributed to smoother surgical procedures. Furthermore, the dynamic nature of paediatric surgery requires a high level of teamwork and communication among medical personnel. Training programmes that incorporate simulation exercises can enhance these skills, allowing teams to practice responses to various scenarios. Such exercises foster an environment where staff can learn from each other and refine their collaborative skills, ultimately leading to improved surgical outcomes. In conclusion, robust health and safety training programmes are essential in paediatric surgery, addressing both the technical and emotional challenges faced by medical staff. By investing in comprehensive training, healthcare facilities can significantly mitigate risks, enhance patient safety, and improve overall surgical results. The integration of these training initiatives not only benefits the medical personnel but also ensures a higher standard of care for the vulnerable paediatric population.

Simulation-Based Quality Improvement and Training to Improve Door to Puncture Time for Mechanical Thrombectomy.

Mechanical Thrombectomy (MT) exists as the gold standard for the management of acute ischaemic stroke secondary to large vessel occlusion. There is a direct correlation between reduced time to reperfusion and improved patient outcomes. Our study aimed to optimise processes and reduce the time from the patient's arrival at hospital to vascular puncture for MT (DTP time) through simulation-based quality improvement and staff training. This single-centre prospective study involved two simulation exercises completed over 3 months from March to May 2023. The multidisciplinary simulations involved staff following the MT patient's hyperacute journey from the time of arrival to the Emergency Department triage. Data from all patients at our centre who underwent MT in the 6-month period pre- and post-simulation training were included. The primary outcome measured was the DTP time. For statistical analysis, a paired t-test was used to compare values. In the period prior to the simulation exercises, our hospital recorded 19 direct-to-hospital presentations for patients requiring MT, where we recorded a mean DTP time of 132.38 min. Post the simulation training, we recorded 26 direct-to-hospital presentations, with a mean DTP time of 104.52 min (a reduction of 27.86 min, p = 0.02). Our study did not find any statistically significant difference in DTP time for patients who were inter-hospital transfer presentations. We validated simulation-based training as an effective intervention for reducing time to reperfusion for patients undergoing MT. Implementation of regular training for staff can improve patient outcomes.

Ownership Concentration and Strategic Supply Reduction

We explore the implications of ownership concentration for the recently concluded incentive auction that repurposed spectrum from broadcast TV to mobile broadband usage in the United States. We document significant multilicense ownership of TV stations. We show that in the reverse auction, in which TV stations bid to relinquish their licenses, multilicense owners have an incentive to withhold some TV stations to drive up prices for their remaining TV stations. Using a large-scale valuation and simulation exercise, we find that this strategic supply reduction increases payouts to TV stations by between 13.5 percent and 42.4 percent. (D44, D47, H82, L13, L82, L88)

The prognostic reasoning system for chronic kidney disease progression (PROGRES-CKD) may help improve waiting list management for outpatient nephrology services in a second-level public hospital in Italy.

The management of patients with non-dialysis dependent chronic kidney disease (NDD-CKD) is challenging due to coexisting diseases, competing risks and uncertainties around optimal transition planning. Such clinical challenges are further exacerbated by physician shortage, coupled with rising service demands, which may hinder timely medical access due to long waiting times. Accurate progression risk assessment may help optimize resource allocation and adapting care based on individual patients' needs. This study validated the Prognostic Reasoning System for Chronic Kidney Disease Progression (PROGRES-CKD) in an Italian public hospital and compared its potential impact on waiting list optimization against physician-based protocols. First we first validated PROGRES-CKD by assessing its accuracy in predicting kidney replacement therapy (KRT) initiation within 6months and 24months in a historical cohort of patients treated at the San Gerardo Hospital (Italy) between 01-01-2015 and 31-12-2019. In a second study we compared PROGRES-CKD to attending nephrologists' prognostic ratings and simulated their potential impact on a waiting list management protocol. We included 2005 patients who underwent 11,757 outpatient nephrology visits in 4years. Most visits occurred for NDD-CKD stage 4 patients; the incidence of KRT onset was 10.8 and 9.32/100 patient-years at the 6 and 24-month prediction horizon cohorts, respectively. PROGRES-CKD demonstrated high accuracy in predicting KRT initiation at 6 and 24months (AUROC = 0.88 and AUROC = 0.85, respectively). Nephrologists' prognostic performance was highly operator-dependent, albeit always significantly lower than PROGRES-CKD. In the simulation exercise, allocation based on PROGRES-CKD resulted in more follow-up visits for patients progressing to end-stage kidney disease (ESKD) and fewer visits for non-progressing patients, compared to allocation determined by nephrologists' prognosis. PROGRES-CKD showed high accuracy in a real-world application. Waiting list simulation suggests that PROGRES-CKD may enable more efficient allocation of resources.

Trauma-Informed Care for Intimate Partner Violence and Sexual Assault: Simulated Participant Cases for Emergency Medicine Learners.

Emergency medicine (EM) providers often care for patients who present with concerns related to sexual assault (SA) or intimate partner violence (IPV). However, many providers feel uncomfortable discussing SA and IPV with patients. We aimed to design a curriculum using trauma-informed care principles to improve self-assessed competency in caring for this patient population. EM learners, including residents, EM physician assistant fellows, and medical students, attended a 25-minute didactic session introducing the concept of trauma-informed care and important questions to ask in IPV and SA cases. Learners then participated in a 15-minute simulated single-patient encounter during which they practiced collecting a trauma-informed history identifying features of IPV or SA and appropriately responding to such disclosures. The encounters were observed by a trained SA medical forensic examiner or a victim advocate. The learners next participated in a 10-minute individual and 15-minute group debrief. Sixteen pre- and 17 postcurriculum self-assessments were completed. There was a statistically significant increase in self-perceived confidence in the learners' ability to collect information (p < .01), use strategies to help patients feel physically and psychologically safe (p < .001), recognize how bias influences patient encounters (p < .05), and provide counseling (p < .05). Learners overall found the learning exercise valuable. The exercise introduced learners to trauma-informed care, improved learner confidence, and was well received. Many EM residency programs incorporate simulation into their curriculum; this simulation exercise can be adapted to other programs' educational needs.

Effectiveness of a hybrid, obesity-specific counselling programme in improving medical students’ self-efficacy and motivational interviewing skills for paediatric obesity counselling

BackgroundThere remain significant barriers to healthcare providers counselling children with obesity and their families on lifestyle modifications to improve health outcomes. Obesity-specific counselling training aims to overcome some of these barriers by equipping healthcare workers with the knowledge and confidence to initiate behaviour change talk with patients. However, to the best of our knowledge, there is currently no obesity-specific counselling training in all medical schools in Singapore. To address this gap, an obesity-specific hybrid training programme was developed for medical students in Singapore, which encompassed e-learning materials on paediatric obesity and motivational interviewing techniques as well as simulated patient exercises. We aim to evaluate the impact of the programme on medical students’ self-efficacy for obesity counselling and motivational interviewing skills, as well as establish participants’ acceptability of the module.MethodsThe medical students’ self-efficacy for patient-centered obesity counselling before and after reviewing the online materials was measured using the Perceived Competence for Obesity Counselling (PCOC), while their motivational interviewing skills were evaluated using the Behaviour Change Counselling Index (BECCI) based on feedback from trained facilitators.ResultsThere was significant improvement in the medical students’ self-efficacy for obesity counselling and motivational interviewing skills after participating in the online module, as measured on the PCOC and BECCI respectively. The training programme was also well-received among participants, with mean scores of more than 4 out of 5 on all items on the evaluation form.ConclusionOur findings support the introduction of such short obesity-specific counselling workshops in medical school curricula as they can be effective in preparing medical students to manage childhood obesity, and potentially other chronic conditions in children and adults, as junior physicians.

Scoping review and proposed curriculum for robotic hepatopancreatobiliary surgery training.

HPB surgery is being increasingly performed robotically worldwide. However, there is no consensus on what constitutes adequate training or an established curriculum. We evaluate the existing literature on formal education in robotic hepatopancreaticobiliary (HPB) surgery and propose a curriculum using Kern's six-step curriculum development model. A systematic search was performed across major databases and the methodology of the Joanna Briggs Institute was followed. The PRISMA-ScR was conformed in reporting. Evidence pertaining to cholecystectomy alone was excluded and studies that described formal training pathways were included. Fifteen curricula were included with predilection towards the pancreas (n = 7, liver: n = 5, combination: n = 3). Almost all studies proposed initial robot system training through online modules, observership and console simulation exercises. Following this, six curricula described procedure-specific anastomosis training. Almost all studies described mentorship and proctorship. The assessment for implementation commonly described includes objective structured assessment of technical skill (OSATS) and cumulative sum technique (CUSUM) for operation time, conversion-to-open rate and postoperative complications. This study has summarised the formal curricula for learning robotic HPB surgery. The majority share similar implementation tools. A comprehensive curriculum based on validated educational principles has been proposed which incorporates these elements.

Single-surgeon training of 14 novice surgeons in robotic cholecystectomy: a study of 300 consecutive cases, assessing training outcomes and surgical performance.

Robotic-assisted surgery (RAS) is a rapidly evolving field, requiring comprehensive training for widespread adoption. The aim of this study was to analyze the effectiveness of RAS cholecystectomy training in improving the technical skills and confidence of novice surgeons. Furthermore, the study examined the transferability of RAS skills to laparoscopic skills, the role of RAS cholecystectomies in reducing errors and improving patient outcomes, and identified factors that predict a successful transition from traditional laparoscopic surgery to RAS surgery. The RAST curriculum includes multimodal learning content delivered through a cloud-based platform, with three steps: basic training, simulation exercises, and structured on-patient training in the operating room. One general surgeon was trained on the Intuitive Surgical da Vinci system and assisted in performing 10 da Vinci-assisted laparoscopic cholecystectomies. In the first 300 patients who underwent robotic cholecystectomy, there were no major complications, conversions to laparoscopy, or open surgeries. The RAST curriculum demonstrates feasibility in providing a comprehensive and effective RAS training experience for surgical residents, reducing the need for extensive travel and high costs. The RAST curriculum is a promising solution for training surgical residents in RAS, with potential for widespread adoption and scalability.

Student survey of simulation standards for continuous improvement (S4CI): Establishing reliability and validity.

Student survey of simulation standards for continuous improvement (S4CI): Establishing reliability and validity.

Risk apportionment to remote and recent asbestos exposures for pleural mesothelioma

the exposure-response relationship between pleural mesothelioma and asbestos has been traditionally described by models that predicted incidence to increase indefinitely by latency. Studies with long observation showed that the increase flattens out beyond 40 years of latency. It has been, therefore, proposed to introduce an exponential decay function into the models Objectives: to show characteristics and implications as to the relevance of remote and recent exposures, by conducting a simulation exercise based on data available from the literature. the traditional and decay models that best fit mortality from pleural cancer during the initial 40 years of observation in the Italian pooled cohort of asbestos workers were selected. The mesothelioma incidence predicted by such models as a function of age at first exposure, exposure duration, and age at risk was compared. It was also compared the proportional weight assigned to remote, intermediate, and recent exposure, by dividing the whole exposure period in three parts of equal duration. the decay, but not the traditional, model fits well the trend observed after 40 years. According to the traditional model, remote exposures have maximum and recent exposures minimum weight: for instance, following an exposure starting at age 20 and lasting 18 years, the incidence at age 80 would be attributed to remote exposures by 47% and by 21% to the recent ones. The decay model predicts only minor differences and even of reversed weight: 34% and 31%, respectively, in this case. remote exposures do not necessarily have overwhelming weight in determining pleural mesothelioma risk. The balance between different exposure periods depends on the time-distribution of exposure.

Mock Court simulations—what is their influence on preparing police officers for the reality of presenting testimony in a court case?

Abstract The preparation of police recruit officers as police witnesses in judicial hearings is critical in contributing to the accuracy and completeness of information in the prosecution of alleged offenders and ultimately to judicial decisions. There is a paucity of studies focused on strategies for preparing police officers for their role in court hearings. This article presents the evaluation of the design and delivery of a Mock Court simulation exercise in preparing police recruits for the reality of this future operational role. The findings from participant surveys and interviews indicate the Mock Court simulation exercises enable participants to more adequately transition theory to practice and is an essential experience for building competence and confidence for their future policing duties. The key elements of the Mock Court simulation design and environment that evoke engagement, presence, and immersion in the simulation are discussed to contribute to the wider police education community endeavours.

Air, Skin, and Biological Monitoring of French Fire Instructors' Exposure to Particles/PAHs During Controlled Fire and Mitigation Strategies.

Occupational exposure as a firefighter was recently classified as carcinogenic to humans by the IARC. Fire instructors' exposure to carcinogenic PAHs is a major concern, and studies that have tried to assess the determinants of their exposure are scarce. An air and biomonitoring study was conducted in fire instructors performing simulated training exercises in enclosed containers. Air samples were collected, as well as urine samples from 22 firefighting instructors, and skin wipes were collected from FFs' skin at the end of the exercises. PAH metabolites (1-hydroxypyrene, 3-hydroxybenzo(a)pyrene, 2/3-hydroxyfluorene, and 2/3-hydroxyphenanthrene) were measured in urine samples at three sampling times (beginning of shift, end of shift, and next morning). Airborne PAHs were dominated by low molecular weight compounds (naphthalene), and levels were as high as 67 µg·m-3 close to the containers, decreasing at higher distances. Skin contamination was observed both on the neck/face and hands/wrists of fire instructors and pilots. Ten times lower skin contamination was observed when nitrile undergloves were worn. High internal exposure was measured, with 1-hydroxypyrene and 3-hydroxybenzo(a)pyrene levels frequently exceeding maximum recommended values in occupational settings (up to 2.8 µmol/mol creatinine for 1-OHP, 14 µmol/mol creatinine for ΣOH-PAH, and 1.0 nmol/mol creatinine for 3-OHBaP), whereas benzene exposure was revealed to be very low. These types of exposure were found to derive both from dermal absorption (combustion products deposited on the skin) and inhalation (when removing SCBA outside the containers). Several recommendations are proposed in order to reduce both exposure routes (nitrile undergloves and half-masks in the vicinity of containers), harmonise decontamination (PPEs) and cleaning procedures, and prevent the dermal absorption of PAH from turnout gear. This study emphasises the complex PAH exposure profiles of fire instructors and characterises the main drivers of exposure, highlighting the need for better mitigation strategies.

Development of an in vitro model to study muscle maladaptation to overtraining

Introduction Physical training stimulates skeletal muscle mitochondrial biogenesis and protein synthesis, inducing beneficial adaptations and promoting performance. However, in some cases when the training load is higher than required, the outcome may lead to non-functional overreaching – a state in which performance may be transiently reduced. This condition is relatively common especially among endurance athletes, and if protracted would result in the development of the overtraining syndrome (OTS), whose impact on skeletal muscle metabolism and function is still unknown. Muscle soreness, increased inflammation and reduced muscle mass are often reported. It has been reported that regeneration of skeletal muscle fibres is impaired, probably through a change in energy metabolism (Grobler et al., 2004). For instance, altered mitochondrial structure and function have been suggested (Grobler et al., 2004). The aim of the present project is to determine the molecular mechanisms underlying skeletal muscle maladaptation’s in response to simulated exercise in vitro. Methods Using a model developed in our laboratory (Zanou et al., 2021), we electrically stimulated C2C12 myotubes (a mouse skeletal muscle cell line) to simulate endurance exercise (Zanou et al., 2021). For simulated training (s-T) the stimulation was applied once daily, for three consecutive days. For simulated overtraining (s-OT), the stimulation was applied three times per day for three consecutive days. Mitochondrial biogenesis biomarkers have been measured, alongside proteomics analysis and mitochondrial respiration. Results In the in vitro s-T model, we observed the expected beneficial adaptations to training, which include myotube hypertrophy, increased fast and slow-twitch myosin heavy chain protein content, and increased mitochondrial respiration. Our proteomics data highlighted many positive adaptations, including upregulation of the muscle contractile and mitochondrial proteins. Immunofluorescence staining of F-actin and of the mitochondrial outer membrane protein Tom20, clearly showed robust F-actin structure and regular mitochondrial distribution in response to s-T. Interestingly, s-OT model presented myotube atrophy, and a decrease in fast and slow-twitch myosin heavy chain protein content. Mitochondrial respiration was increased in s-T and showed a clear trend versus reduction in s-OT. Our proteomics data revealed many downregulated proteins pathways in s-OT including muscle contractile and mitochondrial pathways. Immunofluorescence staining also revealed disrupted F-actin structure and aberrant mitochondrial aggregation in response to s-OT. Conclusions s-T recapitulates training positive adaptations, whereas s-OT recapitulates many of the muscle maladaptation observed in overtraining. Our next studies in human OTS muscle will validate key findings from our in vitro s-OT model and guide our mechanistic investigations into the molecular mechanisms of OTS.

Relationship between disaster preparedness perception, self-efficacy, and psychological capital among Turkish nurses.

Although disasters continue to increase all over the world and international nursing organizations warn nurses to be ready for disasters, it is stated that the training of nurses for disasters is inadequate in Turkey as in many countries, and studies on this subject are limited AIM: This study aimed to explore the relationship between disaster preparedness perception, self-efficacy, and psychological capital among Turkish nurses. This cross-sectional study was conducted with 270 nurses working at a university hospital in Turkey from May 2023 to December 2023. The mean Disaster Preparedness Perception Scale, General Self-Efficacy Scale, and Psychological Capital Questionnaire scores of the nurses were 73.19±11.06, 31.24±3.89, and 98.05±11.35, respectively. According to linear regression analysis, self-efficacy, psychological capital, receiving disaster training, and being exposed to disaster were significant predictive factors that affected disaster preparedness perception. To improve nurses' disaster preparedness, it is vital to strengthen their self-efficacy and psychological capital through various strategies. Managers should identify individual and organizational barriers that affect nurses' readiness for disasters, prepare nurses for all stages of disaster management through continuous training, scenario-based simulation exercises and drills, and create a disaster management culture in the organization.

Sustained effects of bladder point-of-care ultrasound simulation exercise on nursing students: A prospective cohort study

BackgroundPoint-of-care ultrasound (POCUS) can be used in a variety of clinical settings and is a safe and powerful tool for ultrasound-trained healthcare providers, such as physicians and nurses; however, the effectiveness of ultrasound education for nursing students remains unclear. This prospective cohort study aimed to examine the sustained educational impact of bladder ultrasound simulation among nursing students.MethodsTo determine whether bladder POCUS simulation exercises sustainably improve the clinical proficiency regarding ultrasound examinations among nursing students, evaluations were conducted before and after the exercise and were compared with those after the 1-month follow-up exercise. A bladder urine volume measurement simulator and a portable ultrasound device were used during the exercise. Nursing student volunteers participated in this prospective observational study. The primary outcome was the Objective Structured Assessment of Ultrasound Skills (OSAUS) score. The secondary outcomes were the Self-Directed Learning Readiness Scale (SDLRS) and Student Satisfaction and Self-Confidence in Learning (SSSCLS) scores. Differences were analyzed using one-way analysis of variance with repeated measures.ResultsData from 12 students were analyzed. The percentages of total OSAUS scores increased from 34.3% after the initial bladder POCUS simulation exercise to 51.0% after the 1-month follow-up exercise (p < 0.001). The OSAUS scores for several subdomains, including image optimization, systematic reviews, image interpretation, test documentation, and medical decision-making, increased significantly. In addition, the SDLRS significantly increased from 204.4 before the exercise to 233.6 after the 1-month follow-up exercise (p < 0.001), and the SSSCLS confidence scores also increased from 33.7 after the initial exercise to 36.4 after the 1-month follow-up exercise (p < 0.005).ConclusionThe bladder POCUS simulation exercise is effective in continuously improving the clinical performance of nursing students for ultrasound examinations even at 1-month follow-up, increasing their confidence and promoting a self-directed learning attitude.

Synergies in Education: Simulation Techniques, Electronic Portfolios, and SDG for Future-Focused Learning

The "Competence-based Training and Simulation in Healthcare" project aims to transform healthcare education by integrating simulation techniques, electronic portfolios, and the Sustainable Development Goals (SDGs) into teaching practices across partner institutions. Key activities include needs analysis, teacher training, student mobilities, and the creation of electronic portfolio templates and simulation exercises, all aligned with market needs and fostering collaboration, critical thinking, and innovative pedagogy. By engaging with the 17 SDGs, the project produces a guide for their application in healthcare education, enhancing the professional and personal development of educators and students while strengthening transnational collaboration. This initiative seeks to establish a dynamic, responsive educational framework to prepare healthcare professionals for emerging challenges, with this paper focusing on the project's implementation in the Portuguese context.

Dynamic Adaptation of Hematological Parameters, Albumin, and Non-Esterified Fatty Acids in Saddlebred and Standardbred Horses During Exercise.

The response to exercise following a rest period may vary among horse breeds based on the importance of the hematological and hematochemical profiles of athletic horses. Ten Standardbred and ten Italian Saddlebred mares were subjected to a 4-week training program after a seasonal rest, and hematological parameters (red blood cells-RBCs; hemoglobin-Hb; hematocrit-Hct; platelets-PLTs; platelet aggregation-AG; aggregation slope-Slope; fibrinogen-Fb), as well as Albumin (Alb) and non-esterified fatty acids (NEFAs), were analyzed. Blood samples were obtained each week during the training program following a simulated exercise performed at T0 and T4 (T0pre-T0post; T1, T2, T3, and T4pre-T4post). A two-way ANOVA revealed an increase in all assessed parameters post vs. pre at T0 and T4 (p < 0.01) and a decrease in PLTs (p < 0.01) at T0 and T4 in both breeds. A significant effect of breed was observed, with higher values for RBCs and Hb at each time point (p < 0.001); Hct at T0 post, T2, T3, and T4 post; and NEFAs (p < 0.001) at T0 post and T4 post in Standardbred compared to Saddlebred horses. Positive correlations were identified among RBCs, Hb, Hct, PLTs, Alb, and NEFAs in both breeds and between AG and Slope in Saddlebred horses. Negative correlations were identified among AG and RBCs, Hb, Hct, PLTs, Alb, and NEFAs in Standardbred horses and for AG and Slope with RBCs, Hb, Hct, and PLTs in Saddlebred horses. A comparable reaction to training was observed in both breeds following the seasonal rest.