Review of hyperdispersal in wildlife translocations.

Species translocation is a common tool to reverse biodiversity loss, but it has a high failure rate. One factor that contributes to failure is postrelease hyperdispersal, which we define as the long-distance movement of individuals resulting in their failure to contribute to population establishment. We reviewed reported incidences of hyperdispersal and compared rates of hyperdispersal among taxa, population demographics, release cohorts, and success of mitigation techniques. Of 151 conservation translocations (reinforcements and reintroductions) in which animals were tracked, hyperdispersal was confirmed in 52.1% of programs. The prevalence of hyperdispersal (percentage of studies) was relatively consistent across taxa (42.9-60%), but hyperdispersal rates in birds were likely underestimated because 76.9% of bird translocations showed incidences in which birds could not be located after release, but hyperdispersal was unable to be confirmed. Eutherians exhibited a higher average incidence of hyperdispersal (percentage of hyperdispersing individuals in a cohort) of 20.2% than birds, reptiles, and marsupials (10.4%, 15.7%, and 10.3%, respectively). No significant trends were observed for sex, source population, or translocation type, but there were nonsignificant trends for males to hyperdisperse more than females and for higher incidences of hyperdispersal in reinforcements relative to reintroduction programs. Mitigation techniques included temporary confinement, supplementation of resources, and releasing animals in social groups, but only half of studies examining mitigation techniques found them useful. Hyperdispersal incidence was variable within taxa, and we advise against forming translocations strategies based on results from other species. Hyperdispersal is a significant welfare, economic, and conservation issue in translocations, and we suggest definitions, reporting, and experimental strategies to address it.

Revisión de la hiperdispersión en las reubicaciones de fauna Resumen La reubicación de especies se usa muy seguido como herramienta para revertir la pérdida de la biodiversidad a pesar de tener una tasa elevada de fracaso. Un factor que contribuye a este fracaso es la hiperdispersión posterior a la liberación, la cual definimos como el movimiento de larga distancia de los individuos que resulta en su fracaso para contribuir al establecimiento de la población. Revisamos las incidencias reportadas de la hiperdispersión y comparamos las tasas de hiperdispersión entre los taxones, las poblaciones, demografías, grupos de edad liberados y el éxito de las técnicas de mitigación. Confirmamos la hiperdispersión en 52.1% de 151 reubicaciones de conservación (reforzamiento y reintroducciones) en las cuales se rastreó a los animales. La prevalencia de la hiperdispersión (el porcentaje de estudios) tuvo una coherencia relativa en todos los taxones (42.9-60%), aunque probablemente se subestimaron las tasas de hiperdispersión de las aves porque el 76.9% de sus reubicaciones mostraron incidencias en las que no se pudieron ubicar a los individuos después de la liberación, pero tampoco se pudo confirmar la hiperdispersión. Los euterios exhibieron un promedio de incidencia de hiperdispersión (porcentaje de individuos con hiperdispersión dentro de un grupo de edad) del 20.2%, mayor que el de las aves, reptiles y marsupiales (10.4%, 15.7% y 10.3% respectivamente). No observamos tendencias significativas para el sexo, la población original o el tipo de reubicación, aunque sí hubo tendencias no significativas de mayor hiperdispersión en los machos que en las hembras y de mayor incidencia de hiperdispersión en los reforzamientos en relación con los programas de reintroducción. Las técnicas de mitigación incluyeron el confinamiento temporal, el suplemento de recursos y la liberación de animales en grupos sociales, pero sólo la mitad de los estudios que examinaban estas técnicas las encontraron útiles. La incidencia de la hiperdispersión varió en cada taxón, por lo que aconsejamos no estructurar las estrategias de reubicación con base en los resultados de otras especies. La hiperdispersión es un tema importante para el bienestar, la conservación y la economía de las reubicaciones y sugerimos estrategias de definición, reporte y experimentación para abordarla.

Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants.

Maintaining treatment fidelity when implementing evidence-based interventions is a significant challenge. The inability to deliver in-person services due to the COVID-19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch-Up (ABC) program is an evidence-based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and "in-the-moment" commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5-min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in-the-moment comments. On average, parent coaches were able to exceed in-person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

Mantener la fidelidad al tratamiento cuando se implementan intervenciones con base en la evidencia es un reto significativo. La inhabilidad de ofrecer servicios en persona debido a la pandemia del COVID-19 representó un reto crítico a la base de la fidelidad de implementación para los programas de visitas a casa en el mundo. El programa de Afectividad y Bio-conducta de Ponerse el Día (ABC) es una intervención de visitas a casa con base en la evidencia diseñada para aumentar la sensibilidad en los progenitores de infantes que han experimentado temprana adversidad. La eficacia comunitaria de ABC se debe a la rigurosa inspección y supervisión de la fidelidad (Caron et al., 2016). La fidelidad se mide por medio de codificación micro analítica de las oportunidades de crianza y por el comentario " en el momento," ingrediente activo de ABC. En este estudio, examinamos la fidelidad de intervención entre progenitores entrenadores que implementaban ABC a través de salud a distancia. Segmentos de video de 5 minutos de 510 sesiones de salud a distancia ABC al azar, llevadas a cabo por 91 progenitores entrenadores en 48 agencias se codificaron en cuanto a su frecuencia y calidad de los comentarios del momento. En promedio, los progenitores entrenadores pudieron exceder los estándares de fidelidad de comentarios en persona cuando implementaban ABC a través del formato de salud a distancia. La activa inspección y supervisión de la fidelidad inherente a la divulgación de ABC permitió una transición fluida a la implementación de ABC a través de salud a distancia, manteniendo la adhesión a los estándares de fidelidad. Se discuten los retos de procedimiento y clínicos a la implementación de salud a distancia, junto con futuras directrices para la eficacia de programas de salud a distancia.

Le maintien de la fidélité au traitement en mettant en place des interventions basées sur des données factuelles est un défi important. L'incapacité à offrir des services en personne du fait de la pandémie du Covid19 a présenté un défi critique pour la fondation de la mise en place de la fidélité pour les programmes de visite domicile dans le monde entier. Le programme ABC (selon l'anglais Attachment and Biobehavioral Catch-Up, soit Rattrapage de l'Attachement et Rattrapage Biocomportemental) est une intervention de visites à domicile basée sur des données factuelles conçue pour augmenter la sensibilité chez les parents de bébés ayant fait l'expérience d'une adversité précoce. L'efficacité de la communauté de l'ABC est attribuable à un contrôle rigoureux de la fidélité et de la supervision (Caron et al., 2016). La fidélité est mesurée par un codage micro-analytique des opportunités de parentage et des commentaires "au moment", l'ingrédient actif de l'ABC. Dans cette étude nous avons examiné la fidélité de l'intervention chez les entraîneurs de parents mettant en place l'ABC au travers de la télésanté. Des clips de 5-minute randomisés de 510 sessions vidéos de télésanté ABC faites avec 91 entraîneurs de parents de 48 agences ont été codé pour leur fréquence et la qualité des commentaires "au moment". En moyenne les entraîneurs de parent étaient capables d'excéder les standards de fidélité de commentaire en personne en mettant en place l'ABC au travers du format de télésanté. Le contrôle actif de fidélité et de la supervision propre ã la dissémination de l'ABC a permis une transition facile à la mise en place de l'ABC au travers de la télésanté tout en adhérant aux standards de fidélité. Les défis de procédure et les défis cliniques à la mise en place par télésanté sont discutés ainsi que les directions futures pour l'efficacité du programme par télésanté.

Does knowing translate to doing? Practitioners' experiences of Circle of Security-Parenting (COS-P) training and implementation.

This study sought to understand how practitioners perceive and experience the Circle of Security-Parenting (COS-P) training, and further, how they integrate and implement it into practice, and how these experiences influence their use and understanding of the program and its underlying model. A thematic analysis of semistructured interviews at two time points (shortly after training and 3-6 months after training) was used to explore 12 practitioners' experiences of COS-P training and subsequent implementation. Three main themes were identified; clinical salience, personal salience, and partial use of the program. The findings reflected participants' common perception that the model is relevant and generalizable to a wide variety of contexts. It also highlighted potential barriers to implementation, particularly practitioners' experiences using only components of the COS-P program in isolation. The results suggest practitioners' assumptions about client complexities, vulnerabilities, and/or incapacities, can prompt practitioners to withhold the use of COS-P (in part or whole), thereby potentially neglecting key components required for client change. The only participants who implemented the COS-P training in full had additional training in Circle of Security.

Este estudio buscaba comprender cómo los profesionales de la práctica perciben y experimentan el entrenamiento Círculo de Seguridad-Crianza (COS-P), y aún más, cómo ellos lo integran e implementan en la práctica y cómo estas experiencias influyen en su uso y comprensión del programa y el modelo que el mismo enfatiza. Se usó un análisis temático de entrevistas semiestructuradas en dos momentos temporales (poco después del entrenamiento y 3-6 meses después del entrenamiento) para explorar doce experiencias de profesionales de la práctica en cuanto al entrenamiento de COS-P y la subsecuente implementación. Se identificaron tres temas principales; relevancia clínica, relevancia personal y el uso parcial del programa. Los resultados reflejan la percepción común de los participantes de que el modelo es relevante y se puede generalizar a una variedad amplia de contextos. También destacó barreras potenciales para la implementación, particularmente las experiencias de los profesionales de la práctica usando sólo componentes aislados del COS-P. Los resultados sugieren que las suposiciones de los profesionales de la práctica acerca de las complejidades, vulnerabilidades y/o incapacidades del cliente pueden dar pie para que tales profesionales no revelen el uso de COS-P (en parte o totalmente), de modo que potencialmente desatiendan componentes claves requeridos para el cambio en el cliente. Los únicos participantes que implementaron el entrenamiento de COS-P en su totalidad recibieron entrenamiento adicional en cuanto a Círculo de Seguridad.

Cette étude s'est donné pour but de comprendre comment les praticiens perçoivent et font l'expérience de la formation du Cercle de Sécurité-Parentage (COS-P en anglais), et ensuite comment ils l'intègrent et la mettent en place dans leur pratique, ainsi que la manière dont ces expériences influencent leur utilisation et compréhension du programme, tout comme son modèle sous-jacent. Une analyse thématique d'entretiens semi-structurés en deux temps (pas longtemps du Cercle de Sécurité-Parentage (COS-P) après la formation et 3 à 6 mois après la formation) a été utilisée afin d'explorer à la fois les expériences du COS-P faites par douze praticiens et leur mise en place subséquente. Trois thèmes principaux ont été identifiés, la saillance clinique, la saillance personnelle et l'utilisation partielle du programme. Les résultats ont reflété la perception commune des participants selon laquelle le modèle est pertinent et généralisable à une grande variété de contextes. L'étude a aussi mis en lumière les barrières potentielles pour la mise en place, en particulier les expériences des praticiens utilisant uniquement des composantes du programme COS-P en isolation. Les résultats suggèrent que les suppositions des praticiens sur les complexités des clients, leurs vulnérabilités et / ou leurs incapacités, peuvent pousser les praticiens à ne pas utiliser le COS-P (en partie ou totalement), négligeant ainsi potentiellement des composantes clés exigées pour que le client change. Les seuls participants qui ont mis en place la formation COS-P en totalité avaient la formation supplémentaire de Cercle de Sécurité.

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis.

As evidence-based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural-strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off-model, nonsystemic formulations/interventions). Of these, "failure to think in threes" appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.

A medida que los tratamientos familiares factuales para el consumo de sustancias y los problemas de conducta en los adolescentes ganan terreno, la investigación de vanguardia trasciende los ensayos aleatorizados de eficacia teórica para abordar preguntas, por ejemplo, cómo funcionan estos tratamientos y cómo difundirlos mejor en entornos comunitarios. Un factor clave para la difusión eficaz es la fidelidad al tratamiento, que se refiere a implementar una intervención de una manera consecuente con un manual establecido. Si bien la mayor parte de la investigación de fidelidad es cuantitativa, el presente estudio ofrece un análisis clínico cualitativo de fallas de la fidelidad en un ensayo grande multicéntrico de eficacia real de Terapia Familiar Breve y Estratégica (BSFT) para el abuso de drogas en los adolescentes, donde los desarrolladores de la BSFT capacitaron a terapeutas de la comunidad para que apliquen esta intervención en sus propias agencias. Utilizando informes de casos y grabaciones de vídeo de sesiones de terapia, un panel independiente de expertos evaluó primero 103 casos con escalas de fidelidad cuantitativa basadas en el manual de BSFT y el marco estratégico estructural más amplio que respalda la intervención de la BSFT. Como la fidelidad fue generalmente baja, el panel revisó todos los casos cualitativamente para reconocer tipos o categorías emergentes de fallas de la fidelidad. Surgieron diez categorías de fallas caracterizadas por omisiones del terapeuta (p. ej.: el terapeuta no hizo participar a familiares clave, no pensó en grupos de tres) y licencias (p. ej.: desvío del modelo, formulaciones/intervenciones no sistémicas). De estas opciones, la falla en "no pensar en grupos de tres" pareció básica y particularmente problemática, lo cual refleja el lugar fundamental de esta idea en la teoría y la terapia estructural. Aunque nuestras observaciones estén sujetas a un posible sesgo, estas ponen de manifiesto posibles obstáculos a la hora de exportar un tratamiento familiar complejo como la BSFT a entornos comunitarios. Estos resultados también subrayan la importancia de la fidelidad al tratamiento en la investigación sobre terapia familiar.

Old wine in new bottles: decanting systemic family process research in the era of evidence-based practice.

Social cybernetic (systemic) ideas from the early Family Process era, though emanating from qualitative clinical observation, have underappreciated heuristic potential for guiding quantitative empirical research on problem maintenance and change. The old conceptual wines we have attempted to repackage in new, science-friendly bottles include ironic processes (when "solutions" maintain problems), symptom-system fit (when problems stabilize relationships), and communal coping (when we-ness helps people change). Both self-report and observational quantitative methods have been useful in tracking these phenomena, and together the three constructs inform a team-based family consultation approach to working with difficult health and behavior problems. In addition, a large-scale, quantitatively focused effectiveness trial of family therapy for adolescent drug abuse highlights the importance of treatment fidelity and qualitative approaches to examining it. In this sense, echoing the history of family therapy research, our experience with juxtaposing quantitative and qualitative methods has gone full circle-from qualitative to quantitative observation and back again.

Emergency crisis resource management: a simulation-based course developed by the Spanish Society of Emergency Medicine (SEMES) for health sciences students. / Emergency Crisis Resource Management de la Sociedad Española de Medicina de Urgencias y Emergencias: curso de gestión en crisis basado en simulación para estudiantes de ciencias de la salud.

OBJECTIVES: Educational programs based on high-fidelity simulation training aim to promote students' acquisition of nontechnical competencies such as understanding crisis resource management (CRM). This study evaluated the efficacy of a CRM course for students in their last year of university studies in health sciences. The course was developed by the Spanish Society of Emergency Medicine (SEMES). MATERIAL AND METHODS: Quasi-experimental study of a high-fidelity simulation course to teach emergency CRM (E-CRM) using preand postcourse measures of achievement in a single student cohort. A total of 209 students completed 2 selfadministered self-efficacy evaluations of their acquisition of nontechnical competencies and resilience. External observers also assessed the students' nontechnical competencies with objective measurement scales. RESULTS: Scores on resilience and self-efficacy assessments improved through the intervention (F = 25.90 and F = 68.02, respectively; P .001, for both pre-post comparisons). Statistically significant differences were found between students in different health sciences at baseline (t = 2.67; P = .008). Scores improved significantly on the Mayo High Performance Teamwork Scale (F = 6.18, P .001, eta2 = 0.20) and the Ottawa CRM Global Rating Scale (F = 5.58; P .005, eta2 = 0.19). CONCLUSION: The E-CRM course developed by a coordinated multiprofessional team based on high-fidelity simulations improved self-efficacy assessments of resilience and all nontechnical competencies.

OBJETIVO: Los programas educativos dirigidos a la adquisición de competencias no técnicas, tales como el Crisis Resource Management (CRM), basado en simulación de alta fidelidad, implican un aumento de las competencias del alumno en el manejo de situaciones de crisis. El objetivo del presente trabajo es evaluar la eficacia del programa Emergency CRM (E-CRM) de la Sociedad Española de Medicina de Urgencias y Emergencias, dirigido a estudiantes de último año de los grados de ciencias de la salud. METODO: Se llevó a cabo un estudio cuasiexperimental con medidas pre y posintervención, que consistió en un programa de E-CRM con simulación de alta fidelidad, en un único grupo. Participaron un total de 209 estudiantes que completaron dos instrumentos autoadministrados sobre la autoeficacia hacia las competencias no técnicas y la resiliencia. Además, a través de observadores externos se evaluó sus competencias no técnicas con instrumentos de evaluación objetivos. RESULTADOS: El alumnado mejoró las puntuaciones de resiliencia (F = 25,90; p < 0,001) y autoeficacia (F = 68,02; p 0,001) tras la intervención, con diferencias estadísticamente significativas para la resiliencia en la línea basal en función del grupo de estudios (t = 2,67; p = 0,008). Por otro lado, se encontraron mejoras de las puntuaciones obtenidas tanto para el instrumento Mayo High Performance Teamwork Scale (F = 6,18; p 0,001; eta2 = 0,20) como para el Ottawa Global Rating Scale Crisis Resource Management (F = 5,58; p 0,005; eta2 = 0,19). CONCLUSIONES: El programa de E-CRM, basado en simulación de alta fidelidad, con un equipo interprofesional coordinado, mejora la autoeficacia en todas las competencias no técnicas medidas y aumenta la resiliencia.

The development and validation of a new simulator for endourology.

INTRODUCTION: Simulation in medicine has developed a lot in the last few decades. There is a broad range of simulators available, above all for training in surgical procedures. Endourology can benefit much from simulation because the minimally-invasive procedures of endourology frequently have long learning curves, which can be reduced by training with simulators. MATERIALS AND METHODS: A low-fidelity simulator was designed for practicing endourology techniques that use cystoscopy. The process of validation involved 5 experts and 19 non-experts. Experts comprised medical professionals working in a department of urology who had performed at least 100 flexible cystoscopy procedures. Non-experts were residents in internal medicine without experience in any type of endoscopy. Information about face and content validity was collected by means of Likert scales from 1 to 5. To evaluate construct validity, we measured the time to complete two tasks, for which the procedure was evaluated by means of the OSATS global evaluation scale. RESULTS: New simulator was successfully built according to its design. For all evaluated aspects of construct validity, there was a significant difference (p<0.05) between the group of experts and the group of non-experts. Content validity was scored 4.66 (standard deviation ±0.56) by the experts and 4.41 (±0.71) by the non-experts. In the face validity questionnaire, the average score was 4.14 (±0.94), the question receiving the highest score: 4.6 (±0.84) concerned immersion in the procedure. CONCLUSION: The simulator presented is valid both for training up new urologists in endourology technique and for experts seeking to perfect their skills.

Impact of prebriefing on emotions in a high-fidelity simulation session: A randomized controlled study.

INTRODUCTION: Medical simulation is associated with intense emotions which influence human behavior. We aim to investigate how prebriefing impacts on learners' emotions during a high-fidelity simulation (HFS) session. METHODS: This is a prospective randomized controlled study. Participants were randomly allocated to receive a standardized prebriefing (SP group) versus not receiving it (NSP group). Debriefing following the «good judgment¼ approach, structured in reactions, understanding and summary phases, was used in both groups. In order to assess emotions, we used the circumplex model of affect applying the Affect Grid scale, which was performed prior to prebriefing, following case performance and following debriefing. Debriefing times were also assessed. RESULTS: A total of 128 physicians participate in the study (64 vs. 64). Following case performance, this HFS session was experienced with significantly more pleasant emotions compared to baseline, that were maintained during debriefing (p < 0.01) while alertness increased after case performance diminishing after debriefing (p < 0.01). There were no statistical significant differences between groups. In the NSP group, total debriefing (p = 0.003) and understanding phase (p = 0.002) times were significantly longer. CONCLUSIONS: This HFS session was experienced as pleasant with high alertness with no specific emotional impact attributable to prebriefing. Prebriefing leads to a freer flowing debriefing.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study.

INTRODUCTION: The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®". OBJECTIVES: To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course. METHODS: A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively. RESULTS: Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®. CONCLUSIONS: TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

Is adherence to dialectic behaviour therapy for post-traumatic stress disorder (PTSD) and cognitive processing therapy related to treatment outcome in PTSD after childhood abuse?

Background: Literature on the association between therapist adherence and treatment success in the treatment of post-traumatic stress disorder (PTSD) is scarce, and the results are mixed.Objective: To examine the relationship between therapist adherence to dialectical behaviour therapy for PTSD (DBT-PTSD) and cognitive processing therapy (CPT) on treatment outcome in women with PTSD and emotion regulation difficulties after interpersonal childhood abuse.Method: Videotaped therapy sessions from 160 female participants of a large randomized controlled trial [Bohus, M., Kleindienst, N., Hahn, C., Müller-Engelmann, M., Ludäscher, P., Steil, R., Fydrich, T., Kuehner, C., Resick, P. A., Stiglmayr, C., Schmahl, C., & Priebe, K. (2020). Dialectical behavior therapy for posttraumatic stress disorder (DBT-PTSD) compared with cognitive processing therapy (CPT) in complex presentations of PTSD in women survivors of childhood abuse. JAMA Psychiatry, 77(12), 1235. jamapsychiatry.2020.2148] were rated. Adherence to CPT and DBT-PTSD was assessed using two specifically developed rating scales.Results: Higher therapist adherence was associated with a greater reduction of clinician-rated PTSD symptom severity. This effect was more pronounced in the CPT group than in the DBT-PTSD group. Adherence was also related to a greater reduction of self-rated PTSD symptoms, borderline symptoms, and dissociation intensity.Conclusion: Our results indicate that higher therapist adherence can lead to better treatment outcomes in PTSD treatments, especially in CPT.

Higher therapist adherence to cognitive processing therapy was associated with higher treatment gains in women with post-traumatic stress disorder (PTSD) after childhood abuse.Adherence was related to higher reductions in symptom severity of PTSD, borderline symptoms, and dissociation intensity.Adherence to dialectical behaviour therapy for PTSD did not show a strong association with treatment outcome.

Descriptive study of the satisfaction of nursing degree students in high-fidelity clinical simulation practices. / Estudio descriptivo de la satisfacción de los estudiantes del Grado en Enfermería en las prácticas de simulación clínica de alta fidelidad.

OBJECTIVE: To describe the level of satisfaction of nursing students with clinical simulation in their undergraduate training. METHOD: a descriptive observational study of a retrospective cross section was conducted in undergraduate students in Nursing during the academic years 2016-17 and 2017-18. The instrument used was the High Fidelity Clinical Simulation satisfaction scale in students (ESSAF), a validated, anonymous and self-administered questionnaire (alpha .857) to measure the level of satisfaction after high-fidelity clinical simulation practices. RESULTS: Data were collected from a total of 269 students, of which 63.3% were women and the average age of the sample was 21.68±13.46 years. The analysis of frequencies shows results of the grade of satisfaction over 89%, especially in decision-making, the ability to prioritize and learning procedures. Of the answers, 87% exceeded an average of 4 out of 5. The questions in the questionnaire with answers higher than 4.6 were the realism of the cases (4.71), the teacher provides constructive feedback after each session (4.65), the simulation relates theory to practice (4.72), the analysis (debriefing) at the end of the session helps reflection on the cases (4.65) and practical utility (4.69). CONCLUSIONS: Nursing students from the University of Cantabria (Spain) report high satisfaction in high fidelity clinical simulation, confirming its usefulness in the learning process.

Emotional response to a high-fidelity trauma simulation: An observational study. / Respuesta emocional a una simulación de alta fidelidad en trauma: Un estudio observacional.

INTRODUCTION: The emotional environment created during a simulation session can influence learning. Positive emotions improve perceptual processing and facilitate learning, while negative emotions can reduce working memory, resulting in poorer learning outcomes. OBJECTIVES: The aim of this study was to investigate the impact of simulation training on emotions during all phases of a high-fidelity simulation using standard prebriefing and «good judgement debriefing ¼ techniques. METHODS: This was an observational study that included 74 anesthesiologists participating in a simulation-based training. A standardized prebriefing was followed by «good judgement debriefing¼. In order to assess emotions, we used the circumplex model of emotion, and asked participants to complete the affect grid scale before prebriefing (Stage 1), before starting the simulation (Stage 2), before debriefing (Stage 3) and following debriefing (Stage 4). RESULTS: The affect grid scores obtained from 67 participants were analyzed. Following debriefing, the experience of the polytrauma patient simulation was significantly more pleasant compared to previous stages (P<0.01). In addition, participants perceived the activity as becoming increasingly active as it progressed (P<0.01). CONCLUSIONS: High-fidelity trauma simulation creating a safe environment using a standardized prebriefing and «good judgement debriefing¼ is experienced as a pleasant and active activity at all stages of the simulation. Further investigation is needed to assess the impact of these results on learning.

Manejo de la vía aérea ante un caso de paro respiratorio en un escenario clínico simulado. Experiencia en una residencia de pediatría / Airway management during a respiratory arrest in a clinical simulation scenario. Experience at a pediatric residency program

Introducción. La insuficiencia respiratoria es la causa más común de paro cardíaco en pediatría; su reconocimiento y el manejo adecuado son cruciales. La simulación se utiliza para mejorar las habilidades médicas. El objetivo del trabajo fue determinar la proporción de residentes de pediatría que reconocieron un paro respiratorio (PR) pediátrico en un centro de simulación. Métodos. Se realizó un estudio observacional con 77 médicos residentes. Se utilizó un caso simulado de un paciente con dificultad respiratoria que progresa a PR. Resultados. De los 77 participantes, 48 reconocieron el paro respiratorio (62,3 %). El tiempo medio para reconocer el PR fue de 34,43 segundos. Conclusión. El 62,3 % de los participantes logró reconocer el paro respiratorio. Entre aquellos que lo identificaron, el tiempo promedio fue de 34,43 segundos. Se observaron graves deficiencias en algunas de las intervenciones esperadas.

Introduction. Respiratory failure is the most common cause of cardiac arrest in pediatrics. Recognizing and managing it adequately is critical. Simulation is used to improve medical skills. The objective of this study was to establish the proportion of pediatric residents who recognized a respiratory arrest in a child at a simulation center. Methods. This was an observational study in 77 residents. A simulation of a patient with respiratory distress that progressed to respiratory arrest was used. Results. Among the 77 participants, 48 recognized respiratory arrest (62.3%). The mean time to recognize respiratory arrest was 34.43 seconds. Conclusion. Respiratory arrest was recognized by 62.3% of participants. Among those who did so, the average time was 34.43 seconds. Severe failures were noted in some of the expected interventions.

Suicide prevention in a virtual environment: a roadmap for simulation-based education / Prevención del suicidio en un entorno virtual: guion para la enseñanza basada en una simulación / Prevenção do suicídio em ambiente virtual: roteiro para ensino baseado em simulação

Objective: to build and validate a simulation-based education roadmap on suicide prevention in the virtual environment. Method: methodological research subdivided into a development and validation stage. The roadmap was built using a previously drafted template based on international guidelines on good clinical simulation practices and scientific literature on suicide prevention in the virtual environment. For validation, the roadmap was validated by experts through self-application of an assessment form with answers based on "adequate, fair, and inadequate", with a field for suggestions. Descriptive statistics and the Content Validity Index (CVI≥0.8) were used. Results: nine experts took part in the study, the majority of whom were nurses (66.7%), female (55.6%), with an average age of 42.22 years. All the items in the roadmap met the acceptance criteria (CVI≥0.8). Conclusion: this study provides a useful roadmap for teaching suicide prevention in the virtual environment.

Objetivo: elaborar y validar un guion de enseñanza basada en la simulación sobre la prevención del suicidio en el entorno virtual. Método: investigación metodológica subdividida en etapa de elaboración y validación. La elaboración se realizó a partir de un template creado previamente y basado en lineamientos internacionales sobre buenas prácticas de simulación clínica y literatura científica sobre prevención del suicidio en el entorno virtual. Para la validación los especialistas validaron el guion mediante la autoaplicación de un formulario de evaluación cuyas respuestas son: "adecuado, regular e inadecuado", con un campo para sugerencias. Se utilizó estadística descriptiva e Índice de Validez de Contenido (IVC≥0,8). Resultados: participaron nueve especialistas, la mayoría enfermeros (66,7%), mujeres (55,6%), con una edad promedio de 42,22 años. Todos los elementos del guion cumplieron con el criterio de aceptación (IVC≥0,8). Conclusión: este estudio proporciona un guion útil para la enseñanza sobre la prevención del suicidio en el entorno virtual.

Objetivo: construir e validar um roteiro de ensino baseado em simulação sobre a prevenção do suicídio no ambiente virtual. Método: pesquisa metodológica subdividida em etapa de construção e validação. A construção foi realizada a partir de um template previamente elaborado e embasado por diretrizes internacionais em boas práticas de simulação clínica e literatura científica sobre a prevenção do suicídio no ambiente virtual. Para a validação, o roteiro foi validado por especialistas por meio de autoaplicação de formulário de avaliação com respostas baseadas em: "adequado, regular e inadequado", com campo para as sugestões. Foi utilizada a estatística descritiva e o Índice de Validade de Conteúdo (IVC≥0,8). Resultados: participaram nove especialistas, sendo a maioria enfermeiras (66,7%), gênero feminino (55,6%), com média de idade de 42,22 anos. Todos os itens do roteiro alcançaram o critério de aceitação (IVC≥0,8). Conclusão: este estudo disponibiliza um roteiro útil para ser empregado no ensino sobre a prevenção do suicídio no ambiente virtual.

Comparative study between high-fidelity simulation and medium-fidelity simulation in decision-making of nursing students: experimental study / Estudo comparativo entre simulação de alta-fidelidade e simulação de média-fidelidade na tomada de decisão de estudantes de enfermagem: estudo experimental / Estudio comparativo entre simulación de alta fidelidad y simulación de mediana fidelidad en la toma de decisiones de estudiantes de enfermería: estudio experimental

Abstract Objective: to compare the decision-making of Nursing students, before and after theoretical training on basic life support, using the practice of high-fidelity simulation and medium-fidelity simulation. Method: an experimental study was developed, pre- and post-test type, with quantitative, descriptive and inferential analysis, with theoretical training on basic life support and clinical simulation practices, and with evaluation of knowledge and decision-making of Nursing students, at three different moments - before the simulation scenario (T0), after the simulation scenario (T1) and after clinical teaching (T2). Results: 51 students participated in the research, with an average age of 20.25±3.804, of which 92.2% were female. Statistically significant differences (F=6.47; p=0.039) were evident regarding the definition of the problem and development of objectives in decision-making in the experimental group. Conclusion: Nursing students demonstrate an adequate level of knowledge and a good decision-making process, based on the most current instruments produced by scientific evidence, in clinical simulation scenarios in basic life support, and this innovative methodology should be deepened in the Nursing teaching.

Resumo Objetivo: comparar a tomada de decisão dos estudantes de Enfermagem, antes e após a formação teórica sobre suporte básico de vida, com recurso à prática de simulação de alta-fidelidade e simulação de média-fidelidade. Método: desenvolveu-se um estudo experimental, tipo pré e pós-teste, com análise quantitativa, descritiva e inferencial, com realização da formação teórica sobre suporte básico de vida e práticas de simulação clínica, e com avaliação dos conhecimentos e tomada de decisão dos estudantes de Enfermagem, em três momentos distintos - antes do cenário de simulação (T0), após o cenário de simulação (T1) e após a realização de ensino clínico (T2). Resultados: participaram da pesquisa 51 estudantes, com uma média de idade de 20,25±3,804, dos quais 92,2% eram do sexo feminino. Foram evidenciadas diferenças estatisticamente significativas (F=6,47; p=0,039) perante a definição do problema e desenvolvimento dos objetivos na tomada de decisão no grupo experimental. Conclusão: os estudantes de Enfermagem demonstram um nível de conhecimentos adequado e um bom processo de tomada de decisão, com base nos instrumentos mais atuais produzidos pela evidência científica, perante cenários de simulação clínica em suporte básico de vida, devendo esta metodologia inovadora ser aprofundada no ensino de Enfermagem.

Resumen Objetivo: comparar la toma de decisiones de estudiantes de Enfermería, antes y después de la formación teórica sobre soporte vital básico, utilizando la práctica de simulación de alta fidelidad y simulación de mediana fidelidad. Método: se desarrolló un estudio experimental, tipo pretest y postest, con análisis cuantitativo, descriptivo e inferencial, con formación teórica sobre soporte vital básico y prácticas de simulación clínica, y con evaluación del conocimiento y la toma de decisiones de los estudiantes de Enfermería, en tres momentos distintos: antes del escenario de simulación (T0), después del escenario de simulación (T1) y después de la enseñanza clínica (T2). Resultados: participaron de la investigación 51 estudiantes, con edad promedio de 20,25±3,804 años, de los cuales 92,2% eran mujeres. Se evidenciaron diferencias estadísticamente significativas (F=6,47; p=0,039) en cuanto a la definición del problema y desarrollo de los objetivos en la toma de decisiones en el grupo experimental. Conclusión: los estudiantes de Enfermería demuestran un nivel adecuado de conocimientos y un buen proceso de toma de decisiones, basados en los instrumentos más actuales producidos por la evidencia científica, en escenarios de simulación clínica en soporte vital básico, y esta metodología innovadora debe profundizarse en la enseñanza de Enfermería.

Experiencia formativa de académicos en dos universidades latinas en diplomado de simulación clínica en enfermería / Training Experience with Scholars from two Latin-American Universities during a Diploma Course in Nursing Clinical Simulation

Introducción: Capacitar en simulación clínica asegura calidad de la enseñanza e incrementa conocimientos necesarios para realizar procesos dinámicos que involucren creación de entornos hipotéticos de representaciones auténticas de realidades sanitarias. Esta estrategia reviste importancia para concretar productos e insumos derivados de entrenamientos en simulación, ligados a satisfacción de profesionales que finalizan estas experiencias formativas. Objetivo: Conocer la satisfacción general de académicos y el producto obtenido de una experiencia formativa en modalidad de diplomado en simulación clínica de alta fidelidad. Métodos: Estudio descriptivo, de corte trasversal, con análisis teórico-lógico-reflexivo desde la literatura que respaldó el diseño didáctico del proyecto. Se trabajó con la totalidad de académicos de la Facultad de Enfermería, Universidad de Panamá (N = 146), durante mayo-julio del 2022. Hubo clases sincrónicas y asincrónicas y una semana presencial para exposiciones de escenarios. Se evaluó la estrategia con cuestionario de cinco dimensiones validado por criterios de jueces. El puntaje Alfa de Cronbach final fue 0,89. Se incluyeron profesores con más de 92 por ciento de asistencia a clases, los que tuvieron conexiones inestables a encuentros se excluyeron. Se realizó análisis estadístico descriptivo en programa SPSS. Se siguieron normas éticas y recomendaciones para estudios con seres humanos. Resultados: El 99 por ciento evaluó la capacitación con nivel de satisfacción muy alto. Se obtuvieron productos clave, como reglamentos, consentimientos informados y banco de escenarios validados, como insumos de trabajo para la facultad. Conclusiones: Los resultados configuraron respuestas de un grupo de académicos capacitados en simulación clínica, con valoración de muy alta satisfacción. Los productos obtenidos se encaminaron a normativas y guías para uso de simulación(AU)

Introduction: Clinical simulation training ensures the quality of teaching and increases the knowledge necessary to carry out dynamic processes involving the creation of hypothetical environments of authentic representations of health realities. This strategy is important for the realization of products and inputs derived from simulation training, linked to the satisfaction of professionals who complete these training experiences. Objective: To know the general satisfaction of scholars and the product obtained from a training experience as a diploma course in high-fidelity clinical simulation. Methods: A descriptive and cross-sectional study was carried out, following a theoretical-logical-reflexive analysis from the literature, which supported the didactic design of the project. The working methodology included all the scholars from the Nursing School at University of Panama (N=146), during May-July 2022. There were synchronous and asynchronous classes, as well as a face-to-face week for scenario presentations. The strategy was evaluated with a five-dimension questionnaire validated by judges' criteria. The final Cronbach's alpha score was 0.89. Professors with more than 92 percent of class attendance were included; those with unstable connections to meetings were excluded. A descriptive statistical analysis was performed in the SPSS software. Ethical norms and recommendations for studies with human beings were followed. Results: 99 percent assessed the training with a very high level of satisfaction. Key products were obtained, such as regulations, informed consents and a stock of validated scenario, as working inputs for the school. Conclusions: The outcomes included responses from a group of scholars trained in clinical simulation, with very high satisfaction ratings. The products obtained were directed towards regulations and guidelines for the use of simulation(AU)

Simulación interprofesional en estudiantes de enfermería y medicina, experiencias de sus protagonistas / Interprofessional Simulation with Nursing and Medical Students: The Protagonists' Experiences

Introducción: El impacto que ha tenido la implementación y avance de la educación interprofesional en las ciencias de la salud, ha demostrado que, articulado a diferentes estrategias didácticas, como la simulación clínica estandarizada, optimiza el aprendizaje colaborativo y el trabajo en equipo. Objetivo: Comprender los significados que estudiantes de enfermería y medicina le otorgaron a la educación interprofesional, desarrollada a través de simulación clínica estandarizada. Métodos: Estudio cualitativo interpretativo, donde a través de una determinación a priori basadas en criterios, se seleccionaron 40 estudiantes de enfermería y medicina que participaron de cuatro casos dentro de simulación clínica estandarizada, durante el segundo semestre del año 2019. Estas interacciones fueron videograbadas y luego se realizaron grupos focales para indagar la experiencia que los estudiantes habían tenido en la actividad simulada. Se realizó análisis de contenido de los videos y los grupos focales hasta que no se encontraron nuevos códigos. Resultado: Emergieron tres categorías principales: 1) Identificar las habilidades relacionales necesarias para la atención, 2) Aprender a colaborar a través de la educación interprofesional y 3) Sensaciones implícitas dentro de la simulación interprofesional. Conclusiones: La experiencia y significado que los estudiantes de enfermería y medicina le otorgaron a esta didáctica interprofesional les ayudó a reconocer la reflexión como punto de partida para el aprendizaje significativo y a descubrir en el compañero saberes que podían nutrir su proceso de formación, así como impactarlos en el desarrollo de habilidades interpersonales importantes en la práctica y que aplicarán en su futuro profesional(AU)

Introduction: The impact of the implementation and advancement of interprofessional education in health sciences has shown that, in articulation with different didactic strategies (such as standardized clinical simulation), collaborative learning and teamwork are optimized. Objective: To understand the meanings that nursing and medical students gave to interprofessional education, developed through standardized clinical simulation. Methods: An interpretive qualitative study was conducted, by means of an a priori determination based on criteria; 40 nursing and medical students were selected to participate in four cases within standardized clinical simulation, during the second semester of 2019. These interactions were recorded and focus groups were then held to delve into the students' experience of the simulated activity. Content analysis was applied to the videos and focus groups until new codes were found. Results: Three main categories emerged: 1) identifying relational skills needed for care, 2) Learning how to collaborate through interprofessional education, and 3) implicit feelings within interprofessional simulation. Conclusions: The experience and meaning that nursing and medical students gave to this interprofessional didactic resource helped them recognize thinking as a starting point for meaningful learning, as well as discover, in their partners, knowledge that could nurture their training process and impact them in the development of important interpersonal skills in practice and that they will apply in their professional future(AU)

Percepción de la simulación en obstetricia y ginecología en el pregrado y posgrado de una universidad privada chilena / Perception of simulation in obstetrics and gynecology at the undergraduate and postgraduate levels of a private Chilean university

INTRODUCCIÓN: La simulación es una herramienta que promueve la confianza y desarrollo de habilidades en los participantes. En la evaluación de programas formativos la percepción de utilidad se vincula a la confianza y aprendizaje, y corresponde al primer nivel de evaluación según Kirkpatrick. OBJETIVO: Evaluar la percepción de internos y residentes de obstetricia y ginecología en escenarios de simulación. MATERIAL Y MÉTODOS: Investigación descriptiva cuantitativa, en una muestra a conveniencia de internos y residentes, quienes contestaron una escala de valoración global y de preferencias sobre sus simulaciones. RESULTADOS: Se obtuvieron 63 respuestas de internos (63%) y 7 de residentes (78%). La valoración promedio de las simulaciones fue de 6,42 en los internos y de 6,64 de los residentes. El 67% de los internos y el 86% de los residentes no eliminaría ninguna simulación. Los internos repetirían todas las simulaciones, en tanto que los residentes repetirían tres simulaciones de un total de 11. CONCLUSIONES: La valoración de las simulaciones fue alta en ambos grupos, difiriendo en las actividades que prefieren repetir, lo cual puede relacionarse con las competencias inherentes al rol de especialista en comparación al rol del médico general o a las diferencias en autoconfianza de internos y residentes.

INTRODUCTION: Clinical simulation is a training tool that promotes confidence and the development of procedural skills in participants, from initial training to the training of professional teams. In the evaluation of training programs, the measurement of perceived usefulness is linked to confidence and learning and corresponds to a first level of evaluation of the quality of training according to Kirkpatricks model. OBJECTIVE: To evaluate the perception of medical interns and Obstetrics and Gynecology fellows regarding simulation scenarios. MATERIAL AND METHODS: Quantitative descriptive research, in a convenience sample of interns and fellows, who answered a scale of global assessment and preferences about simulations. RESULTS: The average score was 6.42 for the interns and 6.64 for the scholarship recipients. With odd answers about the repetition of scenarios. 67% of the interns and 86% of the fellows responded that they would not eliminate any simulation. Conclusions: The evaluation of the scenarios was excellent and satisfactory by the participants.

Artificial intelligence in the analysis of emotions of nursing students undergoing clinical simulation / Inteligencia artificial en el análisis de las emociones de estudiantes de enfermería sometidos a simulación clínica / Inteligência artificial na análise das emoções dos estudantes de enfermagem submetidos à simulação clínica

ABSTRACT Objective: to assess nursing students' emotions undergoing maternal-child clinical simulation. Methods: an observational study, carried out between June and July 2019. The Focus Group technique was used, with 28 nursing students, randomly distributed into three groups, with qualitative (Bardin technique) and quantitative data (Artificial Intelligence) analysis, to analyze emotions through facial expressions, tone of voice and description of speeches. Results: we defined two categories: "It was not easy, it was very stressful"; and "Very valuable experience". In Artificial Intelligence, emotional distribution between face, voice and speech revealed a prevalence of negative valence, medium-high degree of passivity, medium power to control the situation and medium-high degree of obstruction in task accomplishment. Final considerations: this study revealed an oscillation between positive and negative emotions, and shows to the importance of recognizing them in the teaching-learning process in mother-child simulation.

RESUMEN Objetivo: evaluar las emociones de estudiantes de enfermería en la experiencia de simulación clínica materno-infantil. Métodos: estudio observacional, realizado entre junio y julio de 2019. Se utilizó la técnica de Grupo Focal, con 28 estudiantes de enfermería, distribuidos aleatoriamente en tres grupos, con análisis de datos cualitativos (técnica de Bardin) y datos cuantitativos (Inteligencia Artificial), para el análisis de emociones a través de expresiones faciales, tono de voz y descripción de discursos. Resultados: definimos dos categorías: "No fue fácil, fue muy estresante"; y "Experiencia muy valiosa". En la Inteligencia Artificial, la distribución emocional entre rostro, voz y habla reveló un predominio de valencia negativa, grado medio-alto de pasividad, poder medio para controlar la situación y grado medio-alto de obstrucción en la realización de la tarea. Consideraciones finales: este estudio reveló una oscilación entre emociones positivas y negativas, y apunta a la importancia de reconocerlas en el proceso de enseñanza-aprendizaje en la simulación madre-hijo.

RESUMO Objetivo: avaliar as emoções dos estudantes de enfermagem na vivência da simulação clínica materno-infantil. Métodos: estudo observacional, realizado entre junho e julho de 2019. Utilizada a técnica de Grupo Focal, com 28 estudantes de enfermagem, distribuídos aleatoriamente em três grupos, com análise dos dados qualitativa (técnica de Bardin) e quantitativa (Inteligência Artificial), para a análise das emoções através das expressões faciais, tom de voz e descrição das falas. Resultados: definiram-se duas categorias: "Não foi fácil, foi muito estressante"; e "Experiência muito valiosa". Na Inteligência Artificial, a distribuição emocional entre face, voz e fala revelou prevalência da valência negativa, médio-alto grau de passividade, médio poder de controle da situação e médio-alto grau de obstrução na realização da tarefa. Considerações finais: este estudo revelou oscilação entre emoções positivas e negativas, e aponta para a importância de reconhecê-las no processo de ensino-aprendizagem na simulação materno-infantil.