Prescription of Strong Opioids in Chronic Non-Cancer Pain in the Province of Valladolid (Spain).

Chronic non-cancer pain (CNCP) is one of the leading causes of disability. The use of strong opioids (SOs) in the management of CNCP is increasing, although evidence supporting their use remains limited. Primary care (PC) plays a key role in this context.

Virtual patients using large language models: Scalable, contextualized simulation of clinician-patient dialog with feedback.

Background: Virtual patients (VPs) are computer screen-based simulations of patient-clinician encounters. VP use is limited by cost and low scalability.

Objective: Show proof-of-concept that VPs powered by large language models (LLMs) generate authentic dialogs, accurate representations of patient preferences, and personalized feedback on clinical performance; and explore LLMs for rating dialog and feedback quality.

Enhancing trauma cardiopulmonary resuscitation simulation training with the use of virtual reality (Trauma SimVR): Protocol for a randomized controlled trial.

Background: With the increasing availability and use of digital tools such as virtual reality in medical education, there is a need to evaluate their impact on clinical performance and decision-making among healthcare professionals. The Trauma SimVR study is investigating the efficacy of virtual reality training in the context of traumatic in-hospital cardiac arrest.

Methods And Analysis: This study protocol (clinicaltrials.

Debriefing Methodologies in Nursing Simulation: An Exploratory Study of the Italian Settings.

As part of simulation-based learning, it is well known that debriefing plays a crucial role; ineffective debriefing can lead to a reiteration of errors in decision-making and a poor understanding of one's limitations, compromising the learner's psychological safety and making future simulated learning experiences less effective. In Italy, although simulation has been used in nursing education for more than 20 years, there is a general lack of data regarding the elements of debriefing. An exploratory, cross-sectional, multicenter nationwide study was conducted to identify current debriefing practices in Italian simulation-based nursing education.

Effect of a Training System Utilizing 3D-Printed Patient-Specific Vascular Models on Endovascular Catheterization Performance.

This study aimed to examine the effect of simulation training using a three-dimensional (3D)-printed patient-specific vascular model on the advanced vascular catheterization skills of experienced interventional radiologists (IRs). Two specific anatomic types of 3D-printed patient-specific models from two patients with challenging celiac axis arterial anatomy were constructed. The Global Rating Scale of Endovascular Performance (GRS-EP) was used to evaluate vascular insertion skills.

Cation Effect on the Electrochemical Platinum Dissolution.

Ensuring the stability of electrocatalysts is paramount to the success of electrochemical energy conversion devices. Degradation is a fundamental process involving the release of positively charged metal ions into the electric double layer (EDL) and their subsequent diffusion into the bulk electrolyte. However, despite its vital importance in achieving prolonged electrocatalysis, the underlying causality of catalyst dissolution with the EDL structure remains largely unknown.

Enhancing surgical skills through telesimulation: A multicenter randomized controlled trial on laparoscopic inguinal hernia repair.

Background: Telesimulation has been shown to be effective for teaching simple surgical techniques; however, its usefulness for teaching advanced skills remains unclear. The aim of this randomized controlled trial was to investigate the impact of a telesimulation program on training for laparoscopic inguinal hernia repair.

Methods: Novice trainees were randomly assigned to the intervention group or control group using a permuted block design.

Phase formation and phase stability for the homogenous and heterogeneous amorphous metals versus the crystalline phase.

From molecular dynamics (MD) simulations of melt-quenching and thermal aging procedures in pure Ag, Cu, Ag-Cu binary alloys, and Cu-Zr binary alloys, we have identified two distinct amorphous phases for a metastable undercooled liquid: the homogeneous L-phase with low shear rigidity and the heterogenous G-phase with much higher shear rigidity and a heterogeneity length scale Λ. Here, we examine two-phase equilibration studies showing that the G-phase melts to form the L-phase above ~1,000 K, which then transforms to form the crystal (X) phase; however, below the melting point of the G-Phase (~990 K), the X- and G-phases do not transform into each other. We suggest the presence of a G-phase is likely responsible for embrittlement often observed in metallic glasses.

Efficacy of observational learning on nursing students' learning outcomes in delirium care simulation: A parallel-group randomized trial.

Background: While the learning outcomes of observational learning in simulation-based experiences have been documented, there is a paucity of studies that have provided evidence of the efficacy of observational learning in influencing reaction, performance, and behavioral changes.

Purpose: This study aimed to assess the efficacy of structured observational learning on the learning outcomes of nursing students in delirium care simulations.

Methods: A parallel-group randomized trial design was employed.

Improving Resident Physician History and Physical in Challenging Situations.

Objective: To educate physician trainees using simulation on best management of children with autism spectrum disorder who have neurocognitive and behavioral challenges when experiencing acute illness.

Method: A simulation-based curriculum including baseline assessment, communication techniques, and use of calming resources was developed to educate residents in assessing children with sensory barriers. Traditional simulation and deliberate practice were used to teach this curriculum to second- and third-year pediatric and internal medicine-pediatric residents.

Molecular Strain Accelerates Electron Transfer for Enhanced Oxygen Reduction.

Fe-N-C materials are emerging catalysts for replacing precious platinum in the oxygen reduction reaction (ORR) for renewable energy conversion. However, their potential is hindered by sluggish ORR kinetics, leading to a high overpotential and impeding efficient energy conversion. Using iron phthalocyanine (FePc) as a model catalyst, we elucidate how the local strain can enhance the ORR performance of Fe-N-Cs.

Vaginal delivery of the second twin: simulation to improve trainee knowledge and comfort.

Background: Vaginal delivery in twins is feasible but challenging. Successful vaginal delivery of a non-vertex second twin depends on knowledge of specific obstetrical maneuvers. Skill acquisition at the patient's bedside is difficult, making simulation training an integral part of obstetrics and gynecology residency programs.

Sacrificial MOF-derived MnNi hydroxide for high energy storage supercapacitor electrodes via DFT-based quantum capacitance study.

Electrochemical energy storage plays a critical role in the transition to clean energy. With the growing demand for efficient and sustainable energy solutions, supercapacitors have gained significant attention due to their high specific capacitance, rapid charge/discharge capabilities, long lifespan, safe operation across various temperatures, and minimal maintenance needs. This study introduces a novel approach for the synthesis of high-performance supercapacitor electrodes by using MnNi-MOF-74 as a precursor.

Periductal Mastitis Occurring Among Hubble-Bubble Smokers: A Report of Two Cases and Literature Review.

Periductal mastitis (PM) is a form of nonlactational mastitis. The clinical picture varies from mild periareolar inflammation to frank retroareolar abscess formation. A huge amount of literature is incriminating cigarette smoking as a major contributing factor to the etiology of PM, and cessation of smoking is essential for a successful treatment.

Localizing and Tailoring the Debriefing Assessment for Simulation in Healthcare to Optimize Fit.

Introduction Debriefing in healthcare simulation is helpful in reinforcing learning objectives, closing performance gaps, and improving future practice and patient care. The Debriefing Assessment for Simulation in Healthcare (DASH) is a validated tool. However, localized rater training for the DASH has not been described.

Nonprecious Triple-Atom Catalysts with Ultrahigh Activity for Electrochemical Reduction of Nitrate to Ammonia: A DFT Screening.

Electrochemical nitrate reduction to ammonia (NORR) is promising to not only tackle environmental issues caused by nitrate but also produce ammonia at room temperatures. However, two critical challenges are the lack of effective electrocatalysts and the understanding of related reaction mechanisms. To overcome these challenges, we employed first-principles calculations to thoroughly study the performance and mechanisms of triple-atom catalysts (TACs) composed of transition metals (including 27 homonuclear TACs and 4 non-noble bimetallic TACs) anchored on N-doped carbon (NC).

Distance simulation in surgical education.

Distance and remote simulation have emerged as vital tools in modern surgical education, offering solutions to challenges such as limited operating hours, growing clinical demands, and the need for consistent, high-quality training. This review examines the benefits, limitations, and strategies for implementing sustainable distance simulation, structured around 3 foundational pillars: (1) effective hardware and infrastructure, including simulators and realistic scenarios that enable trainees to develop essential skills; (2) validated training programs grounded in educational theory with a clear focus on skill transfer and predictive validity; and (3) timely access to effective feedback. Distance simulation permits adaptable, scalable training environments, but the addition of remote and deferred feedback has further broadened its impact, helping to overcome the challenges posed by faculty availability and clinician time constraints.

Dynamic supramolecular snub cubes.

Mimicking the superstructures and properties of spherical biological encapsulants such as viral capsids and ferritin offers viable pathways to understand their chiral assemblies and functional roles in living systems. However, stereospecific assembly of artificial polyhedra with mechanical properties and guest-binding attributes akin to biological encapsulants remains a formidable challenge. Here we report the stereospecific assembly of dynamic supramolecular snub cubes from 12 helical macrocycles, which are held together by 144 weak C-H hydrogen bonds.

Metabotropic GABA Receptor Activation Induced by G Protein Coupling.

G protein-coupled receptors (GPCRs) play central roles in regulating cellular responses through heterotrimeric G proteins (GP). Extensive studies have elucidated the complex cellular signaling mediated by GPCRs that accompany dynamic conformational changes upon activation. However, there has been less focus on the role of the GP on the activation process, particularly for class C GPCRs that function as obligate dimers.

Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015).

Background: Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear.

Methods: This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years.

Tantalum-stabilized ruthenium oxide electrocatalysts for industrial water electrolysis.

The iridium oxide (IrO) catalyst for the oxygen evolution reaction used industrially (in proton exchange membrane water electrolyzers) is scarce and costly. Although ruthenium oxide (RuO) is a promising alternative, its poor stability has hindered practical application. We used well-defined extended surface models to identify that RuO undergoes structure-dependent corrosion that causes Ru dissolution.

Application of Large Language Models in Medical Training Evaluation-Using ChatGPT as a Standardized Patient: Multimetric Assessment.

Background: With the increasing interest in the application of large language models (LLMs) in the medical field, the feasibility of its potential use as a standardized patient in medical assessment is rarely evaluated. Specifically, we delved into the potential of using ChatGPT, a representative LLM, in transforming medical education by serving as a cost-effective alternative to standardized patients, specifically for history-taking tasks.

Objective: The study aims to explore ChatGPT's viability and performance as a standardized patient, using prompt engineering to refine its accuracy and use in medical assessments.

Simulation training with haptic feedback of instrument vibrations reduces resident workload during live robot-assisted sleeve gastrectomy.

Background: New surgeons experience heavy workload during robot-assisted surgery partially because they must use vision to compensate for the lack of haptic feedback. We hypothesize that providing realistic haptic feedback during dry-lab simulation training may accelerate learning and reduce workload during subsequent surgery on patients.

Methods: We conducted a single-blinded study with 12 general surgery residents (third and seventh post-graduate year, PGY) randomized into haptic and control groups.