Search

Background: The management of a difficult airway requires training in cricothyroidotomy (CT). The objectives of this study were: (i) to describe technical changes made to The REAL CRIC Trainer model in order to increase its realism, (ii) to assess the model by experts in comparison to a commercial dry model, (iii) to evaluate its performance in a realistic simulation scenario for training technical and behavioural skills, and (iv) to assess whether the model can help to identify anatomic structures by ultrasound (US). Methods: An observational prospective study was conducted in which an assembled modified model was assessed by five experts in CT and comparing it with a commercial dry model. The fidelity of US images obtained in the model was compared to those obtained from volunteers. The usefulness and realism of the model, attached to a high-fidelity simulator's neck in emergent CT clinical scenario, was assessed by the 11 ICU staff taking part. Results: Using a score out of 10, CT performance in our model and in a dry model was rated by the experts as 9 vs. 6, respectively in external appearance, 8.4 vs. 5.8 in tactile fidelity, and 8.6 vs. 4.1 in technical realism. Participants in the simulation gave a mean score of 7.7/10 to the fidelity parameters. Usefulness for training of the model integration into a simulation scenario was rated as 9.6. Ultrasound images were evaluated as high fidelity. Conclusions: Our modified REAL CRIC Trainer model was rated high by experts in CT and participants in a simulated clinical scenario, and may be useful for a complete emergent CT training closer to the clinical reality than the models currently available. Resumen: Introducción: El manejo de la vía aérea difícil comprende el entrenamiento en la cricotiroidotomía (CT). Los objetivos de este estudio fueron: describir los cambios técnicos realizados en el modelo REAL CRIC Trainer para aumentar el realismo, obtener su valoración por expertos respecto a un modelo seco comercializado, evaluar su rendimiento en un escenario de simulación para el entrenamiento de habilidades técnicas y conductuales de la CT emergente y determinar si el modelo permite identificar estructuras anatómicas mediante ecografía. Métodos: Estudio prospectivo y observacional, el modelo ensamblado fue evaluado por 5 expertos en CT que lo compararon con un modelo seco comercial. Se comparó también su fidelidad ecográfica con la de las imágenes obtenidas en voluntario. La utilidad y el realismo del modelo utilizado en un escenario de simulación clínica para CT emergente fue valorada por 11 participantes, personal de la UCI. Resultados: La evaluación por expertos de la CT en el modelo diseñado y en modelo seco comercial, obtuvo puntuaciones de 9 vs. 6 sobre 10, respectivamente en apariencia externa, 8,4 vs. 5,8 en fidelidad táctil y 8,6 vs. 4,1 en realismo de la técnica. Los participantes en la simulación otorgaron una puntuación media de 7,7/10 a los parámetros de fidelidad. La utilidad de integrar el modelo en un escenario de simulación de alta fidelidad fue evaluada en 9,6/10 y las imágenes de ultrasonido fueron consideradas como de alta fidelidad. Conclusiones: El modelo REAL CRIC Trainer modificado fue muy bien valorado tanto por los expertos como por los participantes en un escenario clínico de simulación, y puede ser útil para un entrenamiento completo en CT emergente más próximo a la realidad clínica que los modelos disponibles.

A number of immunotherapies have been developed and adopted for the treatment of urothelial cancer (encompassing cancers arising from the bladder, urethra, or renal pelvis). For these immunotherapies to positively impact patient outcomes, optimal selection of agents and treatment scheduling, especially in conjunction with existing treatment paradigms, is paramount. Immunotherapies also warrant specific and unique considerations regarding patient management, emphasizing both the prompt identification and treatment of potential toxicities. In order to address these issues, the Society for Immunotherapy of Cancer (SITC) convened a panel of experts in the field of immunotherapy for urothelial cancer. The expert panel developed this clinical practice guideline (CPG) to inform healthcare professionals on important aspects of immunotherapeutic treatment for urothelial cancer, including diagnostic testing, treatment planning, immune-related adverse events (irAEs), and patient quality of life (QOL) considerations. The evidence- and consensus-based recommendations in this CPG are intended to give guidance to cancer care providers treating patients with urothelial cancer.