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A simple novel training model for teaching suprapubic catheter (SPC) exchange
Modelo simple y novedoso para la formación del recambio de catéter suprapúbico (CSP)
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"apellidos" => "Biyani" "email" => array:1 [ 0 => "shekhar.biyani@nhs.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Nottingham University Hospital, Nottingham, United Kingdom" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Leicester General Hospital, Leicester, United Kingdom" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Leeds Teaching Hospitals, Leeds, United Kingdom" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Forth Valley Royal Hospital, Larbert, Scotland, United Kingdom" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Modelo simple y novedoso para la formación del recambio de catéter suprapúbico (CSP)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1040 "Ancho" => 900 "Tamanyo" => 100634 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a) Catheter tract brought through a cylindrical excised hole in an abdominal wall replica. The tissue is placed on a table allowing access below for the bladder. b) Small bowel stitched anteriorly to the skin with 3/0 prolene replicating the SPC tract in a patient.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">A Suprapubic Catheter (SPC) is a urinary catheter placed directly into the bladder through the lower abdominal wall. It is commonly used by urologists in clinical conditions such as urethral strictures, prostatic enlargement, neuropathic bladder or urethral trauma. In most cases a SPC is indicated when urethral catheterisation is not possible or desirable.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Once established, a SPC needs regular exchange every 2–3 months to avoid complications such as urinary tract infections, encrustation, bladder stones and recurrent blockages.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Suprapubic catheter (SPC) exchange, therefore, is an essential skill for all urological staff in training, with an estimated 500 new SPC’s per region, per year in the UK.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Despite this, most surgical trainees and nursing staff will face this task for the first time in the acute setting, at night, without direct supervision. Unfortunately, a lack of simulation models and an unpredictability of when SPC changes are required, make it difficult to acquire this skill.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> As such, junior doctors and urology nurses frequently persist with urethral catheterisation, posing a significant risk to patients of urethral injury. Furthermore, a SPC tract will close very rapidly once a catheter has been removed, thereby justifying immediate intervention.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The British Association of Urological Surgeons (BAUS) recommends that <span class="elsevierStyleItalic">“Changes of Suprapubic catheters should be carried out by staff who have been instructed with regard to the technique and complications of suprapubic catheter changes”</span>.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It is clear that SPC insertion should not be delegated to untrained or inexperienced medical staff: however, there remains a distinct lack of realistic training models to replicate SPC exchange where a catheter tract is present. Artificial SPC training models are widely used to teach insertion, with many different models being described within the literature. These include scale pelvic rubber models,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> “balloon bladders”<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and video simulations on the internet. However, all of these are poor in practice at reproducing lifelike epithelial catheter tracts, and therefore offer poor validity and reproducibility in teaching SPC exchange.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Through using animal tissue, we are able to describe a novel, anatomically realistic simulation model for use in suprapubic catheter training. This porcine model was trialed at a national urology simulation boot camp by new urology registrars and validated by expert urologists.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Our model needed to fulfil several criteria in order to reproduce a realistic training experience. Firstly, it needed to provide anatomical accuracy, having the look and feel of a bladder while providing realistic visual and sensory feedback. Furthermore, it needed to be cost effective, reproducible and easy to make in order to be effective in clinical workshops.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A scale reproduction of an abdominal wall was created using a porcine abdominal wall (£6.0, $7.31). A segment of small bowel (£4.50, $5.48) was incised along the antimesenteric border and opened horizontally. The bowel was then wrapped around a size 16 Fr Foley catheter and stitched together using a continuous 3/0 PDS suture, and the rest of the bowel was excised. This will be used as the epithelised SPC tract (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Where the rest of the small bowel was excised, a porcine bladder (£8.0, $9.74) was anastomosed to the bowel using 3/0 PDS. This was filled with water to simulate urine during the simulation exercise (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). Abdominal wall tissue was then excised cylindrically with a scalpel and McIndoe Scissors to create an opening; the small bowel tract with the catheter within was passed through the abdominal wall inferiorly and sutured anteriorly with 3/0 prolene (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a, b). The finished model (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b) is a realistic SPC tract with a 16 Fr Suprapubic catheter in situ and balloon inflated, allowing for SPC exchange training in the simulated setting.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">The simulator was used by 45 urology trainees ranging from core surgical trainees to junior urology registrars at a 5-day specialised urology simulation boot camp. Over the course of 5 days, 10 consultant urologists supervised the training of SPC exchange on this model and afterwards were asked to fill out a questionnaire. The questionnaire examined content validity with a 6-item, a 5-point Likert rating scale used to evaluate domains relevant to the simulator - physical attributes, realism of procedure, realism of materials, and global usefulness ratings (supplementary file). Descriptive data in numbers (mean) is presented.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The 10 consultant Urology trainers had all replaced over 50 SPC’s during their career, with the majority of them doing this with guidewires at least between 11 and 30 times. As experienced clinicians, the trainers gave a reported mean global usefulness for training junior doctors rating for the model of 4.6 out of 5. Furthermore, the expert consensus on the model’s ability to simulate SPC exchange was 4.2 out of 5, indicating our model was “good” in this domain (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">A summary of expert rating assessment of the model can be found in the <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>: these domains assess the model’s content validity, analysing anatomy, realism and ease of use. Representation of the relevant anatomy to teach the procedure scored highest amongst raters at 4.4/5, with 4 experts commenting on this domain as “excellent”. The second highest scoring characteristic was the overall appearance of the SPC tract site (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b) earning 4.2/5. The ease of insertion of a guidewire through the tract and subsequently the ability to insert a catheter over a guidewire, were both rated as 4/5, therefore “good”. Finally, the feel of insertion of the catheter through the tract got a mean score of 3.8/5. No expert gave the model a lower score than 3 (neutral) for any of the 5 domains.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">In the UK, Suprapubic catheter insertion is an indexed procedure for Urology trainees. However, suprapubic catheter exchange is often overlooked and never taught or assessed formally. Furthermore, both trainee Urologists and nurses are expected to be able to perform this skill, often during unsocial hours, and occasionally without instruction.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Over the last few decades, the specialty of urology is in constant evolution. Much of these changes have been the result of technological advancement. Training new residents in various techniques using a well-structured programme represents the most important challenges to the Training Committee today.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> A survey of urology residents demonstrated a lack of standardised training programme across the Europe.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Urological training has seen significant changes to incorporate simulation-based learning both in practical and human factors over recent years.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Our unit, in particular, has developed an innovative, practical, hands-on interactive simulation bootcamp which now forms the foundation of Urological registrar training in the UK.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> We know that through simulation, trainees can demonstrate immediate competence progression in technical skills after utilizing the advantages of models such as this one.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">To our knowledge, this novel suprapubic catheter exchange model is the first of its kind to offer specific training on SPC exchange in a simulated, safe and reproducible environment. Other SPC models in circulation can only offer training on insertion and lack the ability to teach this important skill. On average, our experts reported high satisfaction with their experience using this simulator as a training tool, with an overwhelming agreement in its usefulness for training. Particularly positive feedback also came in the domains of anatomical representation and tract appearance. The tactile feel of insertion of the catheter through the tract scored the lowest amongst our experts: this may be due to the lubrication of the porcine bowel, or due to the artificial anastomosis which needed to be created by the sutures.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Our model is easily reproduced and can be used by most postgraduate education centres throughout the UK and beyond. This model can also be easily modified to suit a trainer’s preferences. For example, comment had been made on its application for vascular access training, PICC/long line insertion and other cannulation-based procedures. Furthermore, this can be used to train nurses and physician associates.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Further work is needed to analyse trainees’ experiences of this model. Specifically, data is required on trainee’s clinical experiences following training on this model. Furthermore, we anticipate this to be rolled out to also incorporate nursing/health care assistant training and surgical assessment in the future.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitations</span><p id="par0080" class="elsevierStylePara elsevierViewall">This study is limited by the small sample size, and lack of trainee feedback. However, the preliminary validity evidence supports the use of this model by trained urologists who recommend the use of the model in simulation. The use of porcine abdominal tissue removes the advantageous bony landmarks often taught for SPC insertion on plastic models. However, the lack of these landmarks shouldn’t affect SPC exchange training, as a tract will already be in place. Furthermore, our model cannot be used outside of education centres without a wet lab as animal tissue forms the basis of this model. A fresh model would be required for each subsequent training course due to issues incurred with long term storage of such tissue.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0085" class="elsevierStylePara elsevierViewall">To our knowledge, this novel suprapubic catheter exchange model is the first of its kind to offer specific training on suprapubic catheter exchange. Its use in a simulated, safe and reproducible environment for training could improve patient safety and satisfaction in the future. On average, our experts reported high satisfaction with their experience using this simulator as a training tool. Particular agreement came in its representation of relevant anatomy and realism to human tissue. Our data suggests this novel animal model is a useful tool that can be integrated into training courses, to facilitate learning this necessary skill in simulation rather than on patients. Future work is planned to obtain validity data from Urology trainees, and also to trial our model with urology nursing staff, who perform this task on a more regular basis.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financial disclosures</span><p id="par0090" class="elsevierStylePara elsevierViewall">Equipment and sponsorship for the Urology Simulation Boot Camp were provided by: Karl Storz, Cook Medical, Ethicon, Dantec, OKB Medical (Simbionix), MediPlus, Teleflex, European Pharma.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1397261" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1280293" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1397260" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1280292" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Financial disclosures" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 12 => array:2 [ "identificador" => "xack486114" "titulo" => "Acknowledgement" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-02" "fechaAceptado" => "2020-01-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1280293" "palabras" => array:4 [ 0 => "Simulation" 1 => "Suprapubic" 2 => "Catheter" 3 => "Urology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1280292" "palabras" => array:4 [ 0 => "Simulación" 1 => "Suprapúbico" 2 => "Catéter" 3 => "Urología" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">To develop a suprapubic catheter (SPC) training model as no specific realistic training model exists to replicate SPC exchange where a catheter tract is present.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We describe a novel, anatomically realistic, animal simulator model for use in SPC training, which was trialed at a national urology simulation boot camp by new urology trainees and validated by expert urologists. A scale reproduction of an abdominal wall was created using a porcine abdominal wall. A segment of small bowel was stitched around a size 16F Foley catheter to form a tract. Abdominal wall tissue was excised cylindrically to create an opening, and the small bowel tract was passed through the abdominal wall and sutured anteriorly, producing a realistic SPC tract: inferiorly, the tract was anastomosed to a porcine urinary bladder. This model was evaluated by 10 expert urologists for content validity with an 8-item 5-point rating scale used to evaluate domains relevant to the simulator.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The domains were scored between 1 and 5 by 10 expert urologists, 1 being «strongly disagree» and 5 being «strongly agree». The average expert ratings of the domains were then calculated and tabulated following the training course. There was an average global rating of 4.2/5 for the model, with an average usefulness for training score of 4.6/5.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The feedback from experts and trainees (informal) was overwhelmingly positive. On average, our experts reported high satisfaction with their experience using this simulator as a training tool.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Desarrollar un modelo de formación sobre el catéter suprapúbico (CSP), ya que no existe un modelo realista específico para replicar el recambio de CSP.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y métodos</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Describimos un modelo animal de simulación, anatómicamente realista, para su uso en la formación del manejo del CSP, el cual fue probado por residentes de urología y validado por urólogos expertos. Usando una pared abdominal porcina, se creó una reproducción a escala de la pared abdominal. Un segmento del intestino delgado fue cosido alrededor de un catéter de Foley de tamaño 16F para formar el tubo. Se crea una apertura cilíndrica en la pared abdominal, realizando un canal para introducir el tracto del intestino delgado; este fue suturado en la parte anterior, produciendo una sonda de CSP de apariencia realista. En la parte inferior la sonda fue anastomosada a una vejiga urinaria porcina. La validez de contenido del modelo fue evaluada por 10 urólogos expertos, con una escala de calificación de 8 ítems y 5 puntos, utilizada para evaluar las distintas áreas relevantes del simulador.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estas áreas fueron puntuadas de 1 a 5 por 10 urólogos expertos, siendo 1 «totalmente en desacuerdo» y 5 «totalmente de acuerdo». El promedio de la calificación de los expertos fue calculado y tabulado al finalizar la formación. La calificación global del modelo fue de 4,2/5, con un promedio de utilidad para la formación de 4,6/5.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La respuesta (informal) obtenida por parte de expertos y alumnos fue altamente positiva. En promedio, nuestros expertos reportaron una experiencia satisfactoria con el uso de este simulador como herramienta de formación.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Materiales y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bratt DG, Berridge C, Young M, Kailavasan M, Taylor J, Biyani CS. Modelo simple y novedoso para la formación del recambio de catéter suprapúbico (CSP). Actas Urol Esp. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.acuro.2020.01.011">https://doi.org/10.1016/j.acuro.2020.01.011</span></p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0110" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0050" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 999 "Ancho" => 900 "Tamanyo" => 101902 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Porcine small bowel wrapped around a 16 Fr Foley catheter using 3/0 PDS. b) Catheter tract anastomosed to porcine bladder using 3/0 PDS.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1040 "Ancho" => 900 "Tamanyo" => 100634 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a) Catheter tract brought through a cylindrical excised hole in an abdominal wall replica. The tissue is placed on a table allowing access below for the bladder. b) Small bowel stitched anteriorly to the skin with 3/0 prolene replicating the SPC tract in a patient.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Very poor \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Poor \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fair \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Good \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Excellent \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall appearance of the suprapubic tract site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tract representation for procedure training \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ease of guidewire insertion through the tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Feel of catheter insertion through the tract \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Feel of tract dilation using catheters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5,0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Training usefulness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Overall ability of the model to simulate the task \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4,2 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2397990.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Expert evaluation of the suprapubic catheter exchange model.</p>" ] ] 3 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.zip" "ficheroTamanyo" => 290 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SAFETY ALERTS: safer insertion of suprapubic catheters: summary of a safety report from the National Patient Safety Agency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. 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Somani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jsurg.2018.06.020" "Revista" => array:6 [ "tituloSerie" => "J Surg Educ" "fecha" => "2019" "volumen" => "76" "paginaInicial" => "215" "paginaFinal" => "222" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30174146" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack486114" "titulo" => "Acknowledgement" "texto" => "<p id="par0100" class="elsevierStylePara elsevierViewall">The porcine material was sourced from Wetlab-Medmeat (<a target="_blank" href="http://www.wetlab.co.uk">www.wetlab.co.uk</a>) UK. We would like to thank Medical Education Team, St James’s University Hospital, Leeds, UK.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000004400000008/v1_202010110822/S2173578620301098/v1_202010110822/en/main.assets" "Apartado" => array:4 [ "identificador" => "6274" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000004400000008/v1_202010110822/S2173578620301098/v1_202010110822/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578620301098?idApp=UINPBA00004N" ]
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| 2021 February | 8 | 0 | 8 |
