New therapies that promote antitumour immunity have been recently developed. Most of these immunomodulatory approaches have focused on enhancing T-cell responses, either by targeting inhibitory pathways with immune checkpoint inhibitors, or by targeting activating pathways, as with chimeric antigen receptor T cells or bispecific antibodies. Although these therapies have led to unprecedented successes, only a minority of patients with cancer benefit from these treatments, highlighting the need to identify new cells and molecules that could be exploited in the next generation of immunotherapy. Given the crucial role of innate immune responses in immunity, harnessing these responses opens up new possibilities for long-lasting, multilayered tumour control.

Harnessing innate immunity in cancer therapy.

Natural killer (NK) cells belong to the innate immune system and contribute to protecting the host through killing of infected, foreign, stressed or transformed cells. Additionally, via cellular cross-talk, NK cells orchestrate antitumor immune responses. Hence, significant efforts have been undertaken to exploit the therapeutic properties of NK cells in cancer. Current strategies in preclinical and clinical development include adoptive transfer therapies, direct stimulation, recruitment of NK cells into the tumor microenvironment (TME), blockade of inhibitory receptors that limit NK cell functions, and therapeutic modulation of the TME to enhance antitumor NK cell function. In this Review, we introduce the NK cell–cancer cycle to highlight recent advances in NK cell biology and to discuss the progress and problems of NK cell–based cancer immunotherapies. In this Review, Smyth and colleagues provide an overview of recent advances in NK cell biology and discuss the progress and problems of NK cell–based cancer immunotherapies.

The NK cell–cancer cycle: advances and new challenges in NK cell–based immunotherapies

Assessment of Routine Chest Roentgenograms and the Physical Examination to Confirm Endotracheal Tube Position

Medication dosing errors in pediatric patients treated by emergency medical services.

An interdisciplinary expert panel of medical and surgical specialists involved in the management of patients with potential spinal cord injuries (SCI) was assembled. Four key questions were created that were of significant interest. These were: (1) what is the optimal type and duration of pre-hospital spinal immobilization in patients with acute SCI?; (2) during airway manipulation in the pre-hospital setting, what is the ideal method of spinal immobilization?; (3) what is the impact of pre-hospital transport time to definitive care on the outcomes of patients with acute spinal cord injury?; and (4) what is the role of pre-hospital care providers in cervical spine clearance and immobilization? A systematic review utilizing multiple databases was performed to determine the current evidence about the specific questions, and each article was independently reviewed and assessed by two reviewers based on inclusion and exclusion criteria. Guidelines were then created related to the questions by a national Canadian expert panel using the Delphi method for reviewing the evidence-based guidelines about each question. Recommendations about the key questions included: the pre-hospital immobilization of patients using a cervical collar, head immobilization, and a spinal board; utilization of padded boards or inflatable bean bag boards to reduce pressure; transfer of patients off of spine boards as soon as feasible, including transfer of patients off spinal boards while awaiting transfer from one hospital institution to another hospital center for definitive care; inclusion of manual in-line cervical spine traction for airway management in patients requiring intubation in the pre-hospital setting; transport of patients with acute traumatic SCI to the definitive hospital center for care within 24h of injury; and training of emergency medical personnel in the pre-hospital setting to apply criteria to clear patients of cervical spinal injuries, and immobilize patients suspected of having cervical spinal injury.

/pdf/pre-hospital-care-management-of-a-potential-spinal-cord-53hbvxb4no.pdf

Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines.

A clinical trial of a 50:50 mixture of nitrous oxide and oxygen for pain relief was carried out to determine the feasibility of its use in a field setting and the side-effects produced by this sedative/analgesic. The gas mixture was delivered from a single-tank system using a demand-valve apparatus which was triggered by the patient's inspiratory effort. This "patient-controlled" sedation/analgesia was provided to 1243 patients over a period of 18 months. Of the 1201 patients evaluated, 20.6% reported minor side-effects consisting of nausea or vomiting (5.7%), dizziness or lightheadedness (10.3%), excitement (3.7%), and numbness (0.3%). Ninety-one (7.6%) patients became drowsy or fell into a light sleep but all were readily aroused by verbal command. All retained the ability to cough or swallow on command. No consistent or clinically adverse changes were found in BP or pulse rates. The trial supports the concept that this agent is a promising sedative/analgesic for the relief of mild to moderate pain and anxiety. Because of its safety, it is particularly suited to use in prehospital emergency care.

Patient-controlled inhalational analgesia in prehospital care: a study of side-effects and feasibility.

Physician medical direction and clinical performance at an established emergency medical services system.

PREFACE The National Highway Traffic Safety Administration (NHTSA) has assumed responsibility for the development of training courses that are responsive to the standards established by the Highway Safety Act of 1966 (amended). Since these courses are designed to provide national guidelines for training, it is NHTSA's intention that they be of the highest quality and be maintained in a current and up-to-date status from the point of view of both technical content and instructional strategy. Paramedic Practice Analysis, and the EMS Agenda for the Future. These continuing education guidelines are part of a series of courses making up a national EMS training program for prehospital care.

/pdf/emt-paramedic-and-emt-intermediate-continuing-education-5ovpfc1ear.pdf

EMT-Paramedic and EMT-Intermediate Continuing Education. National Guidelines.

Patient-Controlled Inhalational Analgesia in Prehospital Care: A Study of Side-Effects and Feasibility

PURPOSE To evaluate the effectiveness of the Actronics Interactive Learning System to teach the psychomotor skills of advanced airway management compared to the traditional method of lecture/demonstration. METHODS The study was a nonrandomized, nonequivalent comparison group design of a convenience sample of 86 American Heart Association (AHA), advanced cardiac life support (ACLS) students, who obtained instruction in airway management by the interactive videodisc (IVD) learning system (n = 41), or by the traditional method of demonstration/return demonstration (n = 45). The evaluation criteria for the students were based on the number of attempts required to perform successfully endotracheal (ET) intubation and esophageal obturator airway (EOA) insertion. RESULTS No statistically significant differences in the performance of ET insertion between the IVD and the traditional method of instruction could be demonstrated. However, initial certifiers for ACLS learning EOA insertion by the IVD method had a treatment effect (p = 0.004) compared to ACLS students learning by the traditional method. This treatment effect was not noted with ET intubation and EOA insertion for students seeking recertification. In a post-test satisfaction questionnaire, 34 IVD students reported satisfaction with learning airway management using this instructional method, but also expressed a preference to have an ACLS instructor available. CONCLUSION This study highlights the role of IVD in teaching the complex skills of advanced airway management.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1049023X00042126

Using interactive videodisc to test advanced airway management skills.

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