Purpose: Patient handovers are critical for patient safety. Studies have shown that nurses are often interrupted during handovers, and standardized guidelines are lacking. This study aimed to develop and evaluate the effectiveness of a new handover method for emergency nurses. Methods: This quasi-experimental study implemented a new handover method from August 1, 2022, at the emergency department of a university hospital. Pre- (34 responses) and post-(16 responses, six months later) surveys and post-interviews (six participants) were conducted. In the pre-survey, data were collected regarding handover-related characteristics, cause of handover error, handover perception and handover error experience. Data regarding handover perception and handover error experience were obtained again at the post-survey. Wilcoxon’s signed rank test was used to compare handover perception and handover error experience. The interview results were analyzed using inductive content analysis. Results: There were no significant differences in information quality or interaction and support, but the new handover method was more efficient, and handover errors decreased. Four themes were identified from interview responses. Conclusion By providing a quiet place and allowing emergency nurses to independently review patient records during handovers, we expect to maintain nursing continuity, increase efficiency, and ultimately ensure patient safety and nurses’ job satisfaction.

Purpose: Patient handovers are critical for patient safety. Studies have shown that nurses are often interrupted during handovers, and standardized guidelines are lacking. This study aimed to develop and evaluate the effectiveness of a new handover method for emergency nurses. Methods: This quasi-experimental study implemented a new handover method from August 1, 2022, at the emergency department of a university hospital. Pre- (34 responses) and post-(16 responses, six months later) surveys and post-interviews (six participants) were conducted. In the pre-survey, data were collected regarding handover-related characteristics, cause of handover error, handover perception and handover error experience. Data regarding handover perception and handover error experience were obtained again at the post-survey. Wilcoxon’s signed rank test was used to compare handover perception and handover error experience. The interview results were analyzed using inductive content analysis. Results: There were no significant differences in information quality or interaction and support, but the new handover method was more efficient, and handover errors decreased. Four themes were identified from interview responses. Conclusion By providing a quiet place and allowing emergency nurses to independently review patient records during handovers, we expect to maintain nursing continuity, increase efficiency, and ultimately ensure patient safety and nurses’ job satisfaction.

Purpose: Patient handovers are critical for patient safety. Studies have shown that nurses are often interrupted during handovers, and standardized guidelines are lacking. This study aimed to develop and evaluate the effectiveness of a new handover method for emergency nurses. Methods: This quasi-experimental study implemented a new handover method from August 1, 2022, at the emergency department of a university hospital. Pre- (34 responses) and post-(16 responses, six months later) surveys and post-interviews (six participants) were conducted. In the pre-survey, data were collected regarding handover-related characteristics, cause of handover error, handover perception and handover error experience. Data regarding handover perception and handover error experience were obtained again at the post-survey. Wilcoxon’s signed rank test was used to compare handover perception and handover error experience. The interview results were analyzed using inductive content analysis. Results: There were no significant differences in information quality or interaction and support, but the new handover method was more efficient, and handover errors decreased. Four themes were identified from interview responses. Conclusion By providing a quiet place and allowing emergency nurses to independently review patient records during handovers, we expect to maintain nursing continuity, increase efficiency, and ultimately ensure patient safety and nurses’ job satisfaction.

Purpose: Patient handovers are critical for patient safety. Studies have shown that nurses are often interrupted during handovers, and standardized guidelines are lacking. This study aimed to develop and evaluate the effectiveness of a new handover method for emergency nurses. Methods: This quasi-experimental study implemented a new handover method from August 1, 2022, at the emergency department of a university hospital. Pre- (34 responses) and post-(16 responses, six months later) surveys and post-interviews (six participants) were conducted. In the pre-survey, data were collected regarding handover-related characteristics, cause of handover error, handover perception and handover error experience. Data regarding handover perception and handover error experience were obtained again at the post-survey. Wilcoxon’s signed rank test was used to compare handover perception and handover error experience. The interview results were analyzed using inductive content analysis. Results: There were no significant differences in information quality or interaction and support, but the new handover method was more efficient, and handover errors decreased. Four themes were identified from interview responses. Conclusion By providing a quiet place and allowing emergency nurses to independently review patient records during handovers, we expect to maintain nursing continuity, increase efficiency, and ultimately ensure patient safety and nurses’ job satisfaction.

Purpose: Diffuse large B-cell lymphoma (DLBCL) is the most common hematologic malignancy worldwide. Although substantial improvement has been achieved by the frontline rituximab-based chemoimmunotherapy, up to 40%-50% of patients will eventually have relapsed or refractory disease, whose prognosis is extremely dismal. Materials and Methods: We have carried out two prospective cohort studies that include over 1,500 DLBCL patients treated with rituximab plus CHOP (#NCT01202448 and #NCT02474550). In the current report, we describe the outcomes of refractory DLBCL patients. Patients were defined to have refractory DLBCL if they met one of the followings, not achieving at least partial response after 4 or more cycles of R-CHOP; not achieving at least partial response after 2 or more cycles of salvage therapy; progressive disease within 12 months after autologous stem cell transplantation. Results: Among 1,581 patients, a total of 260 patients met the criteria for the refractory disease after a median time to progression of 9.1 months. The objective response rate of salvage treatment was 26.4%, and the complete response rate was 9.6%. The median overall survival (OS) was 7.5 months (95% confidence interval, 6.4 to 8.6), and the 2-year survival rate was 22.1%±2.8%. The median OS for each refractory category was not significantly different (p=0.529). Conclusion In line with the previous studies, the outcomes of refractory DLBCL patients were extremely poor, which necessitates novel approaches for this population.

Purpose: We conducted a nationwide, multicenter, prospective registry study for newly diagnosed patients with peripheral T-cell lymphoma (PTCL) to better define the clinical characteristics, treatment patterns, survival outcomes, and the role of upfront autologous stem cell transplantation (ASCT) in these patients. Materials and Methods: Patients with PTCL receiving chemotherapy with curative intent were registered and prospectively monitored. All patients were pathologically diagnosed with PTCL. Results: A total of 191 patients with PTCL were enrolled in this prospective registry study. PTCL, not otherwise specified (PTCL-NOS) was the most common pathologic subtype (n=80, 41.9%), followed by angioimmunoblastic T-cell lymphoma (AITL) (n=60, 31.4%). With a median follow-up duration of 3.9 years, the 3-year progression-free survival (PFS) and overall survival (OS) rates were 39.5% and 60.4%, respectively. The role of upfront ASCT was evaluated in patients who were considered transplant-eligible (n=59). ASCT was performed as an upfront consolidative treatment in 32 (54.2%) of these patients. There were no significant differences in PFS and OS between the ASCT and non-ASCT groups for all patients (n=59) and for patients with PTCL-NOS (n=26). However, in patients with AITL, the ASCT group was associated with significantly better PFS than the non-ASCT group, although there was no significant difference in OS. Conclusion The current study demonstrated that the survival outcomes with the current treatment options remain poor for patients with PTCL-NOS. Upfront ASCT may provide a survival benefit for patients with AITL, but not PTCL-NOS.

Tetanus is a bacterial infection by Clostridium tetani. Its neurotoxin causes spastic paralysis and autonomic dysfunction. Intrathecal infusion of baclofen has been suggested as a pertinent treatment for generalized spasm. Our case describes a patient who had a severe generalized form of tetanus, and was effectively treated with intrathecal baclofen infusion. He showed cerebral and brainstem dysfunction during baclofen infusion, which were reversed without sequelae when baclofen was discontinued.

Selection and insertion of an endotracheal tube (ETT) of appropriate size for airway management during general anesthesia in pediatric patients is very important. A very small ETT increases the risk of inadequate ventilation, air leakage, and aspiration, whereas a very large ETT may cause serious complications including airway damage, post-intubation croup, and, in severe cases, subglottic stenosis. Although the pediatric larynx is conical, the narrowest part, the rima glottidis, is cylindrical in the anteroposterior dimension, regardless of development, and the cricoid ring is slightly elliptical. A cuffed ETT reduces the number of endotracheal intubation attempts, and if cuff pressure can be maintained within a safe range, the risk of airway damage may not be greater than that of an ETT without cuff. The age-based formula suggested by Cole (age/4 + 4) has long been used to select the appropriate ETT size in children. Because age-based formulas in children are not always accurate, various alternative methods for estimating the ETT size have been examined and suggested. Chest radiography, ultrasound, and a three-dimensional airway model can be used to determine the appropriate ETT size; however, there are several limitations.

Purpose: Febrile neutropenia (FN) can cause suboptimal treatment and treatment-related mortality (TRM) in diffuse large B-cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). Materials and methods: We conducted a prospective cohort study to evaluate the effectiveness of pegfilgrastim prophylaxis in DLBCL patients receiving R-CHOP, and we compared them with the PROCESS cohort (n=485). Results: Since January 2015, 986 patients with DLBCL were enrolled. Pegfilgrastim was administered at least once in 930 patients (94.3%), covering 90.3% of all cycles. FN developed in 137 patients (13.9%) in this cohort (23.7% in the PROCESS cohort, p<0.001), and 4.2% of all cycles (10.2% in the PROCESS cohort, p<0.001). Dose delay was less common (≥3 days: 18.1% vs. 23.7%, p=0.015; ≥5 days: 12.0% vs. 18.3%, p=0.023) in this cohort than in the PROCESS cohort. The incidence of TRM (3.2% vs. 5.6%, p=0.047) and infection-related death (1.8% vs. 4.5%, p=0.004) was lower in this cohort than in the PROCESS cohort. The 4-year overall survival (OS) and progression-free survival (PFS) rates of the two cohorts were not different (OS: 73.0% vs. 71.9%, p=0.545; PFS: 69.5% vs. 68.8%, p=0.616). However, in patients aged ≥75 years, the 4-year OS and PFS rates were higher in this cohort than in the PROCESS cohort (OS: 49.6% vs. 33.7%, p=0.032; PFS: 44.2% vs. 30.3% p=0.047). Conclusion Pegfilgrastim prophylaxis is effective in the prevention of FN and infection-related death in DLBCL patients receiving R-CHOP, and it also improves OS in patients aged ≥75 years.

Background: Despite significant technological advances in the implantable pulse generator (IPG), complications can still occur. We report a case that unexpected extrusion of the IPG of spinal cord stimulation (SCS) was promptly identified and successfully removed without any complications. Case: After a car accident 4 years ago, a 55-year-old man who was diagnosed with complex local pain syndrome in his right leg. The SCS was inserted with 2 leads, with the IPG being implanted in the right lower abdomen region. Four years later, he developed extrusion of the IPG from his abdominal region. This unexpected extrusion may have been related to pressure necrosis caused by continued compression of pocket site where a belt was frequently tied. The IPG and the leads were successfully removed without infection occurring. Conclusions To prevent unexpected extrusion of IPG, it is necessary to consider in advance whether the pocket site is pressed against the belt.