Diagnostic Performance in Low- and High-Contrast Tasks of an Image-Based Denoising Algorithm Applied to Radiation Dose-Reduced Multiphase Abdominal CT Examinations.

BACKGROUND. Anatomic redundancy between phases can be used to achieve denoising of multiphase CT examinations. A limitation of iterative reconstruction (IR) techniques is that they generally require use of CT projection data. A frequency-split multi-band-filtration algorithm applies denoising to the multiphase CT images themselves. This method does not require knowledge of the acquisition process or integration into the reconstruction system of the scanner, and it can be implemented as a supplement to commercially available IR algorithms. OBJECTIVE. The purpose of the present study is to compare radiologists' performance for low-contrast and high-contrast diagnostic tasks (i.e., tasks for which differences in CT attenuation between the imaging target and its anatomic background are subtle or large, respectively) evaluated on multiphase abdominal CT between routine-dose images and radiation dose-reduced images processed by a frequency-split multiband-filtration denoising algorithm. METHODS. This retrospective single-center study included 47 patients who underwent multiphase contrast-enhanced CT for known or suspected liver metastases (a low-contrast task) and 45 patients who underwent multiphase contrast-enhanced CT for pancreatic cancer staging (a high-contrast task). Radiation dose-reduced images corresponding to dose reduction of 50% or more were created using a validated noise insertion technique and then underwent denoising using the frequency-split multi-band-filtration algorithm. Images were independently evaluated in multiple sessions by different groups of abdominal radiologists for each task (three readers in the low-contrast arm and four readers in the high-contrast arm). The noninferiority of denoised radiation dose-reduced images to routine-dose images was assessed using the jackknife alternative free-response ROC (JAFROC) figure-of-merit (FOM; limit of noninferiority, -0.10) for liver metastases detection and using the Cohen kappa statistic and reader confidence scores (100-point scale) for pancreatic cancer vascular invasion. RESULTS. For liver metastases detection, the JAFROC FOM for denoised radiation dose-reduced images was 0.644 (95% CI, 0.510-0.778), and that for routine-dose images was 0.668 (95% CI, 0.543-0.792; estimated difference, -0.024 [95% CI, -0.084 to 0.037]). Intraobserver agreement for pancreatic cancer vascular invasion was substantial to near perfect when the two image sets were compared (κ = 0.53-1.00); the 95% CIs of all differences in confidence scores between image sets contained zero. CONCLUSION. Multiphase contrast-enhanced abdominal CT images with a radiation dose reduction of 50% or greater that undergo denoising by a frequency-split multiband-filtration algorithm yield performance similar to that of routine-dose images for detection of liver metastases and vascular staging of pancreatic cancer. CLINICAL IMPACT. The image-based denoising algorithm facilitates radiation dose reduction of multiphase examinations for both low- and high-contrast diagnostic tasks without requiring manufacturer-specific hardware or software.

The effects of a mobile application for patient participation to improve patient safety.

BACKGROUND: Patient participation in patient safety activities in care processes is a fundamental element of safer care. Patients play an important role in preventing patient safety incidents and improving health outcomes. Therefore, healthcare providers need to develop and provide educational materials and actionable tools for patient participation. OBJECTIVES: This study aimed to develop a mobile application for health consumers' participation and evaluate the effect of the mobile application on improving health consumers' participation in patient safety. METHODS: A quasi-experimental design was adopted. We developed a mobile application on the basis of a needs assessment, literature review, compilation of patient safety topics, and validity testing of the application. The target population included Korean adults aged between 30 and 65 years who had visited a medical institution more than once within the most recent 6 months. The intervention group received patient participation training by using the mobile application, Application for Patient Participation in Safety Enhancement, for 2 months. The primary outcome variables were patient safety knowledge, self-efficacy of participation, willingness to participate and experience of patient participation in patient safety activities. End-user satisfaction was assessed using a questionnaire. To assess participants' experiences with the intervention, qualitative data were collected through a focus group interview and open-ended responses to an end-user satisfaction survey. RESULTS: The intervention group (n = 60) had significantly higher overall average scores than the control group (n = 37) with regard to patient safety knowledge (p < .001), self-efficacy of participation (p = .001), willingness to participate (p = .010) and experience of participation (p = .038) in the post-survey. The total mean end-user satisfaction score was 3.56 ± 0.60. The participants expressed the realization that patients could play an important role in improving patient safety. CONCLUSIONS: This study demonstrated that educating health consumers through a mobile application with useful information improves patient participation in patient safety activities. Educational materials and patient participation tools could motivate health consumers' health-related behaviours. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved during the programme development and evaluation.

A Novel Synthetic Antibody Library with Complementarity-Determining Region Diversities Designed for an Improved Amplification Profile.

Antibody discovery by phage display consists of two phases, i.e., the binding phase and the amplification phase. Ideally, the selection process is dominated by the former, and all the retrieved clones are amplified equally during the latter. In reality, the amplification efficiency of antibody fragments varies widely among different sequences and, after a few rounds of phage display panning, the output repertoire often includes rapidly amplified sequences with low or no binding activity, significantly diminishing the efficiency of antibody isolation. In this work, a novel synthetic single-chain variable fragment (scFv) library with complementarity-determining region (CDR) diversities aimed at improved amplification efficiency was designed and constructed. A previously reported synthetic scFv library with low, non-combinatorial CDR diversities was panned against protein A superantigen, and the library repertoires before and after the panning were analyzed by next generation sequencing. The enrichment or depletion patterns of CDR sequences after panning served as the basis for the design of the new library. Especially for CDR-H3 with a higher and more random diversity, a machine learning method was applied to predict potential fast-amplified sequences among a simulated sequence repertoire. In a direct comparison with the previous generation library, the new library performed better against a panel of antigens in terms of the number of binders isolated, the number of unique sequences, and/or the speed of binder enrichment. Our results suggest that the amplification-centric design of sequence diversity is a valid strategy for the construction of highly functional phage display antibody libraries.

Predicting the Need for Step-Up Therapy After EUS-Guided Drainage of Pancreatic Fluid Collections With Lumen-Apposing Metal Stents.

BACKGROUND & AIMS: A significant proportion of individuals with pancreatic fluid collections (PFCs) require step-up therapy after endoscopic drainage with lumen-apposing metal stents. The aim of this study is to identify factors associated with PFCs that require step-up therapy. METHODS: A retrospective cohort study of patients undergoing endoscopic ultrasound-guided drainage of PFCs with lumen-apposing metal stents from April 2014 to October 2019 at a single center was performed. Step-up therapy included direct endoscopic necrosectomy, additional drainage site (endoscopic or percutaneous), or surgical intervention after the initial drainage procedure. Multivariable logistic regression was performed using a backward stepwise approach with a P ≤ .2 threshold for variable retention to identify factors predictive for the need for step-up therapy. RESULTS: One hundred thirty-six patients were included in the final study cohort, of whom 69 (50.7%) required step-up therapy. Independent predictors of step-up therapy included: collection size measuring ≥10 cm (odds ratio [OR], 8.91; 95% confidence interval [CI], 3.36-23.61), paracolic extension of the PFC (OR, 4.04; 95% CI, 1.60-10.23), and ≥30% solid necrosis (OR, 4.24; 95% CI, 1.48-12.16). In a sensitivity analysis of 81 patients with walled-off necrosis, 51 (63.0%) required step-up therapy. Similarly, factors predictive of the need for step-up therapy for walled-off necrosis included: collection size measuring ≥10 cm (OR, 6.94; 95% CI, 1.76-27.45), paracolic extension of the PFC (OR, 3.79; 95% CI, 1.18-12.14), and ≥30% solid necrosis (OR, 7.10; 95% CI, 1.16-43.48). CONCLUSIONS: Half of all patients with PFCs drained with lumen-apposing metal stents required step-up therapy, most commonly direct endoscopic necrosectomy. Individuals with PFCs ≥10 cm in size, paracolic extension, or ≥30% solid necrosis are more likely to require step-up therapy and should be considered for early endoscopic reintervention.

Computerized tomography scan in pre-diagnostic pancreatic ductal adenocarcinoma: Stages of progression and potential benefits of early intervention: A retrospective study.

BACKGROUND: The frequency, nature and timeline of changes on thin-slice (≤3 mm) multi-detector computerized tomography (CT) scans in the pre-diagnostic phase of pancreatic ductal adenocarcinoma (PDAC) are unknown. It is unclear if identifying imaging changes in this phase will improve PDAC survival beyond lead time. METHODS: From a cohort of 128 subjects (Cohort A) with CT scans done 3-36 months before diagnosis of PDAC we developed a CTgram defining CT Stages (CTS) I through IV in the radiological progression of pre-diagnostic PDAC. We constructed Cohort B of PDAC resected at CTS I and II and compared survival in CTS I and II in Cohort A (n = 22 each; control natural history cohort) vs Cohort B (n = 33 and 72, respectively; early interception cohort). RESULTS: CTs were abnormal in 16% and 85% at 24-36 and 3-6 months respectively, before PDAC diagnosis. The PDAC CTgram stages, findings and median lead times (months) to clinical diagnosis were: CTS I: Abrupt duct cut-off/duct dilatation (-12.8); CTS II: Low density mass confined to pancreas (-9.5), CTS III: Peri-pancreatic infiltration (-5.8), CTS IV: Distant metastases (only at diagnosis). PDAC survival was better in cohort B than in cohort A despite inclusion of lead time in Cohort A: CTS I (36 vs 17.2 months, p = 0.03), CTS II (35.2 vs 15.3 months, p = 0.04). CONCLUSION: Starting 12-18 months before PDAC diagnosis, progressive and increasingly frequent changes occur on CT scans. Resection of PDAC at the time of pre-diagnostic CT changes is likely to provide survival benefit beyond lead time.

Psychological Impact of Quarantine on Caregivers at a Children's Hospital for Contact with Case of COVID-19.

Quarantine often provokes negative psychological consequences. Thus, we aimed to identify the psychological and behavioral responses and stressors of caregivers quarantined with young patients after a close contact to a coronavirus disease 2019 case at a children's hospital. More than 90% of the caregivers reported feelings of worry and nervousness, while some of them reported suicidal ideations (4.2%), and/or homicidal ideations (1.4%). Fear of infection of the patient (91.7%) and/or oneself (86.1%) were most frequently reported stressors. A multidisciplinary team including infection control team, pediatrician, psychiatrist, nursing staff and legal department provided supplies and services to reduce caregiver's psychological distress. Psychotropic medication was needed in five (6.9%), one of whom was admitted to the psychiatry department due to suicidality. Quarantine at a children's hospital makes notable psychological impacts on the caregivers and a multidisciplinary approach is required.

Cardiac CT in the Emergency Department: Contrasting Evidence from Registries and Randomized Controlled Trials.

PURPOSE OF REVIEW: To compare outcomes between registries and randomized controlled trials of coronary computed tomographic angiography (CCTA)-based versus standard of care approaches to the initial evaluation of patients with acute chest pain. RECENT FINDINGS: Randomized trials have demonstrated CCTA to be a safe and efficient tool for triage of low- to intermediate-risk patients presenting to the emergency department with chest pain. Recent studies demonstrate heterogeneous result using different standard of care approaches for evaluation of hard endpoints in comparison with standard evaluation. Also, there has been continued concern for increase in subsequent testing after coronary CTA. Although CCTA improves detection of coronary artery disease, it is uncertain if it will bring improvement of long-term health outcomes at this point of time. Careful analysis of the previous results and further investigation will be required to validate evaluation of hard endpoints.

Gastric Heterotopic Pancreas: Computed Tomography With Clinicopathologic Correlation.

Asymptomatic heterotopic pancreas (HP) is benign and can be monitored long term without further intervention. Heterotopic pancreas is sometimes surgically resected because it can be difficult to distinguish HP from neoplastic submucosal masses such as gastrointestinal stromal tumors. Although it is not very common, HP should be considered in the differential diagnosis when diagnosing extramucosal gastric masses to avoid unnecessary intervention. We review gastric HP with pathologic correlation to help with diagnosing HP on computed tomography.

Mobile-Based Video Learning Outcomes in Clinical Nursing Skill Education: A Randomized Controlled Trial.

Mobile devices are a regular part of daily life among the younger generations. Thus, now is the time to apply mobile device use to nursing education. The purpose of this study was to identify the effects of a mobile-based video clip on learning motivation, competence, and class satisfaction in nursing students using a randomized controlled trial with a pretest and posttest design. A total of 71 nursing students participated in this study: 36 in the intervention group and 35 in the control group. A video clip of how to perform a urinary catheterization was developed, and the intervention group was able to download it to their own mobile devices for unlimited viewing throughout 1 week. All of the students participated in a practice laboratory to learn urinary catheterization and were blindly tested for their performance skills after participation in the laboratory. The intervention group showed significantly higher levels of learning motivation and class satisfaction than did the control. Of the fundamental nursing competencies, the intervention group was more confident in practicing catheterization than their counterparts. Our findings suggest that video clips using mobile devices are useful tools that educate student nurses on relevant clinical skills and improve learning outcomes.

Patient safety education and baccalaureate nursing students' patient safety competency: A cross-sectional study.

This cross-sectional study examines baccalaureate nursing programs in South Korea to determine how and to what extent patient safety education was delivered, and to assess nursing students' patient safety competency. The Quality and Safety Education for Nurses (QSEN) student evaluation survey and a Patient Safety Competency Self-Evaluation tool were used. We distributed 234 surveys to senior students in four nursing schools; 206 (88%) students responded to the survey. The majority of students (81.6%) reported that they had received patient safety education during coursework. Patient safety education was delivered primarily by lecture rather than during laboratory or simulation sessions. The degree of coverage of QSEN competency and the students' self-reported competency in total and attitude scores showed statistical differences among nursing schools. Students' attitude score was significantly higher than skill and knowledge. Our results confirm the need to revise the nursing curriculum and to use various teaching methods to deliver patient safety education more comprehensively and effectively. Furthermore, there is a need to develop an integrated approach to ensuring students' balanced competency.

[Structural Topic Modeling Analysis of Patient Safety Interest among Health Consumers in Social Media].

PURPOSE: This study aimed to investigate healthcare consumers' interest in patient safety on social media using structural topic modeling (STM) and to identify changes in interest over time. METHODS: Analyzing 105,727 posts from Naver news comments, blogs, internet cafés, and Twitter between 2010 and 2022, this study deployed a Python script for data collection and preprocessing. STM analysis was conducted using R, with the documents' publication years serving as metadata to trace the evolution of discussions on patient safety. RESULTS: The analysis identified a total of 13 distinct topics, organized into three primary communities: (1) "Demand for systemic improvement of medical accidents," underscoring the need for legal and regulatory reform to enhance accountability; (2) "Efforts of the government and organizations for safety management," highlighting proactive risk mitigation strategies; and (3) "Medical accidents exposed in the media," reflecting widespread concerns over medical negligence and its repercussions. These findings indicate pervasive concerns regarding medical accountability and transparency among healthcare consumers. CONCLUSION: The findings emphasize the importance of transparent healthcare policies and practices that openly address patient safety incidents. There is clear advocacy for policy reforms aimed at increasing the accountability and transparency of healthcare providers. Moreover, this study highlights the significance of educational and engagement initiatives involving healthcare consumers in fostering a culture of patient safety. Integrating consumer perspectives into patient safety strategies is crucial for developing a robust safety culture in healthcare.

Development and evaluation of a forensic nursing competency-based hybrid simulation education program: A quasi-experimental design.

AIM: This study aimed to develop and validate the effectiveness of a hybrid simulation education program designed to enhance the forensic nursing competency of emergency department nurses. BACKGROUND: Emergency nurses often bear the responsibility of conducting forensic nursing assessments and interventions, such as patient recognition and evidence collection, to safeguard patients' legal rights, given their frequent encounters with emergency department patients. Simulation methods have proven effective in training for forensic nursing care. However, there is still a need for the development of forensic nursing education using simulation methods. DESIGN: This study employed a one-group pre-test/post-test quasi-experimental design. A four-hour simulation education program was developed based on the analysis, design, development, implementation, and evaluation model, with a focus on enhancing forensic nursing competency. METHODS: Nurses with more than six months of clinical experience in the emergency department in South Korea were divided into an experimental group (n=23) and a baseline comparison group (n=24). Both groups completed self-evaluations of their forensic nursing competency through a survey. The experimental group underwent the simulation education program, and their forensic nursing performance was evaluated before and after the program. Following the training, participants completed a questionnaire to assess their forensic nursing competency and satisfaction with the program. RESULTS: The initial forensic nursing competency of the experimental and baseline comparison groups was found to be similar. However, the forensic nursing competency and performance of the experimental group exhibited significant improvement after the training. Regarding program evaluation, the average scores on a 5-point scale were as follows: theoretical lecture (4.79 SD 0.27), simulation education (4.78 SD 0.29), simulation design (4.42 SD 0.45), and satisfaction with the educational program (4.82 SD 0.28). CONCLUSIONS: The forensic nursing competency-based simulation education program herein improved the relevant competency and performance of emergency nurses.

Children suspected of having pulmonary embolism: multidetector CT pulmonary angiography--thromboembolic risk factors and implications for appropriate use.

PURPOSE: To evaluate thromboembolic risk factors for pulmonary embolism (PE) detected by using computed tomographic (CT) pulmonary angiography in children and to determine whether such information could be used for more appropriate use of CT pulmonary angiography in this patient population. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant retrospective study and waived the need for patient informed consent. Two hundred twenty-seven consecutive CT pulmonary angiography studies in 227 pediatric patients who underwent CT pulmonary angiography for clinically suspected PE at a single large pediatric referral hospital between July 2004 and March 2011 were evaluated. Age, sex, referral setting, and D-dimer result, as well as seven possible risk factors, were compared between patients with and those without PE. Multiple logistic regression modeling was used to identify the independent risk factors of PE. Receiver operating characteristic curve analysis was applied to determine the optimal cutoff number of risk factors for predicting a positive CT pulmonary angiography result for PE in children. RESULTS: Thirty-six (16%) of 227 CT pulmonary angiography studies were positive for PE. Five risk factors, including immobilization (P < .001), hypercoagulable state (P = .003), excess estrogen state (P = .002), indwelling central venous line (P < .001), and prior PE and/or deep venous thrombosis (P < .001), were found to be significant independent risk factors for PE. With use of two or more risk factors as the clinical threshold, the sensitivity of a positive PE result was 89% (32 of 36 patients), and the specificity was 94% (180 of 191 patients). CONCLUSION: It is unlikely for CT pulmonary angiography results to be positive for PE in children with no thromboembolic risk factors. The use of risk factor assessment as a first-line triage tool has the potential to guide more appropriate use of CT pulmonary angiography in children, with associated reductions in radiation exposure and costs.

Pulmonary embolism detected by pulmonary MDCT angiography in older children and young adults: risk factor assessment.

OBJECTIVE: The purpose of this article is to determine the risk factors for pulmonary embolism (PE) among older children and young adults who underwent pulmonary CT angiography (CTA) for evaluation of clinically suspected PE. MATERIALS AND METHODS: We used our hospital information system to retrospectively identify all consecutive patients 19-25 years old who underwent pulmonary CTA for evaluation of clinically suspected PE between July 2004 and March 2011. Two experienced pediatric radiologists retrospectively and independently reviewed a series of 116 consecutive pulmonary CTA studies from this population. Each examination was reviewed for the presence of PE. Seven possible risk factors (immobilization, prior PE or deep venous thrombosis [DVT], cardiac disease, malignancy, hypercoagulable state, excess estrogen, and central venous line placement) were compared between patients with and without PE using univariate statistics, including Student t test and Pearson chi-square test. Multiple logistic regression modeling was used to identify independent risk factors for PE. Receiver operating characteristic curve analysis was applied to determine the optimal cutoff number of risk factors for predicting a pulmonary CTA result positive for PE. RESULTS: The study population consisted of 116 patients (34 men and 82 women; mean age, 20.7 ± 1.8 years; range, 18.6-25.4 years) who underwent a total of 116 pulmonary CTA studies. Sixteen (14%) of 116 patients were found to have PE on pulmonary CTA. The level of involvement of PE was segmental in 16 of 31 PEs (52%), lobar in eight (26%), subsegmental in five (16%), and main or central in two (6%). Three risk factors--immobilization (p < 0.001), history of prior PE or DVT (p = 0.001), and cardiac disease (p = 0.004)--were found to be significant independent risk factors for the presence of PE detected by pulmonary CTA. When two or more risk factors were used as the clinical threshold, the sensitivity for positive PE was 75% (12/16 patients) and the specificity was 99% (99/100 patients). CONCLUSION: The use of risk factor assessment as a first-line triage tool has the potential to guide more appropriate use of pulmonary CTA in this population, with potential associated reductions in radiation exposure and costs.

Communication education regarding patient safety for registered nurses in acute hospital settings: a scoping review protocol.

INTRODUCTION: The importance of correct and timely communication continues to be emphasised in the area of patient safety. Nurses play a key role in communicating with a variety of healthcare personnel to deliver safe care for patients. Many attempts have been made to improve nursing professionals' communication competencies regarding patient safety. However, the scope, method and effectiveness of communication education regarding patient safety for registered nurses have not been sufficiently reviewed. In order to understand the overall status of this field, a scoping review with a systematic framework is necessary. The objective of this study is to map the extent, range and nature of literature on communication education regarding patient safety for registered nurses in acute hospital settings and identify gaps to guide future research, policy and practice. METHODS AND ANALYSIS: This study will be conducted in accordance with the methodology for scoping reviews developed by Arksey and O'Malley. To strengthen its rigour, the scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The overall review process will involve an independent review by two reviewers to select and analyse literature. The databases to be explored are MEDLINE (Ovid), Embase, Education Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Korean Medical Database (KMBASE). In addition, we will endeavour to include the grey literature through manual searches on patient safety-related websites. This review will target literature on communication programmes for patient safety provided to registered nurses in acute hospital settings and will include peer-reviewed literature in English and Korean since 2000, when research in the field of patient safety started to increase rapidly. ETHICS AND DISSEMINATION: Since this study is a review of previous studies, no ethics approval is required. The findings of the study will be disseminated in a peer-reviewed journal for publication.

Impact of measurement method on interobserver variability of apparent diffusion coefficient of lesions in prostate MRI.

PURPOSE: To compare the inter-observer variability of apparent diffusion coefficient (ADC) values of prostate lesions measured by 2D-region of interest (ROI) with and without specific measurement instruction. METHODS: Forty lesions in 40 patients who underwent prostate MR followed by targeted prostate biopsy were evaluated. A multi-reader study (10 readers) was performed to assess the agreement of ADC values between 2D-ROI without specific instruction and 2D-ROI with specific instruction to place a 9-pixel size 2D-ROI covering the lowest ADC area. The computer script generated multiple overlapping 9-pixel 2D-ROIs within a 3D-ROI encompassing the entire lesion placed by a single reader. The lowest mean ADC values from each 2D-small-ROI were used as reference values. Inter-observer agreement was assessed using the Bland-Altman plot. Intraclass correlation coefficient (ICC) was assessed between ADC values measured by 10 readers and the computer-calculated reference values. RESULTS: Ten lesions were benign, 6 were Gleason score 6 prostate carcinoma (PCa), and 24 were clinically significant PCa. The mean±SD ADC reference value by 9-pixel-ROI was 733 ± 186 (10-6 mm2/s). The 95% limits of agreement of ADC values among readers were better with specific instruction (±112) than those without (±205). ICC between reader-measured ADC values and computer-calculated reference values ranged from 0.736-0.949 with specific instruction and 0.349-0.919 without specific instruction. CONCLUSION: Interobserver agreement of ADC values can be improved by indicating a measurement method (use of a specific ROI size covering the lowest ADC area).

The impact of informal caregivers on depressive symptoms among older adults receiving formal home health care.

This study evaluated the association between presence and types of informal caregivers and the presence of depressive symptoms among older adults receiving formal home health care (HHC). A secondary analysis of data was conducted using a computerized patient care database, the Outcome and Assessment Information Set. Logistic regression analyses were used to examine the data of 8448 patients aged 65 years or older who had been admitted to an HHC agency from acute care hospitals between January 1, 2002 and June 30, 2002. The outcome variable was the presence of depressive symptoms. The primary predictor variable was the presence and types of informal caregivers. Covariates included demographic variables, health status, length of time enrolled in formal HHC, patient living arrangements, and the frequency and types of care received from informal caregivers. A lower percentage of older adults receiving care from both informal caregivers and a formal HHC agency (13.3%) had depressive symptoms than older adults receiving only formal HHC (14.9%) at the end of a 60-day episode in formal HHC. Older adults without an informal caregiver were more likely to experience depressive symptoms than those with an informal caregiver after a 60-day episode in HHC (odds ratio = 1.229, 95% confidence interval = 1.027-1.471). There was no significant association between the types of informal caregivers and the presence of depressive symptoms.

Development and Evaluation of a Teamwork Improvement Program for Perioperative Patient Safety.

BACKGROUND: Effective teamwork in healthcare teams improves quality of care, which positively impacts on patient safety. Teamwork is especially crucial for perioperative nurses because they provide care as a team in the operating room. Previous research on teamwork training has principally addressed the general aspects of healthcare settings and focused on interdisciplinary teamwork and has rarely considered operative settings and nursing teamwork. PURPOSE: The aim of this study was to develop a teamwork improvement program for perioperative patient safety and to evaluate the effectiveness of this program. METHODS: A quasi-experimental design was applied. We developed a teamwork improvement program based on teamwork competencies that focused on the perioperative nursing practice. This research was conducted at two operating centers in a tertiary hospital in South Korea, and a total of 60 perioperative nurses participated, including 28 nurses from the cancer operating center (experimental group) and 32 nurses from the main operating center (control group). The program consisted of four sessions and was delivered to the experimental group for a period of 2 weeks. Following the intervention, the effectiveness of the intervention was measured using a self-report questionnaire, focus group interviews, and program evaluation survey. Data were analyzed using chi-square test, t test, Fisher's exact test, and content analysis. RESULTS: Nearly all (96.4%) of the participants were satisfied with the overall content of the teamwork improvement program. Statistically significant differences were found between the experimental and control groups with regard to teamwork knowledge, teamwork attitudes, communication self-efficacy, and teamwork skills and behaviors. Three themes were elicited from the qualitative analysis, including "recognizing the importance and content of teamwork," "improving teamwork competencies," and "contributing to safe surgery." No significant difference in the incidence of surgical nursing errors was identified between the experimental and control groups within a 4-week period. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The teamwork improvement program developed in this study was demonstrated as effective in improving perioperative nurses' utilization of teamwork competencies in nursing practice and positively changing teamwork. The findings of this study provide evidence that teamwork training increases nurses' teamwork competencies. The clinical application of teamwork tools using competency-based teamwork training may contribute to patient safety and safe nursing practice.

Multisystem IgG4-related disease involving the abdomen and coronary arteries and causing chronic abdominal pain.

IgG4-related disease was originally discovered in patients with autoimmune pancreatitis accompanied by elevated serum IgG4 levels and has subsequently been described in almost every organ system. IgG4-related disease presents with a variety of symptoms according to the organ affected and may be accompanied by serious complications such as organ dysfunction associated with IgG4-positive cell proliferation. We report a case of IgG4-related abdominal disease in a patient who also had involvement of the coronary artery.

Interventions to Engage Patients and Families in Patient Safety: A Systematic Review.

The involvement of patients and families is essential for improving patient safety. However, the role of patients and caregivers in patient safety has recently been receiving attention, and programs and interventions have been implemented for patients and caregivers. The objective of this systematic review was to identify the types of interventions to improve patient safety that focused on engaging patients and their families, and the effectiveness of these interventions. Searching four electronic databases, 2019 articles were obtained; of these, 15 articles met the inclusion criteria. The studies used intervention strategies at the "information" and "involvement" engagement levels. Interventions with strategies only at the information level mostly measured safety perception and were mostly found to be effective. Interventions with both information and involvement strategies measured more diverse outcomes, but their effectiveness was inconsistent. Further studies using a range of intervention strategies and outcomes with more rigorous methodologies are needed.PROSPERO registration number CRD42018096162.