HighlightsThis is the first patient reported with a metastasis to the spleen from a pNET [1]. Spleen metastases are extremely rare and are usually seen with disseminated disease.This is the first report of an isolated metachronous metastasis to the adrenal gland from a pNET, which appeared after 90 months.Serum PIVKA levels have never been reported in a patient with pNET. In this patient, serum PIVKA level was elevated at the time of diagnosis of 5/7 recurrences and returned to baseline levels following treatment. This suggests that PIVKA may be a useful tumor marker in patients with pNET, and deserves further study.

Aim To test a modified team‐based learning approach on undergraduate learning outcomes in an acute‐care nursing course in Japan. Design Mixed‐methods. Methods Students worked on three simulated cases, engaged in pre‐class preparation, completed a quiz and engaged in group work. We collected data on team approach, critical‐thinking disposition and time spent in self‐learning at four time‐points: before the intervention and after each simulated case. Data were analysed using a linear mixed model, a Kruskal–Wallis test and a content analysis. Data sources We recruited nursing students attending a mandatory course in acute‐care nursing at University A. Data were collected at four time‐points between April and July 2018. Data from 73 of 93 respondents were analysed. Results Team approach, critical thinking and self‐learning all increased significantly across the time‐points. Four categories emerged from students' comments: ‘achievement of teamwork’, ‘sense of learning efficacy’, ‘satisfaction with course approach’ and ‘issues related to course approach’. The modified team‐based learning approach led to improvements in team approach and critical‐thinking disposition across the course. Conclusion Incorporating team‐based learning into the curriculum not only contributes to team building but is also effective as a teaching method to improve student learning. Implications for the profession and/or patient care The intervention led to improvements in team approach and critical‐thinking disposition across the course. The educational intervention also led to more time for self‐learning. Future studies should include participants from various universities and evaluate the outcomes over a longer period.

At mass-gathering events of the Olympic and Paralympic Games, a well-organized, on-site medical system is essential. This study evaluated the vulnerabilities of the prehospital medical system of the TOKYO 2020 Olympic and Paralympic Games (TOKYO2020) to propose corrections that can be generalized to other mass gatherings. The healthcare failure mode and effect analysis (HFMEA) was adopted to analyze vulnerabilities of the on-site medical system proposed by the organizing committee of TOKYO2020. Processes from detecting a patient on the scene to completing transport to a hospital were analyzed. Ten processes with 47 sub-processes and 122 possible failure modes were identified. HFMEA revealed 9 failure modes as vulnerabilities: misidentification of patient, delayed immediate care at the scene, misjudgment of disposition from the on-site medical suite, and inappropriate care during transportation to hospital. Proposed corrections included surveillance to decrease blind spots, first aid brochures for spectators, and uniform protocol for health care providers at the scene. The on-site medical system amended by HFMEA seemed to work appropriately in TOKYO2020.