BACKGROUNDChild maltreatment (CM) is a major public health issue. Data collection, analysis, and reporting are widely recognized as key components in developing policies and programs aimed at preventing child maltreatment. Unfortunately, CM is significantly under-coded by healthcare professionals (HCPs) in hospitals. Due to a lack of studies, causes of this under-coding are not fully understood.OBJECTIVEThe aim was to identify and understand challenging factors leading to under-coding of CM in hospitals in Germany and Sweden.PARTICIPANTS AND SETTINGThe sample includes 28 HCPs from different professional groups involved in coding-process: pediatricians (n = 14), child psychiatrists (n = 6), pediatric surgeons (n = 4), medical coding professionals (n = 3), and child protection coordinators (n = 1). Nineteen identified as female and 9 as male; age ranged from 24 to 65.METHODSThe transcripts of the semi-structured interviews have been coded and analyzed using the thematic analysis approach of Braun & Clarke.RESULTSIn this study, four major themes were identified influencing child maltreatment coding practices on multiple levels. (1) The Impact of Systemic Frameworks, describing systemic factors, such as legal requirements and lack of mandatory education; (2) The Role of Organizational Culture and Structures, describing attitude of the clinic, transparency, and shortcomings in quality control; (3) Interpersonal Dynamics of Multidisciplinary Cooperation and Communication; and (4) Intrapersonal Barriers: Knowledge, Uncertainty, and Emotional Burdens.CONCLUSIONIdentified themes significantly influence HCPs coding practices. Addressing these multifaceted challenges requires comprehensive educational programs, improved organizational support, and systemic changes to counteract the under-coding of CM in hospitals.

2025-04-01·Breast Cancer Research and Treatment

The prognostic value of changes in Ki67 following neoadjuvant chemotherapy in residual triple-negative breast cancer: a Swedish nationwide registry-based study

Article

作者: Nyqvist-Streng, Jenny ; Helou, Khalil ; Helou, Mikael ; Chamalidou, Chaido ; Parris, Toshima Z ; Kovács, Anikó

AbstractPurposeTo evaluate the prognostic significance of changes in pre- and post-neoadjuvant chemotherapy (NACT) Ki67 in patients with primary invasive triple-negative breast cancer (TNBC).MethodsPopulation-based registry data were retrieved for patients diagnosed with TNBC between 2007 and 2021 (n = 9262). Multivariable Cox regression analysis was performed for disease-specific survival (DSS) and overall survival (OS) adjusted for age and residual disease in the breast and nodes (RDBN).ResultsOf the 1777 TNBC patients receiving NACT, 54 achieved pathologic complete response (pCR) and 755 had residual disease. Most patients were overweight with stage II disease (78%), grade 3 tumors (53%), and RDBN score 3 (42%). Compared to baseline, tumor size (30 vs. 15 mm; P < 0.0001) and Ki67 levels (63% vs. 48%; P < 2.2e − 16) generally decreased after NACT. Although only 5% of samples increased in size, Ki67 levels often remained unchanged (75%) or increased (0.9%) after treatment, respectively. However, 34% of patients discontinued treatment. Patients showing no changes in Ki67% had more unfavorable OS (P < 0.0001) and DSS (P = 0.00032), with significantly lower 5-year survival probabilities (OS: 66%; DSS: 78%) than those with decreased Ki67% (OS: 87%; DSS: 89%). All patients reaching pCR were alive 5 years after diagnosis. However, only the RDBN score was an independent predictor of survival in the multivariable analyses.ConclusionKi67 often remained unchanged in TNBC patients treated with neoadjuvant chemotherapy, resulting in adverse clinical outcomes. These findings highlight the need for individualized treatment regimens and dynamic monitoring of TNBC patients with high Ki67 post-NACT.

2025-04-01·Clinical Microbiology and Infection

The risk of drug-induced liver injury associated with flucloxacillin: a nationwide, entropy-balanced cohort study

Article

作者: Nilsson, Anton ; Inghammar, Malin ; Jacobsson, Gunnar ; Nibell, Olof ; Björk, Jonas

OBJECTIVESIn this nationwide cohort study in a Scandinavian setting, we aimed to investigate the magnitude of association between flucloxacillin use and drug-induced liver injury (DILI).METHODSNationwide cohort study among adults in Sweden, 2006-2018, was conducted. Register data on filled prescriptions, patient characteristics, co-medications, and DILI were linked. All filled prescriptions for flucloxacillin and oral clindamycin, among Swedish adults aged 18-85 years, were identified. Entropy-balancing methods were used to control for confounding. Cox regression was used to estimate hazard ratios (HRs) for a first diagnosis of DILI, defined as admission to hospital, emergency department or specialist care, or death because of DILI, within 45 days from the start of treatment.RESULTSWithin the main 45-day risk period, there were 219 events of DILI among 1 443 622 flucloxacillin users (incidence rate: 14/10 000 person-years) as compared with nine events among 583 847 oral clindamycin group (incidence rate: 1.4/10 000 person-years). This corresponded to an HR of 7.32 (95% CI: 4.1-13.0). The absolute risk difference for users of flucloxacillin compared with clindamycin in the main period was 11 cases of DILI (95% CI: 5-20) per 100 000 courses. The risk diminished in the subsequent periods, 46-90 days (HR: 4.17; 95% CI: 1.44-12.10), and 91-180 days (HR: 0.72; 95% CI: 0.36-1.44).DISCUSSIONIn this nationwide cohort study, the use of flucloxacillin was associated with a sevenfold increased risk of DILI, predominantly in the first 45 days of exposure.

100 项与 Skaraborg Hospital 相关的药物交易

登录后查看更多信息

100 项与 Skaraborg Hospital 相关的转化医学

登录后查看更多信息