Trends in infection-related patient safety incident reporting before and during the COVID-19 pandemic in Korea.

Purpose: The purpose of this study was to analyze the trends and characteristics of infection-related patient safety incident reporting before and during the coronavirus disease 2019 (COVID-19) pandemic in Korea, and to provide basic data for preventing infection-related patient safety incidents and improving their management. Methods: A cross-sectional analysis of secondary national data (Patient Safety Reporting Data) was conducted. In total, 517 infection-related patient safety incidents reported from 2018 to 2021 were analyzed. Changes in the number of reports before and during the COVID-19 pandemic and differences in variables related to infection-related patient safety incidents were analyzed using the chi-square test and independent t-test in SPSS 29.0. Results: This study found that infection-related patient safety incidents decreased during the COVID-19 pandemic compared to before the pandemic. Furthermore, incident-related characteristics, such as the type of healthcare organization, severity of harm, and post-incident actions, changed during the COVID-19 pandemic. Conclusion: The many changes in the infection control system and practices during the COVID-19 pandemic may have contributed to a decrease in the reporting of infection-related patient safety incidents. It is hoped that longitudinal studies on patient safety incidents related to the pandemic and analytical studies on factors influencing patient safety incidents will continue to be conducted to prevent and improve patient safety incidents. [ FROM AUTHOR] Copyright of Journal of Korean Biological Nursing Science is the property of Korean Society of Biological Nursing Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Use of metolazone as an adjunct therapy to loop diuretics in diuretic resistant acute decompensation of heart failure: A systematic review and meta-analysis: Metolazone in diuretic resistant AHF: A Meta-Analysis

Introduction: Loop diuretics are the first-line treatment for volume overload in acute decompensation of congestive heart failure (AHF). Loop diuretic resistance is common due to pharmacologic tachyphylaxis. Therefore, thiazide and thiazide-like diuretics are often used as add-on therapy to combine two different pharmacologic mechanisms. This systemic review and meta-analysis aimed to synthesize the current evidence on the efficacy and safety of metolazone and other thiazide-like diuretics in AHF. Method(s): PRISMA guidelines were followed in conducting this systematic review. PubMed, Scopus, PubMed Central, and Embase databases were searched using relevant keywords for studies published before 5 Jan 2022. and title screening was performed, followed by full-text screening using the Covidence software. Data were extracted, and analysis was done using Cochrane Review Manager (RevMan v5.1). The results were reported in odds ratio and mean difference with 95% confidence intervals. Result(s): Out of 2999 studies identified by database search, eight studies met the inclusion criteria (2 RCTs and 6 cohort studies). Pooled analysis using a random-effects model showed no difference in mean difference among the metolazone group and control group for 24 hours total urine output (MD 69.32, 95% CI -638.29 to 776.94;n = 551;I2 = 84%), change in urine output in 24 hours (MD -284.09, 95% CI -583.99 to 15.81;n = 345;I2 = 0%), 48 hours total urine output (MD -465.62, 95% CI -1302.22 to 370.99;n = 242;I2 = 0%) and urine output at 72 hours (MD -13.24, 95% CI -90.88 to 64.40;n = 205;I2 = 0%). However, studies with furosemide only in the comparator arm, 24 hours of total urine outcome favored metolazone (MD 692.70, 95% CI 386.59 to 998.82;n = 334;I2 = 0%). There was no difference between the two groups in the rate of adverse events, loss of weight, mortality, or readmission rates. Conclusion(s): Metolazone therapy in diuretic resistant AHF may improves urine output and facilitates achieving a net negative balance. Thus, metolazone and thiazide-like diuretics can be used as add-on therapy in acute decompensation of heart failure, especially in diuretic resistance.Copyright © 2023 The Author(s)

We should be learning as much from failure as success

'You do not know what you will find, you may set out to find one thing and end up discovering something entirely different'-Alexander Fleming As the pace at which medicine is advancing continues to accelerate, haematologists will increasingly find themselves practising unfamiliar medicine and using novel treatments. Whilst most scientific breakthroughs hopefully lead to an overall improvement in quality of life and prognosis, it is imperative that enough attention is paid to the shortcomings of new treatments and adverse events. The recent COVID-19 pandemic is a stark reminder of the cyclical nature of history and the need for healthcare professionals to utilise lessons learnt by our predecessors. Fleming and the discovery of penicillin highlights how mistakes in practice can sometimes lead to unexpected but useful revelations. The use of thalidomide as a treatment for hyperemesis gravidarum in the 1960s devastatingly lead to birth defects in thousands of people. Today, the repurposing of thalidomide, through lateral thinking and further study, has contributed to significant improvements in the prognosis of patients with Multiple Myeloma.1 Mortality following allogenic stem cell transplant continues to decrease overtime as knowledge surrounding complications and how to manage these improves, despite the fact that patients receiving stem cell transplants are becoming increasingly complex.2 These examples from history demonstrate the merit in studying adverse events and undesired outcomes. National reviews of patient health records indicate that errors currently occur in 10% of hospital admissions.3 With new treatments and more complex patients this will likely increase. It is estimated that voluntary reporting by healthcare professionals of such events only occurs 70% of the time.3 History should be used to guide essential changes in attitudes towards error reporting and help to create an ethos where 'failings' are more willingly recognised as a tool to guide improvement and innovation.

SUSTAINABILITY REPORTING AS STRATEGIC CRISIS RESPONSE MECHANISM: AN INNOVATIVE APPROACH

Most companies have been severely affected by various business risks due to the COVID-19 outbreak. Their limited resources during this adverse period have forced them to be more concerned with their companies' survival than making sustainability initiatives that incur extra costs. Consequently, companies have faced a challenge in reporting imposed-sustainability statements. According to Wenzel et al. (2020) and Zharfpeykan and Ng (2021), companies can innovatively improvise the regular sustainability reporting to become a strategic tool to portray to stakeholders how companies respond to and address sustainable matters during a crisis period. Thus, this paper presents the concept of sustainability reporting as a strategic crisis response mechanism and proposes a model and matrix that maps the stakeholder engagement disclosure strategy with quality disclosure. Moreover, the paper discusses how this reporting can be influenced by internal governance mechanisms. The paper further suggests the moderating role of enterprise risk management (ERM) in this relationship. This concept can potentially guide managerial decisions on ideal sustainability practices that may not impair companies' capacity to survive during future crises. It may act as an effective instrument in meeting stakeholders' expectations of companies to perform their roles as good corporate citizens during a crisis. © 2023 The Authors.

Association Between COVID-19 Pandemic and Serious Mental Illness: Systematic Review within Salutogenesis Model for Public Health Management

Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.

Population-Based Model of the Fraction of Incidental COVID-19 Hospitalizations during the Omicron BA.1 Wave in the United States

1. Background: Some reports have suggested that as many as one-half of all hospital inpatients identified as COVID-19-positive during the Omicron BA.1 variant-driven wave were incidental cases admitted primarily for reasons other than their viral infections. To date, however, there are no prospective longitudinal studies of a representative panel of hospitals based on pre-established criteria for determining whether a patient was, in fact, admitted as a result of the disease. 2. Materials and Methods: To fill this gap, we developed a formula to estimate the fraction of incidental COVID-19 hospitalizations that relies on measurable, population-based parameters. We applied our approach to a longitudinal panel of 164 counties throughout the United States, covering a 4-week interval ending in the first week of January 2022. 3. Results: Within this panel, we estimated that COVID-19 incidence was rising exponentially at a rate of 9.34% per day (95% CI, 8.93–9.87). Assuming that only one-quarter of all Omicron BA.1 infections had been reported by public authorities, we further estimated the aggregate prevalence of active SARS-CoV-2 infection during the first week of January to be 3.45%. During the same week, among 250 high-COVID-volume hospitals within our 164-county panel, an estimated one in four inpatients was COVID-positive. Based upon these estimates, we computed that 10.6% of such COVID-19-positive hospitalized patients were incidental infections. Across individual counties, the median fraction of incidental COVID-19 hospitalizations was 9.5%, with an interquartile range of 6.7 to 12.7%. 4. Conclusion: Incidental COVID-19 infections appear to have been a nontrivial fraction of all COVID-19-positive hospitalized patients during the Omicron BA.1 wave. In the aggregate, however, the burden of patients admitted for complications of their viral infections was far greater. [ FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Integrating flipped/blended learning into the ultrasound clinical governance session

Education and training is one of the pillars of clinical governance that helps to maintain and improve the quality of patient care within the NHS. The impact of COVID-19 has disrupted the delivery of governance sessions. Original large departmental face-to-face sessions have changed because of social distancing, staff sickness or staff having to isolate. Furthermore, part-time staff often miss clinical governance sessions and do not have the opportunity to maintain training compared to full time staff. The need to deliver education and training is still crucial for staff development and optimising patient care and safety. This poster explores how flipped learning combined with blended learning that is used within academic institutions can also be used to deliver clinical governance within the ultrasound department. Considering the IMPALA framework and its components, the following format is an alternative provision that could be used to deliver governance: online presentation including a video/audio clip;selfdirected study/activity;face to face or online session. The format would ideally suit new guidelines being introduced into a department, for example the applying O-RADS to images. Similarly, the format would suit education and training in case studies, protocols and even departmental quizzes or discussion forums. Including video/audio allows staff to feel in touch and be included with their peers despite circumstances potentially not allowing all to be present. Pillars of governance are crucial to deliver optimal patient care. The education component is also very important to ultrasound practitioners. CPD is continuous and staff should be provided with equal opportunities despite working patterns or absence. Alternative methods to deliver governance sessions should be used as well as the traditional departmental/face to face session. The given format allows the ultrasound department to give education and training to all staff maintaining staff CPD and optimal patient care.

Performance reporting in the healthcare sector: evidence from Italian healthcare organisations

PurposeThe present research aims to understand the performance disclosure levels provided by Italian healthcare organisations (HCOs). The authors conducted this study to assess the transparency of HCOs' performance reporting processes by examining the amount and the type of information disclosed in Annual Performance Reports (APRs).Design/methodology/approachThe present study uses a qualitative research methodology based on manual content analysis. The APRs of a sample of 171 Italian public HCOs were analysed.FindingsResults evidence that the APRs provide a sufficient level of disclosure of performance information, putting high attention on the epidemiological conditions;however, the APRs do not present a strong information function for stakeholders' decision-making purposes. The Italian HCOs APRs are not easily understandable because the APRs are not very concise and present information mainly in discursive terms with limited graphic support.Originality/valueTo the best of the authors' knowledge, this is the first research investigating both the extent and type of performance information reported by Italian HCOs in the APRs, considering the particular contextual conditions caused by the most significant challenge the healthcare (HC) sector has faced in recent years: the epidemiological crisis of the coronavirus disease 2019 (COVID-19). The study also explores whether APRs are currently used by HCOs as a merely regulatory requirement or as an information tool for accountability and decision-making purposes.

The Case of the Missing 2020 Cancers: Using Claims Data to Investigate a Deficit in Incident Cancer Case Reports to the New York State Cancer Registry in 2020.

Background: As the February 2022 Surveillance, Epidemiology, and End Results (SEER) Call for Data deadlines approached, the New York State Cancer Registry had received reports for approximately 10% fewer consolidated incident cases for 2020 than expected. We used claims data to examine changes in the volume of cancer claim records during the COVID-19 pandemic and possible contributors to the deficit in cancer reports. Methods: The New York State (NYS) Statewide Planning and Research Cooperative System (SPARCS) requires reporting of all patient encounters from licensed ambulatory surgery, emergency department, and hospital inpatient and outpatient providers. Each record includes patient demographics and up to 17 diagnosis codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). For this project, we extracted 6,725,416 SPARCS records with any malignant neoplasm code for 2018 through June 2021 for NYS residents. Using SAS 9.4, we focused on comparing the cancer-related records for 2020 to the records from 2019. Results: Overall, there were 5% more cancer-related records in 2019 than in 2018 (2,009,600 vs 1,914,364), but 8.2% fewer records in 2020 (1,844,054 total) than in 2019. Looking by month and year, the number of claims in the first 2 months of 2020 exceeded the numbers from 2019 by 5%. However, a decrease in the number of claims started in March 2020, with the biggest drop in April 2020, where there was a deficit of 38.8% for cancer-related encounter reports relative to the same month the previous year. Although the numbers rose after April, the number of claims for the last half of 2020 was still 4% lower than the same time frame in 2019. There were substantial decreases in the number of records in 2020 for all encounter types and across levels of each covariate examined, including age, sex, race/ethnicity, and facility region of NYS. In analyses of all reporting facilities, facilities in New York City had a more pronounced and more prolonged drop in reporting in 2020 than facilities in the rest of the state. Conclusion: Although SPARCS data do not provide definitive evidence of decreases in incident cancer diagnoses, these data suggest that there were fewer cancers diagnosed among NYS residents in 2020. Additional analyses are needed to assess the impacts of COVID-19-related delays in cancer diagnosis and treatment on stage at diagnosis and outcomes.

A review of state regulations for child care: Preventing, recognizing and reporting child maltreatment.

BACKGROUND: Prior to the COVID-19 pandemic, nearly 60% of children under 5 years of age were cared for in out-of-home child care arrangements in the United States. Thus, child care provides an opportunity to identify and address potential child maltreatment. However, during the pandemic, rates of reporting child maltreatment decreased-likely because children spent less time in the presence of mandated reporters. As children return to child care, states must have regulations in place to help child care providers prevent, recognize and report child maltreatment. However, little is known about the extent to which state regulations address child maltreatment. Therefore, the purpose of this cross-sectional study was to assess state regulations related to child maltreatment and compare them to national standards. METHOD: We reviewed state regulations for all 50 states and the District of Columbia for child care centres ('centres') and family child care homes ('homes') through 31 July 2021 and compared these regulations to eight national health and safety standards on child maltreatment. We coded regulations as either not meeting, partially meeting or fully meeting each standard. RESULTS: Three states (Colorado, Utah and Washington) had regulations for centres, and one state (Washington) had regulations for homes that at least partially met all eight national standards. Nearly all states had regulations consistent with the standards requiring that caregivers and teachers are mandated reporters of child maltreatment and requiring that they be trained in preventing, recognizing and reporting child maltreatment. One state (Hawaii) did not have regulations consistent with any of the national standards for either centres or homes. CONCLUSIONS: Generally, states lacked regulations related to the prevention, recognition and reporting of child maltreatment for both centres and homes. Encouraging states to adopt regulations that meet national standards and further exploring their impact on child welfare are important next steps.

Have News Reports on Suicide and Attempted Suicide During the COVID-19 Pandemic Adhered to Guidance on Safer Reporting?

Background: Associations between sensational news coverage of suicide and increases in suicidal behavior have been well documented. Amid growing concern over the impact of the COVID-19 pandemic on suicide rates, it is especially important that news coverage adheres to recommended standards. Method: We analyzed the quality and content of print and online UK news reports of possible COVID-19-related suicides and suicide attempts in the first 4 months of the pandemic (N = 285). Results: The majority of reports made explicit links between suicidal behavior and the COVID-19 pandemic in the headline (65.5%), largely based on statements by family, friends, or acquaintances of the deceased (60%). The impact of the pandemic on suicidal behavior was most often attributed to feelings of isolation (27.4%), poor mental health (14.7%), and entrapment due to government-imposed restrictions (14.4%). Although rarely of poor overall quality, reporting was biased toward young people, frontline staff, and relatively unusual suicides and, to varying degrees, failed to meet recommended standards (e.g., 41.1% did not signpost readers to sources of support). Limitations: This analysis cannot account for the impact of reporting on suicide. Conclusion: Careful attention must be paid to the quality and content of reports, especially as longer-term consequences of the pandemic develop.

The readiness of the spontaneous reporting system for COVID-19 vaccines safety monitoring in Croatia.

We aimed to identify whether a spontaneous reporting system (SRS) in Croatia could timely identify and confirm signals for COVID-19 vaccines. Post-marketing spontaneous reports of adverse drug reactions (ADRs) following COVID-19 immunisation reported to the Agency for Medicinal Products and Medical Devices of Croatia (HALMED) were extracted and analysed. 6624 cases reporting 30 655 ADRs following COVID-19 immunisation were received from 27th December 2020 to 31st December 2021. Available data in those cases were compared with data available to the EU network at the time when signals were confirmed and minimisation measures were implemented. 5032 cases, reporting 22 524 ADRs, were assessed as non-serious, and 1,592 cases, reporting 8,131 ADRs as serious. The most reported serious ADRs, which were listed in the MedDRA Important medical events terms list, were syncope (n = 58), arrhythmia (n = 48), pulmonary embolism (n = 45), loss of consciousness (n = 43), and deep vein thrombosis (n = 36). The highest reporting rate had Vaxzevria (0.003), followed by Spikevax and Jcovden (0.002), and Comirnaty (0.001). Potential signals were identified, however, they couldn't be timely confirmed solely on cases retrieved by SRS. In order to overcome the limitations of SRS, active surveillance and post-authorisation safety studies of vaccines should be implemented in Croatia.

Menstrual abnormalities after COVID-19 vaccination in the Netherlands: A description of spontaneous and longitudinal patient-reported data.

AIMS: During the COVID-19 vaccination campaigns, the number of reports of menstrual abnormalities increased rapidly. Here, we describe the nature and potential risk factors associated with menstrual abnormalities based on spontaneously reporting data as well as data from a prospective cohort event monitoring (CEM) study as these are poorly studied. METHODS: Reports of menstrual abnormalities received by the Netherlands Pharmacovigilance Centre Lareb in the spontaneous reporting system between February 2021 and April 2022 were summarized. In addition, logistic regression analysis was performed on the reported menstrual abnormalities in the CEM study to assess the association between person characteristics, prior SARS-CoV-2 infection and use of hormonal contraceptives and the occurrence of menstrual abnormalities after vaccination. RESULTS: We analysed over 24 000 spontaneous reports of menstrual abnormalities and over 500 episodes (among 16 929 included women) of menstrual abnormalities in the CEM study. The CEM study showed an incidence of 41.4 per 1000 women aged ≤54 years. Amenorrhoea/oligomenorrhoea and heavy menstrual bleeding collectively accounted for about half of all abnormalities reported. Significant associations were observed for the age group 25-34 years (odds ratio 2.18; 95% confidence interval 1.45-3.41) and the Pfizer vaccine (odds ratio 3.04; 95% confidence interval 2.36-3.93). No association was observed for body mass index and presence of most comorbidities assessed. CONCLUSION: The cohort study showed a high incidence of menstrual disorders among women aged ≤54 years, and this observation was supported by the analysis of spontaneous reports. This suggests that a relation between COVID-19 vaccination and menstrual abnormalities is plausible and should be further investigated.

Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals' experiences after 3 years, including the COVID-19 pandemic period.

OBJECTIVES: Unsafe medical care causes morbidity and mortality among the hospital patients. In a postanaesthesia care unit (PACU), increasing patient safety is a joint effort between different professions. The Green Cross (GC) method is a user-friendly incident reporting method that incorporates daily safety briefings to support healthcare professionals in their daily patient safety work. Thus, this study aimed to describe healthcare professionals' experiences with the GC method in a PACU setting 3 years after its implementation, including the period of the coronavirus disease 2019 pandemic's three waves. DESIGN: An inductive, descriptive qualitative study was conducted. The data were analysed using qualitative content analysis. SETTING: The study was conducted at a PACU of a university hospital in South-Eastern Norway. PARTICIPANTS: Five semistructured focus group interviews were conducted in March and April 2022. The informants (n=23) were PACU nurses (n=18) and collaborative healthcare professionals (n=5) including physicians, nurses and a pharmacist. RESULTS: The theme 'still active, but in need of revitalisation' was created, describing the healthcare professionals' experiences with the GC method, 3 years post implementation. The following five categories were found: 'continuing to facilitate open communication', 'expressing a desire for more interprofessional collaboration regarding improvements', 'increasing reluctance to report', 'downscaling due to the pandemic' and 'expressing a desire to share more of what went well'. CONCLUSIONS: This study offers information regarding the healthcare professionals' experiences with the GC method in a PACU setting; further, it deepens the understanding of the daily patient safety work using this incident reporting method.

Spontaneously reported adverse events following COVID-19 basic and booster immunizations in the Netherlands.

INTRODUCTION: The rapid roll-out of novel COVID-19 vaccines made near real-time post-marketing safety surveillance essential to identify rare and long-term adverse events following immunization (AEFIs). In light of the ongoing booster vaccination campaigns, it is key to monitor changes in observed safety patterns post-vaccination. The effect of sequential COVID-19 vaccinations, as well as heterologous vaccination sequences, on the observed post-vaccination safety pattern, remains largely unknown. METHODS: The primary objective of this study was to describe the profile of spontaneously reported AEFIs following COVID-19 vaccination in the Netherlands, including the primary and booster series. Reports from consumers and healthcare professionals were collected via a COVID-19 vaccine-tailored online reporting form by the National Pharmacovigilance Centre Lareb (Lareb) between 6 January 2021 and 31 August 2022. The data were used to describe the most frequently reported AEFIs per vaccination moment, the consumer experienced burden per AEFI, and differences in AEFIs reported for homologous and heterologous vaccination sequences. RESULTS: Lareb received 227,884 spontaneous reports over a period of twenty months. Overall, a high degree of similarity in local and systemic AEFIs per vaccination moment was observed, with no apparent change in the number of reports of serious adverse events after multiple COVID-19 vaccinations. No differences in the pattern of reported AEFIs per vaccination sequence was observed. CONCLUSION: Spontaneous reported AEFIs demonstrated a similar reporting pattern for homologous and heterologous primary and booster series of COVID-19 vaccination in the Netherlands.

The child abuse reporting guideline compliance in Korean newspapers.

The rate of child abuse has sharply increased worldwide, especially during the COVID-19 pandemic. As the media's role in addressing child abuse cases is crucial, several international and formal organizations have established child abuse reporting guidelines. This study investigated how closely journalists follow reporting guidelines in addressing child abuse cases. Five major Korean presses and 189 articles from January 1, 2018, to January 31, 2021, were selected using the keyword "child abuse." Each article was analyzed using a guideline framework consisting of 13 items regarding the five principles of the Korean Ministry of Health and Welfare and Central Child Protection Agency reporting guidelines. This study identified a radical growth in media reporting on child abuse cases in South Korea; almost 60% of the articles analyzed came from 2020 and 2021. More than 80% of the articles analyzed did not provide abuse resources, and 70% did not provide factual information. 57.1% of the articles instigated negative stereotypes, and about 30% explicitly mentioned certain family types in the headlines. Nearly 20% of the articles provided excessive details about the method used. Approximately 16% exposed victims' identities. Some articles (7.9%) also described victims as sharing responsibility for the abuse. This study indicates that the media reports of child abuse in South Korea did not follow the guidelines in many facets. The present study discusses the limitations of the current guidelines and suggests future directions for the news media in reporting on child abuse cases nationwide.