Interdisciplinary Collaboration Needed in Obtaining High-Quality Medical Information in Child Abuse Investigations

Background Despite reporting legislation, healthcare providers (HCPs) do not always report and collaborate in cases of suspected child abuse. Recognizing this leaves children at risk, the Wisconsin Child Abuse Network (WI CAN) sought to understand barriers to mandated reporting and collaboration with child abuse investigators. Objective The purpose of the study was to investigate barriers for professionals in providing and obtaining high-quality medical information in child abuse investigations. Participants and setting Participants included five discipline-specific focus groups: HCPs, child protective services (CPS), law enforcement, lawyers, and judges. All professionals had been directly involved in Wisconsin child abuse cases. Methods This qualitative study consisted of discipline-specific focus groups, directed by open-ended interview questions. Data analysis was completed through the narrative inquiry methodology. Results Barriers to providing and obtaining high-quality medical information in child abuse investigations were both discipline-specific and universal amongst all groups. Discipline-specific barriers included: HCPs’ discomfort with uncertainty; CPS’ perception of disrespect and mistrust by HCPs; law enforcement’s concerns with HCPs’ overstepping professional boundaries; lawyers’ concern of HCPs’ discomfort with court proceedings; and judges’ perception of a lack of understanding between all disciplines. Universal barriers included: value of high-quality medical information in child abuse investigations, burden of time and money; unequal resources between counties; a need for protocols, and a need for interdisciplinary collaboration. Conclusion Findings from this study suggest several ways to address identified barriers. Possible interventions include equalizing resources between urban and rural counties (specifically financial resources and access to child abuse experts); protocolizing reporting and investigations; and, increasing interprofessional education

Helping Nurses Identify and Report Sentinel Injuries of Child Abuse in Infants

Sentinel injuries (SIs) are some of the earliest and most readily identifiable red flags of child abuse. SIs are unexpected bruising or intra-oral injuries in pre-mobile infants and highly correlated with child abuse. However, SIs are not always recognized and reported as red flags of child abuse. Infants are left at risk for continued harm when SIs are not identified and reported. Although increasing nurses\u27 knowledge of SIs is important, child abuse researchers and behavioral theorists have identified that knowledge alone does not predict nurses\u27 behaviors when identifying and reporting suspected child abuse. Other predictors may include implicit biases, interpersonal and inter-professional relationships, and nurses\u27 understanding of mandatory reporting laws. Nurses may improve their recognition and comfort of reporting SIs and all suspected child abuse by being alert for SIs, being aware of potential implicit biases, communicating in non-technical language with families, understanding the clinical evaluation of suspected child abuse, and understanding the processes of Child Protective Services (CPS). Using these steps, nurses can fulfill their legal and ethical responsibilities to protect and advocate for victimized children

Epithelial membrane protein-2 (EMP2) promotes angiogenesis in glioblastoma multiforme.

Glioblastoma multiforme (GBM) is the most aggressive malignant brain tumor and is associated with an extremely poor clinical prognosis. One pathologic hallmark of GBM is excessive vascularization with abnormal blood vessels. Extensive investigation of anti-angiogenic therapy as a treatment for recurrent GBM has been performed. Bevacizumab, a monoclonal anti-vascular endothelial growth factor A (VEGF-A), suggests a progression-free survival benefit but no overall survival benefit. Developing novel anti-angiogenic therapies are urgently needed in controlling GBM growth. In this study, we demonstrate tumor expression of epithelial membrane protein-2 (EMP2) promotes angiogenesis both in vitro and in vivo using cell lines from human GBM. Mechanistically, this pro-angiogenic effect of EMP2 was partially through upregulating tumor VEGF-A levels. A potential therapeutic effect of a systemic administration of anti-EMP2 IgG1 on intracranial xenografts was observed resulting in both significant reduction of tumor load and decreased tumor vasculature. These results suggest the potential for anti-EMP2 IgG1 as a promising novel anti-angiogenic therapy for GBM. Further investigation is needed to fully understand the molecular mechanisms how EMP2 modulates GBM pathogenesis and progression and to further characterize anti-EMP2 therapy in GBM