Health Care Region Research Articles

A real-world study on the impact of infection load on mortality in multiple myeloma patients in Finland.

Infections are a clinically significant cause of mortality in multiple myeloma (MM) patients. The high number of infections in MM patients is due to the immunosuppressive effects of the disease itself as well as treatment-related immunosuppression. In this real-world evidence (RWE) study, we used several nationwide healthcare registries of Finland to investigate the effect of infection load on mortality in MM patients during 1997-2021. The highest number of infections was recorded during the first year after MM diagnosis. In patients who received allogenic or autologous stem cell transplantation (ASCT), the number of infections during the first two years post diagnosis was significantly higher than in those treated without ASCT. When compared to their age-, sex-, and region-matched controls, MM patients accrued more infections during the year prior to diagnosis. Intriguingly, patients under 70 years old had significantly more infections already 3 years before diagnosis when compared to their matched controls. Prior to MM diagnosis, the relative proportion of streptococcal septicaemia and pneumonia due to Streptococcus pneumoniae increased the most. Of note, even one recorded infection prior to diagnosis was associated with significantly shorter median overall survival. Importantly, Cox proportional hazard models show that recorded infections both before and after diagnosis increase the independent risk of mortality in MM patients.

Overview of AI regulation in healthcare: A comparative study of the EU and South Africa

This article provides a comparative analysis of the regulatory landscapes governing artificial intelligence (AI) in healthcare in the European Union (EU) and South Africa (SA). It critically examines the approaches, frameworks and mechanisms each jurisdiction employs to balance innovation with ethical considerations, patient safety, data privacy and accountability. The EU’s proactive stance, embodied by the AI Act, offers a structured and risk-based categorisation for AI applications, emphasising stringent guidelines for risk management, data governance and human oversight. In contrast, SA’s regulatory environment is characterised by its infancy and lack of specificity, with existing legislation such as the National Health Act and the Medicines and Related Substances Act providing a foundational but limited framework for addressing the unique challenges posed by AI in healthcare. The article delves into the dynamic nature of AI technologies, highlighting the need for continuous risk assessment, the importance of transparent and responsible data governance and the critical role of human oversight in ensuring patient safety and autonomy. It discusses the obligation of clear liability frameworks to address potential malfunctions and security breaches in AI applications. Through this comparative lens, the manuscript identifies regulatory gaps and proposes that the South African Law Reform Commission (SALRC) should play a predominant role in developing draft legislation for AI prior to the evolution of challenges related to these technologies.

Accuracy of smartphone hearing tests: a comparative study with traditional pure tone audiometry

BackgroundHearing impairment, a widespread sensory deficit, disproportionately affects low- and middle-income countries. Various hearing assessment methods exist, each with limitations. Pure tone audiometry (PTA), the gold standard, is subjective, unsuitable for children, expensive, and requires expertise. Smartphone hearing tests are emerging as cost-effective, user-friendly alternatives, but they cannot measure bone conduction and occasionally yield false thresholds.AimThis study aims to compare smartphone-based hearing tests with PTA in patients at the Aminu Kano Teaching Hospital’s ENT Clinic.MethodsA cross-sectional descriptive study enrolled participants aged 18 and above, including those with normal hearing and varying degrees of hearing loss. Each participant underwent a smartphone hearing test, screening PTA, and diagnostic PTA. The results were analyzed using SPSS version 22.ResultsThe study included 92 subjects (184 ears) aged 18–68 years. Smartphone tests accurately detected 94.3% of ears with normal hearing and 97.5% of ears with hearing loss based on screening PTA. At higher frequencies, the smartphone detected 98.4% of ears with hearing loss, showing a strong positive correlation with PTAv results. At speech frequencies, the smartphone detected 100% of ears with hearing loss, again showing a positive correlation. At lower frequencies, the smartphone detected 73% of ears with hearing loss, showing a positive correlation but with a significant statistical difference.ConclusionThe smartphone hearing test exhibited a strong positive correlation with screening PTAv in hearing assessment, without a statistically significant difference. This suggests that smartphone hearing tests could serve as a viable alternative for hearing assessments, particularly in low-resource settings. This research has implications for improving access to hearing healthcare in resource-constrained regions.

Association between social cohesion and food insecurity among adults living in a healthcare region in southern Brazil

BackgroundFood insecurity (FI) has grown worldwide in recent years, especially in developing countries. Studies have shown that aspects of the social environment, such as social cohesion in the neighborhood, may be associated with FI; however, this topic has yet to be explored, in Brazil. This study aims to verify the association between aspects of the perceived social environment of the neighborhood (social cohesion) and FI.MethodsThis is a cross-sectional study with adults and elderly individuals (n = 400) residing in a healthcare region in Porto Alegre, Rio Grande do Sul (Brazil). The sample is selected proportionally from areas of higher and lower socioeconomic status, and data are collected through household interviews. The presence of FI is assessed using the Brazilian Food Insecurity Scale (short version). The perception of the neighborhood regarding social cohesion is obtained using a questionnaire validated for the Brazilian population. Poisson regression with robust variance was used to estimate the crude and adjusted prevalence ratios (PRs) and their respective 95% confidence intervals (95% CIs).ResultsIndividuals with more positive perceptions of social cohesion in the neighborhood are less likely to experience FI than those with less positive perceptions [PR = 0.73; 95% CI (0.55–0.97)], after adjustments.ConclusionsThe community social environment is independently associated with FI and may have characteristics that positively influence the probability of individuals experiencing FI. Interventions at the community level are necessary to address FI.

What is it all about? An explorative study of patients’ experiences with medication free treatment

BackgroundAs a response to the political decision by the Norwegian Ministry of Health and Care Services to establish some kind of “medication free treatment” for patients with severe mental illness throughout the country, a 6-bed ward unit dedicated to offer such treatment was in 2017 established in Tromsø, Norway by the North Norway Health Care Region. The aim of the present study was to explore the experiences of patients admitted to this ward unit.MethodSemi-structured interviews were conducted with 19 persons who had received treatment from the ward during the period January 2017 to October 2021. Analysis was done in line with Systematic Text Condensation and interviews were recorded, transcribed and analyzed using software NVivo.ResultsThe importance of engaging in a dialogue about the possibilities of living a life without medication was unanimously validated, along with a focus on empowerment, motivation, activity and flexibility. Not everyone reported fulfillment of their own wishes or the ward’s goal of tapering down, and reflected upon emotions such as ambivalence or fear. Three core concepts were identified to describe the participants’ experiences: 1) Tapering off, 2) Relations, and 3) Frames and content. A fourth concept overarches the process formed by these concepts; 4) Processes across categories.ConclusionThe study contributes to a deeper understanding of what "medication free" truly means, going beyond simply taking or not taking medications. It adds nuance to the debate surrounding medication free treatment. The ability to taper off medications is linked to intrapersonal factors, such as readiness and personal commitment, as well as the therapeutic environment, including the frames and values present on the ward. "Medication free" is more complex than it may initially appear, as many participants continue to use some form of psychotropic drugs. The sense of being part of something new and "exclusive" can be understood in light of what participants felt was lacking in previous treatment. It appears to be a need of rediscovering the significance of empowerment and empathic relationships in treatment of severe mental illness, in order to foster a sense of coherence and meaning.

Legal obstacles jeopardise research in personalised medicine - experiences from a Nordic collaboration within rheumatology.

Personalised medicine in chronic complex diseases such as rheumatoid arthritis (RA) is within reach but requires international multi-stakeholder collaboration. We exemplify how national implementations of the General Data Protection Regulation (GDPR) have introduced administrative delays and created disincentives for data sharing and collaborative research. Our Danish/Swedish/Norwegian research collaboration (the 3-year NordForsk-funded "NORA" project) aims to develop a personalised medicine approach for the management of RA, built on the exploitation of unique existing data sources: longitudinal data from clinical rheumatology registries, research cohorts, nationwide health care registries, and biobank material from >20 sample collections. Data and results are shared and accessed remotely by collaborators at secure servers. New biomarker assays and patient-centric implementations of the results are to be explored, validated, and disseminated to patients and health care via the development of digital tools. Following the advice of legal experts at the involved academic or public institutions and private companies, GDPR compliance resulted in >20 legal documents to govern the collaboration (consortium-, joint controller-, research collaboration-, data sharing-, and a series of unique two-way data processing-, and material transfer agreements). Lack of agreed-upon templates, policies, procedures, and a shortage of legal resources have caused considerable delays. Thus, our research consortium has spent more time ensuring GDPR compliance than on actual research activities. The current interpretation and implementation of the legal premises (rather than the GDPR per se) for research collaborations caused unnecessary barriers and delays. Our experiences call for Nordic trust-based code-of-conduct-like framework agreements, and for harmonisation of procedures and templates, lest the Nordic advantage in research be lost.

Prospect, Legal, and Health Risks in Adopting The Metaverse in Medical Practice: a Case Study of Nigeria

The Metaverse provides a prospective opportunity for medical practitioners to improve patient engagement, training of medical personnel, and simulation-based learning. It allows for immersive telemedicine medical practice, enabling medical practitioners to render medical services to patients in remote areas through realistic virtual consultation and training of medical personnel and students through a lifelike simulation. However, despite the potential of the Metaverse concept in medical practice, certain legal and medical issues could mitigate its usefulness. In this regard, this study adopts a hybrid method of research in ascertaining the prospect, legal, and health risks of utilizing the metaverse in medical practice. 256 questionnaires were distributed, and the result obtained was analysed using descriptive and analytical methods. The study found that there are several potentials for utilizing the metaverse in medical practice. However, there are legal and medical risks in utlising the metaverse in medical practice and they include; patient data privacy, regulation, licensing, patient consenting to virtual medical treatment, and accountability for medical errors in the metaverse. Furthermore, the study also found that spending longer hours in the metaverse could result in sedentary behavior, associated with medical issues like obesity, musculoskeletal disorders, and cardiovascular problems. It was therefore concluded and recommended that the metaverse holds significant promise for the future of medical practice in Nigeria, offering innovative solutions that can transform healthcare delivery and education. However, to avoid legal and medical issues that may occur, there is a need for regulatory compliance with healthcare regulations.

Type II diabetes and metformin use does not affect colorectal cancer prognosis.

Previous studies on the impact of metformin and colorectal cancer (CRC) outcomes have been limited by small size and confounding by indication, yielding inconsistent results. The aim of this study was to assess whether diabetes and pre-diagnostic metformin use influence CRC prognosis. The study was performed using the Colorectal Cancer Data Base Sweden, a register-linkage originating from the Swedish Colorectal Cancer Register with linkage to national health care registers and demographic registers. All adult patients diagnosed with primary non-metastatic CRC between 2007 and 2016, treated with curative surgery, were identified and followed up from 90 days post-surgery until December 31, 2022. Antidiabetic medication use was defined as dispensed prescription ≥6 months of use within 1 year of surgery. Type II diabetes mellitus (T2DM) patients were divided into three treatment groups (i) diet only, (ii) metformin user, and (iii) non-metformin user. Cox regression models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for time to recurrence, CRC-specific, and all-cause mortality, adjusted for relevant covariates. Of 33,028 non-metastatic CRC patients, 4539 (13.7%) had T2DM, with 1745 using metformin. A T2DM diagnosis was not associated with increased recurrence rate or CRC-specific mortality; HRadj 0.97 (95% CI 0.89-1.06) and HRadj 0.95 (95% CI 0.87-1.05), respectively, compared with non-diabetic patients. Furthermore, no association between T2DM, metformin use, and recurrence or CRC-specific mortality was seen, HRadj 0.98 (95% CI 0.86-1.12) and HRadj 0.98 (95% CI 0.85-1.13), respectively. T2DM is not associated with an elevated recurrence or CRC-specific mortality. Additionally, metformin use does not impact CRC prognosis.

Validity of prenatal AUDIT screening for alcohol disorders - a Nationwide Swedish register study.

This study aims to assess the external validity of the Alcohol Use Disorders Identification Test (AUDIT) in Swedish prenatal care as an indicator for alcohol-addiction disorders, and to characterize women with mismatched information in healthcare registers. This study was designed as a National register-based study. Sweden. The study sample included 739,735 pregnancies over the period 2014-2020. Prospectively collected prenatal AUDIT screening in the Swedish Pregnancy register was linked to national health databases through individual identification number. The AUDIT score was dichotomized into < 6 points (low-risk use) and ≥ 6 points (hazardous use). Alcohol addiction disorders were defined by a diagnostic code in The Swedish National Patient Register or drugs dispensed for alcohol dependence in the Swedish Prescribed Drug Register. The diagnostic properties of AUDIT were assessed based on sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy (proportion of true positive and true negative) for an AUDIT score of ≥ 6 points for alcohol disorders. Women with mismatched information in the register were characterized and assessed by multinominal logistic regression, using women with matched information in the registers for reference. An alcohol-related disorder was recorded in 3.1%, while 25,770 (3.5%) had an AUDIT point ≥ 6. The diagnostic accuracy of the AUDIT ≥ 6 points for detection of an alcohol related disorder during a year prior to pregnancy was 95.7% (95% confidence interval [CI]: 95.7, 95.8), with a positive LR of 8.03 (95% CI: 7.5, 8.6). The sensitivity for detecting a pre-pregnancy alcohol related disorder was 33.0% (95% CI: 30.9, 35.1). Being young, nulliparous, of low education, and of Swedish origin increased the likelihood of being misclassified with the AUDIT. Prior psychiatric care was associated with false negatives, especially for women with neuropsychiatric disorders (odds ratio [OR]: 10.39, 95% CI: 9.89, 10.90). The accuracy of AUDIT in screening for alcohol disorders at a population-based level was high, but only identified one third of women with alcohol-related disorders when using a cut-off of six points criterion.

Qualitative exploration of 3D printing in Swedish healthcare: perceived effects and barriers

BackgroundThree-dimensional (3D) printing produces objects by adding layers of material rather than mechanically reducing material. This production technology has several advantages and has been used in various medical fields to, for instance, improve the planning of complicated operations, customize medical devices, and enhance medical education. However, few existing studies focus on the adoption and the aspects that could influence or hinder the adoption of 3D printing.ObjectiveTo describe the state of 3D printing in Sweden, explore the perceived effects of using 3D printing, and identify barriers to its adoption.MethodsA qualitative study with respondents from seven life science regions (i.e., healthcare regions with university hospitals) in Sweden. Semi-structured interviews were employed, involving 19 interviews, including one group interview. The respondents were key informants in terms of 3D printing adoption. Data collection occurred between April and May 2022 and then between February and May 2023. Thematic analysis was applied to identify patterns and themes.ResultsAll seven regions in Sweden used 3D printing, but none had an official adoption strategy. The most common applications were surgical planning and guides in clinical areas such as dentistry, orthopedics, and oral and maxillofacial surgery. Perceived effects of 3D printing included improved surgery, innovation, resource efficiency, and educational benefits. Barriers to adoption were categorized into organization, environment, and technology. Organizational barriers, such as high costs and lack of central decisions, were most prominent. Environmental barriers included a complex regulatory framework, uncertainty, and difficulty in interpreting regulations. Technological barriers were less frequent.ConclusionsThe study highlights the widespread use of 3D printing in Swedish healthcare, primarily in surgical planning. Perceived benefits included improved surgical precision, innovation, resource efficiency, and educational enhancements. Barriers, especially organizational and regulatory challenges, play a significant role in hindering widespread adoption. Policymakers need comprehensive guidance on 3D printing adoption, considering the expensive nature of technology investments. Future studies could explore adoption in specific clinical fields and investigate adoption in non-life science regions within and outside Sweden.

THE LEGAL PROTECTION OF HOSPITALS IN THE CASE OF NON-BPJS PATIENTS WHO ABSCOND AS A FORM OF BAD FAITH DUE TO THEIR INABILITY TO PAY

Hospitals often encounter financial difficulties when non-BPJS patients evade payment due to financial incapacity, with some institutions unfairly shifting the financial burden onto doctors. This situation raises serious legal, ethical, and employment concerns, especially in light of Law No. 17 of 2023 on Health, which mandates institutional responsibility for patient management. Meanwhile, Artificial Intelligence (AI) offers promising solutions for predicting and mitigating financial risks by identifying high-risk patients, though it introduces new challenges regarding data privacy, accountability, and liability. This study aims to explore the legal protections available to doctors when patients abscond without paying, and to propose a legal framework for integrating AI in healthcare to prevent such incidents. Using a normative legal approach, the research analyzes key provisions of Law No. 17/2023, employment regulations, and relevant case studies involving financial disputes between doctors and hospitals. The results show that imposing financial liability on doctors not only breaches employment principles but also contradicts healthcare regulations. Furthermore, AI can improve financial risk management by helping hospitals predict and prevent non-payment cases, though its implementation requires clear legal guidelines to avoid unintended consequences for medical staff. In conclusion, hospitals must bear financial responsibility for unpaid patient bills to protect doctors' legal rights. Additionally, a comprehensive regulatory framework for AI is essential to ensure that the technology is implemented fairly, safeguarding both healthcare professionals and patient interests.

Defining Responsibility: A Framework Analysis of Error Attribution and Accountability in AI Telemedicine Services

This study examines the regulatory landscape governing liability and accountability in AI telemedicine in Ghana. Using the CREAC (Context, Rules, Explanation, Application, Conclusion) legal analytical approach, it analyzes existing Ghanaian healthcare laws and regulations in the context of AI telemedicine. The study finds that while Ghana has a comprehensive set of healthcare regulations, they are inadequately equipped to address the unique challenges posed by AI in telemedicine, particularly regarding liability determination, accountability mechanisms, and error management. Significant gaps exist in current legislation, leaving Ghana vulnerable to the risks associated with AI in healthcare. The study recommends developing AI-specific healthcare legislation, updating existing laws, establishing a national AI in healthcare ethics committee, implementing a certification system for AI in healthcare, and creating a specialized AI healthcare liability framework. These measures aim to balance innovation in AI telemedicine with patient safety and ethical healthcare delivery.

Evaluating Patient Rights and Agency: An In-depth Examination of Autonomous Decision-Making in AI-Powered Telemedicine

This study examines the adequacy of regulations concerning consent and patient autonomy in AI telemedicine in Ghana. Using the IRAC (Issue, Rule, Analysis, and Conclusion) method, the research analyzes existing Ghanaian healthcare laws and regulations in the context of AI-driven telemedicine. The study finds significant gaps in the current regulatory framework, including a lack of specific provisions for informed consent in AI telemedicine, unclear guidelines on maintaining patient autonomy, and inadequate addressing of liability issues in AI-assisted healthcare. Recommendations include developing specific AI healthcare legislation, updating existing laws to incorporate AI and telemedicine considerations, establishing AI ethics committees, and implementing short-term mitigation strategies such as interpretive guidelines and enhanced disclosure protocols. The study emphasizes the need for a two-pronged approach: long-term regulatory development and immediate implementation of interim measures to protect patient rights and ensure ethical use of AI in telemedicine.

Demystifying the Black Box: A Technical Analysis of Transparency Requirements in Clinical AI Systems

This analysis examines the adequacy of Ghana's current regulatory framework in addressing AI explainability in clinical decision support systems. It evaluates existing healthcare laws, derives underlying principles, and assesses their application to AI governance. The study finds significant gaps in the current regulatory regime, including a lack of AI-specific provisions, insufficient explainability requirements, and inadequate frameworks for liability and accountability. While existing principles provide a foundation, they are insufficient to fully address the challenges posed by AI in healthcare. The analysis concludes that comprehensive regulatory development is needed, including AI-specific healthcare regulations, technical standards for explainability, and enhanced regulatory capacity. This study is significant as it provides a roadmap for developing effective AI explainability regulations in Ghana's healthcare sector. It highlights the urgent need for regulatory evolution to ensure safe, ethical, and transparent use of AI in clinical decision support, potentially serving as a model for other developing nations facing similar challenges.

Ensuring AI Algorithm Fairness in Healthcare Decision-Making

This paper provides a comprehensive analysis of artificial intelligence (AI) implementation in Ghana's healthcare system, synthesizing findings from recent Ghanaian studies. It examines legal and regulatory frameworks, ethical considerations, bias and fairness, transparency and accountability, interdisciplinary approaches, patient rights and data protection, healthcare access and equity, and implementation and oversight. The analysis reveals both significant opportunities for AI to improve healthcare delivery in Ghana and substantial challenges in ensuring its ethical, equitable, and effective implementation. Key findings highlight the need for AI-specific healthcare regulations, investment in local capacity building, culturally sensitive AI design, robust fairness and accountability mechanisms, and ongoing stakeholder engagement. This paper contributes to the discourse on AI in healthcare in developing countries, offering insights into the unique challenges faced by lower-middle-income countries. It aims to inform evidence-based policymaking and enrich academic understanding of AI implementation in diverse cultural and economic contexts.

Advancing Algorithmic Justice: A Systematic Review of Fair Decision-Making Protocols in Healthcare AI

This paper provides a comprehensive analysis of artificial intelligence (AI) implementation in Ghana’s healthcare system, synthesizing findings from recent Ghanaian studies. It examines legal and regulatory frameworks, ethical considerations, bias and fairness, transparency and accountability, interdisciplinary approaches, patient rights and data protection, healthcare access and equity, and implementation and oversight. The analysis reveals both significant opportunities for AI to improve healthcare delivery in Ghana and substantial challenges in ensuring its ethical, equitable, and effective implementation. Key findings highlight the need for AI-specific healthcare regulations, investment in local capacity building, culturally sensitive AI design, robust fairness and accountability mechanisms, and ongoing stakeholder engagement. This paper contributes to the discourse on AI in healthcare in developing countries, offering insights into the unique challenges faced by lower-middle-income countries. It aims to inform evidence-based policymaking and enrich academic understanding of AI implementation in diverse cultural and economic contexts.

Cost effectiveness and return on investment analysis for surgical care in a conflict-affected region of Sudan.

The delivery of healthcare in conflict-affected regions places tremendous strains to health systems, and the economic value of surgical care in conflict settings remains poorly understood. Our aims were to evaluate the cost-effectiveness, societal economic benefits, and return on investment (ROI) for surgical care in a conflict-affected region in Sudan. We conducted a retrospective study of surgical care from January to December 2022 at the Mother of Mercy-Gidel Hospital (MMH) in the Nuba Mountains of Sudan, a semi-autonomous region characterized by chronic and cyclical conflict. We collected data on all patients undergoing surgical procedures (n = 3016), including age, condition, and procedure. We used the MMH budget and financial statements to measure direct medical and non-medical expenditures (costs) for care. We estimated the proportion of expenditures for surgical care through a survey of surgical vs non-surgical beds. The benefits of care were calculated as averted disability-adjusted life-years (DALYa) based on predicted outcomes for the most common 81% of procedures, and then extrapolated to the overall cohort. We calculated the average cost-effectiveness ratio (CER) of care. The societal economic benefits of surgical care were modeled using a human capital approach, and we performed a ROI analysis. Uncertainty was estimated using sensitivity analysis. We found that the CER for all surgical care was $72.54/DALYa. This CER is far less than the gross domestic product per capita in the comparator economy of South Sudan ($585), qualifying it as very cost-effective by World Health Organization standards. The total societal economic impact of surgical care was $9,124,686, yielding a greater than 14:1 ROI ratio. Sensitivity analysis confirmed confidence in all output models. Surgical care in this conflict-affected region of Sudan is very cost-effective, provides substantial societal economic benefits, and a high return on investment.

Patient safety incidents in anaesthesia: a qualitative studyof trainee experience from a single UK healthcare region.

Anaesthetic training has always had patient safety as part of the curriculum. However, there is limited emphasis on what happens when things do not go to plan. Our aims were to understand the impact of involvement in patient safety incidents on anaesthetic trainees in our region, to describe the range of support currently offered and put forward suggestions for improvement. An initial electronic survey was sent to all anaesthetic trainees in a single UK healthcare region to capture qualitative and quantitative information on patient safety incidents. After completing the questionnaire, participants were asked to consent to involvement in a semi-structured interview to provide a more detailed understanding of the impact of safety incidents. Data were analysed from the questionnaires and interview transcripts using descriptive statistics and thematic analysis. Thirty-four completed questionnaires were analysed revealing 27 trainees had been involved in a patient safety incident. Ten semi-structured interviews were conducted and six themes were identified: team dynamics (including adequacy of staffing and supportive departmental culture); context of the event; reflex immediate support post-event; working environment pending completion of the investigation; personal impact (including physical and mental health); and suggestions for future support. This study has shown the significant impact of safety incidents on anaesthetic trainees in one training region in the UK and highlights the importance of implementing early, tailored debriefs led by trained facilitators, the value of a supportive work environment and the need to raise awareness of system-based approaches to learning from incident investigations. Further research should guide the format and delivery of support for trainees to provide more helpful and timely interventions after patient safety incidents and reduce the risk of future harm to both patients and trainees.

Biologics Used for Psoriasis: A Drug Utilization Study Based on Two Nationwide Danish Data Sources.

Biological treatment has been a game changer in the management of moderate-to-severe psoriasis. In Denmark, biological treatment for psoriasis is registered in two data sources. We aimed to describe the utilization of biologics for psoriasis in Denmark using data from both data sources separately. We used data from two different nationwide Danish data sources: The healthcare registries and the clinical quality database, Dermbio. Utilization patterns were described by three different parameters: (1) distribution of drugs used in the first treatment episodes, (2) treatment cascade on a population level, and (3) drug survival using Kaplan Meier (KM) analysis and the proportion of patients covered (PPC) method. From January 1, 2011, to December 31, 2018, we found 1878 users of biologics in the healthcare registries and 2264 in Dermbio. Adalimumab, ustekinumab, and secukinumab were the most common first-choice treatments throughout the study period. According to the healthcare registries, it was most common to have more than one treatment episode with the same drug. In Dermbio, most were registered to have only one observable treatment episode overall in the study period. Ustekinumab showed the longest drug survival in both databases. Drug survival was longer for all biologics in Dermbio than in the healthcare registries. Adalimumab, ustekinumab, and secukinumab were the most common first-choice treatments in Denmark. Overall, ustekinumab showed the longest drug survival. We observed important differences in treatment cascades and drug survival between Dermbio and the healthcare registries, which should be considered when using these data sources to perform drug utilization studies on biologics.

The Western Denmark Heart Registry and Population-Based National Health Registries.

The Western Denmark Heart Registry (WDHR) is a semi-national, multicenter-based clinical registry with unique potential for cardiovascular research. The registry has provided detailed prospectively registered information on patient and procedure characteristics since 1999. WDHR data can be linked to additional data in other healthcare registries in Denmark. Therefore, the WDHR is a valuable data resource for cardiovascular research, providing a foundation for numerous research projects and publications. This review describes three currently available cohorts from the WDHR containing individual-level information on: i) 200,647 first-time coronary angiographies from 2003 to 2021, ii) 88,630 first-time percutaneous coronary interventions from 1999 to 2022, and iii) 85,512 first-time coronary computed tomography angiographies from 2008 to 2021. Furthermore, we describe other frequently cross-linked Danish healthcare registries containing information on various patient characteristics and outcomes, such as vital status, cause of death, hospitalizations, medications, and laboratory test results. The comprehensive overview of these cohorts aims to assist researchers, collaborators, and other interested parties in understanding the scope and potential applications of the available data. All cohorts are regularly updated, thereby supporting continuing research on cardiovascular clinical practice and prognosis in Denmark.