RESUMO
PURPOSE: The purpose of this study was to characterize clinician-scientists in ophthalmology and identify factors associated with successful research funding, income, and career satisfaction. DESIGN: Cross-sectional study. METHODS: A survey was conducted of clinician-scientists in ophthalmology at US academic institutions between April 17, 2019, and May 19, 2019. Collected information including 1) demographic data; 2) amount, type, and source of startup funding; first extramural grant; and first R01-equivalent independent grant; 3) starting and current salaries; and 4) Likert-scale measurements of career satisfaction were analyzed using multivariate regression. RESULTS: Ninety-eight clinician-scientists in ophthalmology were surveyed across different ages (mean: 48 ± 11 years), research categories, institutional types, geographic regions, and academic ranks. Median startup funding ranged from $50-99k, and median starting salaries ranged from $150-199k. A majority of investigators (67%) received their first extramural award from the National Eye Institute, mainly through K-award mechanisms (82%). The median time to receiving their first independent grant was 8 years, mainly through an R01 award (70%). Greater institutional startup support (P = .027) and earlier extramural grant success (P = .022) were associated with earlier independent funding. Male investigators (P = .001) and MD degreed participants (P = .008) were associated with higher current salaries but not starting salaries. Overall career satisfaction increased with career duration (P = .011) but not with earlier independent funding (P = .746) or higher income (P = .300). CONCLUSIONS: Success in research funding by clinician-scientists in ophthalmology may be linked to institutional support and earlier acquisition of extramural grants but does not impact academic salaries. Nevertheless, career satisfaction among clinician-scientists improves with time, which is not necessarily influenced by research or financial success.
Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Medicina Clínica/estatística & dados numéricos , Renda/estatística & dados numéricos , Satisfação no Emprego , Pessoal de Laboratório/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Apoio à Pesquisa como Assunto/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
Nerve growth factor (NGF) is a neurotrophin that activates nociceptive neurons to transmit pain signals from the peripheral to the central nervous system and that exerts its effects on neurons by signalling through tyrosine kinase receptors. Antibodies that inhibit the function of NGF and small molecule inhibitors of NGF receptors have been developed and tested in clinical studies to evaluate the efficacy of NGF inhibition as a form of analgesia in chronic pain states including osteoarthritis and chronic low back pain. Clinical studies in individuals with painful knee and hip osteoarthritis have revealed that NGF inhibitors substantially reduce joint pain and improve function compared with NSAIDs for a duration of up to 8 weeks. However, the higher tested doses of NGF inhibitors also increased the risk of rapidly progressive osteoarthritis in a small percentage of those treated. This Review recaps the biology of NGF and the studies that have been performed to evaluate the efficacy of NGF inhibition for chronic musculoskeletal pain states. The adverse events associated with NGF inhibition and the current state of knowledge about the mechanisms involved in rapidly progressive osteoarthritis are also discussed and future studies proposed to improve understanding of this rare but serious adverse event.
Assuntos
Dor Crônica/tratamento farmacológico , Medicina Clínica/estatística & dados numéricos , Fator de Crescimento Neural/antagonistas & inibidores , Manejo da Dor/métodos , Animais , Anti-Inflamatórios não Esteroides/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Doença Crônica , Medicina Clínica/tendências , Ensaios Clínicos como Assunto , Progressão da Doença , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Modelos Animais , Dor Musculoesquelética/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Osteoartrite/patologia , Manejo da Dor/estatística & dados numéricos , Qualidade de Vida , Ratos , Recuperação de Função Fisiológica , Resultado do TratamentoRESUMO
BACKGROUND: Men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) infection and sexually transmitted infection (STI) in China. Inadequate clinical services and poor clinical competency among physicians are major barriers to improving the sexual health of MSM. This study aims to understand physician clinical competency in providing MSM health services in China. METHODS: We conducted an online cross-sectional survey among Chinese physicians who have seen male patients for STI complaints in the past year. We obtained information on individual demographics, clinical practice, attitudes toward MSM, and interest in contributing to MSM clinical services. We defined an MSM-competent physician as one who asked male patients about sexual orientation, sexual practices, and recommended HIV/ STI testing during a clinic visit. We conducted multivariable logistic regression to identify factors associated with MSM competency. RESULTS: In total, 501 physicians completed the survey. The most common subspecialties were dermatovenereology (33.1%), urology (30.1%), and general medicine (14.4%). Roughly half (n = 267, 53.3%) reported seeing MSM in the past 12 months. Among physicians who saw MSM in the past 12 months, 60.3% (n = 161) met criteria as MSM-competent physicians, and most (n = 234, 87.6%) MSM-competent physicians reported positive or neutral attitudes towards MSM. Over 60% of all physicians were willing to participate in activities for improving MSM services, such as training and being on a list of physicians willing to serve MSM. MSM-competent physicians showed no sociodemographic differences compared with non MSM-competent physicians. MSM-competent physicians were more willing to have their medical institution named on a public clinic list capable of serving MSM (aOR: 1.70, 95%CI: 1.01-2.86) and being on a public physician list capable of serving MSM (aOR: 1.77, 95%CI: 1.03-3.03). CONCLUSIONS: MSM-competent physicians included a broad range of individuals that practiced in diverse clinical settings. Most physicians were interested in improving and expanding MSM clinical services, despite having neutral attitudes toward same-sex behavior. Future interventions should focus on developing MSM clinical competency and expanding services that meet the needs of MSM.
Assuntos
Competência Clínica/normas , Médicos/normas , Infecções Sexualmente Transmissíveis/terapia , Adulto , Idoso , Atitude do Pessoal de Saúde , China , Medicina Clínica/normas , Medicina Clínica/estatística & dados numéricos , Estudos Transversais , Atenção à Saúde/normas , Feminino , Infecções por HIV/psicologia , Infecções por HIV/terapia , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Sexologia/normas , Sexologia/estatística & dados numéricos , Comportamento Sexual , Saúde Sexual/normas , Minorias Sexuais e de Gênero/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/psicologia , Inquéritos e Questionários , Urologia/normas , Urologia/estatística & dados numéricos , Venereologia/normas , Venereologia/estatística & dados numéricos , Adulto JovemRESUMO
Objectives The aim of the present study was to investigate differences in prevalence, as well as risk and protective factors, for exposure to workplace aggression between male and female clinicians in Australian medical practice settings. Methods In a cross-sectional, self-report study in the third wave of the Medicine in Australia: Balancing Employment and Life survey (2010-11), 16327 medical practitioners were sampled, with 9449 (57.9%) respondents working in clinical practice. Using backward stepwise elimination, parsimonious logistic regression models were developed for exposure to aggression from external (patients, patients' relatives or carers and others) and internal (co-workers) sources in the previous 12 months. Results Overall, greater proportions of female than male clinicians experienced aggression from external (P<0.001) and internal (P<0.01) sources in the previous 12 months. However, when stratified by doctor type, greater proportions of male than female general practitioners (GPs) and GP registrars experienced external aggression (P<0.05), whereas greater proportions of female than male specialists experienced external (P<0.01) and internal (P<0.01) aggression. In logistic regression models, differences were identified in relation to age for males and experience working in medicine for females with external and internal aggression; working in New South Wales (vs Victoria) and internal aggression for females; a poor medical support network and external aggression, and perceived unrealistic patient expectations with internal aggression for males; warning signs in reception and waiting areas with external aggression for males; and optimised patient waiting conditions with external and internal aggression for females. Conclusions Differences in risk and protective factors for exposure to workplace aggression between male and female clinicians, including in relation to state and rural location, need to be considered in the development and implementation of efforts to prevent and minimise workplace aggression in medical practice settings. What is known about the topic? Workplace aggression is prevalent in clinical medical settings, but there are conflicting reports about sex-based differences in the extent of exposure, and little evidence on differences in risk and protective factors for exposure to workplace aggression. What does this paper add? Differences in workplace aggression exposure rates between male and female clinicians are highlighted, including when stratified by doctor type. New evidence is reported on differences and similarities in key personal, professional and work-related factors associated with exposure to external and internal aggression. What are the implications for practitioners? In developing strategies for the prevention and minimisation of workplace aggression, consideration must be given to differences between male and female clinicians, including with regard to personality, age and professional experience, as well as work locations, conditions and settings, as risk or protective factors for exposure to aggression in medical work.
Assuntos
Agressão , Medicina Clínica/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Fatores SexuaisRESUMO
The use and interpretation of P values is a matter of debate in applied research. We argue that P values are useful as a pragmatic guide to interpret the results of a clinical trial, not as a strict binary boundary that separates real treatment effects from lack thereof. We illustrate our point using the result of BOLERO-1, a randomized, double-blind trial evaluating the efficacy and safety of adding everolimus to trastuzumab and paclitaxel as first-line therapy for HER2+ advanced breast cancer. In this trial, the benefit of everolimus was seen only in the predefined subset of patients with hormone receptor-negative breast cancer at baseline (progression-free survival hazard ratio = 0.66, P = 0.0049). A strict interpretation of this finding, based on complex 'alpha splitting' rules to assess statistical significance, led to the conclusion that the benefit of everolimus was not statistically significant either overall or in the subset. We contend that this interpretation does not do justice to the data, and we argue that the benefit of everolimus in hormone receptor-negative breast cancer is both statistically compelling and clinically relevant.
Assuntos
Neoplasias da Mama/epidemiologia , Medicina Clínica/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Método Duplo-Cego , Everolimo/uso terapêutico , Feminino , Humanos , Paclitaxel/uso terapêutico , Modelos de Riscos Proporcionais , Receptor ErbB-2 , Trastuzumab/uso terapêuticoRESUMO
We conducted a systematic review of the 2012-2013 multistate fungal meningitis epidemic in the United States from the perspectives of clinical response, outbreak investigation, and epidemiology. Articles focused on clinical response, outbreak investigation, and epidemiology were included, whereas articles focused on compounding pharmacies, legislation and litigation, diagnostics, microbiology, and pathogenesis were excluded. We reviewed 19 articles by use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. The source of the fungal meningitis outbreak was traced to the New England Compounding Center in Massachusetts, where injectable methylprednisolone acetate products were contaminated with the predominant pathogen, Exserohilum rostratum. As of October 23, 2013, the final case count stood at 751 patients and 64 deaths, and no additional cases are anticipated. The multisectoral public health response to the fungal meningitis epidemic from the hospitals, clinics, pharmacies, and the public health system at the local, state, and federal levels led to an efficient epidemiological investigation to trace the outbreak source and rapid implementation of multiple response plans. This systematic review reaffirms the effective execution of a multisectoral public health response and efficient delivery of the core functions of public health assessment, policy development, and service assurances to improve population health.
Assuntos
Medicina Clínica/normas , Surtos de Doenças/estatística & dados numéricos , Meningite Fúngica/epidemiologia , Saúde Pública/métodos , Medicina Clínica/métodos , Medicina Clínica/estatística & dados numéricos , Humanos , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Saúde Pública/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: During the years 2008 and 2009, 1,191 biomedical articles authored by Chilean investigators working in Chile were indexed in PubMed. AIMS: To evaluate the potential visibility of those articles, according to scientometric indexes of the journals where they were published. METHODS: Those journals where the articles had been published were identified and each journals Impact Factor (JIF), 5-year JIF, SCImago Journal Rank (SJR), SCImago Quartiles (Q) for 2010 and the Source Normalized Impact per Paper (SNIP) for 2008-2009 were identified. RESULTS: Three hundred and twelve articles (26,2%) were dedicated to experimental studies in animals, tissues or cells and they were classified as Biomedicine, while 879 (73,8%) were classified as Clinical Medicine; in both areas the main type of articles were original reports (90% and 73.6%, respectively). Revista Médica de Chile and Revista Chilena de Infectología concentrated the greater number of publications. Articles classified in Biomedicine were published more frequently in English and in journals with higher scientometric indexes than those classified in Clinical Medicine. CONCLUSIONS: Biomedical articles dealing with clinical topics, particularly case reports, were published mostly in national journals or in foreign journals with low scientometric indexes. It can be partly attributable to the authors interest in reaching local readers. The evaluation of research productivity should combine several scientometric indexes, selected according to the field of research, the institution's and investigators interests, with a qualitative and multifactorial assessment.
Assuntos
Bibliometria , Pesquisa Biomédica/estatística & dados numéricos , Medicina Clínica/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , PubMed/estatística & dados numéricos , Animais , Chile , Humanos , Internacionalidade , Fator de Impacto de Revistas , Publicações Periódicas como Assunto/normasRESUMO
Background: During the years 2008 and 2009, 1,191 biomedical articles authored by Chilean investigators working in Chile were indexed in PubMed. Aims: To evaluate the potential visibility of those articles, according to scientometric indexes of the journals where they were published. Methods: Those journals where the articles had been published were identified and each journals Impact Factor (JIF), 5-year JIF, SCImago Journal Rank (SJR), SCImago Quartiles (Q) for 2010 and the Source Normalized Impact per Paper (SNIP) for 2008-2009 were identified. Results: Three hundred and twelve articles (26,2%) were dedicated to experimental studies in animals, tissues or cells and they were classified as Biomedicine, while 879 (73,8%) were classified as Clinical Medicine; in both areas the main type of articles were original reports (90% and 73.6%, respectively). Revista Médica de Chile and Revista Chilena de Infectología concentrated the greater number of publications. Articles classified in Biomedicine were published more frequently in English and in journals with higher scientometric indexes than those classified in Clinical Medicine. Conclusions: Biomedical articles dealing with clinical topics, particularly case reports, were published mostly in national journals or in foreign journals with low scientometric indexes. It can be partly attributable to the authors interest in reaching local readers. The evaluation of research productivity should combine several scientometric indexes, selected according to the field of research, the institution's and investigators interests, with a qualitative and multifactorial assessment.
Assuntos
Animais , Humanos , Bibliometria , Pesquisa Biomédica/estatística & dados numéricos , Medicina Clínica/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , PubMed/estatística & dados numéricos , Chile , Internacionalidade , Fator de Impacto de Revistas , Publicações Periódicas como Assunto/normasRESUMO
OBJECTIVES: Very little is known about the relative contributions of physician specialty groups and individual physicians to overall clinical laboratory expenditures. The objectives of this study were to determine the costs of clinical laboratory test expenditures attributable to 30 medical specialties and the associated per capita physician expenditures for an entire major Canadian city. Only chemistry, hematology, and microbiology tests were included in this study. METHODS: Retrospective cohort study involving all physicians in Calgary, Canada, and surrounding areas (n = 3,499) and secondary data on laboratory test orders. RESULTS: Data were obtained on approximately 20 million test requests. The mean clinical laboratory test expenditure, in Canadian dollars, per physician was $27,945 for all physicians combined. Total expenditures by primary care physicians (family physicians and general practitioners) accounted for 58% of total expenditures. CONCLUSIONS: There was wide variation in clinical laboratory test expenditures among specialties and on a per capita basis within medical specialties.
Assuntos
Técnicas de Laboratório Clínico/economia , Técnicas de Laboratório Clínico/estatística & dados numéricos , Medicina Clínica/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Especialização/estatística & dados numéricos , Canadá , Serviços de Laboratório Clínico/economia , Serviços de Laboratório Clínico/estatística & dados numéricos , Medicina Clínica/economia , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos , Especialização/economiaRESUMO
BACKGROUND: Modeling count and binary data collected in hierarchical designs have increased the use of Generalized Linear Mixed Models (GLMMs) in medicine. This article presents a systematic review of the application and quality of results and information reported from GLMMs in the field of clinical medicine. METHODS: A search using the Web of Science database was performed for published original articles in medical journals from 2000 to 2012. The search strategy included the topic "generalized linear mixed models","hierarchical generalized linear models", "multilevel generalized linear model" and as a research domain we refined by science technology. Papers reporting methodological considerations without application, and those that were not involved in clinical medicine or written in English were excluded. RESULTS: A total of 443 articles were detected, with an increase over time in the number of articles. In total, 108 articles fit the inclusion criteria. Of these, 54.6% were declared to be longitudinal studies, whereas 58.3% and 26.9% were defined as repeated measurements and multilevel design, respectively. Twenty-two articles belonged to environmental and occupational public health, 10 articles to clinical neurology, 8 to oncology, and 7 to infectious diseases and pediatrics. The distribution of the response variable was reported in 88% of the articles, predominantly Binomial (nâ=â64) or Poisson (nâ=â22). Most of the useful information about GLMMs was not reported in most cases. Variance estimates of random effects were described in only 8 articles (9.2%). The model validation, the method of covariate selection and the method of goodness of fit were only reported in 8.0%, 36.8% and 14.9% of the articles, respectively. CONCLUSIONS: During recent years, the use of GLMMs in medical literature has increased to take into account the correlation of data when modeling qualitative data or counts. According to the current recommendations, the quality of reporting has room for improvement regarding the characteristics of the analysis, estimation method, validation, and selection of the model.
Assuntos
Medicina Clínica/estatística & dados numéricos , Modelos LinearesRESUMO
BACKGROUND AND PURPOSE: Descriptions of uncommon diseases with intracranial imaging abnormalities are often difficult to find in the radiology literature. We hypothesized that reported imaging findings of such conditions in the recent literature were more frequent in clinical compared with radiology journals. MATERIALS AND METHODS: PubMed searches from December 1, 2007 to December 1, 2012 were performed for 5 uncommon CNS diseases with intracranial imaging manifestations: 1) Susac syndrome; 2) amyloid ß-related angiitis; 3) Parry-Romberg syndrome/en coup de sabre; 4) transient lesion of the splenium of the corpus callosum; and 5) reversible cerebral vasoconstriction syndrome. Articles were classified as a case report, case series, or original research. Journals were categorized as radiology or clinical. The 1- and 5-year Impact Factors of the journals were recorded. RESULTS: Two hundred two articles were identified for the 5 diseases, including 151 (74%) case reports, 26 case series (13%), and 25 original research articles (13%); 179 (89%) were published in nonradiology journals, compared with 23 (11%) in radiology journals. There was no significant difference between the mean 1- and 5-year Impact Factors of the radiology and clinical journals. CONCLUSIONS: Recent reports of the selected uncommon diseases with intracranial manifestations are more frequent in clinical journals when compared with dedicated radiology publications. Most publications are case reports. Radiologists should review both radiology and clinical journals when reviewing imaging features of uncommon diseases affecting the brain. Lack of reporting on such disease in the radiology literature may have significant practice, educational, and research implications for the radiology community.
Assuntos
Encefalopatias/diagnóstico , Medicina Clínica/estatística & dados numéricos , Fator de Impacto de Revistas , Publicações Periódicas como Assunto/estatística & dados numéricos , PubMed/estatística & dados numéricos , Editoração/estatística & dados numéricos , Doenças Raras/diagnóstico , Humanos , Publicações Periódicas como Assunto/classificação , Editoração/classificação , Radiologia/estatística & dados numéricosAssuntos
Pesquisa Biomédica/estatística & dados numéricos , Escolha da Profissão , Educação Médica/economia , Estudantes de Medicina/estatística & dados numéricos , Adulto , Medicina Clínica/estatística & dados numéricos , Estudos Transversais , Economia , Feminino , Humanos , Masculino , Inquéritos e Questionários , Reino UnidoRESUMO
OBJECTIVES: This study examined the extent to which a range of personal, professional, and work factors are associated with workplace aggression experienced by medical practitioners in Australian clinical practice settings. METHODS: An exploratory, descriptive study of cross-sectional, self-report survey design was undertaken in the third wave of the Medicine in Australia: Balancing Employment and Life survey during 2010-2011. Of 16 327 medical practitioners sampled, 9951 (60.9%) responded and 9449 (57.9%) worked in clinical practice. Logistic regression was undertaken to detect statistically significant associations between a suite of personal, professional, and work variables and eight binary outcome variables measuring exposure to verbal or written and physical aggression from patients, patients' relatives or carers, co-workers and others external to the workplace during the previous year. RESULTS: Age was consistently negatively associated and external control orientation was consistently positively associated with workplace aggression exposure from each source. Key variables related to work conditions (total hours worked, unpredictable work hours, a poor support network of other doctors, patients with unrealistic expectations, patients with complex health and social problems) and the presence of workplace aggression prevention and minimization strategies (alerts to high risk of aggression, restricting or withdrawing access for aggressive persons and optimized patient waiting) were also associated with aggression exposure. CONCLUSIONS: A broader implementation of strategies to prevent and minimize the likelihood and consequences of workplace aggression is required and needs to take account of both the individual and sub-group profiles of medical practitioners. Strategies need to mitigate the more challenging aspects of medical work, including excessive work hours, inadequate access to professional support networks, and larger caseloads of patients with complex conditions.
Assuntos
Agressão , Medicina Clínica/estatística & dados numéricos , Corpo Clínico/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Adulto , Austrália , Estudos Transversais , Feminino , Medicina Geral , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Studies have shown for many years that the cause of errors or patient injury is in a high proportion of cases to be found under human factors. Human factors include all those factors which determine the safety and capabilities of humans especially in complex situations or systems. Up to now this topic has barely been systematically dealt with in training and there is a large deficit. Modern simulation team training with systematic use of established principles of adult education and the implementation of crisis resource management (CRM) for teams can have enormous positive effects for patient safety. The concept of CRM for increasing human reliability is, however, barely used systematically for training. Simulation team training for critical events (not for emergency cases) is barely used. Professional performance at the highest level can only be expected from teams which regularly participate in team training for critical situations. In addition to simulation training with human factors, other aspects of patient safety are also essential. The concept of high reliability organizations (HRO) could make an important contribution in the sense of a safe hospital concept and includes the collection and analysis of critical incidents (critical incident reporting system CIRS) as well as the focus on the system of patient safety instead of individual persons and errors.
Assuntos
Medicina Clínica/estatística & dados numéricos , Erros Médicos/prevenção & controle , Erros Médicos/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão da Segurança/métodos , Gestão da Segurança/organização & administração , Gestão da Segurança/estatística & dados numéricos , Medicina Clínica/organização & administração , Atenção à Saúde/estatística & dados numéricos , AlemanhaRESUMO
OBJECTIVE: To describe the 12-month prevalence of verbal or written and physical aggression from patients, patients' relatives or carers, coworkers and others in Australian clinical medical practice. DESIGN, SETTING AND PARTICIPANTS: An exploratory, descriptive study of cross-sectional survey design in the third wave (March 2010 to June 2011) of the Medicine in Australia: Balancing Employment and Life longitudinal survey. MAIN OUTCOME MEASURES: Proportions of clinicians reporting verbal or written and physical aggression from each aggression source and the significance of differences reported by doctor type, sex, international medical graduate status, age and postgraduate experience. RESULTS: Of 16,327 medical practitioners sampled, a response rate of 60.9% (9951) was achieved and 9449 (57.9%) were in Australian clinical practice. Participants comprised 3515 general practitioners and GP registrars, 3875 specialists, 1171 hospital non-specialists and 888 specialists in training. Overall, 70.6% of medical practitioners experienced verbal or written aggression and 32.3% experienced physical aggression from one or more sources in the previous 12 months. While patterns of exposure were complex, more female clinicians, international medical graduates (IMGs) and hospital-based clinicians experienced workplace aggression. Age and postgraduate experience were significantly negatively associated with aggression exposure. CONCLUSIONS: This is the first nationwide study of workplace aggression from all sources experienced by all subpopulations of Australian medical clinicians. The findings suggest particular risks for younger and more junior hospital-based clinicians, and for IMGs in general practice. A failure to address this important professional and public health concern may contribute to ongoing challenges in the recruitment and retention of medical practitioners in an era of increasing shortages internationally.
Assuntos
Agressão , Medicina Clínica/estatística & dados numéricos , Local de Trabalho/estatística & dados numéricos , Austrália , Estudos Transversais , Feminino , Medicina Geral , Humanos , Estudos Longitudinais , Masculino , Médicos , Prevalência , Inquéritos e QuestionáriosRESUMO
BACKGROUND: International collaboration is increasingly used in biomedical research. AIM: To describe the characteristics of scientific production in Latin America and the main international collaboration networks for the period 2000 to 2009. MATERIAL AND METHODS: Search for papers generated in Latin American countries in the Clinical Medicine database of ISI Web of Knowledge v.4.10 - Current Contents Connect. The country of origin of the corresponding author was considered the producing country of the paper. International collaboration was analyzed calculating the number of countries that contributed to the generation of a particular paper. Collaboration networks were graphed to determine the centrality of each network. RESULTS: Twelve Latin American countries participated in the production of 253,362 papers. The corresponding author was South American in 79% of these papers. Sixteen percent of papers were on clinical medicine and 36% of these were carried out in collaboration. Brazil had the highest production (22,442 papers) and the lower percentage of international collaboration (31%). North America accounts for 63% of collaborating countries. Only 8% of collaboration is between South American countries. Brazil has the highest tendency to collaborate with other South American countries. CONCLUSIONS: Brazil is the South American country with the highest scientific production and indicators of centrality in South America. The most common collaboration networks are with North American countries.
Assuntos
Bibliometria , Medicina Clínica/estatística & dados numéricos , Cooperação Internacional , Publicações Periódicas como Assunto , Editoração/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricos , América do SulRESUMO
OBJECTIVES: To report doctors' rejection of specialties as long-term careers and reasons for rejection. DESIGN: Postal questionnaires. SETTING: United Kingdom. PARTICIPANTS: Graduates of 2002, 2005 and 2008 from all UK medical schools, surveyed one year after qualification. MAIN OUTCOME MEASURES: Current specialty choice; any choice that had been seriously considered but not pursued (termed 'rejected' choices) with reasons for rejection. RESULTS: 2573 of 9155 respondents (28%) had seriously considered but then not pursued a specialty choice. By comparison with positive choices, general practice was under-represented among rejected choices: it was the actual choice of 27% of respondents and the rejected choice of only 6% of those who had rejected a specialty. Consideration of 'job content' was important in not pursuing general practice (cited by 78% of those who considered but rejected a career in general practice), psychiatry (72%), radiology (69%) and pathology (68%). The surgical specialties were the current choice of 20% of respondents and had been considered but rejected by 32% of doctors who rejected a specialty. Issues of work-life balance were the single most common factor, particularly for women, in not pursuing the surgical specialties, emergency medicine, the medical hospital specialties, paediatrics, and obstetrics and gynaecology. Competition for posts, difficult examinations, stressful working conditions, and poor training were mentioned but were mainly minority concerns. CONCLUSIONS: There is considerable diversity between doctors in their reasons for finding specialties attractive or unattractive. This underlines the importance of recruitment strategies to medical school that recognize diversity of students' interests and aptitudes.
Assuntos
Atitude do Pessoal de Saúde , Escolha da Profissão , Medicina Clínica/estatística & dados numéricos , Satisfação no Emprego , Médicos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Especialização/estatística & dados numéricos , Adulto , Feminino , Humanos , Relações Interprofissionais , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Vigilância da População , Inquéritos e Questionários , Reino UnidoRESUMO
Background: International collaboration is increasingly used in biomedical research. Aim: To describe the characteristics of scientific production in Latin America and the main international collaboration networks for the period 2000 to 2009. Material and Methods: Search for papers generated in Latin American countries in the Clinical Medicine database of ISI Web of Knowledge v.4.10 - Current Contents Connect. The country of origin of the corresponding author was considered the producing country of the paper. International collaboration was analyzed calculating the number of countries that contributed to the generation of a particular paper. Collaboration networks were graphed to determine the centrality of each network. Results: Twelve Latin American countries participated in the production of253,362 papers. The corresponding author was South American in 79% of these papers. Sixteen percent of papers were on clinical medicine and 36% of these were carried out in collaboration. Brazil had the highest production (22,442 papers) and the lower percentage of international collaboration (31%). North America accounts for 63% of collaborating countries. Only 8% of collaboration is between South American countries. Brazil has the highest tendency to collaborate with other South American countries. Conclusions: Brazil is the South American country with the highest scientific production and indicators of centrality in South America. The most common collaboration networks are with North American countries.
Assuntos
Bibliometria , Medicina Clínica/estatística & dados numéricos , Cooperação Internacional , Publicações Periódicas como Assunto , Editoração/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricos , América do SulRESUMO
In the Traditional Chinese Medicine (TCM) cross-sectional survey conducted by our team, we were interested in determining the risk factors of osteoporosis. To analyze this TCM study, we had to deal with three statistical problems: (1) a very large number of potential risk factors, (2) interactions among potential risk factors, and (3) nonlinear effects of some continuous-scale risk factors. To address these analytic issues, we used two data mining methods, support vector machine recursive feature elimination and random forest; to deal with the curse of high-dimensional risk factors, we applied another data mining technique of association rule learning to discover the potential associations among risk factors. Finally, we employed the generalized partial linear model (GPLM) to determine nonlinear effects of an important continuous-scale risk factor. The final GPLM model shows that TCM symptoms play an important role in assessing the risk of osteoporosis. The GPLM also reveals a nonlinear effect of the important risk factor, menopause years, which might be missed by the generalized linear model.