Stigmatizing Terminology for Outcomes and Processes (STOP) in Alcohol Research: A Meta-epidemiologic Assessment of Language Used in Clinical Trial Publications.

INTRODUCTION: Stigmatizing language used to describe patients and medical conditions is associated with poorer health outcomes. A recent investigation showed that approximately 80% of medical literature focused on alcohol use disorder (AUD) contained stigmatizing terms related to individuals; however, the quantification of stigmatizing terminology for outcomes and processes (STOP) among AUD research is unknown. Thus, our primary objective was to evaluate publications of clinical trials for their inclusion of STOP. METHODS: We performed a systematic search of PubMed for AUD clinical trials between January 1, 2017 and June 30, 2021. Article screening and data extraction were performed in a masked, duplicate manner by 2 investigators. We searched the full text of included manuscripts for STOP. We reported the frequency and percentage of manuscripts with STOP and individual terms. We evaluated associations between STOP usage and several clinical trial characteristics via logistic regression. RESULTS: Our search returned 1552 articles, which were then randomized and the first 500 were screened for inclusion. Of 147 included articles, 115 (78.2%) included STOP. The most common STOP were "drop out" (38.78%; 57/147), "relapse" (36.05%; 53/ 147), and "adherent, nonadherence" (35.37%; 52/147). No significant associations were found between STOP usage and trial characteristics. DISCUSSION: STOP was found in a majority of AUD clinical trial publications. As AUD is highly stigmatized, steps should be taken to eliminate usage of STOP in literature pertaining to AUD treatments. Many stigmatizing terms can be replaced by person-centered, more clinically accurate terms to further combat AUD stigma.

The (see text) in the Praecepta: The Medical Fee and its Impact on the Patient.

The brief collection of deontological guidelines entitled Praecepta is one of the most important literary evidence regarding the fee of the ancient physician. This chapter focuses on three passages from the Praecepta, which offer us a wealth of information on this topic. Some technical terms used in the text, such as the term µiσθápiov, show clearly that the author intends both to provide guidelines for the ideal bedside manners and to defend the repute of the physicians from the widespread charge of greed. In some regards, the author of the Praecepta depicts medicine as a 'liberal' art: the good physician disdains monetary gain as the main goal of his service, and aims to safeguard the social status and reputation of the medical profession. On the other hand, the author of the Praecepta enlightens his readers on the bad behaviour of both charlatan physicians and bad-mannered patients.

Case Histories in Late Byzantium: Reading the Patient in John Zacharias Aktouarios' On Urines.

This paper provides the first analysis of case histories in the Byzantine period as they feature in the On Urines of John Zacharias Aktouarios (ca. 1275-ca. 1330). This group of clinical accounts is of special importance in that they have no counterpart in the Greek-speaking world since Galen. This study aims to illustrate various factors determining the patient's response to the physician's advice through close examination of John's clinical narratives. The first part deals with the terminology that John uses to indicate the patient's gender, age, social status, and clinical condition. The second part explores the significance of John's acquaintance with the patients, the patient's socio-economic background, and also the patient's experience in connection with the physician's professional expertise.

Minimally invasive surgery fellowship graduates: Their demographics, practice patterns, and contributions.

BACKGROUND: Fellowship opportunities in minimally invasive surgery, bariatric, gastrointestinal, and hepatobiliary arose to address unmet training needs. The large cohort of non-Accreditation Council for Graduate Medical Education -accredited fellowship graduates (NACGMEG) has been difficult to track. In this, the largest survey of graduates to date, our goal was to characterize this unique group's demographics and professional activities. STUDY DESIGN: A total of 580 NACGMEG were surveyed covering 150 data points: demographics, practice patterns, academics, lifestyle, leadership, and maintenance of certification. RESULTS: Of 580 previous fellows, 234 responded. Demographics included: average age 37 years, 84% male, 75% in urban settings, 49% in purely academic practice, and 58% in practice <5 years. They averaged 337 operating room cases/year (approximately 400/year for private practice vs 300/year for academic). NACGMEG averaged 100 flexible endoscopies/year (61 esophagogastroduodenoscopies, 39 colon). In the past 24 months, 60% had submitted abstracts to a national meeting, and 54% submitted manuscripts to peer-reviewed journals. Subset analyses revealed relevant relationships. There was high satisfaction (98%) that their fellowship experience met expectations; 78% termed their fellowships, versus 50% for residencies, highly pertinent to their current practices. 63% of previous fellows occupy local leadership roles, and most engage in maintenance of certification activities. CONCLUSION: Fellowship alumnae appear to be productive contributors to American surgery. They are clinically and academically active, believe endoscopy is important, have adopted continuous learning, and most assume work leadership roles. The majority acknowledge their fellowship training as having met expectations and uniquely equipping them for their current practice.

Misrepresentation in multidisciplinary pain medicine fellowship applications to a single academic program.

BACKGROUND AND OBJECTIVES: Publication misrepresentation by residency applicants has been well documented, but fewer studies have investigated it in fellowship applicants, specifically in pain medicine. We therefore sought to evaluate the demographics of pain medicine fellowship applicants and the type, number, and accuracy of referenced publications they reported. METHODS: Applications to the Multidisciplinary Pain Medicine fellowship program in the Mayo School of Graduate Medical Education, Rochester, Minnesota were reviewed for three consecutive academic years (2009-2012). Demographic information and publications claimed by applicants were compiled, and publications were scrutinized by a medical librarian for accuracy. RESULTS: Over a 3-year period, 179 fellowship applications were received. Of the 179 applicants, more than half (106 [59%]) listed at least one publication. Of 324 listed publications, 263 were verifiable; of these, 14 (5.3%) were deemed fraudulent, and six (2.3%) contained an inaccuracy possibly conferring a competitive advantage. In our small sample size, we found no difference in the rate of publications or in the accuracy of listed publications across subspecialties, or between US medical graduates and international medical graduates. CONCLUSIONS: The lack of national data, specifically on applicant misrepresentation, due to the heretofore absence of a universal application process or match, impedes assessment of the extent to which these findings are representative of the national applicant pool. We observed notable trends (few female applicants; numerous international medical graduate applicants) different from those reported by other specialties. Despite the low rate (5.3%) of fraudulent publications, fellowship program directors and selection committees should be aware of this possibility to ensure selection of fellows with the highest degree of professional and ethical integrity.

Peer-review and editorial process of the Ethiopian Medical Journal: ten years assessment of the status of submitted manuscripts.

BACKGROUND: The Ethiopian Medical Journal (EMJ) is a peer-reviewed journal, now 50 years old. Many medical journals, including EMJ, follow a peer review system that has evolved from the 18th century process for reviewing submitted manuscripts. However, not much is known about peer review and editorial processes by many authors who submit manuscripts to the EMJ. OBJECTIVE: To describe procedures related to EMJ peer-review and editorial decision making and asses the status of manuscripts submitted to the journal in the ten year period between 2001 and 2010. METHODS: All the minutes of the editorial board meetings of the ten years period 2001-2010 and relevant documents were reviewed. The minutes have details including date of submission, dates to and from reviewers, date of decision, number of assigned peer reviewers and comments given by reviewers for each submitted manuscript. The length of time took in the processes and the decision made (accepted or rejected) for each submitted manuscript was calculated from the dates. RESULTS: All submitted manuscripts passed through three stages: internal per-review by an editorial board member, external peer review by selected reviewers and final editing stage by an assigned editorial member. A total of 615 manuscripts were submitted to EMJ in the ten years period 2001-2010. Five hundred and one (82.7%) manuscripts were accepted for publication by peer reviewers, while 74 (12.2%) were rejected and 31 (5.1%) were withdrawn. Acceptance was lowest among original articles (81.3%) followed by teaching or review articles (84.3%) and case reports (89.3%). Thirty-two (8.4%) manuscripts were accepted within 6 months following submission and 50% were accepted within in one year of submission. About 6% of manuscripts were delayed for more than two years with a maximum delay of 43 months. CONCLUSION: Even though, there is a decline trend on the delay of processing manuscripts, EMJ has long to go in order to improve the quality of the journal and shorten the slow peer review process. Expansion of the use of electronic technology to communicate with authors and reviewers and motivating reviewers by conducting workshops and continuing medical educations are recommended to strengthen the process of peer review in the EMJ.

Systematic assessment of the representativeness of published collections of the traditional literature on Chinese medicine.

BACKGROUND: The traditional Chinese medical literature provides a substantial resource for natural products research. When undertaking systematic searches, investigators need to assess the scope, content, and relevance of collections both singly and in comparison. OBJECTIVES: This study examines eight collections of pre-modern literature, develops an approach to quantitatively assess their content, and compares their relative inclusivity. METHODS: All publications listed in each collection were collated and a uniform scoring system was developed to account for variant editions, incorporation of multiple books under a single title, addition of commentaries, and other factors affecting content. Comparisons were undertaken between collections to determine the degree of overlap, genres of literature represented, and relevance to natural products research. RESULTS: Following adjustments for differences in how books were listed, duplications, and variant editions, Zhong Hua Yi Dian (Encyclopaedia of Traditional Chinese Medicine) (4th edition CD) is the largest collection of complete books containing 1009 different books. Zhong Guo Ben Cao Quan Shu (The Complete Collection of Traditional Texts on Chinese Materia Medica) contains 2026 titles including multiple editions and extracts, so after adjustments the number of different complete books is approximately 740. No collection was fully inclusive of the others, but Zhong Hua Yi Dian includes between 52.1% and 91.5% of the books in the six smaller collections. CONCLUSIONS: Comparing traditional collections is complex due to variant editions and multiple titles. This necessitates examination of the text rather than title alone. Prior to undertaking systematic searches, the characteristics of collections need to be investigated, duplicated books identified, and differences between editions should be assessed. Its size, electronic format, and broad spread of genres makes Zhong Hua Yi Dian suitable for systematic searches, but due to the lack of bibliographical detail on included books, cross-referencing to other collections is recommended.

Enablers and disablers allowing trainees' abstracts to proceed to full manuscripts: lessons from a large neonatal training program.

OBJECTIVE: To study trainee and supervisor perspectives for success or failure of conversion of abstracts to full manuscripts. STUDY DESIGN: Abstracts presented by trainees between 2000 and 2005 were identified from the syllabi of the Paediatric Academic Society, Canadian Paediatric Society and Hot Topics meetings. The trainee and senior supervisor for each abstract were asked to complete a web-based survey that explored enablers and disablers. RESULT: Of the 187 abstracts identified, 62 (33%) had trainees as primary authors. Of these, the responses of 42 (68%) trainees and 50 (81%) supervisors were collected; the responses of 21 (50%) trainees and 19 (38%) supervisors reported success in converting the abstract to a manuscript. According to trainees, good research idea, supportive supervisors and practical design were the main enablers, whereas limited time for research and the limited data collection only for abstracts were the main disablers. According to supervisors, adequate research time and the trainees' interest were the main enablers, whereas limited data collection and lack of trainees' interest were the main disablers. Specified research training, allocation of protected research time and making publication mandatory were suggested by both to enhance publication rate. CONCLUSION: Training programs should consider research training needs and provide dedicated time to improve research productivity by trainees.

Conflicts of interest at medical journals: the influence of industry-supported randomised trials on journal impact factors and revenue - cohort study.

BACKGROUND: transparency in reporting of conflict of interest is an increasingly important aspect of publication in medical journals. Publication of large industry-supported trials may generate many citations and journal income through reprint sales and thereby be a source of conflicts of interest for journals. We investigated industry-supported trials' influence on journal impact factors and revenue. METHODS AND FINDINGS: we sampled six major medical journals (Annals of Internal Medicine, Archives of Internal Medicine, BMJ, JAMA, The Lancet, and New England Journal of Medicine [NEJM]). For each journal, we identified randomised trials published in 1996-1997 and 2005-2006 using PubMed, and categorized the type of financial support. Using Web of Science, we investigated citations of industry-supported trials and the influence on journal impact factors over a ten-year period. We contacted journal editors and retrieved tax information on income from industry sources. The proportion of trials with sole industry support varied between journals, from 7% in BMJ to 32% in NEJM in 2005-2006. Industry-supported trials were more frequently cited than trials with other types of support, and omitting them from the impact factor calculation decreased journal impact factors. The decrease varied considerably between journals, with 1% for BMJ to 15% for NEJM in 2007. For the two journals disclosing data, income from the sales of reprints contributed to 3% and 41% of the total income for BMJ and The Lancet in 2005-2006. CONCLUSIONS: publication of industry-supported trials was associated with an increase in journal impact factors. Sales of reprints may provide a substantial income. We suggest that journals disclose financial information in the same way that they require them from their authors, so that readers can assess the potential effect of different types of papers on journals' revenue and impact.

Life's a pitch.

Competing for large external design and branding contracts can be daunting - however, this article explains how it can also be healthy for more than just the bottom line of your budget.

Integrative approach to quality assessment of medical journals using impact factor, eigenfactor, and article influence scores.

BACKGROUND: Impact factor (IF) is a commonly used surrogate for assessing the scientific quality of journals and articles. There is growing discontent in the medical community with the use of this quality assessment tool because of its many inherent limitations. To help address such concerns, Eigenfactor (ES) and Article Influence scores (AIS) have been devised to assess scientific impact of journals. The principal aim was to compare the temporal trends in IF, ES, and AIS on the rank order of leading medical journals over time. METHODS: The 2001 to 2008 IF, ES, AIS, and number of citable items (CI) of 35 leading medical journals were collected from the Institute of Scientific Information (ISI) and the http://www.eigenfactor.org databases. The journals were ranked based on the published 2008 ES, AIS, and IF scores. Temporal score trends and variations were analyzed. RESULTS: In general, the AIS and IF values provided similar rank orders. Using ES values resulted in large changes in the rank orders with higher ranking being assigned to journals that publish a large volume of articles. Since 2001, the IF and AIS of most journals increased significantly; however the ES increased in only 51% of the journals in the analysis. Conversely, 26% of journals experienced a downward trend in their ES, while the rest experienced no significant changes (23%). This discordance between temporal trends in IF and ES was largely driven by temporal changes in the number of CI published by the journals. CONCLUSION: The rank order of medical journals changes depending on whether IF, AIS or ES is used. All of these metrics are sensitive to the number of citable items published by journals. Consumers should thus consider all of these metrics rather than just IF alone in assessing the influence and importance of medical journals in their respective disciplines.

Results, rhetoric, and randomized trials: the case of donepezil.

Whether donepezil provides meaningful benefit to patients with Alzheimer's disease (AD) is controversial, but drug sales annually total billions of dollars. A review of data from published randomized clinical trials (RCTs) found rhetorical patterns that may encourage use of this drug. To create a reproducible observation, the sentences occurring at five specific text sites in all 18 RCTs of donepezil for AD were tabulated, as were study design, sources of financial support, and outcomes that could be compared between trials. Rhetoric in the 13 vendor-supported trials (15 publications) was strongly positive. Three early trials used the motif "efficacious (or effective) ... treating ... symptoms" four times. "Well-tolerated and efficacious" or an equivalent motif appeared 11 times in five RCTs. Nine RCTs referred 15 times to previously proven effectiveness. Seven trials encourage off-label use, for "early" cognitive impairment, severe dementia in advance of the Food and Drug Administration labeling change, or behavioral symptoms. These rhetorical motifs and themes appeared only in the vendor-supported trials. Trials without vendor support described the drug's effects as "small" or absent; two emphasized the need for better treatments. RCT results were highly consistent in all trials; the small differences do not explain differences in rhetoric. At these text sites in the primary research literature on donepezil for AD, uniformly positive rhetoric is present in all vendor-supported RCTs. Reference to the limited benefit of donepezil is confined to RCTs without vendor support. Data in the trials are highly consistent. This observation generates the hypothesis that rhetoric in vendor-supported published RCTs may promote vendors' products.