Research Funding, Income, and Career Satisfaction Among Clinician-Scientists in Ophthalmology in the United States.

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.

The evolution of nerve growth factor inhibition in clinical medicine.

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.

Docencia clínica en tercer curso del Grado de Medicina. Estudio secuencial de 7.5 cursos académicos / Clinical skills training in the third course of Medicine. Sequential evaluation of 7.5 cycles

Introducción: No hay muchos estudios que valoren la docencia clínica de una asignatura determinada. Este estudio pretende ser la continuidad de uno que se publicó en esta misma revista en 2015. Sujetos y métodos: Se han analizado las encuestas a alumnos de los cursos desde 2011-2012 hasta diciembre de 2018, lo que representa 7,5 cursos. Los objetivos de la estancia clínica no cambiaron a lo largo del período analizado, ni tampoco varió el número de alumnos por unidad ni las siete unidades/centros docentes. Resultados: Se han recogido 1.180 encuestas (92% del total). Se constató una muy buena valoración global del período de docencia clínica (mediana: 5; primer cuartil: 4, en escala de 1 a 5), sin variaciones significativas en los cursos analizados. Tampoco hubo variaciones significativas en ninguna de las siete unidades docentes. Conclusión: La docencia clínica está muy bien valorada de forma global en esta asignatura en las distintas unidades docentes, sin variaciones a lo largo del tiempo

Introduction: There are few studies regarding the clinical skills training of a particular matter. The present study reflect the continuation of a previous work published in 2015 in the same journal. Subjects and methods: The period of study represents 7,5 cycles (2011-2018). The main objectives of the clinical practice as well as the number of students and the number of facilities did not change over time. Results: A total number of 1,180 (92%) of the requested surveys were collected. A very good global qualification was assessed (median: 5; first quartile: 4, in 1-5 scale) without significant differences either through the time or among the different seven units. Conclusions: Clinical skills training in this matter is considered near excellent without significant variations through the time

Identifying MSM-competent physicians in China: a national online cross-sectional survey among physicians who see male HIV/STI patients.

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.

Differences in risk and protective factors for workplace aggression between male and female clinical medical practitioners in Australia.

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.

Statistical controversies in clinical research: statistical significance-too much of a good thing .

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.

Un paso adelante. Caminando hacia el futuro / One step forward. Walking to the future

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Clinical Response, Outbreak Investigation, and Epidemiology of the Fungal Meningitis Epidemic in the United States: Systematic Review.

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.

[An analysis of Chilean biomedical publications in PubMed in the years 2008-2009]. / Análisis de las publicaciones biomédicas chilenas indizadas en PubMed, en los años 2008 y 2009.

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 journal’s 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.

Reflexiones nerviosas. Los fantasmas / Reflections nerve. The ghosts

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Análisis de las publicaciones biomédicas chilenas indizadas en PubMed, en los años 2008 y 2009 / An analysis of Chilean biomedical publications in PubMed in the years 2008-2009

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 journal’s 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.

Yearly Clinical Laboratory Test Expenditures for Different Medical Specialties in a Major Canadian City.

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.

Methodological quality and reporting of generalized linear mixed models in clinical medicine (2000-2012): a systematic review.

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 (n = 64) or Poisson (n = 22). 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.

Intracranial imaging of uncommon diseases is more frequently reported in clinical publications than in radiology publications.

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.

Personal, professional, and work factors associated with Australian clinical medical practitioners' experiences of workplace aggression.

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.

[Patient safety: data on the topic and ways out of the crisis]. / Patientensicherheit : Daten zum Thema und Wege aus der Krise.

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.

A national study of workplace aggression in Australian clinical medical practice.

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.

[Scientific production in clinical medicine and international collaboration networks in South American countries]. / Redes de colaboración y producción científica sudamericana en medicina clínica, ISI Current Contents 2000-2009.

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.