1,721,030 research outputs found
Short-acting beta 2 agonists for stable chronic obstructive pulmonary disease
No full textChronic Obstructive Pulmonary Disease (COPD) is a chronic condition characterised by progressive airflow limitation that is at most partially reversible. Despite the lack of reversibility patients often report symptomatic improvement with short-acting beta 2 bronchodilator medications. They are used on either an "as required" or a "regular plus as required basis" and they may be used in conjunction with other bronchodilator medicines such as ipratropium and methylxanthines. These medicines are used in the management of both stable and acute exacerbations of COPD. This review examined the effect of short-acting beta 2 bronchodilators given by inhalation in stable COPD.To determine the clinical effect and assess the adverse effects of inhaled short-acting beta 2 agonist bronchodilators compared with placebo in stable COPD.Only randomised controlled trials (RCTs) were considered. RCTs were identified using the Cochrane Airways Group database (CENTRAL). In addition, the reference lists of review articles and RCTs retrieved in full were searched for other potentially relevant citations.Only trials with adult patients with stable COPD, as defined by internationally accepted guidelines (ATS, ERS or BTS) were included in this review. All trials had a minimum duration of 7 days of regular treatment with short-acting beta 2 bronchodilators given by inhalation and compared with placebo. Data from trials where beta 2 agonists were used alone or in combination with other medicines (e.g. ipratropium bromide) were used only if there was a direct comparison between beta 2 bronchodilator alone and placebo.Outcomes were analysed as continuous or dichotomous outcomes, using standard statistical techniques. For continuous outcomes, the weighted mean difference (WMD) and 95\% confidence intervals were calculated and for dichotomous outcomes, the odds ratio was calculated with 95\% confidence intervals by Peto's methods. Funnel plots were used to test for publication bias.Thirteen studies were included in this review. Most had small sample sizes and some of the sutides used very short-acting outdated compounds. All the studies used a cross-over design and were of high quality. Spirometry done at the end of study period was measured after administration of treatment (post-bronchodilator) which showed both FEV1 (0.150 L/min, 95\%CI: 0. 02-0.28) and FVC (0.310 L, 95\%CI: 0.00-0.62) to improve significanly but slightly when compared to placebo. A few studies measured FRC, airway resistance or conductance at the end of the study period. In all cases these measurements were done several hours after treatment, and no significant differences (p>0.05 in all cases) were found between the bronchodilator and placebo groups. Walking test Large increases in 6MW distance was observed in two studies, however one study did not show any positive improvements. There was a large increase in the 12MW distance as shown by one study. Due to the small number of studies reporting this outcome no significant differences were found in the walking distance between the bronchodilator and placebo groups. Peak Flow Rate Both morning (36. 04 L/min; 95\%CI: 0.80-71.27) and evening (36.68 L/min; 95\%CI: 2. 47-70.89) PEFR were significantly higher during active treatment than during placebo. Symptoms Breatlessness was measured on various scales therefore data that were presented in a suitable form were combined using standardized means for inclusion in the analysis. A significant improvement (-0.33; 95\%CI: -0.58 to -0.07 with p=0.01) in the breathlessness score was observed during treatment with beta-2 agonist when compared to placebo. Cough was reported to improve significantly (data not usable) during treatment with beta2 agonist in one study but not in two others. A non-significant decrease in sputum production was reported by Wilson 1980, however four other studies reported n
Cultivating a primary care medical workforce for New Zealand: Lessons from a longitudinal tracking project
No full textThis thesis seeks to understand the underlying factors associated with a career choice for General Practice among New Zealand medical students and graduates. General Practice is a critical piece of New Zealand’s health system, providing primary care to the community and gatekeeping access to more specialised tiers of healthcare. The shortage of GPs in New Zealand is well-documented. However, we have little knowledge about the specialty intentions of recent medical graduates, and influences that motivate their choice of a GP career.
I begin by outlining the historical context of the iterative health system and policy reforms in New Zealand, to provide insight as to why the GP workforce operates in the way it does today. Next, I take a post-positivist perspective in applying a mixed methods approach to the major empirical work of the thesis. A pilot study lays the foundations for analysis of quantitative data provided by students and graduates through the Medical Schools Outcomes Database and longitudinal tracking project. In phase one, contributions from 6,421 domestic medical students and graduates identify the factors that are associated with graduates’ preference for General Practice five years post-graduation. Phase two sees interviews with twenty graduates provide qualitative evidence regarding the important considerations influencing their medical career decisions, and the significant time-points in the decision-making process.
I combined the evidence provided by phase one and two of this study to develop a model of GP workforce enhancement for New Zealand, the General Practice Enhancement Model (GPEM). This model depicts the influences that are important to medical students and graduates when considering a choice for General Practice, and plots these across the training timeline. The model estimates the potential impact on workforce outcomes from addressing factors identified as influential in General Practice career choice. In doing so, a range of recommendations for workforce enhancement are made. I use the model to map the likely impact of government General Practice workforce policies, and determine that the desired workforce outcomes are unlikely to be met unless a broader programme of policy change is undertaken. However, this does not mean we cannot or should not act
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Medical workforce development in New Zealand: insights from a medical programme
No full textNew Zealand (NZ) has a reputation for excellence in medical education and training, and the cost-effectiveness of its health system. Like other Western countries, it is facing an immediate and major medical workforce crisis that is set to last for years. With little extra money available for education or health, the health demands from an ageing population and current inequities in delivery of care mandate an approach to obtain the most from every doctor trained. Medical schools have the responsibility for the selection and early education of these doctors. Student numbers in NZ have increased; however, given that the vast majority of medical students will complete their medical degree, then proceed to work in a medically-related area, the composition of student cohorts and their experiences during the medical programme, are fundamental early steps in the shaping of a future specialist workforce for the community’s needs. This thesis examines aspects of medical workforce development in NZ from the perspective of an educational leader in the Faculty of Medical and Health Sciences (FMHS) at The University of Auckland, provider of one of NZ’s two medical programmes. It describes ways that the FMHS is responding to the challenge to produce doctors with the aptitude to deliver the necessary medical care for its own community. It justifies endeavours already undertaken by the school, and clarifies ways in which medical schools, more widely, might enhance their contribution to the development of the future medical workforce. Within the thesis are reports of studies based on data from students and graduates of the Auckland programme. The first describes the work and life experiences of Auckland women medical graduates and explores how these women made career choices. This investigation found that lives of women outside medicine have remained remarkably similar over decades: most have children, and most wish to work flexibly over that time. More women are entering specialties other than general practice, but there are ongoing barriers to participation and progression to specialist level. A conclusion is that the health and education systems must adapt further to maximise the contributions and productivity of this half of the workforce. Subsequent studies relate to the demographics and career intentions of current medical students, and the impacts of their education thus far on that choice. These studies were made possible through the establishment of the FMHS Tracking Project in 2006; described in detail. Among other findings, insights are gained into ways that the proportion of medical students interested in a general practice career may be increased. The thesis concludes with the proposing of a framework within which medical schools and other stakeholders might consider selection of student cohorts and their education, as well as enhancing retention and workforce orientation towards the priority scopes of medical practice needed by the NZ community in the coming years
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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