The Author Impact Factor as a Metric to Evaluate the Impact of Neurosurgical Researchers.

OBJECTIVE: The objective of this study was to assess the Author Impact Factor (AIF) as a useful metric and as a complement to the h-index among neurosurgical researchers. METHODS: The 5-year AIF and h-index were compared among 3 groups of researchers: 1) the 100 most prolific of all time within general neurosurgical journals ("Experienced"), 2) the 100 most prolific during the 2015-2019 period within general neurosurgical journals ("Trending Group"), and 3) the 100 postgraduation year 7 neurosurgical residents with the highest h-index ("Amateur"). RESULTS: The Amateur group had a lower median h-index than the Experienced (6 vs. 55; P < 0.001) and Trending (6 vs. 43; P < 0.001) groups. The highest h-index of the Amateur group (24) was lower than the first quartile of the Experienced (46.25) and Trending (26.00) groups. The Amateur group had a lower median 5-year AIF than the Experienced (2.15 vs. 3.17; P < 0.001) and Trending (2.15 vs. 2.85; P = 0.02) groups. Unlike the h-index, the gap between the 5-year AIF distribution of the Amateur group and other groups was not profound. Although there was a positive correlation between the metrics in the 3 groups, they did not proxy for each other. For instance, while the h-index of some experienced authors that have not published recently was high, their AIFs were zero. Also, some Amateur authors published very impactful articles and had a high 5-year AIF. However, since their number of publications is inevitably low, their h-index were low. CONCLUSIONS: The AIF provides intuitive and complementary information to the h-index regarding the research output of neurosurgical authors.

Patients' preferences regarding physicians' gender: a clinical center cross-sectional study

ABSTRACT BACKGROUND: Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE: To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING: Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS: Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS: The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS: The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.

Patients' preferences regarding physicians' gender: a clinical center cross-sectional study.

BACKGROUND: Even with the significant growth of female representation within medicine, inequality and prejudice against this group persist. OBJECTIVE: To analyze patients' preferences regarding the gender of physicians in general and according to different specialties, and the possible reasons behind their choice. DESIGN AND SETTING: Cross-sectional study at the Clinical Center of the University of Caxias do Sul, Brazil. METHODS: Over a three-month period in 2020, 1,016 patients were asked to complete a paper-based 11-item questionnaire. RESULTS: The majority (81.7%; n = 830) of the patients did not have a preference regarding the gender of physicians in general. The preference rate for same-gender physicians was 14.0% (n = 142/1,016), and this preference was more common among female than among male patients (17.6% versus 7.0%; odds ratio, OR = 2.85; 95% confidence interval, CI = 1.80-4.52; P < 0.001). When asked about their preference for the gender of the specialist who they were waiting to see, the overall preference rate for a same-gender professional was 17.2% (n = 175). Preference for same-gender specialists was higher for specialties essentially based on pelvic or breast examination (i.e. gynecology, urology, proctology and mastology), compared with others (33.4% versus 9.7%; OR = 4.69; 95% CI = 3.33-6.61; P < 0.001). CONCLUSIONS: The patients' model for choice of their physician does not seem to involve physicians' gender in general or in the majority of medical specialties. The data presented in this study may make it easier to understand patients' preferences and concerns.

Perception of gender discrimination among spine surgeons across Latin America: a web-based survey.

BACKGROUND CONTEXT: Female physicians rarely choose spine surgery as their specialty. Although the specialty's nature and its associated lifestyle are potential barriers, gender-related issues may play an important part. PURPOSE: To evaluate the gender discrimination among spine surgeons across Latin America. STUDY DESIGN: Cross-sectional survey. PATIENT SAMPLE: The participants in this study were 223 AO Spine Latin America (AOSLA) registered members who answered the web-based survey. OUTCOME MEASURES: Personal and professional demographics; gender-related objective and subjective experiences regarding career and personal life. METHODS: A survey link containing a 24-item questionnaire was sent to the members' e-mails in September 2019. The survey was designed to evaluate the perception of gender discrimination by spine surgeons during their academic and professional lives. RESULTS: Out of 223 members who answered the survey, 196 (87.96%) were male and 27 (12.11%) female. Most were orthopedic surgeons (64.13%), ≥40 years of age (55.16%), and had <20 years of experience (69.95%). Gender discrimination was more frequent among women than among men (66.67% vs. 1.02%), as did discouragement from becoming a spine surgeon, orthopedic surgeon, or neurosurgeon (81.48% vs. 0.51%). Females reported higher rates of sexual harassment (44.44% vs. 7.65%) and more often felt disadvantaged because of gender (55.56% vs. 2.55%). Working harder than men to achieve the same prestige and lack of female mentorship were the most common obstacles reported by women (55.56%). Residency/fellowship influenced the decision to postpone/avoid having children for 66.67% of women but only 37.75% of men. Creation of a Women's Committee in AO Spine was supported by 74.07% of women and 38.78% of men. CONCLUSIONS: Gender-based discrimination affects women more frequently than men in spine surgery. These experiences likely contribute to the low prevalence of female spine surgeons. Efforts to mitigate bias and support the professional development of women in neurosurgery, orthopedics and spine communities are encouraged.

HIV and Surgery for Degenerative Spine Disease: A Systematic Review.

BACKGROUND AND STUDY AIMS: The objective of this review is to evaluate the incidence of operative treatment, outcomes, and complications of surgery for degenerative spine disease (DSD) on human immunodeficiency virus (HIV) positive patients. Combined antiretroviral treatment led HIV patients to live long enough to develop many chronic conditions common in the uninfected population. Surgery for DSD is one of the most commonly performed neurosurgical procedures. However, the incidence of spine surgery for DSD in HIV-positive patients seems to be lower than that in uninfected individuals, although this has not been clearly determined. METHODS: A systematic search of the Medline, Web of Science, Embase, and SciElo databases was conducted. Only primary studies addressing DSD surgery on HIV-positive patients were included. Evaluated variables were rates of surgical treatment, surgical outcomes and complications, year of publication, country where study was conducted, type of study, and level of evidence. RESULTS: Six articles were included in the review from 1,108 records. Significantly lower rates of DSD surgery were identified in HIV-infected patients (0.86 per 1,000 patient-years) when compared with uninfected patients (1.41 per 1,000 patient-years). There was a significant increase in spinal surgery in HIV-positive patients over time, with a 0.094 incidence per 100,000 in the year 2000 and 0.303 in 2009. HIV-positive patients had very similar outcomes when compared with controls, with 66.6% presenting pain relief at a 3-month follow-up. Higher incidences of hospital mortality (1.6 vs. 0.3%; p < 0.001) and complications (12.2 vs. 9.5%, p < 0.001) were observed in HIV carriers. CONCLUSIONS: HIV-positive individuals appear to undergo less surgery for DSD than HIV-negative individuals. Improvement rates appear to be similar in both groups, even though some complications appear to be more prevalent in HIV carriers. Larger studies are needed for decisive evidence on the subject.

Remote Patient Monitoring: A Systematic Review.

Introduction: Remote patient monitoring or telemonitoring aims at improving patient care through digitally transmitted health-related data. That allows early detection of disease decompensation and intervention, patient education and improves patient-physician relationship. Despite its relevance, there are no comprehensive reviews evaluating the variables discussed by clinical studies on telemonitoring. Methods: A systematic literature search of PubMed was performed to identify studies about telemonitoring published between 2000 and 2018. These had to be case reports with >5 cases, comparative or clinical studies/trials. The following variables were evaluated: year of publication, author's country, discussed topic, objective of study, follow-up time, number of telemonitoring patients, primary outcome, use of teleconsultation and tele-education, presence of a control group, effectiveness of telemonitoring, telemonitoring strategies, and level of evidence. Results: After screening 947 records, 272 articles were included. The review showed a growing number of publications over the years, with 43.0% being published between 2015 and 2018, providing generally positive results (76.8%). The United States was responsible for 38.2% of articles. Cardiovascular disease was the topic of 47.8% of studies, whereas surgical pathologies and postoperative care represented only 2.6%. Wireless devices or smartphone apps were the most popular strategy (75.7%), with 17.6% of studies employing tele-education and 24.6% employing teleconsultation measures. Most publications were OCEBM Level of Evidence 2 (73.5%). Conclusion: Telemonitoring appears to maximize patient care and effectiveness of treatment. The number of publications illustrates the growing interest in the matter. Telemonitoring has yet to be evaluated in the setting of postoperative care and surgical pathologies.