Perceptions in health and medical research careers: the Australian Society for Medical Research Workforce Survey

OBJECTIVE: To report on the sentiments of the Australian health and medical research (HMR) workforce on issues related to employment and funding opportunities. DESIGN, SETTING AND PARTICIPANTS: In August 2006, the Australian Society for Medical Research (ASMR) invited all of its members to participate in an online survey. The survey took the form of a structured questionnaire that focused on career aspirations, career development and training opportunities, attitudes toward moving overseas to work, and employment conditions for medical researchers. MAIN OUTCOME MEASURES: Researchers' views on career opportunities, funding opportunities, salary and quality of the working environment; impact of these views on retaining a skilled medical research workforce in Australia. RESULTS: Of the 1258 ASMR members, 379 responded (30% response rate). Ninety-six per cent of respondents were currently based in Australia; 70% had a PhD or equivalent; and 58% were women. Most respondents worked at hospital research centres (37%), independent research institutes (28%) or university departments (24%). Sixty-nine per cent had funding from the National Health and Medical Research Council, with the remainder funded by other sources. Over the previous 5 years, 6% of respondents had left active research and 73% had considered leaving. Factors influencing decisions about whether to leave HMR included shortage of funding (91%), lack of career development opportunities (78%) and poor financial rewards (72%). Fifty-seven per cent of respondents were directly supported by grants or fellowships, with only 16% not reliant on grants for their continuing employment; 62% believed that funding had increased over the previous 5 years, yet only 30% perceived an increase in employment opportunities in HMR. Among the respondents, twice as many men as women held postgraduate qualifications and earned >or= dollars 100 000 a year. CONCLUSIONS: Employment insecurity and lack of funding are a cause of considerable anxiety among Australian health and medical researchers. This may have important implications for the recruitment and retention of researchers.     

Giant sternal metastasis secondary to follicular carcinoma of the thyroid gland: report of a case

A 70-year-old woman was admitted to our department for investigation and treatment of a progressively enlarging multinodular goiter and a fast growing mass infiltrating the sternum. The patient was euthyroid, but computed tomography (CT) and ultrasonography showed a mass in the anterior mediastinum infiltrating the sternum, with a dominant nodule in the right lobe of the thyroid. Fine needle aspiration biopsy results from both the cervical and the mediastinal masses were suggestive of follicular thyroid carcinoma. The patient underwent total thyroidectomy, thymectomy, and total removal of the mass, along with parts of the sternum, sternocleidomastoid muscle, and attached ribs. The thoracic wall was reconstructed with gortex dual mesh covered by muscle flaps from both pectoralis major muscles. Pathological analysis of both masses confirmed the fine needle aspiration findings and the patient received three cycles of radioactive iodine treatment. She had an uneventful postoperative course, but died of a stroke 8?years later.     

Enthesopathy of the Lateral Cord of the Plantar Fascia

The objective of this study was to raise awareness of the diagnosis of enthesopathy of the lateral cord of the plantar fascia (LCPF) and describe its sonographic findings. We conducted a retrospective case series of 13 sonographic examinations with the diagnosis of LCPF enthesopathy. Two cadaver dissections of the plantar foot were performed for anatomic correlation. Sonographic findings of LCPF enthesopathy included generalized or focal hypoechoic thickening, loss of the normal fibrillar echo texture, cortical irregularity of the fifth metatarsal tuberosity, and vascularity on color Doppler imaging. Anatomic dissections of the plantar foot detailed the course of the LCPF and served as a guide for optimal sonographic imaging. Enthesopathy of the LCPF is an important etiology of nontraumatic pain at the base of the fifth metatarsal. Sonographic evaluation can readily show the characteristic findings of LCPF enthesopathy.     

Spectral Doppler sonography of musculoskeletal soft tissue masses.

OBJECTIVE: To determine whether resistive indices obtained from spectral Doppler waveforms can be used to distinguish benign from malignant musculoskeletal soft tissue masses. METHODS: A retrospective review of Doppler sonograms was performed for 52 patients with 53 soft tissue masses. All masses showed internal flow on color or power Doppler sonography, and spectral Doppler sonography yielded waveforms from which resistive indices were calculated. This information was analyzed along with the histologic diagnosis of each lesion with significance set at P > .05. RESULTS: There were 19 benign lesions and 34 malignancies. The resistive indices of the benign masses ranged from 0.44 to 1.0 (mean +/- SD, 0.72 +/- 0.42), whereas the malignant masses had resistive indices ranging from 0.28 to 1.0 (mean, 0.62 +/- 0.36). There was no statistically significant (P > .05) difference between the resistive indices of benign and malignant lesions. CONCLUSIONS: Resistive indices cannot be used to distinguish benign from malignant musculoskeletal soft tissue masses.     

Reducing electronic health record-related burnout in providers through a personalized efficiency improvement program

ObjectiveTo give providers a better understanding of how to use the electronic health record (EHR), improve efficiency, and reduce burnout.Materials and MethodsAll ambulatory providers were offered at least 1 one-on-one session with an “optimizer” focusing on filling gaps in EHR knowledge and lack of customization. Success was measured using pre- and post-surveys that consisted of validated tools and homegrown questions. Only participants who returned both surveys were included in our calculations.ResultsOut of 1155 eligible providers, 1010 participated in optimization sessions. Pre-survey return rate was 90% (1034/1155) and post-survey was 54% (541/1010). 451 participants completed both surveys. After completing their optimization sessions, respondents reported a 26% improvement in mean knowledge of EHR functionality (P < .01), a 19% increase in the mean efficiency in the EHR (P < .01), and a 17% decrease in mean after-hours EHR usage (P < .01). Of the 401 providers asked to rate their burnout, 32% reported feelings of burnout in the pre-survey compared to 23% in the post-survey (P < .01). Providers were also likely to recommend colleagues participate in the program, with a Net Promoter Score of 41.DiscussionIt is possible to improve provider efficiency and feelings of burnout with a personalized optimization program. We ascribe these improvements to the one-on-one nature of our program which provides both training as well as addressing the feeling of isolation many providers feel after implementation.ConclusionIt is possible to reduce burnout in ambulatory providers with personalized retraining designed to improve efficiency and knowledge of the EHR.     

Ultrasound-guided treatment of peripheral entrapment mononeuropathies

The advent of high-resolution neuromuscular ultrasound (US) has provided a useful tool for conservative treatment of peripheral entrapment mononeuropathies. US-guided interventions require careful coordination of transducer and needle movement along with a detailed understanding of sonoanatomy. Preprocedural planning and positioning can be helpful in performing these interventions. Corticosteroid injections, aspiration of ganglia, hydrodissection, and minimally invasive procedures can be useful nonsurgical treatments for mononeuropathies refractory to conservative care. Technical aspects as well as the current understanding of the indications and efficacy of these procedures for common entrapment mononeuropathies are reviewed in this study. Muscle Nerve, 2019     

Case report: acute thrombotic occlusion and pseudoaneurysm of the brachial artery diagnosed by Doppler ultrasound after nondiagnostic angiography

The swift and accurate diagnosis of acute arterial occlusion and limb ischemia is critical to prevent morbidity from this vascular emergency as reported by Bettman et al. (Radiology 215:101–105, 2000). There are a number of imaging modalities available to the diagnosing physician. However, the most appropriate modality may vary according to the clinical presentation. We present an atypical case of acute thrombosis of the brachial artery, which could not be diagnosed by conventional angiography, but was identified successfully with Doppler ultrasound. We also briefly discuss the issues surrounding vascular imaging in this case and overview the strengths and weaknesses of available imaging modalities.