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Family Medicine Theses and Dissertations

This collection contains theses and dissertations from the Department of Family Medicine, collected from the Scholarship@Western Electronic Thesis and Dissertation Repository

Theses/Dissertations from 2023 2023

The Attainment of Obstetrical Competency in Postgraduate Family Medicine Training: A Qualitative Study , Nisha Arora

The Population-Centered Medical Model: A Theory of Practice for Public Health and Preventive Medicine , Sudit Ranade

Jumping Ship and Going to the Other Side: Experiences of Nurses who retrain as Doctors , Anne Robinson

Theses/Dissertations from 2020 2020

The experiences of Family Medicine teachers and Family Medicine residents in multimorbidity care and education , Julie A. Copeland

The Health Experiences of Long-haul Truck Drivers and their Relationship with their Primary Care Provider , Jennifer K. Johnson

Gestational Weight Gain - Its Importance To Pregnant Women And Their Children , Helena Piccinini-Vallis

Utilization of Healthcare by Immigrants in Canada: A Cross-Sectional Analysis of the Canadian Community Health Survey , Nisanthini Ravichandiran

Theses/Dissertations from 2019 2019

Japanese patients' preference for Patient-centered medicine and its association with the satisfaction of patients with their family physicians , Tesshu Kusaba

Measuring Multimorbidity , Eng Sing E S Lee

Focused Practice and Enhanced Skills PGY3 Training in Family Medicine: A Mixed Methods Study. , Melad I. Marbeen

Family Physician's Clinical Inertia in the Management of Hypoglycemia , Caroline V. Martignoni Rebicki

Knowledge and Attitudes Towards Breastfeeding Among Medical Students at Memorial University , Amanda L. Pendergast

Theses/Dissertations from 2018 2018

Transitions in Medical Education , Britta Laslo

Theses/Dissertations from 2017 2017

The impact of an EMR on the management of adult patients with type two diabetes by family physicians in ruralnewfoundland , John A. Campbell

Patient-centered Primary Care of Adults with Severe or Profound Developmental Disabilities: The Patient–Physician Relationship , Katherine C. Stringer

Theses/Dissertations from 2016 2016

An Evaluation of the Determinants of Job Satisfaction in Canadian Family Physicians , Jana L. Malhotra

Theses/Dissertations from 2015 2015

Psychotherapy in Family Medicine , Saadia N. Hameed

How Family Physicians in Saskatchewan Make Lung Cancer Screening Decisions , Nusrat Jamil

"A family doctor can do that!" Is there a role for a formalized referral network for office procedures in family practices of Newfoundland and Labrador? , Annabeth J. Loveys

Theses/Dissertations from 2014 2014

Integrating Spirituality and Medical Education: What Students and Teachers Have to Say - A Qualitative Study , Sharon N. Hatcher

Theses/Dissertations from 2013 2013

Bio-Identical Hormone Therapy: Understanding Women's Decision-Making Process and Family Physicians' Views , Lemmese AlWatban

What Shapes Family Physicians' Patterns of Care for Community Patients at End of Life? , Joshua D. Shadd

Theses/Dissertations from 2012 2012

Functional Recovery and Caregiver Support of Stroke Patients Admitted for Rehabilitation in Singapore Community Hospitals (1996 to 2005) , Gerald Koh

The Role of Religion and Spirituality in the Care of Patients in Family Medicine , Michael F. Lee-Poy

Understanding Compassion in Family Medicine: A Qualitative Study , Jane Melek Uygur

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©1878 - 2016 Western University

MARK H. EBELL, MD, MS, AND ROLAND GRAD, MD, MSc

June 8, 2020 Editor's Note: The hypertension study (reference 5) is under investigation by the editor of the journal in which it was published due to inconsistencies in the data noted by others. Caution is warranted regarding applying these findings to clinical care.

Am Fam Physician. 2020;101(10):608-617

Author disclosure: Dr. Ebell is cofounder and editor-in-chief of Essential Evidence Plus. See Editor's Note . Dr. Grad has no relevant financial affiliations.

In 2019, regular surveillance of 110 English-language research journals identified 254 studies that met the criteria to become POEMs (patient-oriented evidence that matters). Physician members of the Canadian Medical Association rated these POEMs for their relevance to patients in their practices. This article summarizes the clinical questions and bottom-line answers from the top 20 POEMs of 2019. Taking blood pressure medications at night results in a large mortality reduction over six years compared with morning dosing. Automated devices are the best way to measure blood pressure. Nonfasting lipid profiles are preferred over fasting lipid profiles, and nonfasting and fasting lipid profiles are equally effective at predicting risk. The benefit of statins for primary prevention in people 75 years and older is uncertain at best. Aspirin has no net benefit for primary prevention of cardiovascular disease and has no effect on cancer outcomes. An Italian study found fecal immunochemical testing over five biennial screening cycles has a similar colorectal cancer yield as screening colonoscopy, whereas a meta-analysis found that taking aspirin, an anticoagulant, or a nonsteroidal anti-inflammatory drug has no impact on the positive predictive value of fecal immunochemical testing. Regarding infections, a meta-analysis showed that patients presenting with symptoms of acute respiratory tract infection are unlikely to have pneumonia if vital signs and the lung examination findings are normal. For streptococcal pharyngitis (strep throat), penicillin V at a dosage of 800 mg four times a day for five days is at least as effective as a dosage of 1,000 mg three times a day for 10 days. A primary care study in the United Kingdom reinforced that clinicians should counsel parents of children with lower respiratory tract symptoms to be patient, because these infections can take three weeks or more to fully resolve. Among direct oral anticoagulants, apixaban has the lowest bleeding risk, and cotreating with a proton pump inhibitor significantly reduces bleeding risk. Single ibuprofen doses from 400 to 800 mg significantly reduce acute pain to a similar degree. The two-dose recombinant zoster vaccine is much more effective than the single-dose live, attenuated vaccine but with a greater risk of injection site pain. Exercise helps reduce the risk of falls in older adults. Practice guidelines from 2019 on antithrombotics for atrial fibrillation, the management of type 2 diabetes mellitus, and screening for breast cancer were judged to be especially relevant.

Every year for the past 21 years, a team of experts in evidence-based medicine have systematically reviewed more than 110 English-language research journals to identify the original research most likely to change and improve primary care practice. The team includes experts in family medicine, pharmacology, hospital medicine, and women's health. 1 , 2

The goal of this process is to identify POEMs (patient-oriented evidence that matters). A POEM must report at least one patient-oriented outcome, such as improvement in symptoms, morbidity, or mortality. It should also be free of important methodologic bias, making the results valid and trustworthy. Finally, if applied in practice, the results would change what some family physicians do in patient care by prompting them to adopt a beneficial new practice or discontinue one that is ineffective or harmful. This should improve patient outcomes. Of more than 20,000 research studies published in 2019 in the journals reviewed by the POEMs team, 254 met criteria for validity, relevance, and practice change.

The Canadian Medical Association (CMA) purchases a subscription to POEMs for its members, many of whom receive the daily POEM by email. When members read a POEM, they can rate it with a validated questionnaire called the Information Assessment Method. POEM ratings address the domains of clinical relevance, cognitive impact, use in practice, and expected health benefits if that POEM were to be applied in patient care. 3 , 4 In 2019, each of the 254 POEMs were rated by an average of 1,530 physicians.

In this article, we present the 20 POEMs rated highest for clinical relevance by CMA members in 2019. This installment of our annual series ( https://www.aafp.org/afp/toppoems ) summarizes the clinical question and bottom-line answer for each research study identified as a top 20 POEM, organized by topic and followed by a brief discussion. We also present the three most relevant practice guidelines identified by CMA members. The full text of the POEMs in this article are available at https://www.aafp.org/journals/afp/content/top-poems/2019.html .

Hypertension

Hypertension is among the most common conditions managed by primary care physicians and is the topic of the two POEMs rated most relevant to readers in 2019 ( Table 1 ) . 5 , 6 Researchers randomized 19,168 adults with hypertension to take their antihypertensive medications at bedtime or first thing in the morning. 5 Patients were prescribed an antihypertensive from an approved list of the most common therapies. Patients taking their medications at bedtime had a lower likelihood of the composite outcome of myocardial infarction (MI), coronary revascularization, heart failure, stroke, or cardiovascular death (hazard ratio = 0.55; 95% CI, 0.50 to 0.61; number needed to treat to prevent one event over 6.3 years = 20). All-cause mortality was reduced to a similar extent. This is a large effect for a six-year study, and a practice-changer for many patients and physicians. Best of all, it costs nothing to make this change. See Editor's Note

How we measure blood pressure continues to be a subject of research. The next POEM was a meta-analysis of 31 studies, which included a total of 9,279 patients and compared automated in-office blood pressure readings with in-office manual measurements or ambulatory automated recordings during waking hours (the reference standard). 6 Automated in-office measurements were performed without anyone present to activate the machine and used three to five readings separated by one- to two-minutes. Ambulatory automated measurements were 13.4/5.9 mm Hg lower than the manual in-office measurements and were similar to the in-office automated measurements. To avoid starting or intensifying antihypertensive medication unnecessarily, it is critical to measure blood pressure using an automated device. Patients should also bring in their home device so that it can be calibrated with the office device.

Behavioral Medicine

Behavioral medicine POEMs are summarized in Table 2 . 7 – 9 The first POEM in this group was a well-executed network meta-analysis of medical therapy for generalized anxiety disorder. 7 A network meta-analysis includes studies comparing drugs with each other and with placebo, allowing for direct and indirect comparisons. The meta-analysis included 89 studies involving 25,000 patients and 22 different drugs; none of the studies were longer than 26 weeks. After excluding drugs that were poorly tolerated such as quetiapine (Seroquel), paroxetine (Paxil), and benzodiazepines, the most effective commercially available drugs overall were, in order of effectiveness, bupropion (Wellbutrin), duloxetine (Cymbalta), mirtazapine (Remeron), hydroxyzine, sertraline (Zoloft), pregabalin (Lyrica), venlafaxine, escitalopram (Lexapro), fluoxetine (Prozac), buspirone (Buspar), and citalopram (Celexa). Drugs that did not significantly decrease anxiety scores included imipramine, maprotiline, opipramol (not available in the United States), tiagabine (Gabitril), vilazodone (Viibryd), and vortioxetine (Trintellix). The drugs with the best combination of effectiveness and tolerability were duloxetine, pregabalin, venlafaxine, and escitalopram.

The next POEM included videotaped encounters between 252 patients and 15 English primary care physicians. 8 Patients were asked about the main reason for their visit beforehand, and this reason was almost always addressed during the visit. However, of the 139 patients who identified at least one symptom in the previsit interview, 43 failed to disclose a total of 67 symptoms during the visit, most often stress, worries or sadness; tiredness or sleep problems; problems passing urine; headache; and intimate or other personal problems. Although physicians cannot ask every patient about all of their problems during a visit, it is important to know that patients may not fully disclose symptoms. Physicians should make patients feel as safe as possible while looking for cues to undisclosed symptoms, and routinely asking, “Is there anything else I can help you with?”

The last POEM in the behavioral medicine group was an individual patient data meta-analysis of how early treatment response impacts later outcomes in patients with depression. 9 The researchers combined the individual patient data from 30 randomized trials, with 2,184 patients receiving placebo and 6,058 receiving active therapy. After six weeks of treatment, about 50% of patients in the active treatment group responded to treatment, with 32% achieving remission of symptoms. Response was defined as at least a 50% reduction in the Hamilton Rating Scale for Depression score, and remission was defined as a score of 7 points or less. By 12 weeks, the response rate was 68% in the active treatment group, with 49% achieving remission. Patients with improvement at two weeks were more likely to respond by six weeks, whereas among patients without early improvement, 33% responded by six weeks and 43% by 12 weeks. The absence of an early response does not preclude later response; therefore, physicians should not be too quick to change antidepressant medications.

Cardiovascular

Cardiovascular medicine POEMs are summarized in Table 3 . 10 – 14 The first two POEMs in this group address statin use. Many physicians and laboratory staff continue to insist that patients be fasting for lipid profile testing. The first POEM compared fasting and nonfasting lipid profiles in the same patients four weeks apart. 10 There was little difference between fasting and nonfasting measurements of low-density and high-density lipoprotein cholesterol levels and only a small increase in triglyceride levels (25 mg per dL [0.28 mmol per L]) with nonfasting measurements. Most importantly, the association between lipid levels and subsequent cardiovascular events was identical for fasting and nonfasting lipid measurements. Guidelines support nonfasting lipid measurements. 15 , 16 It is time to simplify our patients' lives and educate local laboratory staff, who often turn away patients who disclose that they are not fasting.

In the next POEM, data were pooled from 28 randomized trials of statins with more than 186,000 total patients. 11 This report focused on the 14,000 patients who were 75 years or older; the median follow-up was five years. There was only a small reduction in the composite outcome of MI and cardiovascular death among all patients (2.6% with statins vs. 3.0% with placebo; number needed to treat = 250 per year); the benefit was significant only in patients with preexisting cardiovascular disease. Statins had no effect on revascularization, stroke, cancer incidence, or cancer mortality.

This was a big year for aspirin studies. The next three POEMs, from two separate trials, examine the benefits and harms of aspirin therapy for primary prevention in contemporary populations. Prior studies that found a net benefit of aspirin for the primary prevention of cardiovascular disease and cancer (mostly colorectal) all recruited patients before 2002. In more recent years, fewer patients smoke or have uncontrolled hypertension, more are taking a statin, and we have widespread colorectal cancer screening. In this context, does aspirin still have a role?

Two aspirin POEMs were from the ASPREE (Aspirin in Reducing Events in the Elderly) trial, which included 19,114 adults 70 years and older in the United States and Australia (65 and older if black or Hispanic). Patients without known cardiovascular disease were randomized to aspirin, 100 mg, or placebo and were followed for a median of 4.7 years. The first POEM found no significant reduction in the likelihood of cardiovascular disease with aspirin, including fatal cardiovascular disease, fatal or nonfatal MI, and fatal or nonfatal ischemic stroke. However, they found a significant increase in major hemorrhages with aspirin. 12 The second POEM from the ASPREE trial found no difference between groups for disability-free survival, defined as a composite of death, dementia, or persistent physical disability. 13 A separate report from the ASPREE investigators (not one of the top 20 POEMs) found an increase in all-cause mortality with aspirin, primarily due to a significant increase in cancer-specific mortality (3.1% vs. 2.3%).

The third aspirin POEM was from the ASCEND (A Study of Cardiovascular Events in Diabetes) trial and included 15,480 adults 40 years and older with diabetes mellitus but no known cardiovascular disease. The patients were randomized to aspirin, 100 mg, or placebo and were followed for a median of 7.4 years. 14 There was a reduction in the composite of nonfatal MI, nonfatal stroke, or cardiovascular death with aspirin, but a corresponding increase in major hemorrhage with no effect on cardiovascular or all-cause mortality.

What do we tell our patients? A recent meta-analysis compared trials of aspirin therapy that recruited patients from 1978 to 2002 with four large trials that recruited patients since 2005. 17 The newer studies showed fewer cardiovascular benefits and no reduction in cancer incidence or mortality with aspirin as primary prevention. Based on a meta-analysis of the four most recent studies with a total of 61,604 patients, for every 1,200 patients taking aspirin instead of placebo for five years, there would be four fewer major cardiovascular events and three fewer ischemic strokes but eight more major hemorrhages, including three more intracranial hemorrhages. This study agrees with recent European guidelines that no longer recommend aspirin for primary prevention. 18 The 2016 U.S. Preventive Services Task Force (USPSTF) and 2019 American College of Cardiology guidelines recommend consideration of aspirin for primary prevention only in selected patients at high cardiovascular risk and low bleeding risk. 19 , 20 The USPSTF recommendation is currently being updated. 21

Cancer Screening

The three POEMs on cancer screening ( Table 4 ) address colorectal cancer. 22 – 24 Fecal immunochemical testing (FIT) is the recommended method for colorectal cancer screening in most countries that have screening programs and is the subject of the first two POEMs in this group. The first POEM is an Italian study that reported the diagnostic yield of five rounds of biennial FIT in persons 50 to 69 years of age submitting a single specimen. 22 The highest rates of detection occurred in the first round, as prevalent cancers were detected, and declined and then stabilized in later rounds. Over the 10-year study, about 25% of men and 18% of women had a positive test result requiring a follow-up colonoscopy. The cumulative rate was 6% for advanced adenoma and 0.85% for colorectal cancer, which are similar to findings in studies of colonoscopy in Italy and the United States. 25 , 26 These results mean we can have confidence in FIT as a screening test while we wait for the results of ongoing randomized trials of FIT vs. colonoscopy-based screening.

The second POEM about FIT was a meta-analysis evaluating the impact of aspirin, nonsteroidal anti-inflammatory drugs, and anticoagulants on the positive predictive value of the test. 23 It could theoretically go in either direction, increasing false positives by making noncancerous lesions more likely to bleed or increasing true positives by making cancers and adenomas more likely to bleed. The researchers found that the use of any of these medications had almost no effect on the positive predictive value, which was approximately 6% for colorectal cancer and 40% for advanced neoplasia. FIT requires only a single specimen and no dietary preparation, and now we know that patients undergoing FIT can continue to take medications that increase bleeding risk.

Finally, a study used a Swedish cancer registry with 173,796 patients to determine the impact of family history on the risk of colorectal cancer. 24 The relative risk of colorectal cancer using no affected relatives as the reference was 1.2 for a single second-degree relative with a history of colorectal cancer, 1.6 for a single first-degree relative or two second-degree relatives, 2.3 for one first-degree relative and one second-degree relative, 2.5 for two first-degree relatives, and 5.4 for one first-degree and two second-degree relatives. However, a previous study found that this family history–related risk is attenuated once patients reach 55 years of age. 27

POEMs on managing infections are summarized in Table 5 . 28 – 30 The first POEM is a meta-analysis of studies that recruited outpatients with acute respiratory tract infections who received chest radiography. 28 The goal was to identify the best sign, symptom, or combination that allows clinicians to rule out community-acquired pneumonia (CAP). The researchers found that for patients with the combination of normal vital signs and normal lung examination findings, the likelihood of CAP is low at 0.4%. This could help reduce unnecessary chest radiography if applied consistently.

The second POEM in this group was selected as one of the top three research studies out of more than 400 presented at the 2019 North American Primary Care Research Group meeting. 29 This Swedish study included 422 adults and children presenting to a primary care physician with moderately severe streptococcal pharyngitis (strep throat). Patients were randomized to penicillin V at a dosage of 800 mg four times a day for five days or 1,000 mg three times a day for 10 days. Those receiving the higher dose over a shorter course of treatment had similar cure rates as those receiving longer-duration therapy, with quicker symptom resolution and no increase in recurrence. Many other studies have found similar results with antibiotics for a range of infections.

An accurate prognosis can potentially help patients avoid unnecessary antibiotic use and return visits. The third POEM in this group recruited 485 healthy children in the United Kingdom, and parents were instructed to contact the researchers every time the child had a respiratory tract infection. 30 One-half of the children had at least one infection, with a median duration of nine days; 90% recovered by day 23. Lower respiratory tract infections were associated with a longer duration of symptoms and ear infections were associated with a shorter duration. This reinforces that clinicians should counsel parents of children with lower respiratory tract symptoms to be patient.

Miscellaneous

Four additional POEMs are summarized in Table 6 . 31 – 34 The first is a cohort study of more than 1.6 million Medicare beneficiaries who started an anticoagulant between 2011 and 2015. 31 Bleeding rates were compared, adjusting for available covariates using propensity score matching (i.e., matching patients who were similar other than choice of anticoagulant). The adjusted incidence of hospitalization for upper gastrointestinal tract bleeding was significantly higher in those who received rivaroxaban (Xarelto) compared with those who received dabigatran (Pradaxa), warfarin (Coumadin), or apixaban (Eliquis); 144 per 10,000 person-years vs. 120, 113, and 73, respectively). For all agents combined, adding a proton pump inhibitor significantly reduced bleeding risk (76 out of 10,000 per year vs. 115 out of 10,000 per year; number needed to treat = 256), although rivaroxaban still had the highest bleeding rate.

The next POEM identified 225 adults presenting to the emergency department with acute pain (mostly musculoskeletal); the average pain score was 6 to 7 out of 10. 32 They were then randomized to a single dose of 400-mg, 600-mg, or 800-mg ibuprofen. An hour after taking the medication, there was no difference between groups, which all had pain scores between 4.4 and 4.5.

The third POEM in this group is a meta-analysis of studies comparing two doses of the recombinant zoster vaccine (Shingrix) with one dose of the live, attenuated vaccine (Zostavax) for the prevention of shingles. 33 Shingrix was more effective but caused more systemic adverse events, although mild, and more injection site pain.

Finally, a systematic review identified 46 studies of the impact of exercise on fall risk in patients 59 years or older. 34 Most of the programs used moderate-intensity exercise, with about one hour of exercise three times per week. The researchers found that exercise significantly decreased the overall risk of falls and resulting injuries but did not affect the risk of multiple falls, hospitalization, or mortality. Fractures were less likely in the exercise group but not significantly.

Practice Guidelines

POEMs sometimes summarize high-impact practice guidelines from important organizations. Key messages from the three highest-rated guidelines are summarized in Table 7 . 35 – 37

The American College of Chest Physicians recommends initiating direct oral anticoagulant therapy in patients with newly diagnosed atrial fibrillation, avoiding aspirin or aspirin plus clopidogrel (Plavix) to prevent thromboembolism, using risk scores for stroke and bleeding, and avoiding cotreatment with aspirin and an anticoagulant if possible. 35

The American Diabetes Association/European Association for the Study of Diabetes guideline for type 2 diabetes mellitus continues to recommend educating patients about diabetes self-management and providing support as the cornerstone of therapy, and metformin as the preferred initial therapy. 36 If a second agent is needed, there are many options, although glucagon-like peptide 1 receptor antagonists or sodium-glucose cotransporter 2 inhibitors are recommended for patients with established heart disease; sodium-glucose cotransporter 2 inhibitors are preferred for patients with heart failure or chronic kidney disease.

The American College of Physicians recommendations for breast cancer screening generally parallel those of the USPSTF, which are supported by the American Academy of Family Physicians. Recommendations include shared decision-making in women 40 to 49 years of age, biennial mammography from 50 to 74 years of age or until the woman's life expectancy is less than 10 years, and eliminating the clinical breast examination as a screening test for women who undergo regular mammography. 37 – 39

The full text of the POEMs discussed in this article is available at https://www.aafp.org/journals/afp/content/top-poems/2019.html .

A list of top POEMs from previous years is available at https://www.aafp.org/afp/toppoems .

Editor's Note: This article was cowritten by Dr. Mark Ebell, who is deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell, Inc. Because of Dr. Ebell's dual roles and ties to Essential Evidence Plus, the concept for this article was independently reviewed and approved by a group of AFP 's medical editors. In addition, the article underwent peer review and editing by three of AFP 's medical editors. Dr. Ebell was not involved in the editorial decision-making process.—Sumi Sexton, MD, Editor-in-Chief.

The authors thank Wiley-Blackwell, Inc., for giving permission to excerpt the POEMs; Drs. Allen Shaughnessy, Henry Barry, David Slawson, Nita Kulkarni, and Linda Speer for their work in selecting and writing the original POEMs; the academic family medicine fellows and faculty of the University of Missouri–Columbia for their work as peer reviewers; Pierre Pluye, PhD, for his work in codeveloping the Information Assessment Method; and Maria Vlasak for her assistance with copyediting the POEMs for the past 26 years.

Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489-499.

Ebell MH, Barry HC, Slawson DC, et al. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350-355.

Grad RM, Pluye P, Mercer J, et al. Impact of research-based synopses delivered as daily e-mail: a prospective observational study. J Am Med Inform Assoc. 2008;15(2):240-245.

Pluye P, Grad RM, Johnson-Lafleur J, et al. Evaluation of email alerts in practice: Part 2. Validation of the information assessment method. J Eval Clin Pract. 2010;16(6):1236-1243.

• Hermida RC, Crespo JJ, Domínguez-Sardiña M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial [published online October 22, 2019]. Eur Heart J . 2019. Accessed March 10, 2020. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478

Roerecke M, Kaczorowski J, Myers MG. Comparing automated office blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hypertension. A systematic review and meta-analysis. JAMA Intern Med. 2019;179(3):351-362.

Slee A, Nazareth I, Bondaronek P, et al. Pharmacological treatments for generalised anxiety disorder [published correction appears in Lancet . 2019;393(10182):1698]. Lancet. 2019;393(10173):768-777.

Paskins Z, Sanders T, Croft PR, et al. Non-disclosure of symptoms in primary care: an observational study. Fam Pract. 2018;35(6):706-711.

de Vries YA, Roest AM, Bos EH, et al. Predicting antidepressant response by monitoring early improvement of individual symptoms of depression: individual patient data meta-analysis. Br J Psychiatry. 2019;214(1):4-10.

Mora S, Chang CL, Moorthy MV, et al. Association of nonfasting vs fasting lipid levels with risk of major coronary events in the Anglo-Scandinavian Cardiac Outcomes Trial–lipid lowering arm. JAMA Intern Med. 2019;179(7):898-905.

Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. Lancet. 2019;393(10170):407-415.

McNeil JJ, Wolfe R, Woods RL, et al.; ASPREE Investigator Group. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509-1518.

McNeil JJ, Woods RL, Nelson MR, et al.; ASPREE Investigator Group. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379(16):1499-1508.

Bowman L, Mafham M, Wallendszus K, et al.; ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529-1539.

Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J. 2016;37(25):1944-1958.

Grundy SM, Stone NJ. 2018 cholesterol clinical practice guidelines: Synopsis of the 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline. Ann Intern Med. 2019;170(11):779-783.

Moriarty F, Ebell MH. A comparison of contemporary versus older studies of aspirin for primary prevention [published online November 21, 2019]. Fam Pract . 2019. Accessed March 10, 2020. https://academic.oup.com/fampra/advance-article/doi/10.1093/fampra/cmz080/5637484

Piepoli MF, Hoes AW, Agewall S, et al.; The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37(29):2315-2381.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol . 2019;74(10):1429–1430]. J Am Coll Cardiol. 2019;74(10):e177-e232.

Bibbins-Domingo K. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(12):836-845.

U.S. Preventive Services Task Force. Aspirin use to prevent cardiovascular disease and colorectal cancer: preventive medication. April 2016. Accessed February 14, 2010. https://bit.ly/343LnT6

Zorzi M, Hassan C, Capodaglio G, et al. Long-term performance of colorectal cancer screening programmes based on the faecal immunochemical test. Gut. 2018;67(12):2124-2130.

Nieuwenburg SAV, Vuik FER, Kruip MJHA, et al. Effect of anticoagulants and NSAIDs on accuracy of faecal immunochemical tests (FITs) in colorectal cancer screening: a systematic review and meta-analysis. Gut. 2019;68(5):866-872.

Tian Y, Kharazmi E, Sundquist K, et al. Familial colorectal cancer risk in half siblings and siblings: nationwide cohort study. BMJ. 2019;364:l803.

Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(14):1287-1297.

Segnan N, Senore C, Andreoni B, et al. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology. 2007;132(7):2304-2312.

Schoen RE, Razzak A, Yu KJ, et al. Incidence and mortality of colorectal cancer in individuals with a family history of colorectal cancer. Gastroenterology. 2015;149(6):1438-1445.e1.

Marchello CS, Ebell MH, Dale AP, et al. Signs and symptoms that rule out community-acquired pneumonia in outpatient adults: a systematic review and meta-analysis. J Am Board Fam Med. 2019;32(2):234-247.

Skoog Ståhlgren G, Tyrstrup M, Edlund C, et al. Penicillin V four times daily for five days versus three times daily for 10 days in patients with pharyngotonsillitis caused by group A streptococci: randomised controlled, open label, non-inferiority study. BMJ. 2019;367:l5337.

Hay AD, Anderson E, Ingle S, et al. Respiratory tract infections in children in the community: prospective online inception cohort study. Ann Fam Med. 2019;17(1):14-22.

Ray WA, Chung CP, Murray KT, et al. Association of oral anticoagulants and proton pump inhibitor cotherapy with hospitalization for upper gastrointestinal tract bleeding. JAMA. 2018;320(21):2221-2230.

Motov S, Masoudi A, Drapkin J, et al. Comparison of oral ibuprofen at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2019;74(4):530-537.

Tricco AC, Zarin W, Cardoso R, et al. Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis. BMJ. 2018;363:k4029.

de Souto Barreto P, Rolland Y, Vellas B, et al. Association of long-term exercise training with risk of falls, fractures, hospitalizations, and mortality in older adults. A systematic review and meta-analysis. JAMA Intern Med. 2019;179(3):394-405.

Lip GYH, Banerjee A, Boriani G, et al. Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest. 2018;154(5):1121-1201.

Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669-2701.

Qaseem A, Lin JS, Mustafa RA, et al. Screening for breast cancer in average-risk women: a guidance statement from the American College of Physicians. Ann Intern Med. 2019;170(8):547-560.

U.S. Preventive Services Task Force. Breast cancer: screening. January 2016. Accessed February 14, 2020. https://bit.ly/2ykUZwU

American Academy of Family Physicians. Clinical preventive service recommendation. Breast cancer. Accessed February 14, 2020. https://www.aafp.org/patient-care/clinical-recommendations/all/breast-cancer.html

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Master's and doctoral theses in family medicine and their publication output, Suez Canal University, Egypt

Affiliation.

• 1 Department of Family Medicine, Suez Canal University, Ismailia, Egypt.
• PMID: 25949959
• PMCID: PMC4408693
• DOI: 10.4103/2249-4863.154622

Background: The completion of a thesis is a significant requirement for both a Master's and a doctorate degree in general practice/family medicine (GP/FM). A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The quality of the theses can be judged by the proportion of published papers.

Objective: This study aimed to describe Master's and doctoral theses in family medicine and their publications between 1982 and 2014.

Materials and methods: GP/FM degree theses were reviewed at the Faculty of Medicine and central Suez Canal libraries. Several characteristics were extracted from each thesis relating to the main researcher, supervisors, themes, and study methods according to predefined criteria. Publications from the theses were described.

Results: Over 33 years, 208 theses were completed by 173 GP/FM researchers. The majority of the theses were for Master's degrees (84.1%). Regarding the study design, most of the degree theses were cross-sectional studies (76.9%). The adult population was targeted in 33.7% of research theses. Nonprobability sampling was used in 51%. Rural communities were the setting of research in 43.8%, and primary health center (PHC)-based studies in 59.1%. The "Patient" category exceeded the other categories (28.4%). Publication from theses started in the second decade of research production. Of the degree theses, 21.6% original articles were published. Only 13.3% of articles from theses were published in PubMed-indexed journals. The researcher was first author in 62.2% of published articles.

Conclusion: The production of GP/FM theses and their publications are going to increase. Continuous assessment and planning for GP/FM studies are recommended.

Keywords: Family medicine; general practice; medical journal Egypt; publication bias; research.

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Family Medicine ,  an official journal of the Society of Teachers of Family Medicine, aims to publish high quality, original scholarship about education in family medicine and primary care. The journal publishes original research, systematic reviews, narrative essays, and policy analyses relevant to the discipline of family medicine, particularly focusing on primary care medical education, health workforce policy, and health services research. The journal does not publish clinical review articles.

Family Medicine is committed to advancing efforts towards inclusion and antiracism in all journal-related activities. We endeavor to eliminate bias and racism in our editorial process and published content. Read the full diversity statement . 

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Submission deadline: August 15

Family Medicine seeks submissions for a theme issue on recruiting, mentoring, and promoting a diverse family medicine workforce. Family medicine is one of the most gender and racially diverse specialties, yet the discipline lags behind the general population in diversity, particularly in academic settings. Yet a diverse workforce is paramount to the health of patients and communities and success within organizations. Therefore our goal is to collect high-quality articles on pathway programs, recruitment initiatives, and meaningful retention and promotion strategies aimed to diversify the family medicine workforce. Original research and brief reports are welcome. FM Focus submissions must have high yield, concise information that will be published as an infographic. Narrative essay submissions should share original stories from the perspective of students, residents, faculty members, or practicing physicians.

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The Diabetes Code . Scherger JE.  Fam Med. 2019;51(3):286-287. 

Racism as Experienced by Physicians of Color in the Health Care Setting . Serafini K, Coyer C, Brown Speights J, et al. Fam Med. 2020: 52(4):282-287. 

PedHITSS: A Screening Tool to Detect Childhood Abuse in Clinical Settings . Shakil A, Day PG, Chu J, Woods SB, Bridges K. Fam Med. 2018;50(10):763-769.

The Shared Principles of Primary Care: A Multistakeholder Initiative to Find a Common Voice . Epperly T, Bechtel C, Sweeney R, et al. Fam Med. 2019;51(2):179-184.

Joint Guidelines for Protected Nonclinical Time for Faculty in Family Medicine Residency Programs. Griesbach S, Theobald M, Kolman K, et al.   Fam Med. 2021;53(6):443-452. 

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Digital Commons @ USF > College of Public Health > Community and Family Health > Theses and Dissertations

Community and Family Health Theses and Dissertations

Theses/dissertations from 2023 2023.

The Influence of Psychosocial Factors on Opioid Decision-Making for Cancer-Related Pain Among Breast Cancer Survivors: A Mixed Method Study , Melody Nichole Chavez

Improving Interview Skills through Virtual Reality with Behavior Skills Training for Students with Disabilities , Garrit DuBois

Theses/Dissertations from 2022 2022

Exploring Parenthood and the Influence of Lived Experiences on Parenting Behaviors Among Child Welfare-Involved Adults , Veronica Howell

Theses/Dissertations from 2021 2021

Multi-object Localization in Robotic Hand , Tsing Tsow

Theses/Dissertations from 2019 2019

Cancer-Related Risk Behaviors and Screening Intention among Recreational Sport Athletes , Aldenise P. Ewing

Understanding the Family Planning Care Experiences of Young Black Women Using an Intersectionality Mixed Methods Approach , Rachel G. Logan

Understanding the Implementation of Integrated Care for People Living with HIV , Vickie A. Lynn

Effects of an Academic Enrichment Program on Elementary-Aged Students' Performance , Lauren E. Nieder

Risk and Resilience Pertaining to Mental Health of Youth Attending a College in Kathmandu Who Were Exposed to the 2015 Earthquakes During Their Adolescence: A Mixed Method Study , Vinita Sharma

Understanding the adoption process of an HPV vaccine school-entry requirement in Puerto Rico , Coralia Vázquez-Otero

Theses/Dissertations from 2018 2018

The Nutrition Transition Among the Andean Kichwas of Ecuador , Vanessa Alicia Chee

Teaching Debit Card Skills Using General Case Programming , Kristin More

An Examination of Factors that Affect the Utilization of Mental Health Services by Adolescents , Nichole A. Murray

An examination of the relationship between health literacy and dietary practices among college students: A test of the Integrated Model of Health Literacy , Alison B. Oberne

Through the Lens of Objectification Theory: Social Media Use and Women's Behavioral Health , Gina-Maria Roca

Theses/Dissertations from 2017 2017

Exploring Nutritional Needs, Roles, and Expectations of Latina Breast Cancer Survivors , Pamela Carolina Birriel

Mixed Method Study of Condom Use among Emerging Adults with New Sex Partners Met Online or Offline , Shana M. Green

Neighborhood Deprivation, Food Insecurity and Gestational Weight Gain , Sabrina Luke

An Exploration of Social Determinants of Health Constructs as Potential Mediators between Disability and Condom Usage , Karina Pineda

Reducing Caregiver Burden: Fostering Healthy Aging and Social Support , Maria A. Rodriguez

Theses/Dissertations from 2016 2016

Using Auditory Feedback to Improve Striking for Mixed Martial Artists , Frank Krukauskas Krukauskas

Contextual Factors and the Syndemic of Alcohol Use and Risky Sexual Behaviors Among Men Who Have Sex with Men , Humberto López Castillo

Exploration of the Pregnancy-Related Health Information Seeking Behavior of Women who Gave Birth in the Past Year , Laura Kathleen Merrell

Investigating Pakistan’s Contraception Rate Plateau: A Multilevel Analysis to Understand the Association between Community Contextual Factors and Modern Contraception Use , Mahmooda Khaliq Pasha

An Assessment of Elementary School Children’s Diet and Physical Activity Levels , Karen Tamara Serrano Arce

Smoking Among Youth Living with HIV: The Intersection of Behavioral Health and Chronic Disease , Todd Wells

Theses/Dissertations from 2015 2015

Food Insecurity and Hunger Experiences and their Impact on Food Pantry Clients in the Tampa Bay , Nora Brickhouse Arriola

Exploring the Underlying Mechanisms of Comorbid ADHD and Eating Disorders , Jennifer Rebecca Bleck

Theoretically Guided Examination of Caregiver Strain and its Relationship with School-Based Mental Health Services Utilization and Parent Engagement in Services , Amy Lynn Green

Pathogenic Policy: Health-Related Consequences of Immigrant Policing in Atlanta, GA , Nolan Sean Kline

Associations between Social Determinants of Health and Adolescent Pregnancy: An Analysis of Data from the National Longitudinal Study of Adolescent to Adult Health , Sarah Britney Maness

Reproductive Health Seeking Behaviors Among Female University Students: An Action Oriented Exploratory Study , Robin Emily Mowson

Women’s Use Of and Decision‐Making Regarding Geo‐Social Networking Applications to Arrange Sexual Experiences , Shireen Mary Noble

HEALTH INFOR[M-ED] : Black College Females Discuss a Virtual Reality (VR) Platform for Sexual Health Education and Training , Henry Arnett Ross

The Influence of Relationship Status on HPV Vaccine Decision-Making among Young Adult Women , Erika L. Thompson

HPV Vaccine Decision-Making among Male Sexual Minorities: An Integrative Theoretical Framework for Vaccine Promotion , Christopher W. Wheldon

Implementation of Medicaid Managed Long-term Services and Supports for Adults with Intellectual and/or Developmental Disabilities: A State’s Experience , Heather Jeanne Williamson

Theses/Dissertations from 2014 2014

Use of System Dynamics Modeling to Explicate the Theory-of-Change of a Social Marketing Innovation , Brian J. Biroscak

Risk Factors for Recurrent Major Depressive Disorder in a Nationally Representative Sample , Graig Charles DeFeo

Residency Education in Preparing Adolescent and Young Adults for Transition to Adult Care: A Mixed Methods Pilot Study , Janet S. Hess

Paternal Support for Breastfeeding: A Mixed Methods Study to Identify Positive and Negative Forms of Paternal Social Support for Breastfeeding As Perceived by First-time Parent Couples , Amy Lester

Monitoring and Use of Social Media In Emergncy Management In Florida , Leila Martini

An Exploration of the Health Experiences of Youth Who Were Trafficked for Sex , Christine Ann Meister

Individual and Partner Characteristics Associated with Genital Herpes Disclosure and the Relationship between Disclosure Outcomes, Rejection, and Future Intentions to Disclose , Jaime L. Myers

Understanding Factors Determining Early Termination from a Government Assistance Program for Maternal and Child Health: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) , Anthony Dominic Panzera

An Examination of Coalition Functioning and Use of Evidence-Based Practices: A Case Study of Four Community Substance Abuse Coalitions , Nichole M. Snyder

Religiosity, Spirituality, and Depressive Symptoms in Older Adults in an Active Living Community , Monica D'adrianne Solomon

Long-Term Mindfulness Meditation: Anxiety, Depression, Stress And Pain, Is There A Connection For Public Health? , Sara Spowart

Substance Abuse Prevention in American Indian and Alaska Native Communities: Exploration of Guiding Theoretical Underpinnings and Theoretical Fit in Practice , Margaret L. Walsh

Theses/Dissertations from 2013 2013

Universal Tumor Screening for Lynch Syndrome: Identification of system-level implementation factors influencing patient reach , Deborah Le Cragun

The Water Culture Beliefs of Embera Communities and Maternal and Child Health in the Republic of Panama , Ilenia Anneth Forero

An Exploration of the Meaning and Consequences of Unintended Pregnancy among Latina Cultural Subgroups: Social, Cultural, Structural, Historical and Political Influences , Natalie Dolores Hernandez

The Relationship between High School Coaches' Beliefs about Sports Injury and Prevention Practice Readiness , Siwon Jang

Parent Distress in Life with a Child with Type 1 Diabetes , Lauren Nicole Johnson

Parent Pathways: Recognition and Responses to Developmental Delays in Young Children , Jennifer Marshall

The Role of Connectedness and Religious Factors on Bullying Participation among Preadolescents in Puerto Rico , Melissa C. Mercado-Crespo

Utilizing Habit Reversal and Contingency Contracting to Impact Eating Habits With Obese Individuals , Christopher Thomas Scull

Theses/Dissertations from 2012 2012

A Study of Potential Risk Factors of Depression among Latina Breast Cancer Survivors , Claudia Ximena Aguado Loi

Assessing the Psychometric Properties Of A Self-Efficacy Measure Within A Patient Navigation Research Program , Mariana Arevalo

A Cross-National Analysis of the Human Papillomavirus, Sexually Transmitted Infections, and Sexual Behavior among Men , Euna Marie August

A Systematic Review of Interventions to Increase Mental Health Service Use , Jennifer Greene

Beliefs of and Attitudes Toward Sexual Violence by a Diverse Group of Self-Identified Male Collegiate Athletes , Belinda-Rose James

Theses/Dissertations from 2011 2011

Drug Courts Work, but How? Preliminary Development of a Measure to Assess Drug Court Structure and Processes , Blake Barrett

The Role of Male Partners in Childbirth Decision Making: A Qualitative Exploration with First-Time Parenting Couples , Sharon Dejoy

Navigating the Child Welfare System: An Exploratory Study of Families' Experiences , Lianne Fuino Estefan

An Evaluation of the Early Steps Referral Process in Hillsborough County to Detect Delays in Access to Early Intervention Services , Jessica Fry Johnson

Understanding the Psychosocial Aspects of Waterpipe Smoking Among College Students , Mary Pautler Martinasek

Theses/Dissertations from 2010 2010

Low Documented Risk Cesarean Sections and Late-Preterm Births: The Florida Experience , Heather Breeze Clayton

An Exploratory Study of the Intrapersonal, Socio-cultural, and Behavioral Factors that Influence HIV Risk Behaviors Among Ethnic Subgroups of Black Heterosexual Men: The Intersection of the Beliefs and Perceptions of Black Women , Shalewa Noel-Thomas

Before the Storm: Evacuation Intention and Audience Segmentation , Homer J. Rice

The Relationship Between Knowledge and Beliefs About Human Papillomavirus, Acceptance of the Human Papillomavirus Vaccine, and Intentions to Practice Safer Sex Behaviors Among Female College Students , Theresa Scorcia-Wilson

Exploring Colorectal Cancer Diagnosis Disclosure to First-Degree Relatives: An African American Family Case Series , Kamilah B. Thomas

Theses/Dissertations from 2009 2009

Determinants of Nutrition Appointment Non-Attendance among Male Veterans , Claire Fontenot Bell

Exploring the Effects of BMI Health Report Card Letters Among 6 th Grade Students and Parents: An Application of the Social Cognitive Theory , Jenna M. Kaczmarski

Examining the Title X Family Planning Program’s (Public Law 91-572) Legislative History through a Feminist Lens: A Thematic Analysis and Oral Histories with Key Stakeholders in Florida , Cheryl A. Vamos

Theses/Dissertations from 2008 2008

The Getting Ready to Learn Program: An Impact Report , Rosa M. Avila

The Cumulative Effects of Victimization, Community Violence, and Household Dysfunction on Depression and Suicide Ideation in a Cohort of Adolescent Females , Katherine Best

Dental Hygienists' Beliefs, Norms, Attitudes, and Intentions Toward Treating HIV/AIDS Patients , Barbara Clark-Alexander

Organizational Culture in Children's Mental Health Systems of Care , Jessica Mazza

A Modified Obesity Proneness Model in the Prediction of Weight Status Among High School Students , Joyce E. Nickelson

The Role of Pharmacists and Emergency Contraception: An Assessment of Pharmacy School Curricula in the U.S. and the Knowledge, Attitudes, and Dispensing Practices of Florida Pharmacists. , Alice R. Richman

Measuring Culture Change as an Evaluation Indicator: Applying Cultural Consensus Analysis to Cultural Models of Lymphatic Filariasis in Haiti , Kelly M. Simpson

Association among Neonatal Mortality, Weekend or Nighttime Admissions And Staffing in a Neonatal Intensive Care Unit , Leisa J. Stanley

The Social Construction of a Special Needs Program for Hurricanes , Robert E. Tabler Jr., M.A., C.H.E.S.

Theses/Dissertations from 2007 2007

Attitudinal factors related to driving behaviors of young adults in Belize: An application of the precaution adoption process model , Ismael A. Hoare

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Formal MD Thesis Requirement

All students at Yale School of Medicine engage in research and are required to write an MD thesis during medical school. The only exceptions are students who have earned a PhD degree in the health sciences before matriculation and students enrolled in Yale’s MD/PhD program. The YSM MD Thesis is under the governance of the EPCC, which meets regularly to recommend rules, regulations, and deadlines.

Deadlines/Important Dates

Thesis approval process, thesis awards, required formatting and components of the md thesis, examples for reference section formatting, avoiding the risk of copyright violation and liability when submitting your md thesis, instructions for submitting a thesis to the yale medicine thesis digital library, thesis depositors declaration form, evaluations of advisor, student evaluation of thesis advisor.

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Thesis Deadlines for the 2023-2024 Academic Year

Md students:.

The Office of Student Research, in conjunction with the Dean’s Office, has established the following deadlines for theses submitted in partial fulfillment of the requirements for graduation in May 2024. The deadlines ensure that (1) students have sufficient time to complete their theses; (2) that there is sufficient time for rigorous departmental review and subsequent revision by students before final approval. These deadlines are strictly followed. Students are strongly encouraged to submit their theses well before the Class of 2024 Thesis Deadlines provided below. This timeliness will provide students, advisors, and sponsoring departments sufficient time for useful review and revision. It should be recognized by all concerned that the integrity of the thesis requirement and effective, rigorous review requires adherence to these deadlines. OSR will hold periodic “Thesis Check-in Sessions” via zoom for the Class of 2024 and will send periodic reminder emails with more detailed instructions as these deadlines approach.

*Students missing the August 4th, January 19th, and/or March 29th deadlines will be referred to the Progress Committee to ensure they receive adequate support to make progress towards this graduation requirement. Students missing the January 19th and/or March 29th deadlines will be ineligible for thesis prizes at graduation.

Extensions beyond the above thesis deadlines will be granted only for special circumstances and must have the approval of the student’s thesis mentor/advisor, academic advisor, and the Departmental Thesis Chairperson . Students seeking an extension for the January 19, 2024, deadline must submit a Thesis Deadline Extension Request Form to their Academic Advisor, and the Departmental Thesis Chair, for approval. Students missing the August 4th, January 19th, and/or March 29th deadlines will be referred to the Progress Committee to ensure they receive adequate support to make progress towards this graduation requirement. In the event of an extension, if granted, the following ABSOLUTE Class of 2024 Thesis Extension Deadlines will apply:

*All late theses require an extension. The student must submit the Thesis Deadline Extension Request Form before January 19, 2024.

MD/MHS Students:

Consistent with degree requirements, MD/MHS students must present their thesis to their three-person committee prior to the January 19th deadline. Students are encouraged to start arranging the date of this committee meeting in the fall to avoid unanticipated delays.

MD/PhD Students:

A different process applies to students in the MD/PhD program. For students enrolled in the combined MD/PhD Program, the dissertation submitted to and approved by the Graduate School will satisfy the MD thesis requirement. Therefore, MD/PhD students who have already defended their dissertation and received their PhD should provide this information to OSR via email as soon as possible.

To ensure compliance with YSM graduation deadlines, MD/PhD students in the class of 2024 who have not defended and submitted their dissertation to the Graduate School by the October 1, 2023, deadline will need to submit a copy of their dissertation directly to OSR via the MD/PhD Box Upload Link by March 15, 2024. OSR will convene a committee to review the dissertation, obtain feedback, and provide approval for graduation. Please note that MD/PhD students must also defend and submit their dissertation to the Graduate School no later than March 15, 2024, to meet the Graduate School spring degree deadline for conferral of the PhD degree. MD/PhD students who have not yet defended their dissertation should provide this information to OSR. If there are any questions about the process, please contact the MD/PhD Office.

Financial support is not provided for writing the thesis.

Thesis Preparation and Approval

Preparation for thesis submission begins in the summer of the fourth year with the OSR leadership. At this time, timeline and practices are distributed via email and reviewed with students in class meetings. Because thesis approval is a lengthy process involving three levels of review, students are encouraged to manage their time well and start writing their first draft early in the fall semester of their final year of medical school. A suggested timeline is provided below.

July : Thesis deadlines are distributed via email to all students in the graduating class and an informational session is held. Students should be on track to complete their thesis research by mid-fall. Any student anticipating a challenge in this regard should contact the OSR as soon as possible. All students expecting to graduate in May of a given year must, provide the OSR with information regarding their thesis title and mentor/advisor. Students will receive an email from the OSR containing a Medtrics link requesting this information. The OSR will contact all thesis mentors/advisors to confirm this role and to provide information and expectations regarding the thesis process.

August – December : Students should be finalizing research and writing their thesis draft. As the semester progresses, activities should shift from the data generation/analysis to the writing of the actual thesis. Students should do their best to complete the first draft of the thesis by mid-late December. Because students are also involved in the residency application and interview process, they are discouraged from starting new projects at this time.

December – January : This period is devoted to reviewing and editing of thesis draft that is ultimately approved by their thesis mentor/advisor and submitted by the student to the Thesis Chair of their sponsoring department. The YSM thesis mentor/advisor will be asked to complete a thesis assessment that evaluates the student’s mastery of YSM’s research-related educational objectives and provides formative summative feedback to the student.

January – March : The Departmental Thesis Chair coordinates thesis review by external reviewers. An “external reviewer” is defined as an individual who is not directly involved in the project. This individual may be a Yale faculty member internal or external to YSM or may hold a faculty appointment at an outside institution. This reviewer is required to complete a thesis assessment and provide formative summative feedback, as well as recommendations for any required changes, to the thesis. Departmental Thesis Chairs review assessments, notify students of departmental approval, and transmit these approvals to the OSR.

March : Theses and their associated assessments undergo school-level review by the OSR. Students receive YSM approval of their thesis along with summative feedback obtained during the review process. Students incorporate any required changes into their thesis and upload to the Yale Medicine Digital Thesis Library/Eli Scholar via the ProQuest platform (see below).

April : The OSR confirms that theses have been deposited into the Yale Medicine Digital Thesis Library and the registrar receives the names of students who have completed the thesis requirement.

The central role of the medical student thesis is to assess student’s performance on the YSM’s research-related educational objectives. As such, all students are expected to produce an excellent piece of scholarly work. In recognition of these achievements, the OSR has worked to develop an award process that celebrates the wonderful research being done by our students without creating a competitive atmosphere surrounding the thesis. Hence, thesis awards are based on competency-based assessments submitted by thesis mentors/advisors and reviewers during the approval process, and internal review of the final thesis that was deposited into the Yale Medicine Digital Thesis Library. Consistent with all other graduation prizes, YSM MD Thesis Awards will remain confidential until they are announced in the YSM Commencement Program on May 20, 2024. While some departments may elect to confer thesis “honors” based upon their own internal review, this recognition is distinct from YSM graduation prizes and is not under OSR’s purview.

Read about the required formatting and components for the thesis .

See helpful examples for reference section formatting.

Read about avoiding the risk of copyright violation and liability when submitting your MD Thesis.

Learn more about submitting a thesis to the Yale Medicine Thesis Digital Library .

Learn more about the Thesis Depositors Declaration Form.

Learn more about evaluating your experience with your thesis advisor .

Apply for a Thesis Extension

Read about the required formatting and components for the thesis.

Yale Journal of Biology and Medicine

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Yale Medicine Thesis Digital Library

Starting with the Yale School of Medicine (YSM) graduating class of 2002, the Cushing/Whitney Medical Library and YSM Office of Student Research have collaborated on the Yale Medicine Thesis Digital Library (YMTDL) project, publishing the digitized full text of medical student theses on the web as a valuable byproduct of Yale student research efforts. The digital thesis deposit has been a graduation requirement since 2006. Starting in 2012, alumni of the Yale School of Medicine were invited to participate in the YMTDL project by granting scanning and hosting permission to the Cushing/Whitney Medical Library, which digitized the Library’s print copy of their thesis or dissertation. A grant from the Arcadia Fund in 2017 provided the means for digitizing over 1,000 additional theses. IF YOU ARE A MEMBER OF THE YALE COMMUNITY AND NEED ACCESS TO A THESIS RESTRICTED TO THE YALE NETWORK, PLEASE MAKE SURE YOUR VPN (VIRTUAL PRIVATE NETWORK) IS ON.

Theses/Dissertations from 2023 2023

Radiomics: A Methodological Guide And Its Applications To Acute Ischemic Stroke , Emily Avery

Characterization Of Cutaneous Immune-Related Adverse Events Due To Immune Checkpoint Inhibitors , Annika Belzer

An Investigation Of Novel Point Of Care 1-Tesla Mri Of Infants’ Brains In The Neonatal Icu , Elisa Rachel Berson

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center , Gabriel BetancurVelez

Effectiveness Of Acitretin For Skin Cancer Prevention In Immunosuppressed And Non-Immunosuppressed Patients , Shaman Bhullar

Adherence To Tumor Board Recommendations In Patients With Hepatocellular Carcinoma , Yueming Cao

Clinical Trials Related To The Spine & Shoulder/elbow: Rates, Predictors, & Reasons For Termination , Dennis Louis Caruana

Improving Delivery Of Immunomodulator Mpla With Biodegradable Nanoparticles , Jungsoo Chang

Sex Differences In Patients With Deep Vein Thrombosis , Shin Mei Chan

Incorporating Genomic Analysis In The Clinical Practice Of Hepatology , David Hun Chung

Emergency Medicine Resident Perceptions Of A Medical Wilderness Adventure Race (medwar) , Lake Crawford

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis , Wyatt Benajmin David

Representing Cells As Sentences Enables Natural Language Processing For Single Cell Transcriptomics , Rahul M. Dhodapkar

Life Vs. Liberty And The Pursuit Of Happiness: Short-Term Involuntary Commitment Laws In All 50 US States , Sofia Dibich

Healthcare Disparities In Preoperative Risk Management For Total Joint Arthroplasty , Chloe Connolly Dlott

Toll-Like Receptors 2/4 Directly Co-Stimulate Arginase-1 Induction Critical For Macrophage-Mediated Renal Tubule Regeneration , Natnael Beyene Doilicho

Associations Of Atopic Dermatitis With Neuropsychiatric Comorbidities , Ryan Fan

International Academic Partnerships In Orthopaedic Surgery , Michael Jesse Flores

Young Adults With Adhd And Their Involvement In Online Communities: A Qualitative Study , Callie Marie Ginapp

Becoming A Doctor, Becoming A Monster: Medical Socialization And Desensitization In Nazi Germany And 21st Century USA , SimoneElise Stern Hasselmo

Comparative Efficacy Of Pharmacological Interventions For Borderline Personality Disorder: A Network Meta-Analysis , Olivia Dixon Herrington

An Examination Of Honor Society Membership, Mistreatment, And Discrimination By Medical Student Demographics , Katherine Ann Hill

Factors Influencing Decision For Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy , Julian Huang

Beta-Catenin Nuclear Transport In Wnt Signaling: Kap-Beta2/transportin Mediates Nuclear Import Of Beta-Catenin Via A Py-Nls Motif In A Ran Gtpase Dependent Manner , Woong Y. Hwang

Perspectives On Emergency Department-Initiated Buprenorphine Among Clinical Pharmacists , Marissa Justen

Examination For Independent Predictors Of Seasonality Of Birth Across Forty-Nine Low- And Middle-Income Countries: Analyses Of The United States Agency For International Development Demographic And Health Survey Data , Jehanzeb Kayani

Pediatricians, Social Identity, And The Law In The Early-Twentieth-Century United States , Christopher R. Keys

Single Neuronal Firing Dynamics In A Mouse Model For Absence Seizures , Waleed Khan

The Impact Of Cannabidiol In Patients With Early Psychosis: A Randomized Controlled Trial , Sreeja Kodali

Renalase Agonist Therapy And The Cardiac Response To Pressure Overload In Chronic Kidney Disease , Govind Krishna Kumar Nair

Sociodemographic And Insurance Disparities In Urologic Oncology Care Access And Surgical Outcomes , Folawiyo Laditi

How Ethics Committees Deliberate Resource Allocation For Undocumented Children, A Qualitative Analysis , YuKyung Lee

Mental Health Service Use Among Immigrant And U.S. Born Asian American Pacific Islanders , Hieronimus Loho

Severity And Operative Age In Metopic Synostosis: The Association With Neurocognitive Outcomes , Aaron Samuel Long

Comparison Of The Bone Bruise Patterns In Contact And Non-Contact Acute Anterior Cruciate Ligament Injuries , Jay Thomas Moran

Multi-Omic Differences Between Right And Left Sided Colorectal Cancer Liver Metastases , Montana Tremaine Morris

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research , Muzzammil Imran Muhammad

Investigating Effects Of Glycolysis Inhibition On Metabolism And Extracellular Ph In A Mouse Model Of Hepatocellular Carcinoma , David Nam

Applying Deep Learning To Identify Imaging Biomarkers To Predict Cardiac Outcomes In Cancer Patients , Aishwarya Kishore Nene

Incarcerated Patients Have Higher Mortality After Trauma: An Unreported Healthcare Disparity , Harry NewmanPlotnick

The Association Between Social Needs Care Coordination And Social Needs Status Amongst Patients In A Federally Qualified Health Center , Autumn Nobles

Diagnosis Of Polycystic Ovary Syndrome And Non-Hispanic Black Race Are Predictive Of Hypertension In Reproductive Age Women -Analysis Of Real World Electronic Medical Record Data , Nyerovwo Okifo

Utility Of Shear Wave Elastography In Breast Cancer Diagnosis: A Systematic Review And Meta-Analysis , Aishwarya Pillai

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State , Anna Grace Preston

Associations Of Frailty With Tumor Characteristics & Longitudinal Outcomes In Patients With Meningiomas , Hanya M. Qureshi

A Single Nucleotide Polymorphism In An Rgs6 Enhancer Regulates Heart Rate Variability And Parasympathetic Modulation , Namita Ravi

Firearm Injury Prevention Strategies In Children And Young Adults , Christopher Schenck

Assessing Quality Of Oral Cancer Care Across A Health System And Region: Opportunities To Improve Care , Hemali Parimal Shah

Single-Cell Transcriptomic Atlas Reveals Molecular Drivers Of Human Inner Ear Development , Amar H. Sheth

More Than Meets The Eye: Improving Recognition Of Child Abuse In Emergency Departments , May Shum

A Novel Smarcc1-Mutant Bafopathy Implicates Epigenetic Dysregulation Of Fetal Neural Progenitors In The Pathogenesis Of Congenital Hydrocephalus , Amrita K. Singh

Baseline Skin Cytokine Profiles Determined By Rna In Situ Hybridization Correlate With Response To Dupilumab In Patients With Eczematous Dermatitis , Katelyn Singh

Barriers To Identifying Learning Disabilities: A Qualitative Study Of Clinicians And Educators , Lauren Stone

"Come On. I Need An Answer." A Mixed-Methods Study Of Barriers And Disparities In Diagnostic Odysseys , Zeyu Tang

Cognitive Impairment And Long-Term Health Outcomes In Patients With Coronary Microvascular Dysfunction , Abriana Tasillo

Family Dyads, Emotional Labor, And The Theater Of The Clinical Encounter: Co-Constructive Patient Simulation As A Reflective Tool In Child And Adolescent Psychiatry Training , Isaiah Thomas

Comparative Effectiveness Of Digital Breast Tomosynthesis For Breast Cancer Screening In Older Women , Akhil Upneja

Analysis Of Prices And Outcomes For Common Hospitalized Conditions In 2021 , Lina Vadlamani

Recording Multiunit Activity Of The Locus Coeruleus In An Awake Mouse Model Of Focal Limbic Seizures , Marcus Valcarce-Aspegren

Improving Cancer Classification With Domain Adaptation Techniques , Juliana Veira

Soil-Transmitted Helminthiases And Deworming Response In School-Aged Children In Retalhuleu, Guatemala , Rebeca Esther Vergara Greeno

The Synergy Between Physiologic Dendritic Cells And Mrna-Loaded Lipid Nanoparticles And Its Potential As A Cellular Immunotherapy , Brian Myles Wei

Lipid Profiles Help Explain Protection From Atherosclerosis In Ascending Aortic Aneurysm Patients , Gabe Weininger

The Impact Of Peer Interventions On Physical Activity For Individuals Living With Mental Illness , Julia Wolfe

Perioperative Outcomes In Patients With Systemic Sclerosis: An Analysis Of A Large Case Series , Luying Yan

Engineering And Evaluating Biodegradable Bioadhesive Nanoparticle-Encapsulated Sunscreens , Beverly Xi Yu

Theses/Dissertations from 2022 2022

Contested Spaces, Stigmatized Treatment: Methadone In 1970s New York, Boston, And New Orleans , Zoe Miranda Adams

Comorbid Pad And Mvd: A Retrospective Nrd Analysis Of Trends, Outcomes, And Readmissions , Miguel Algara

Epidemiology Of Domestic Violence-Related Ocular Injuries Among Adult Patients , Joana E. Andoh

Longitudinal Modeling Of Early Hiv Burden In The Central Nervous System , Victor Diego Armengol

Generating Clinical Evidence Using Real World Data And Personal Digital Devices , Victoria L. Bartlett

Incidence And Prognosis Of Cranial Neuropathies In Children With Covid-19: A Systematic Review And Meta-Analysis , Priyanka Bisarya

A Deep Dive In Head & Neck Cancer: Machine Learning Applications In Diagnostic And Prognostic Evaluations , Alexandra Tan Bourdillon

A Serological Survey Of Sars-Cov-2 Infection In Casino Employees , Julian Campillo Luna

The Real Cause Of The Broken Rib: Developments In Pediatricians' Approach To Child Abuse; 1960 - 2020 , Sofia Charania

Identification Of A Novel Link Between Adiposity And Visuospatial Ability , Herbert Alexander Chen

Predictors Of Very Late Onset Infection In Kidney Transplant Recipients At Least Ten Years Post Transplant , Harry Cheung

Deep Learning Algorithms For Predicting Response To Neoadjuvant Chemotherapy For Breast Cancer , Rachel Choi

Testing Ictal Conscious Awareness: Responsiveness Versus Recall Of Experiences During Seizures , Violeta Contreras Ramirez

Mechanisms Of Progestin Resistance In Reproductive-Age Women With Atypical Endometrial Hyperplasia , Katherine Mcmaster Cooke

Biomarkers Of Egfr Decline After Pediatric Cardiac Surgery In The Assess-Aki Cohort , Christina Anne-Josiane De Fontnouvelle

Amd3100 Administration For The Treatment Of Asherman’s Syndrome In A Murine Model , Pablo Antonio Delis

Fracture Callus Evaluation In The Setting Of Breast Cancer Metastasis And Rescue Of Healing Via Inhibition Of Erk1/2 , Christopher Dussik

Primary Care Characteristics And Medication Management Among Patients Receiving Office Based Opioid Treatment With Buprenorphine , Xinxin Du

Factors Impacting Trauma-Specific Quality Of Life Following Injury: A Multi-Center Assessment In Lebanon , Ali Elreichouni

Consciousness: Mechanisms And Neuropsychiatric Outcomes , Isaac Gilbert Freedman

Investigation Of Outcomes Following Cervical Spine Surgery In Patients With Pre-Existing Non-Spinal Neurological Conditions , Anoop Raj Galivanche

Medical Students’ Experiences, Knowledge, And Perceptions Of Patients With Substance Use Disorder , Sophia Francesca Gamez

“people Fall Through The Cracks”: Prolonged Lengths Of Stay Beyond Medical Necessity , Lucy Gao

Housing As Healthcare: The Role Of Homelessness In Patient Characteristics And Retention In Outpatient Medication For Opioid Use Disorder Treatment , Marina Gaeta Gazzola

Sleep Apnea In Veterans With Schizophrenia: Estimating Prevalence And Impact On Cognition , Stephen Edward Ghazikhanian

Self-Injurious Behavior And Problematic Video Gaming In Adolescents With Problematic Shopping , Norman Robert Greenberg

Importance Of Social Support In Older Adults After Hospitalization For Acute Myocardial Infarction , Yaakov Green

In-Vivo Nanoparticle Delivery To Fetal Mouse Pancreas And Liver , Mary Elizabeth Guerra

Characteristics Of Inpatient Behavioral Health Services And Hormonal Treatment Decision-Making In Transgender/gender-Expansive Youth , Justin William Halloran

Preferential Utilization Of Resident Physicians To Care For Patients With Medicaid And Persons Of Color At Us Academic Health Centers , Samer Hassan

Atypical Presentation Of Hereditary Hypophosphatemic Rickets With Hypercalciuria Due To Digenic Mutations , Bryan Bo-Ran Ho

Gender Differences In Outcomes Of Coordinated Specialty Care For Early Psychosis , Seong Im Hong

Resident Physician Thriving And The Residency Experience During The Covid-19 Pandemic: A Qualitative Study , Joshua Hyman

Early Experience With The Fda’s Breakthrough Devices Program And Potential Payment Mechanisms , James Johnston

Page 1 of 31

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Faculty of Family Medicine Dissertations

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Home > MAHE Student Work > KMCMLR

Kasturba Medical College, Mangalore Theses and Dissertations

Theses/dissertations from 2021 2021.

“The Impact of Self-Stigma of Seeking Help and Perceived Social Support on Burnout among Clinical Psychologists” , Aavrita A

The impact of self-stigma of seeking help &percieved social support on burnout among clinical psychologists. , Aavrita .

Immediate Effects of Novel Hand Rehabilitation Board on Fine Motor Skills in Children with Cerebral Palsy. , Romita Fernandes. Abraham

"COMPARISON OF THREE SCORING CRITERIA TO ASSESS RECOVERY FROM GENERAL ANAESTHESIA IN THE POST-ANAESTHESIA CARE UNIT- A LONGITUDINAL OBSERVATIONAL STUDY " , Shagun Aggarwal

Comparative predictive validity of Alberta Infant Motor Scale and Infant Neurological International Battery in Low Birth Weight Infants- A Prospective Longitudinal Study. , Polisetti Siva Sai Anand

Antagonistic Asynchrony in Muscle Recruitment Pattern of Forward Reach Movement In Children With Cerebral Palsy. , Sanya Anklesaria

Muscle fatigue response of rotator cuff muscles in sitting and standing postures , Lisanne Aranha

Effectiveness of static weight bearing versus modified constraint induced movement therapy on improving hand function in hemiplegic cerebral palsy- A Randomized Clinical Trial. , Ruth Bavighar

How informed are our patients about generic medicines? – A study from coastal South India , Darshan BB

Morphological variants of the human spleen, a cadaveric study , Murlimanju BV

Association between cervical breast cancer and Diabtetes mellitus among women seeking health care in tertiary hospitals od south India: A cross sectional study , Pratik Kumar Chatterjee

Carcinoma Breast in among Women with Diabetes Mellitus: A Case Control Study , Pratik Kumar Chatterjee

Perception of Empathy among medical students: A cross sectional study , Pratik Kumar Chatterjee

CLINICOMYCOLOGICAL PROFILE OF DERMATOPHYTOSIS IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA , Adyashree Dalai

Study of outcome of Ponseti technique of management for idiopathic clubfoot in a tertiary center in south India , Lulu Damsas

Comparative study of emotional labour &burnout on life satisfaction among school teachers across different educational settings , Meghana Dharampalan

“Comparative Study of Emotional Labor and Burnout on Life Satisfaction Among School Teachers Across Different Educational Settings” , Meghana V. Dharmapalan

“Relationship Between Sexual Fantasy, Sexual Communication, Personality Traits and Sexual Satisfaction in Married Individuals” , Rhea Dhir

Comparing the efficacy of USG guided supraclavicular brachial plexus block with or without intercostobrachial nerve block for forearm surgeries – an observational study , DIKSHA D’MELLO

Does Quality of Sitting influence Functional Mobility in Cerebral Palsy? A cross-sectional study , Kaiorisa N. Doctor

Factors effecting gait velocity in osteoarthritis knee-An observational study. , Lisha Gretal D’silva

Effect of Inspiratory Muscle Training on Pulmonary Function, Functional Capacity, Quality Of Life And Length Of Stay in individuals undergoing Cardiac Surgery , Fiona Verdine Dsouza

Relationship of Academic Resilience with Self-Efficacy, and Perceived Social Support; Among Civil Service Aspirants , Neha Eldho

EFFICACY, FEASIBILITY, AND SAFETY OF PERCUTANEOUS IMAGE-GUIDED CATHETER DRAINAGE OF THORACIC, ABDOMINAL, AND PELVIC FLUID COLLECTION , Aishwarya Gadwal

Comparison of efficacy of two different bolus doses of norepinephrine as prophylac-tic to prevent post-spinal hypotension during elective caesarean section , PRANATHI GARAPATI

Trends in Frailty and its Associated factors in Community Dwelling Elderly Indian Population during COVID-19 Pandemic- A Prospective Analytical Study , Karan Gautam

Speech Sound acquisition in some south Indian Dravidian languages: A systematic review , Jesica George

Comparison of Femoral nerve block with Dexmedetomidine and Adductor canal block with Dexmedetomidine for postoperative analgesia for Total Knee Arthroplasty . , NEHA GEORGE

Assessment Of Cardiovascular Risk Factors In Patients With Osteoarthritis Knee , Sagar Goel

Effectiveness of Intermittent Cervical Traction with and without Neural Mobilization in Discogenic Cervical Radiculopathy , Aditi Goyal

Study of maternal and cord blood vitamin B12 levels with anthropometry in term neonates born to normal and malnourished mothers: a hospital based cross sectional study , Sugapradha a. GR

Development of a Questionnaire to Determine the Intervention and Service Delivery Practices of Speech-Language Pathologists for Children with Speech Sound Disorders in India , Shaily Gupta

Relationship between Physical Activity, Objective Sleep Parameters and Circadian Rhythm in Patients with Head and Neck Cancer receiving Chemoradiotherapy- A Longitudinal Study , Rachita Gururaj

“Emotional Contagion, Perceived Stress and Coping Strategies Among Nurses” , Saumya Hariharan

Assessment of knowledge and belief about stuttering among undergraduate medical students , Anushree Harihar

Association of serum lipid levels and other systemic risk factors with retinal hard exudates in diabetic retinopathy patients. , Harshita Mukesh Hiran

Assessment of risk of Diabetes Mellitus by using Indian Diabetes Risk Score among Housekeeping staff , Ramesh Holla

“Emotional Intelligence, Self-compassion, and Life-Satisfaction In Clinical Psychologists” , Vania Jacob

UPPER-CROSSED SYNDROME AND DISABILITY IN SHOULDER ADHESIVE CAPSULITIS. , Aishwarya Jaideep

Study to assess the role of doppler ultrasound in evaluation of arteriovenous hemodialysis fistula and the complications of hemodialysis access , Ishank Jain

Relationship between burnout compassion fatigue, work environment & mindfulness in medical residents , Pranay Javeri

“Relationship Between Burnout, Compassion Fatigue, Work Environment and Mindfulness in Medical Residents” , Pranay Harichandra Javeri

“Dating Anxiety in Emerging Adults” , Jisha V. Jayaprakash

“Relationship Between Tolerance for Disagreement and Mindfulness in Married Males and Married Females” , Jahnavi Jha

Antibiotic usage and susceptibility patterns in Uncomplicated UTI in a Tertiary Hospital in South India , Christy John

Association of bed rise difficulty scale with trunk impairment and functional scales among stroke patients , Leena G. John

Is there a correlation between Pediatric Berg Balance Scale and Centre of Pressure Excursion measured through Dual Axis Static Force Plate™ to assess Balance in Children with Spastic Cerebral Palsy and Typically Developing? , Niharika Joshi

Comparison of Sensory Processing Responses in Cerebral Palsy Subtypes and Typically Developing Children (7-36 months): A Cross Sectional Study. , Archana Antony K

‘A study on the Role of Learned Helplessness, Selfefficacy and Perceived Social Support in Determining Resilience in Parents of Children with Neurodevelopmental Disorders’ , Benaisha Khurshed Katrak

A study of correlation of maternal serum zinc levels with breast milk and cord blood of late preterm neonates , Rashmi Katti

Correlation of histopathology and direct immunofluorescence findings in clinically diagnosed prurigo nodularis , Haritha K

Difference in proximal femur loading due to muscle activity during partial weight bearing and NWB standing- A cross-sectional study. , Smital Kshirsagar

Effect of Sesamol on neurobiochemical changes in diet induced (DIO) obesity model of Zebra fish (Danio rerio) , Rashmii K.S.

Importance of integration of medical ethics with undergraduate medical curriculum- Instructors and student’s perspectives. , Rashmii K.S.

Long-term potentiation (LTP): A simple yet powerful cellular process in learning and memory , Rashmii K.S.

Parkinson's Disease Overview: Alternative Potential Curcumin Treatment, Current Treatment and Prevalence Among Ethnic Groups , Rashmii K.S.

Smart brain of India vs. tricky drugs , Rashmii K.S.

The Role of Professionalism and Ethics Training: Instructor’s and Student’s perspectives in a medical College , Rashmii K.S.

Violence Against Doctors: A Qualitative Study On This Rising Predicament , Rashmii K.S.

Morphometric study of the gracilis muscle and its pedicles , Chettiar Ganesh Kumar

Comparative study of bed side tests to assess difficult airway in paediatric patients , S.Abinandha Kumar

Euphorbia thymifolia (Linn.)- A review on ethno pharmacological properties , Vasavi Kumblekar

COMPARISON OF KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS THE USE OF SUNSCREEN IN DAILY LIFE BETWEEN FIRST -AND THIRD -YEAR MEDICAL STUDENTS , Aarushi Lall

‘Feminist Identity, Socio-cultural Attitude Towards Appearance, and Body Images issues in Emerging Adult Women’ , Sheena Lonappan

A novel approach to quantify the Dynamic Windlass Mechanism , Ishita Mahajan

METFORMIN VERSUS INSULIN IN THE MANAGEMENT OF GESTATIONAL DIABETES , Varikuti Manogna

Cognitive abilities among employed and unemployed middle-aged women – a systematic review , Aswini M

‘Emotional Intelligence, Job Satisfaction and Psychological Well-being Among Nurses’ , Chetna M

RELATIONSHIP OF COMPUTER AIDED DESIGN(CAD)-BASED PHOTOGRAMMETRY FOR FACIAL DYSFUNCTION WITH FACIAL GRADING SYSTEMS FOR BELL’S PALSY: A PROSPECTIVE OBSERVATIONAL STUDY , Ankita Mehendale

“Effect of Sensation Seeking and Anxious Traits on Suicidal Ideation Among Adults by Birth Order” , Haripriya G. M

Clinical & radiological assessment of intertrochanteric fractures treated with PFN A2 , Harish M

Effect of a home-based pulmonary rehabilitation programme on respiratory function, functional capacity, and quality of life in patients with chronic obstructive pulmonary disease , Vaibhavi Mhatre

Profiling Communication Characteristics of Individuals with Acquired Neuro-communication Disorder in a Tertiary Care Setup , Nikita Subudhi M

Relationship between weight bearing symmetry, trunk control and fear of fall amongst subjects with stroke: A cross sectional study , VIVIAN NEHAL MONIS

Lower extremity muscle recruitment pattern during sit to stand transfer in children with cerebral palsy as compared to typically developing children- a cross sectional study. , Kiran P. Nadgauda

Knowledge, attitudes and practices of Indian classical singers towards vocal healthcare , Raveena Muralidharan Nair

"Perspectives of Indian Speech Language Pathologists on Adolescent Language Assessment" , Rohana Muralidharan Nair

Effect Of Yoga On Perceived Stress And Pulmonary Function In High Stressed Postmenopausal Women , Vinodini NA

Refractory errors, blood groups & diabetes mellitus: A corrleative study in south Indian population , Vinodini NA

Comparison of Functional outcomes for displaced extra-articular distal radius fractures managed by Conservative versus Operative methods: A Prospective cohort study , Muhammed Ehsan Nazeer

COMPARATIVE STUDYOF THE EFFECTIVENESS OF VAPOCOOLANT SPRAY VERSUS EMLA®® CREAM IN REDUCING PAIN DURING INTRAVENOUS CANNULATION IN ADULT POPULATION , Sisla Nazer P

Assessment of attitude among public towards stuttering in a coastal city of Southern Karnataka , Prithvi N

"Severity assessment of acute pancreatitis using ct severity index and modified ct severity index: association with clinical outcomes and ranson’s criteria. " , GEETANJALI PARMAR

“The Effect of Culture Shock on Adjustment and Psychological Wellbeing Among College Going Students” , Akanksha Patra

‘Effect of Religiosity on Attitude Towards Euthanasia in Medical Students’ , Sumedha Pawar

Development Of A Questionnaire To Determine The Clinical Assessment Practices Of Speech-Language Pathologists For Children With Speech Sound Disorders In India , Prasila Elsa Philip

Correlation of oxidised LDL with oxidant and antioxidant enzymes in subjects with elevated LDL levels , Pooja p

Association of emotional intelligence of primigravida mothers with breastfeeding self efficacy in the early postpartum period and exclusive breastfeeding rates up to 6 months. , Priyanka Reddy p

Morphometric study of the Sartorius muscle and its vascular pedicles , M.D. Prameela

Comparison of the analgesic duration using ultrasound guided popliteal sciatic nerve block between diabetics with neuropathy and non-diabetics without neuropathy , GANESH PRASAD

Early follicular and Mid-luteal phase associated changes in Lower extremity Muscle strength , length and Agility in amateur female athletes – a Prospective Analytical study , Vishnu Priya

Assessment of mobile device based educational intervention on breastfeeding technique in multigravida mothers and its effect on early infant feeding pattern- A randomized controlled trial. , Keerthi Raj

THERMAL ULTRASOUND, MANIPULATION AND EXERCISE ON PAIN AND MOUTH OPENING IN CHRONIC TEMPOROMANDIBULAR JOINT DISORDER: A CASE REPORT , Suchita S. Rao

Correlation of Histopathology and Direct Immunofluorescence: Findings in clinically diagnosed Prurigo nodularis in a Tertiary care hospital , Haritha Reddy

EFFECT OF POSITIONING ON THE PAIN RESPONSE OF INFANTS VACCINATED WITH IPV AND PENTAVALENT (dtwp-HEPATITIS B-HEMOPHILUS INFLUENZA B) VACCINES , Sontosh Reddy

Assessment of the acceptable length of Right internal jugular central venous catheters. , Nivedhitha R

PRELEVANCE OF WORK RELATED DERMATOLOGICAL SYMPTOMS IN HEALTH CARE WORKERS IN COVID-19 ERA , Rana R

COMPARISON OF TWO ROUTINE FACIAL EXERCISE PROTCOLS FOR BELL’S PALSY- A RANDOMIZED CONTROLLED TRIAL , Stephanie Santiago

Profiling selected speech characteristics in individuals with Chronic Cough , Nawal Palakkal Sathar

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• v.4(2); Apr-Jun 2015

Master's and doctoral theses in family medicine and their publication output, Suez Canal University, Egypt

Hebatallah nour-eldein.

1 Department of Family Medicine, Suez Canal University, Ismailia, Egypt

Nadia M. Mansour

Abdulmajeed a. abdulmajeed, background:.

The completion of a thesis is a significant requirement for both a Master's and a doctorate degree in general practice/family medicine (GP/FM). A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The quality of the theses can be judged by the proportion of published papers.

This study aimed to describe Master's and doctoral theses in family medicine and their publications between 1982 and 2014.

Materials and Methods:

GP/FM degree theses were reviewed at the Faculty of Medicine and central Suez Canal libraries. Several characteristics were extracted from each thesis relating to the main researcher, supervisors, themes, and study methods according to predefined criteria. Publications from the theses were described.

Over 33 years, 208 theses were completed by 173 GP/FM researchers. The majority of the theses were for Master's degrees (84.1%). Regarding the study design, most of the degree theses were cross-sectional studies (76.9%). The adult population was targeted in 33.7% of research theses. Nonprobability sampling was used in 51%. Rural communities were the setting of research in 43.8%, and primary health center (PHC)-based studies in 59.1%. The “Patient” category exceeded the other categories (28.4%). Publication from theses started in the second decade of research production. Of the degree theses, 21.6% original articles were published. Only 13.3% of articles from theses were published in PubMed-indexed journals. The researcher was first author in 62.2% of published articles.

Conclusion:

The production of GP/FM theses and their publications are going to increase. Continuous assessment and planning for GP/FM studies are recommended.

Introduction

The term “research” is included in the European definition of general practice/family medicine (GP/FM): An academic and scientific discipline with its own educational content, research, evidence base and clinical activity, and a clinical specialty orientated to primary care.[ 1 ] The era of evidence-based medicine (EBM) aims to apply evidence gained by a scientific method to change current medical practice. EBM stands on the foundation of research.[ 2 ]

In many ways, research is the root of family medicine. It is a vital component of what physicians do to care for patients.[ 3 ] Most research originates from academic departments of family medicine or from collaborative initiatives with researchers in developed countries. There is generally a paucity of researchers, resources, and expertise.[ 4 ] Research experience is valuable to the physician's evidence-based practice, as it imparts skills such as literature search, collecting and analyzing data, and the critical appraisal of evidence.[ 5 ]

A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The amount of hard work and effort that goes into a thesis should not be restricted within the departmental and institutional libraries– rather, it should also reach the scientific community.[ 6 ] The quality of the theses can be judged by the proportion of published papers. One indicator of the scientific value of a thesis and its acceptability is publication in a peer-reviewed journal.[ 7 ] Publishing a journal article drawn from a completed thesis leads to career enhancement and personal satisfaction.[ 8 ]

The work that culminates in a thesis provides the basis for a professional journal article. However, writing a professional journal article differs from writing a thesis. Individuals who have completed a Master's thesis or equivalent should consider publication.[ 9 ] Previous studies performed in developed and developing countries suggest that the publication rate of theses is not very high and ranges 1.2-52.3%.[ 10 ]

At Suez Canal University (SCU), the General Practice department started the postgraduate Master's degree (M.Sc.) program in 1980, and the first physicians from the program graduated in 1982. The doctorate program was established in 1986. The name of the department was changed to Family Medicine in 1995.[ 11 ] Before 1997, there had been no FM training program in Egypt except at SCU.[ 12 ] After more than three decades, the current study was made with the aim to describe the Master's and doctoral theses and their publication rates by GP/FM researchers at SCU between 1982 and 2013.

Materials and Methods

This was an observational, descriptive study, and the required data were collected between May and November 2014.

Research selection

• Master's and doctoral theses in GP and FM available in the libraries of SCU were reviewed. The theses of GP or FM researchers in other specialties and essays/reviews were excluded
• Published articles in medical journals were included based on the name of the main researcher of GP/FM theses, and the title of the published article that could be the same or share the GP/FM thesis in its theme. Articles published in 2014 that were produced from theses in 2013 were also included. Full-text articles were reviewed in either soft or hard copies. Commentaries, letters to the editor, and publications in conferences were excluded.

Methods of search

• Theses were identified by using: (1) Manual search of thesis registries and (2) Electronic search of the SCU library website
• Published articles were identified as in the previous study by Abdulmajeed et al .:[ 13 ] (1) Manual search at the Faculty of Medicine-SCU library; (2) PubMed and Google search; (3) Both manual and internet searches at national university journal libraries and their websites for either soft or print copies.

Data analysis

The data were extracted from theses and the published articles from the same entered into a computer and analyzed using a Statistical Package for Social Sciences program (SPSS, version 20, IBM, Chicago, USA). Data were presented using descriptive statistics in the form of frequencies and percentages for the qualitative variables and Microsoft Excel 2007 for presentation in graphs.

• The production of theses and their publications in medical journals were described over more than three decades. The number of theses and publications from theses each year was described.
• Theses were analyzed for their study designs:[ 14 ] Quantitative study designs were subdivided into observational studies (cross-sectional, case control, and cohort) and intervention studies, either with randomization (controlled randomized) or without randomization (including quasi-experimental, uncontrolled, and controlled nonrandomized).[ 15 , 16 , 17 ] Sampling techniques[ 18 ] were divided into probability or nonprobability; geographical settings were described as a rural or an urban community. The community was further defined as primary health center (PHC), school, hospital, household, workplace, or social club. Population groups that were targeted by these studies were described
• The themes of theses were analyzed using five of the seven categories that were previously used in another study. These are:[ 14 ] (1) Clinical: Research related to diseases, prevention, prognosis, risk factors, and therapy; (2) Epidemiology: Research on the prevalence and incidence of diseases; (3) Family physician/Health service (FP-HS): Research related to consultations, physicians’ knowledge, attitude, or behavior regarding health problems, prescribing, training health-care teams, quality of care, health-care utilization, and undergraduate education; (4) Guidelines: Research related to development, implementation, and adherence to guidelines; and (5) Patient: Research related to the patient's compliance, the role of family issues, a patient's knowledge, attitudes, or behavior regarding illness, patients’ disease-related sociodemographic characteristics, or their quality of life. Research and remaining categories were not found within the studied theses. Additionally, the International Classification of Primary Care 2- English (ICPC 2-E) was used in the diagnoses of disease-related studies.[ 19 ] The themes or diagnoses of the theses might be multiple; the researchers included the one representing the major part of the study
• The researchers of the theses: The main researchers were analyzed for the total number of GP/FM researchers at SCU; the medical degrees of the researchers were registered as Bachelor of medicine (M.B.B.Ch.) or Master's degree (M.Sc.). Regarding the authorship of published articles, the order of the main researcher was described.
• Published articles from theses were analyzed for the following: Medical degree of the respective theses; whether regionally or nationally or internationally published; whether available on PubMed search, on journal websites, or in print only; the number of publications per one thesis; and the time between the completion and publication of a thesis.

Two hundred eight theses were reviewed at the SCU libraries. These works were completed over a period of 33 years. Figure 1 shows the numbers of theses and publications from theses. The publications from theses started in the second decade of research production and continue. Of all the theses, 5/41 (12.2%) were published in the second decade and 19/71 (26.7%) in the third decade.

The annual production of theses and their publication output

Theses characteristics

The study design of most degree theses (76.9%) was the observational cross-sectional study. A cross-sectional study design was most frequently chosen in Master's theses (89.6%). Interventions with randomization were mentioned in only 6.3% of all theses. Most of the intervention studies were mentioned in doctoral theses; nearly half of the doctoral theses (46.2%) included intervention without randomization, and only 23.1% mentioned intervention with random allocation to control groups. Of the research sampling techniques, nonprobability accounted for just over half (51%). On the other hand, 61.5% of the doctoral theses mentioned probability samples. Nearly one-third of the theses (33.7%) focused on adult populations, and a quarter of them (23.6%) on children and adolescents. Relatively more studies were carried out in rural (43.8%) than in urban communities (34.1%), but urban settings were mentioned more than rural ones in doctoral theses. More than half of the studies were carried out in PHCs (59.1%). With the exception of the Guidelines category, there was no major difference between the other four themes of research; the patient category (28.4%) was followed by FP-HS (25.5%) [ Table 1 ].

Characteristics of Master's and doctoral theses

Figure 2 shows that according to the diagnostic criteria of disease in International Classification of Primary Care, Second Edition (ICPC 2-E), general unspecified diagnosis represented one-fifth of the research, that is, 45/208 (21.6%), followed by endocrine, metabolic, and nutritional at 32/208 (15.4%), and pregnancy, childbearing, and family planning, at 24/208 (11.5%).

Diagnostic groups of degree theses according to International Classification of Primary Care, Second Edition (ICPC 2-E)

Researchers’ characteristics

One hundred sixty-seven family physicians completed 208 theses. The majority of researchers with M.B.B.Ch. (97.7%) produced Master's theses, while only 22.5% with M.Sc. degrees completed doctoral theses. More researchers completed one thesis on FM than those who completed two (83.2% vs 16.8%). Regarding the authorship of published theses, 62.2% of the main researchers were named first author, 8.9% second author, and 22.2% last author [ Table 2 ].

Characteristics of Master's and doctoral researchers

Publications from theses

The percentage of published articles from theses (1982-2014) was 21.6% of all degree theses over a period of 33 years of research production. Most of the published articles were from Master's theses (77.8%) and only 10 (22.2%) were from doctoral theses. Most of the published theses (68.9%) resulted in articles in national journals and 31.1% in regional/international journals. The majority of articles were published in journal websites (64.4%). Six out of 45 articles from theses (13.3%) were published in PubMed-indexed journals, 11.4% from Master's theses, and 20% from doctorate theses. There was a single publication from each of the 41 theses and two publications from two theses. Less than half of the published articles (42.2%) appeared in the year after the completion of the theses [ Table 3 ].

Characteristics of publications from Master's and doctoral theses

The present study reviewed the print copies of 208 Master's and doctoral theses with 45 original research articles published from them. Other studies have assessed the quality of theses by postgraduate medical students,[ 7 , 20 ] but this study described the patients and methods of degree theses.

In the present study, the study design of most degree theses was found to be the cross-sectional study (76.9%). The selection of the cross-sectional study design in Master's theses could be related to many reasons: For instance, they can be used to generate hypotheses and ideas for further research using more rigorous study designs. In addition, cross-sectional studies are relatively inexpensive and safe.[ 17 , 20 ] Doctoral theses on FM were fewer than Master's theses and this could be related to personal factors, as some of our academic members are abroad without completing their doctorate programs. On the other hand, a doctoral degree is only allowed for the academic members. Intervention designs were chosen mostly in doctoral theses, as more time and experience are required for them. High-quality studies as randomized controlled interventions were mentioned in 5% of all studies. These are expensive, and more funding might be necessary to realize more such trials.[ 21 ] In Egypt, the research in FM is developing but mostly not funded.

Half of the research sampling was either consecutive or convenience nonprobability samples. Despite the drawbacks of nonprobability sampling, the method can be useful when descriptive comments about the sample itself are desired.[ 22 ] In addition, this type of sampling explains the other finding that 59.1% of studies were carried out in PHCs, as it is quick, inexpensive, and convenient in the context of such centers. Adults (33.7%) comprised the study populations in all research theses. A possible explanation is that most chronic disease studies are confined to adult populations. More studies were carried out in rural (43.8%) than in urban (34.1%) communities. This finding is explained by the fact that seven out of 10 training centers at SCU serve rural communities.

Except for the Guidelines category, there was no major difference between the other four themes of research; the patient category accounted for 28.4%, followed by FP-HS at 25.5%. According to the diagnostic criteria of disease ICPC 2-E, a variety of topics were searched. General, unspecified diagnosis represented one-fifth of the research (21.6%), which could be related to studying PHC service within the FP-HS category; this was followed by endocrine, metabolic, and nutritional (15.4%) research, and then pregnancy, childbearing, and family planning (11.5%), the diagnoses of which are related mostly to the patient category.

The study by Kovacević et al . in Croatia showed a growing trend in the number of articles from Master's theses and doctoral dissertations dealing with health system research over a period of 20 years between 1990 and 2010.[ 23 ] In a German study, 55.5% of the published articles on GP were in the HS research category and the diagnostic groups according to ICPC 2 showed a variety of diagnoses, with psychological/psychosomatic accounting for 22.9% and cardiovascular for 21.6%, while the general unspecified topics accounted for only (2%).[ 19 ] Although these findings were from the published articles, they could reflect their original research themes. Diagnostic criteria differ from one country to another, which was expected and may be related to the different prioritization of different health problems in different communities.

The vast majority of researchers accomplished only one study per researcher within the GP/FM department (97.7%). On the other hand, only 22.5% completed doctorate theses There were four researchers who completed only their doctoral theses in the department, and this explains the difference between the number of researchers (35) who completed two theses and the number of researchers who completed their M.Sc. theses (39). There is only one mandatory research that ends with writing of theses as a requirement for each postgraduate degree (Master's or doctorate). Regarding authorship, a Master's/doctoral candidate was the first author named in 62.2% of the published articles, while the supervisor was first author in 37.8%. These results were lower than those from the Arriola-Quiroz et al . study,[ 24 ] in which the medical students were first authors in 83.5% of the articles, but higher than those from the Dhaliwal et al . study,[ 25 ] in which the candidate was the first author listed in only 44% of papers, while the supervisor was named first in the rest (a majority) of the papers. In Finland, on reviewing diploma theses, the student was found to be the first author named in 30 articles (49.2%), the second author in 21 (34.4%), and the third- or later-mentioned author in 10 (16.4%).[ 7 ]

First and last authorship issues vary in evaluation. The first authorship of the supervisors could be related to many factors: The student rarely has the skills or knowledge necessary to conceptualize and design a study, and authorship credit could also be determined by degree of scientific or professional contribution.[ 25 ] Other institutions consider the last author named to be the principal author.

The published articles from theses in medical journals comprised 22.4% of all studied theses. In terms of the relationship between published article and degree of the original thesis, 77.8% articles were from Master's theses and 22.2% from medical doctoral theses. Previous studies[ 25 , 26 , 27 ] had revealed a low rate of publication from biomedical theses. The French study by Salmi et al .,[ 26 ] revealed that only 17.0% of theses were published. Caan and Cole found that the research evidence associated with doctoral degrees is often left unpublished, across many settings.[ 27 ] Other studies explained the low publication rates by factoring in the possibility of researchers’ workload of teaching, routine professional obligations, and financial obstacles preventing publication.[ 25 ] Although in the FM department at SCU Master's theses mainly serve an educational purpose for the junior researchers, it could also prove their research and writing skills to the supervisors (lecturers/assistant professors) with their subsequent publication. Master's degree theses are often less complicated and less time-consuming, which makes their publication faster than medical doctoral theses.

Of all published theses, 68.9% were published in national journals and 31.1% in regional/international journals. Similar findings were mentioned in a Peruvian study, where most of the published theses (80%) were published in Spanish and in Peruvian journals and 17 theses (20%) were published in foreign journals (with all of them indexed in MEDLINE).[ 24 ] The Indian study[ 25 ] mentioned that of the published theses 23% resulted in papers in national journals and 67% in international journals. The choice of journal could be influenced by such factors as the following: The need to reach an appropriate academic audience; the time between submission of a paper and its subsequent publication; and the level of academic credibility of the journal, often assessed by Impact Factor.[ 28 ]

Six out of 45 (13.3%) articles from theses were published in PubMed-indexed journals, of which four (11.4%) were from Master's theses and two (20%) from doctorate theses. In addition, the published articles on journal websites accounted for 64.4%. These findings were nearly similar to the Croatian study by Frković et al ., in two University Schools of Medicine, which found that articles among Master's theses, 13% in Rijeka and 14% in Zagreb were published on MEDLINE, while among articles from Doctor of Philosophy (Ph.D.) theses, 11% in Rijeka and 41% in Zagreb were.[ 29 ] These results were less than those from the Indian study; the rate of publication in PubMed-indexed journals for papers derived from postgraduate theses is 30%. Dhaliwal et al . mentioned that PubMed publication could be a marker of the visibility to scientific communities,[ 25 ] on the other hand, publication in PubMed journals could be related to the scope of the journal and the quality of the submitted manuscripts.

The present study found that 91.1% of all theses resulted in single publication and only two theses (8.9%) resulted in two publications per thesis. Additionally, the Croatian study by Frković et al . found that most of the theses resulted in a single publication (95%), only 5% in two, and 0.4% in three publications.[ 29 ] There is a dilemma regarding multiple publications from one thesis, as some consider that the quality of a thesis can be judged by the number of published papers associated with it.[ 7 , 30 ] However, there are standard requirements for the submission of manuscripts to biomedical journals, and repetitive publication originating from a single research project indicates scientific misconduct.[ 31 ]

Of all published articles from theses, 42.2% appeared in the year after thesis completion. The results were consistent with the Indian study, where most of the publications from theses in an Indian institution appeared in the year after completion of the postgraduate course.[ 25 ] The French study found that 27% of theses appeared in print in the first year and nearly 50% after two years.[ 26 ] At SCU, the delay in publication could be related to the fact that such publication is not obligatory as in other countries,[ 25 ] or the suitable time for the supervisors to present their works to the scientific community. On the other hand, some journals had a longer time interval between the acceptance and publication of certain topics within their scope.

The publications from theses started in the second decade of research production and continue: 12.2% of theses were published in the second decade and 26.7% in the third decade. In the first decade of research production, most of the postgraduate general practitioners were not academic, and as publication is one of the requirements for advancement and promotion in an academic career, the academic staff started their publications in the second decade.

The researchers could not find published articles related to theses and their publications on FM, so the discussion was based on studies related to biomedical theses in general. Other manuscripts from the studied theses may be still unpublished at the time submission of the current paper.

Conclusion and Recommendations

Master's and doctoral research (1982-2013) resulted in 201 theses, with 22.4% of them being published as original articles in medical journals. Only 13.3% were published in PubMed-indexed journals. The production and publication of theses are on the rise. Hence, a continuous assessment and planning of research of theses are recommended.

Acknowledgments

The researchers would like to acknowledge the librarians of the Faculty of Medicine and the Central Library of SCU for their cooperation.

Source of Support: Nil.

Conflict of Interest: None declared.

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Olsson, Thomas. "Risk Prediction at the Emergency Department." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2004. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-4632.

Carney, Nancy Ann. "Patient-Guided Investigation of the Restoration of Health Following Traumatic Brain Injury." PDXScholar, 1998. https://pdxscholar.library.pdx.edu/open_access_etds/2697.

Rööst, Mattias. "Pre-hospital Barriers to Emergency Obstetric Care : Studies of Maternal Mortality and Near-miss in Bolivia and Guatemala." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-112481.

Barakat, Soraia Fatima Coelho. ""Caracterização da demanda do Serviço de Emergências Clínicas de um hospital terciário do município de São Paulo"." Universidade de São Paulo, 2004. http://www.teses.usp.br/teses/disponiveis/5/5159/tde-07112005-174138/.

Ott, Kenneth Brad. "The Closure of New Orleans' Charity Hospital After Hurricane Katrina: A Case of Disaster Capitalism." ScholarWorks@UNO, 2012. http://scholarworks.uno.edu/td/1472.

Moolla, Zuraida. "Case mix and workload of patients seen at three private emergency centres in Cape Town, South Africa." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/25467.

Nentrup, Randall. "Emergency Hazardous Materials Incidents: Case Studies for EPA Federal OnScene Coordinators." Digital Commons @ East Tennessee State University, 1989. https://dc.etsu.edu/etsu-works/8562.

Bowen, Mariya. "Development of Pediatric Emergency Medicine Fellowship for Advanced Practice Registered Nurses: A Case Study." Diss., North Dakota State University, 2018. https://hdl.handle.net/10365/27858.

Andrews, Stephen P. "Computer-assisted emergency evacuation planning using TransCAD case studies in Western Massachusetts /." Amherst, Mass. : University of Massachusetts Amherst, 2009. http://scholarworks.umass.edu/theses/345/.

Roberts, Rebecca Kate. "Studies in the periphery of spelling : six patient case studies of graphemic buffer disorder." Thesis, University of Exeter, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269849.

Bosman, Justice Selvyn. "Principles of physics implicit in emergency medical rescue education and operational practice: a case study of motor vehicle related rescue." Thesis, Cape Peninsula University of Technology, 2019. http://hdl.handle.net/20.500.11838/2967.

Engvall, Mikael. "BARNPERSPEKTIV VID UTFORMNING AV REGIONAL KATASTROFMEDICINSK BEREDSKAP I SVERIGE : EN NATIONELL STUDIE BLAND REGIONALA BEREDSKAPSSAMORDNARE." Thesis, Röda Korsets Högskola, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-279.

Marshall, Jane. "Sentence processing in aphasia : single case treatment studies." Thesis, City University London, 1994. http://openaccess.city.ac.uk/7424/.

Solebo, Colette. "The first 24 hours : mortality and other outcomes of paediatric emergency care in Lagos : a case study." Thesis, University of Warwick, 2014. http://wrap.warwick.ac.uk/61795/.

Leung, Wing-sze Grace, and 梁穎詩. "Emergency and crisis management: a case studyof Hau Tak Market fire incident and its impact on the Link and thesociety." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2010. http://hub.hku.hk/bib/B4440315X.

Onder, Ozdemir Neslihan. "Writers in pursuit of scholarly publications : case studies from the discipline of medicine." Thesis, University of Sheffield, 2017. http://etheses.whiterose.ac.uk/18563/.

Van, Woerden Hugo. "Atypical organisms affecting the respiratory tract and their sequelae – a series of case studies." Thesis, Cardiff University, 2012. http://orca.cf.ac.uk/39357/.

Locke, Eward P. "The use of military forces for emergency management| A comparative case study of the United States and Israel." Thesis, Capella University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3603822.

Military organizations are often called upon to assist with emergency management missions, so it is critical that they have appropriately established and well understood organizational perceptual factors. Military organizations are often unique within a nation, which increases the challenge for scholars to effectively analyze how organizational factors are influenced by the dynamics of national use of military forces for emergency management missions. There are several disparate theories of government organization, but the most recent and relevant is Keith James' organizational science of disaster and terrorism prevention and response theory. James' theory identified several important organizational factors specific to emergency management organizations. These factors include organizational structure and networks, processes, teams, leadership, and technology. James' organizational factors guided the development of this qualitative comparative case study's interview protocol with 24 members from the strategic, operational, and tactical levels of the United States National Guard and Israeli Homefront Command. Results revealed why two nations use their military forces for disaster response as well as provided a description of how each organization is used within their respective nation. The data affirmed aspects of James' theory, including relevant structural, networking, and procedural factors and identified the other organizational factors within James' theory as possible areas for future research. Finally, based upon interview participant perceptions, recommendations were made to the leadership of the Homefront Command and National Guard regarding areas of potential organizational emphasis to include internal messaging, additional doctrine, and clarified organizational structures for disaster response.

Downing, Christopher. "Black populations in epidemiological Alzheimer's disease case-control and cohort studies : a discussion and review." Honors in the Major Thesis, University of Central Florida, 2008. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/1076.

Grimsley, Christina, and Stephen B. MD FAAEM Blankenship. "Case Report: Tension Pneumothorax Complicated by Massive Subcutaneous Emphysema." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/113.

Morrow, Susan Elizabeth. "Research strategy in UK academic medicine : four case studies in the University of London." Thesis, University of Sussex, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262717.

Jarman, Lisa Charlotte. "Galen in Early Modern English medicine : case-studies in history, pharmacology and surgery 1618-1794." Thesis, University of Exeter, 2013. http://hdl.handle.net/10871/15279.

Van, Pinxteren Myrna. "Tracing ‘paper', discovering people: three ethnographic case studies exploring the use of health information to improve health services in Gugulethu." Doctoral thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32367.

Hallberg, Anneli. "SOS 112– vad har inträffat? : En studie av framgångs- och riskfaktorer i nöd-samtalet utifrån ett förbättringsarbete för att öka säkerställandet av vitala parametrar genom reflektion." Thesis, Hälsohögskolan, Högskolan i Jönköping, The Jönköping Academy for Improvement of Health and Welfare, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-40755.

Grajales, III Francisco Jose. "Social media : a comprehensive knowledge synthesis and case studies of applications in medicine and health(care)." Thesis, University of British Columbia, 2012. http://hdl.handle.net/2429/42806.

Linden, Luan Paula. "Pharmaceutical industry perspectives on factors that influence the adoption and diffusion of drugs in the UK : four case studies." Thesis, University of Birmingham, 2014. http://etheses.bham.ac.uk//id/eprint/4897/.

O'Brien, Siobhan. "The ultimate alternative : a single case study understanding Jason's journey from addiction to self-recovery." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Health Sciences, c2012, 2012. http://hdl.handle.net/10133/3110.

Harris, Rochelle. "The cost of professionalization: a case study of osteopathic medicine in the united states." Scholar Commons, 2005. http://scholarcommons.usf.edu/etd/2968.

Tian, Xiao Ying. "The study of Chinese herbal medicine in embryonic development of mice." HKBU Institutional Repository, 2009. http://repository.hkbu.edu.hk/etd_ra/1071.

Meeuwisse, Willem H. "The effect of salbutamol on performance in elite non-asthmatic athletes." Thesis, University of British Columbia, 1990. http://hdl.handle.net/2429/28769.

De, La Cruz Cara. "A Mixed Method Study on the Peripartum Experience and Postpartum Effects of Emergency Hysterectomy Due To Postpartum Hemorrhage." Scholar Commons, 2011. http://scholarcommons.usf.edu/etd/3423.

Veronin, Michael A. "The Validity of Health Claims on the World Wide Web: A Case Study of the Herbal Remedy Opuntia." Thesis, University of North Texas, 2000. https://digital.library.unt.edu/ark:/67531/metadc2441/.

Lukhozi, Sipho Michael. "Dual obligations in clinical forensic medicine." Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/86537.

Vaišvilienė, Jolanta. "Greitosios medicinos pagalbos pasirengimo veikti ekstremalių situacijų atvejais tyrimas." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2014. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2014~D_20140618_233423-53499.

Palmer, Ryan Tyler. "Exploring Online Community Among Rural Medical Education Students: A Case Study." PDXScholar, 2013. https://pdxscholar.library.pdx.edu/open_access_etds/990.

Muffet-Willett, Stacy L. "Waiting for a Crisis: Case Studies of Crisis Leaders in Higher Education." University of Akron / OhioLINK, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=akron1290118943.

Blue, Ian A. "The professional working relationship of rural nurses and doctors : four South Australian case studies." Title page, table of contents and abstract only, 2002. http://web4.library.adelaide.edu.au/theses/09PH/09phb6582.pdf.

Wong, Hay-tai, and 黃熙締. "Attitudes of accident and emergency department nurses towards extending and expanding their professional roles in Hong Kong: a pilot study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B3197286X.

Cordella, Marisa 1961. "The dynamic consultation : a discourse-analytical study of doctor-patient communication in Chilean Spanish." Monash University, Dept. of Linguistics, 2001. http://arrow.monash.edu.au/hdl/1959.1/8920.

Partington, Hazel Ann. "Post-qualification education and professional identity in the contested landscape of Complementary and Alternative Medicine : a case of transformative learning in an online setting." Thesis, University of Central Lancashire, 2017. http://clok.uclan.ac.uk/23989/.

Li, Xiangyu. "Delaying Evacuation: Risk Communication in Mobilizing Evacuees." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc699992/.

何湛華. "三仁湯及其臨床應用的文獻研究." HKBU Institutional Repository, 2010. http://repository.hkbu.edu.hk/etd_ra/1124.

Lindsey, Amy M. "A tornado hazard analysis for Indiana and an evaluation of the emergency management needs of the Amish community." Muncie, Ind. : Ball State University, 2009. http://cardinalscholar.bsu.edu/422.

Dahlbom, Gro. "The art of saving life : Interaction of the initial trauma care system from a cognitive science persepctive." Thesis, Linköpings universitet, Institutionen för datavetenskap, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-70704.

Entwistle, P. A. "The use of hypnosis as an auto-ethnographic modality in the exploration and management of overweight and obesity : selected case studies." Thesis, Liverpool John Moores University, 2016. http://researchonline.ljmu.ac.uk/4212/.

Kondo-Legan, Vala. "Exploration of Disorganized Attachment in Emotionally Disturbed Children Through Art Therapy: Case Studies at a Therapeutic School." Digital Commons at Loyola Marymount University and Loyola Law School, 2012. https://digitalcommons.lmu.edu/etd/102.

Pineda, Kimberly Rose. "Intercultural communication in healthcare interpreting : an exploration of possibilities." Scholarly Commons, 2010. https://scholarlycommons.pacific.edu/uop_etds/754.

Fisher, Gweneth. "Drying up the bedwetting : retelling of a narrative journey." Thesis, Link to the online version, 2005. http://hdl.handle.net/10019/1023.

Glackin, Patrick. "The evolving role of the healthcare assistant and its implications for regulation in the Republic of Ireland : a case study approach." Thesis, Northumbria University, 2016. http://nrl.northumbria.ac.uk/32561/.

Katikireddi, Srinivasa Vittal. "The relationship between evidence and public health policy : case studies of the English public health white paper and minimum unit pricing of alcohol in Scotland." Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4687/.

Scientists discover the cellular functions of a family of proteins integral to inflammatory diseases

In a scientific breakthrough, Mount Sinai researchers have revealed the biological mechanisms by which a family of proteins known as histone deacetylases (HDACs) activate immune system cells linked to inflammatory bowel disease (IBD) and other inflammatory diseases.

This discovery, reported in Proceedings of the National Academy of Sciences (PNAS) , could potentially lead to the development of selective HDAC inhibitors designed to treat types of IBD such as ulcerative colitis and Crohn's disease.

"Our understanding of the specific function of class II HDACs in different cell types has been limited, impeding development of therapies targeting this promising drug target family," says senior author Ming-Ming Zhou, PhD, Dr. Harold and Golden Lamport Professor in Physiology and Biophysics and Chair of the Department of Pharmacological Sciences at the Icahn School of Medicine at Mount Sinai. "Through our proof-of-concept study, we're unraveling the mechanisms of class II HDACs, providing essential knowledge to explore their therapeutic potential for safer and more effective disease treatments."

The Mount Sinai team focused specifically on class IIa HDACs, which exhibit more tissue-specific functions than class I HDACs, which act more broadly. Among the 18 histone deacetylases discovered to date in mammals, HDAC4 and HDAC7 -- both class IIa HDACs -- stand out for their roles in regulating the development and differentiation of Th17 cells. These cells are known for producing interleukin-17 (IL-17), a highly inflammatory cytokine associated with a spectrum of disorders, including IBD, multiple sclerosis, and rheumatoid arthritis. Given the strong correlation between excessive Th17 cell activity and human disease, scientists have focused on pharmacological or genetic interventions targeting HDAC4/7 to mitigate Th17 cell-mediated inflammation.

In their groundbreaking study, the Mount Sinai researchers delineated a previously unrecognized mechanism by which HDAC4 and HDAC7 operate independently yet cooperatively to govern Th17 cell differentiation and transcription. Transcription is the initial step of gene expression involving copying of the DNA sequence to generate RNA molecules; it is crucial for most biological processes.

"The role of class IIa HDACs in Th17 cells and inflammatory disease has been largely unexplored until now," notes lead author Ka Lung Cheung, PhD, Assistant Professor of Pharmacological Sciences at Icahn Mount Sinai. "Mechanistically, we've discovered that class IIa HDACs orchestrate both gene transcriptional activation and repression to steer the process of Th17 cell differentiation. This significant revelation deepens our comprehension of the previously ambiguous role of class IIa HDACs in biology and human disease."

As a critical aspect of their investigation, the research team found that a potent class IIa HDAC inhibitor, TMP269, influenced the differentiation of Th17 cells in a mouse model of ulcerative colitis. This pivotal discovery underscores the potential of pharmacological inhibition of class IIa HDACs as a promising therapeutic approach for addressing Th17-related inflammatory and autoimmune diseases, the study reported.

Expanding on this foundation of knowledge, researchers in the Zhou Lab and the Cheung Lab at Mount Sinai plan to concentrate on refining class IIa HDAC inhibitors with better efficacies for treating various types of Th17-mediated diseases.

"While our study primarily examined inflammatory bowel disease, specifically colitis," says Dr. Zhou, "we believe our findings pave the way for extensive research into advanced therapies targeting severe inflammation in various other pathologies within the human body."

• Crohn's Disease
• Immune System
• Gastrointestinal Problems
• Developmental Biology
• Biotechnology
• Rheumatoid arthritis
• Coeliac disease
• Immune system
• White blood cell
• Chemotherapy
• Multiple sclerosis

Story Source:

Materials provided by The Mount Sinai Hospital / Mount Sinai School of Medicine . Note: Content may be edited for style and length.

Journal Reference :

• Ka Lung Cheung, Li Zhao, Rajal Sharma, Anurupa Abhijit Ghosh, Michael Appiah, Yifei Sun, Anbalagan Jaganathan, Yuan Hu, Alannah LeJeune, Feihong Xu, Xinye Han, Xueting Wang, Fan Zhang, Chunyan Ren, Martin J. Walsh, Huabao Xiong, Alexander Tsankov, Ming-Ming Zhou. Class IIa HDAC4 and HDAC7 cooperatively regulate gene transcription in Th17 cell differentiation . Proceedings of the National Academy of Sciences , 2024; 121 (18) DOI: 10.1073/pnas.2312111121

Cite This Page :

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Strange & offbeat.

Medical schools raise alarm over declining interest in family medicine

People walk on the grounds of the University of Toronto on Sept. 9, 2020 in Toronto. CARLOS OSORIO/Reuters

Medical-school leaders are raising the alarm over their students’ declining interest in providing traditional cradle-to-grave primary care at a moment when the country is desperate for more family doctors.

Senior officials at four Ontario medical schools told a news conference on Tuesday that significant reforms, including raising pay and reducing administrative burdens, are necessary to persuade the physicians of tomorrow to choose family medicine over higher-paid specialties.

“This is urgent,” said Azadeh Moaveni, director of undergraduate medical education in the department of family and community medicine at the University of Toronto. “We need to do something now so that students will pick family medicine as their career of choice.”

Dr. Moaveni and her colleagues delivered their plea on the same day that the Canadian Medical Association warned the federal government’s proposed increases to capital-gains taxes could imperil physician recruitment and retention.

Medical associations for Nova Scotia, New Brunswick, Manitoba, Saskatchewan, Alberta and B.C. also issued statements to The Globe and Mail echoing the concerns of the national doctors’ association. The Ontario Medical Association criticized the new tax measures last week.

Prime Minister Justin Trudeau and Finance Minister Chrystia Freeland dismissed those complaints Tuesday, saying physicians are at the “very, very top” of the income scale and so can afford to pay more taxes.

“We are asking the most successful in this country to do a little bit more,” Mr. Trudeau said at a news conference in Saskatoon. “It’s fair to ask those who have succeeded extraordinarily well to be there to make sure that a lot more people have the opportunity to succeed.”

Last week Ottawa unveiled a $19.4-billion tax hike over five years through changes to the capital-gains inclusion rate – up to two-thirds from one-half – which means that more of the income generated from the sale of an asset, such as property or a stock, is taxed.

For individuals, the first $250,000 of capital gains will continue to be taxed under an inclusion rate of 50 per cent. But for corporations, the new 67-per-cent rate will kick in on the first dollar of capital gains.

This is important for physicians because most operate their practices as small businesses through medical professional corporations, which leaves them more sensitive to changes in capital-gains rules than a salaried worker might be.

The federal government’s comments mischaracterize the lives of doctors on the front lines who are not among Canada’s multimillionaires, said Canadian Medical Association president Kathleen Ross, who is also a family physician in B.C.

Dr. Ross said the proposed changes also risk exacerbating a pronounced doctor shortage that is already expected to get worse with a predicted “tsunami” in an aging profession.

As small-business owners, most physicians in Canada do not receive benefits, pensions or maternity- or paternity-leave pay. To offset that gap, Dr. Ross said that, across the country, physicians agreed to incorporate their practices in order to save for retirement , rather than be paid more up front under their provincial agreements.

After being encouraged by provinces to incorporate their practices, Dr. Ross said the federal tax changes amount to “a clear grab at our retirement savings.”

While the proposed changes to capital-gains taxes are most likely to affect doctors at the end of their careers, those just starting out look at the financial situation of their older peers when deciding what type of medicine to practise.

Later this week, the organization that matches medical-school graduates to residency positions is scheduled to release data from the final round of this year’s matching process, including whether any family medicine placements went unclaimed.

In this year’s first round, 108 of 560 family medicine residency slots in Ontario went unfilled, up from 100 last year, 61 in 2022, 52 in 2021 and 30 in 2020, according to Andrew Park, the president of the Ontario Medical Association, which held the briefing at which Dr. Moaveni and other medical educators spoke Tuesday.

Ontario has successfully filled most vacancies in the second round of matching in the past, but Dr. Park said the first-round data are the latest sign that medical students are souring on family practice.

Last year, 100 family medicine residency positions went unfilled nationwide after the final round, the most in at least a decade. The majority were in Quebec. The Canadian Resident Matching Service (CaRMS) reported that in 2023, 30.3 per cent of graduates of Canadian medical schools named family medicine as their first choice of discipline, down from a recent high of 38 per cent in 2015.

Jobin Varughese, the interim assistant dean of primary care education at Toronto Metropolitan University, said medical students are most often turned off from family medicine when they encounter burned-out doctors working in solo or small group practices without the support of a team of nurses, pharmacists, social workers and administrators to share the load.

In September of 2025, TMU will open a new medical school northwest of Toronto in Brampton, a fast-growing magnet city for new immigrants where Dr. Varughese said chronic disease rates are high and primary-care access is decreasing. “Communities that are medically underserved, like Brampton, are significantly impacted by fewer students choosing family medicine,” he said.

An estimated 14 per cent of Canadians don’t have access to a regular health care provider, according to the most recent Statistics Canada survey data from 2022. However, a separate survey of 9,000 Canadians conducted in the fall of 2022 for the U of T-led Our Care project suggested the figure was closer to 22 per cent.

Medical-school leaders in other parts of Canada acknowledged the challenge of persuading graduates to choose traditional family practice, but said their institutions are working hard to make the discipline more appealing.

Remuneration is one important challenge. The average Canadian family doctor earned $299,000 in gross payments (before overhead costs) in 2022, significantly less than $382,000, on average, for medical specialists and $507,000 for surgical specialists, according to the most recent figures from the Canadian Institute for Health Information.

Another is that some graduates bristle at the thought of spending hours every day on paperwork and running a business, rather than seeing patients, said Brenda Hemmelgarn, dean of the Faculty of Medicine and Dentistry at the University of Alberta.

”Family medicine is such an important part of our health care system. It’s foundational to everything that we do,” Dr. Hemmelgarn said. “But the way it’s administered right now, there are challenges in the profession.”

Still, Amanda Condon, head of the department of family medicine in the Max Rady College of Medicine at the University of Manitoba, said medical educators shouldn’t let their students lose sight of the joys of primary care.

“Being a family doctor is awesome,” Dr. Condon said. “I feel like we need to highlight that more because despite all of the challenges and all of the difficulties, it still is very rewarding, very powerful and super important work.”

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Working Parents, Plan for the Week with This Simple Exercise

• Avni Patel Thompson

To avoid surprises and decision fatigue, take 20 minutes to preview your family’s commitments.

As work travel and hours in the office mount, work parents are feeling the logistical challenges of making every week happen — from kid pickup and dropoff and sports practice to meal planning and doctor’s appointments. The main difficulties lie in managing the firehose of information, coping with decision fatigue, and dealing with surprises like an illness or a forgotten event. The best approach for avoiding — or mitigating — these obstacles is the weekly preview: A planning session between the core adults in the family each week to go over what’s coming. The week’s plan is documented and discussed, highlighting variances from typical weeks and indicating back-up plans for particularly tricky spots.

It’s been nearly four years since we first met Amir and Ria as they were navigating the early months of Covid with two jobs and two young children at home.

• AT Avni Patel Thompson  is the founder and CEO of  Milo, the world’s first app to tackle the invisible load of running and raising a family. She is a third-time founder building technology solutions that make everyday parenting lighter and more connected. Previously she was the founder of YC-backed Poppy. Prior to taking the entrepreneurial plunge, she spent over a decade building consumer businesses at P&G, adidas, and Starbucks. She has an MBA (HBS ’08) and a BSc Chemistry from the University of British Columbia. She lives in Vancouver with her husband and two daughters.

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The Evolving Danger of the New Bird Flu

An unusual outbreak of the disease has spread to dairy herds in multiple u.s. states..

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

From “The New York Times,” I’m Sabrina Tavernise, and this is “The Daily.”

[MUSIC PLAYING]

The outbreak of bird flu that is tearing through the nation’s poultry farms is the worst in US history. But scientists say it’s now starting to spread into places and species it’s never been before.

Today, my colleague, Emily Anthes, explains.

It’s Monday, April 22.

Emily, welcome back to the show.

Thanks for having me. Happy to be here.

So, Emily, we’ve been talking here on “The Daily” about prices of things and how they’ve gotten so high, mostly in the context of inflation episodes. And one of the items that keeps coming up is eggs. Egg prices were through the roof last year, and we learned it was related to this. Avian flu has been surging in the United States. You’ve been covering this. Tell us what’s happening.

Yes, so I have been covering this virus for the last few years. And the bird flu is absolutely tearing through poultry flocks, and that is affecting egg prices. That’s a concern for everyone, for me and for my family. But when it comes to scientists, egg prices are pretty low on their list of concerns. Because they see this bird flu virus behaving differently than previous versions have. And they’re getting nervous, in particular, about the fact that this virus is reaching places and species where it’s never been before.

OK, so bird flu, though, isn’t new. I mean I remember hearing about cases in Asia in the ‘90s. Remind us how it began.

Bird flu refers to a bunch of different viruses that are adapted to spread best in birds. Wild water birds, in particular, are known for carrying these viruses. And flu viruses are famous for also being shapeshifters. So they’re constantly swapping genes around and evolving into new strains. And as you mentioned back in the ‘90s, a new version of bird flu, a virus known as H5N1, emerged in Asia. And it has been spreading on and off around the world since then, causing periodic outbreaks.

And how are these outbreaks caused?

So wild birds are the reservoir for the virus, which means they carry it in their bodies with them around the world as they fly and travel and migrate. And most of the time, these wild birds, like ducks and geese, don’t even get very sick from this virus. But they shed it. So as they’re traveling over a poultry farm maybe, if they happen to go to the bathroom in a pond that the chickens on the farm are using or eat some of the feed that chickens on the farm are eating, they can leave the virus behind.

And the virus can get into chickens. In some cases, it causes mild illness. It’s what’s known as low pathogenic avian influenza. But sometimes the virus mutates and evolves, and it can become extremely contagious and extremely fatal in poultry.

OK, so the virus comes through wild birds, but gets into farms like this, as you’re describing. How have farms traditionally handled outbreaks, when they do happen?

Well, because this threat isn’t new, there is a pretty well-established playbook for containing outbreaks. It’s sometimes known as stamping out. And brutally, what it means is killing the birds. So the virus is so deadly in this highly pathogenic form that it’s sort of destined to kill all the birds on a farm anyway once it gets in. So the response has traditionally been to proactively depopulate or cull all the birds, so it doesn’t have a chance to spread.

So that’s pretty costly for farmers.

It is. Although the US has a program where it will reimburse farmers for their losses. And the way these reimbursements work is they will reimburse farmers only for the birds that are proactively culled, and not for those who die naturally from the virus. And the thinking behind that is it’s a way to incentivize farmers to report outbreaks early.

So, OK, lots of chickens are killed in a way to manage these outbreaks. So we know how to deal with them. But what about now? Tell me about this new strain.

So this new version of the virus, it emerged in 2020.

After the deadly outbreak of the novel coronavirus, authorities have now confirmed an outbreak of the H5N1 strain of influenza, a kind of bird flu.

And pretty quickly it became clear that a couple things set it apart.

A bald eagle found dead at Carvins Cove has tested positive for the highly contagious bird flu.

This virus, for whatever reason, seemed very good at infecting all sorts of wild birds that we don’t normally associate with bird flu.

[BIRD CRYING]

He was kind of stepping, and then falling over, and using its wing to right itself.

Things like eagles and condors and pelicans.

We just lost a parliament of owls in Minneapolis.

Yeah, a couple of high profile nests.

And also in the past, wild birds have not traditionally gotten very sick from this virus. And this version of the virus not only spread widely through the wild bird population, but it proved to be devastating.

The washing up along the East Coast of the country from Scotland down to Suffolk.

We were hearing about mass die-offs of seabirds in Europe by the hundreds and the thousands.

And the bodies of the dead dot the island wherever you look.

Wow. OK. So then as we know, this strain, like previous ones, makes its way from wild animals to farmed animals, namely to chickens. But it’s even more deadly.

Absolutely. And in fact, it has already caused the worst bird flu outbreak in US history. So more than 90 million birds in the US have died as a result of this virus.

90 million birds.

Yes, and I should be clear that represents two things. So some of those birds are birds who naturally got infected and died from the virus. But the vast majority of them are birds that were proactively culled. What it adds up to is, is 90 million farmed birds in the US have died since this virus emerged. And it’s not just a chicken problem. Another thing that has been weird about this virus is it has jumped into other kinds of farms. It is the first time we’ve seen a bird flu virus jump into US livestock.

And it’s now been reported on a number of dairy farms across eight US states. And that’s just something that’s totally unprecedented.

So it’s showing up at Dairy farms now. You’re saying that bird flu has now spread to cows. How did that happen?

So we don’t know exactly how cows were first infected, but most scientists’ best guess is that maybe an infected wild bird that was migrating shed the virus into some cattle feed or a pasture or a pond, and cattle picked it up. The good news is they don’t seem to get nearly as sick as chickens do. They are generally making full recoveries on their own in a couple of weeks.

OK, so no mass culling of cows?

No, that doesn’t seem to be necessary at this point. But the bad news is that it’s starting to look like we’re seeing this virus spread from cow to cow. We don’t know exactly how that’s happening yet. But anytime you see cow-to-cow or mammal-to-mammal transmission, that’s a big concern.

And why is that exactly?

Well, there are a bunch of reasons. First, it could allow the outbreak to get much bigger, much faster, which might increase the risk to the food supply. And we might also expect it to increase the risk to farm workers, people who might be in contact with these sick cows.

Right now, the likelihood that a farmer who gets this virus passes it on is pretty low. But any time you see mammal-to-mammal transmission, it increases the chance that the virus will adapt and possibly, maybe one day get good at spreading between humans. To be clear, that’s not something that there’s any evidence happening in cows right now. But the fact that there’s any cow-to-cow transmission happening at all is enough to have scientists a bit concerned.

And then if we think more expansively beyond what’s happening on farms, there’s another big danger lurking out there. And that’s what happens when this virus gets into wild animals, vast populations that we can’t control.

We’ll be right back.

So, Emily, you said that another threat was the threat of flu in wild animal populations. Clearly, of course, it’s already in wild birds. Where else has it gone?

Well, the reason it’s become such a threat is because of how widespread it’s become in wild birds. So they keep reintroducing it to wild animal populations pretty much anywhere they go. So we’ve seen the virus repeatedly pop up in all sorts of animals that you might figure would eat a wild bird, so foxes, bobcats, bears. We actually saw it in a polar bear, raccoons. So a lot of carnivores and scavengers.

The thinking is that these animals might stumble across a sick or dead bird, eat it, and contract the virus that way. But we’re also seeing it show up in some more surprising places, too. We’ve seen the virus in a bottle-nosed dolphin, of all places.

And most devastatingly, we’ve seen enormous outbreaks in other sorts of marine mammals, especially sea lions and seals.

So elephant seals, in particular in South America, were just devastated by this virus last fall. My colleague Apoorva Mandavilli and I were talking to some scientists in South America who described to us what they called a scene from hell, of walking out onto a beach in Argentina that is normally crowded with chaotic, living, breathing, breeding, elephant seals — and the beach just being covered by carcass, after carcass, after carcass.

Mostly carcasses of young newborn pups. The virus seemed to have a mortality rate of 95 percent in these elephant seal pups, and they estimated that it might have killed more than 17,000 of the pups that were born last year. So almost the entire new generation of this colony. These are scientists that have studied these seals for decades. And they said they’ve never seen anything like it before.

And why is it so far reaching, Emily? I mean, what explains these mass die-offs?

There are probably a few explanations. One is just how much virus is out there in the environment being shed by wild birds into water and onto beaches. These are also places that viruses like this haven’t been before. So it’s reaching elephant seals and sea lions in South America that have no prior immunity.

There’s also the fact that these particular species, these sea lions and seals, tend to breed in these huge colonies all crowded together on beaches. And so what that means is if a virus makes its way into the colony, it’s very conducive conditions for it to spread. And scientists think that that’s actually what’s happening now. That it’s not just that all these seals are picking up the virus from individual birds, but that they’re actually passing it to each other.

So basically, this virus is spreading to places it’s never been before, kind of virgin snow territory, where animals just don’t have the immunity against it. And once it gets into a population packed on a beach, say, of elephant seals, it’s just like a knife through butter.

Absolutely. And an even more extreme example of that is what we’re starting to see happen in Antarctica, where there’s never been a bird flu outbreak before until last fall, for the first time, this virus reached the Antarctic mainland. And we are now seeing the virus move through colonies of not only seabirds and seals, but penguin colonies, which have not been exposed to these viruses before.

And it’s too soon to say what the toll will be. But penguins also, of course, are known for breeding in these large colonies.

Probably. don’t have many immune defenses against this virus, and of course, are facing all these other environmental threats. And so there’s a lot of fear that you add on the stress of a bird flu virus, and it could just be a tipping point for penguins.

Emily, at this point, I’m kind of wondering why more people aren’t talking about this. I mean, I didn’t know any of this before having this conversation with you, and it feels pretty worrying.

Well, a lot of experts and scientists are talking about this with rising alarm and in terms that are quite stark. They’re talking about the virus spreading through wild animal populations so quickly and so ferociously that they’re calling it an ecological disaster.

But that’s a disaster that sometimes seems distant from us, both geographically, we’re talking about things that are happening maybe at the tip of Argentina or in Antarctica. And also from our concerns of our everyday lives, what’s happening in Penguins might not seem like it has a lot to do with the price of a carton of eggs at the grocery store. But I think that we should be paying a lot of attention to how this virus is moving through animal populations, how quickly it’s moving through animal populations, and the opportunities that it is giving the virus to evolve into something that poses a much bigger threat to human health.

So the way it’s spreading in wild animals, even in remote places like Antarctica, that’s important to watch, at least in part because there’s a real danger to people here.

So we know that the virus can infect humans, and that generally it’s not very good at spreading between humans. But the concern all along has been that if this virus has more opportunities to spread between mammals, it will get better at spreading between them. And that seems to be what is happening in seals and sea lions. Scientists are already seeing evidence that the virus is adapting as it passes from marine mammal to marine mammal. And that could turn it into a virus that’s also better at spreading between people.

And if somebody walks out onto a beach and touches a dead sea lion, if their dog starts playing with a sea lion carcass, you could imagine that this virus could make its way out of marine mammals and into the human population. And if it’s this mammalian adapted version of the virus that makes its way out, that could be a bigger threat to human health.

So the sheer number of hosts that this disease has, the more opportunity it has to mutate, and the more chance it has to mutate in a way that would actually be dangerous for people.

Yes, and in particular, the more mammalian hosts. So that gives the virus many more opportunities to become a specialist in mammals instead of a specialist in birds, which is what it is right now.

Right. I like that, a specialist in mammals. So what can we do to contain this virus?

Well, scientists are exploring new options. There’s been a lot of discussion about whether we should start vaccinating chickens in the US. The government, USDA labs, have been testing some poultry vaccines. It’s probably scientifically feasible. There are challenges there, both in terms of logistics — just how would you go about vaccinating billions of chickens every year. There are also trade questions. Traditionally, a lot of countries have not been willing to accept poultry products from countries that vaccinate their poultry.

And there’s concern about whether the virus might spread undetected in flocks that are vaccinated. So as we saw with COVID, the vaccine can sometimes stop you from getting sick, but it doesn’t necessarily stop infection. And so countries are worried they might unknowingly import products that are harboring the virus.

And what about among wild animals? I mean, how do you even begin to get your head around that?

Yeah, I mean, thinking about vaccinating wild animals maybe makes vaccinating all the chickens in the US look easy. There has been some discussion of limited vaccination campaigns, but that’s not feasible on a global scale. So unfortunately, the bottom line is there isn’t a good way to stop spread in wild animals. We can try to protect some vulnerable populations, but we’re not going to stop the circulation of this virus.

So, Emily, we started this conversation with a kind of curiosity that “The Daily” had about the price of eggs. And then you explained the bird flu to us. And then somehow we ended up learning about an ecological disaster that’s unfolding all around us, and potentially the source of the next human pandemic. That is pretty scary.

It is scary, and it’s easy to get overwhelmed by it. And I feel like I should take a step back and say none of this is inevitable. None of this is necessarily happening tomorrow. But this is why scientists are concerned and why they think it’s really important to keep a very close eye on what’s happening both on farms and off farms, as this virus spreads through all sorts of animal populations.

One thing that comes up again and again and again in my interviews with people who have been studying bird flu for decades, is how this virus never stops surprising them. And sometimes those are bad surprises, like these elephant seal die-offs, the incursions into dairy cattle. But there are some encouraging signs that have emerged recently. We’re starting to see some early evidence that some of the bird populations that survived early brushes with this virus might be developing some immunity. So that’s something that maybe could help slow the spread of this virus in animal populations.

We just don’t entirely know how this is going to play out. Flu is a very difficult, wily foe. And so that’s one reason scientists are trying to keep such a close, attentive eye on what’s happening.

Emily, thank you.

Thanks for having me.

Here’s what else you should know today.

On this vote, the yeas are 366 and the nays are 58. The bill is passed.

On Saturday, in four back-to-back votes, the House voted resoundingly to approve a long-stalled package of aid to Ukraine, Israel and other American allies, delivering a major victory to President Biden, who made aid to Ukraine one of his top priorities.

On this vote, the yeas are 385, and the no’s are 34 with one answering present. The bill is passed without objection.

The House passed the component parts of the $95 billion package, which included a bill that could result in a nationwide ban of TikTok.

On this vote, the yeas are 311 and the nays are 112. The bill is passed.

Oh, one voting present. I missed it, but thank you.

In a remarkable breach of custom, Democrats stepped in to supply the crucial votes to push the legislation past hard-line Republican opposition and bring it to the floor.

The House will be in order.

The Senate is expected to pass the legislation as early as Tuesday.

Today’s episode was produced by Rikki Novetsky, Nina Feldman, Eric Krupke, and Alex Stern. It was edited by Lisa Chow and Patricia Willens; contains original music by Marion Lozano, Dan Powell, Rowan Niemisto, and Sophia Lanman; and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Andrew Jacobs.

That’s it for “The Daily.” I’m Sabrina Tavernise. See you tomorrow.

• April 24, 2024   •   32:18 Is $60 Billion Enough to Save Ukraine?
• April 23, 2024   •   30:30 A Salacious Conspiracy or Just 34 Pieces of Paper?
• April 22, 2024   •   24:30 The Evolving Danger of the New Bird Flu
• April 19, 2024   •   30:42 The Supreme Court Takes Up Homelessness
• April 18, 2024   •   30:07 The Opening Days of Trump’s First Criminal Trial
• April 17, 2024   •   24:52 Are ‘Forever Chemicals’ a Forever Problem?
• April 16, 2024   •   29:29 A.I.’s Original Sin
• April 15, 2024   •   24:07 Iran’s Unprecedented Attack on Israel
• April 14, 2024   •   46:17 The Sunday Read: ‘What I Saw Working at The National Enquirer During Donald Trump’s Rise’
• April 12, 2024   •   34:23 How One Family Lost $900,000 in a Timeshare Scam
• April 11, 2024   •   28:39 The Staggering Success of Trump’s Trial Delay Tactics
• April 10, 2024   •   22:49 Trump’s Abortion Dilemma

Hosted by Sabrina Tavernise

Produced by Rikki Novetsky ,  Nina Feldman ,  Eric Krupke and Alex Stern

Edited by Lisa Chow and Patricia Willens

Original music by Marion Lozano ,  Dan Powell ,  Rowan Niemisto and Sophia Lanman

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The outbreak of bird flu currently tearing through the nation’s poultry is the worst in U.S. history. Scientists say it is now spreading beyond farms into places and species it has never been before.

Emily Anthes, a science reporter for The Times, explains.

On today’s episode

Emily Anthes , a science reporter for The New York Times.

Background reading

Scientists have faulted the federal response to bird flu outbreaks on dairy farms .

Here’s what to know about the outbreak.

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The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Mike Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, John Ketchum, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Dan Farrell, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Summer Thomad, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

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