Canadian Family Physician最新文献

Objective: To assess the use of common author ordering conventions, their effects on measures of citation impact, and their implications for the assessment of individual researchers and researcher rankings.

Design: Analysis of associations between the use of author ordering conventions, measures of citation impact, and researcher rankings using publications by Canadian primary health care researchers included in the Scopus database.

Setting: Canada.

Participants: The 49 living Canadian primary health care researchers with the most first-author citations.

Main outcome measures: Spearman rank correlations were assessed between rankings based on number of first-author citations and alternative measures of number of citations. Changes in researcher rankings were assessed based on alternative citation metrics.

Results: Rank order correlations varied from 0.55 (first author vs h index) to 0.83 (first-author citations vs first- and second-author citations). The proportion of researchers whose rankings changed by 12 or more ranks (25% or greater absolute change) compared to rankings based on first-author citations varied from 14% for rankings based on first- and second-author citations to 51% for rankings based on h index.

Conclusion: The variability and inconsistency of author ordering thwart efforts to identify or create valid measures to rank citation impact. Adoption of author ordering based on contribution as a universal convention would enhance the reliability and validity of comparisons and rankings across disciplines and research fields and would facilitate comparisons among candidates for hiring, tenure, promotion, and awards.

Objective: To familiarize family physicians with new and emerging evidence regarding the underlying central nervous system (nociplastic) pathogenesis of many chronic pain conditions and review modalities of psychotherapy that can specifically target nociplastic pain and other symptoms.

Quality of evidence: Psychotherapy modalities for the treatment of patients with nociplastic chronic pain (eg, pain reprocessing therapy, emotional awareness and expression therapy, intensive short-term dynamic psychotherapy) have level I evidence to support their efficacy in treating patients with various pain conditions as well as those with other chronic symptoms lacking clear structural causes.

Main message: Family physicians should be aware that many patients with chronic pain and other persistent symptoms may benefit from therapeutic approaches that target the central nervous system rather than the site where symptoms are felt. Meta-analyses have shown that older nonspecific modalities of psychotherapy (eg, cognitive behavioural therapy, acceptance and commitment therapy) have limited efficacy in treating patients with these conditions. Recent trial evidence and systematic reviews have shown that pain reprocessing therapy, emotional awareness and expression therapy, and intensive short-term dynamic psychotherapy can be helpful for many patients with nociplastic symptoms and may also help improve comorbid mood and anxiety symptoms.

Conclusion: Psychotherapy is a safe and effective way to treat patients with chronic pain conditions that have nociplastic components. Access to effective therapy modalities may be a limiting factor, but self-treatment using online or virtual resources can be helpful for many patients.