Background: Gender disparity remains a prominent medical workforce issue, extending beyond surgical specialties with low proportions of female doctors.Aims: To examine female representation within Australia and New Zealand (NZ) among physician specialties and certain comparator surgical specialties with a focus on cardiology as an outlier of workforce gender equality.Methods: Data of practising medical specialists, new consultants and trainees were sought from the Australian Health Practitioner Regulation Agency, the Medical Council of NZ and the Royal Australasian College of Surgeons (2015)(2016)(2017). The stratified data pertaining to interventional cardiologists were obtained through direct contact with individual hospitals (from 2017 to 2018) and derived from state-based cardiac registries.Results: In Australia and NZ, there were fewer female practising adult medicine physician consultants (n = 8956, 32%, P < 0.001), with gender disparities seen across most physician specialties. Cardiology (15%) was the only physician specialty with <20% representation; gastroenterology (23%), neurology (27%) and respiratory medicine (29%) had <30% female representation at the consultant level. The rates of cardiology (15%) and interventional cardiology (5%) were similar to general surgery (15%) and orthopaedics (4%). Although more than half of physician trainees are female, and most physician specialties are approaching or have equal gender ratios at the trainee level, cardiology (23%) and interventional cardiology (9%) remain significantly underrepresented.Conclusions: Cardiology is the only physician specialty with <20% female consultants, and this disparity is reflected throughout every stage of the cardiology training programme. Increased awareness and proactive strategies are needed to improve gender disparity within this underrepresented medical specialty.
Takotsubo cardiomyopathy (TC) is acute stress-induced cardiomyopathy with characteristic transient wall motion abnormalities. TC has a clinical presentation similar to an acute coronary syndrome, including chest pain or dyspnoea, ECG changes and elevated cardiac enzymes. TC often occurs after emotional stress. There are approximately 50 TC cases reported related to seizure activity, and our review revealed 15 articles which were associated with status epilepticus. This condition can be a serious complication of seizures. We report a case of TC after status epilepticus in a patient who had been seizure-free for 20 years.
The radial approach was associated with significantly higher DAP and FT compared to the femoral approach during an initial introductory phase which was likely insufficient to develop radial proficiency. The results of this study are consistent with previous studies and may influence choice of access for non-emergent diagnostic coronary angiography before radial proficiency has been established, particularly for patients more susceptible to radiation risks.
IntroductionThe best strategy in patients with prior coronary artery bypass graft surgery (CABG) who present with non-ST elevation myocardial infarction (NSTEMI) remains less well defined. We compare the characteristics, therapeutic interventions and outcomes of patients with prior CABG presenting with NSTEMI.MethodsAll patients who presented to our hospital during 2007–2012 with available electronic records were analysed retrospectively. Outcomes were compared between patients who underwent coronary angiography or percutaneous coronary intervention (PCI) versus those who were treated medically.ResultsA total of 117 patients were analysed. Of that, 79 patients were managed medically while 38 underwent early angiography, of which only 11 (9.5%) received PCI. Patients treated medically (did not undergo angiography) were older (74±10 vs70±8; p=0.05). ECG changes were the only independent predictor for early angiography (OR 0.4, 95% CI 0.15 to 0.99; p=0.05) while recurrent chest pain (OR 0.2, 95% CI 0.05 to 0.97; p=0.05) predicted PCI on multivariate analysis. The PCI group had higher Global Registry of Acute Cardiac Events (GRACE) score (176±29 vs 150±31; p=0.01). No significant difference was found in readmission rates, morbidity (unstable angina pectoris, NSTEMI, ST elevation myocardial infarction (STEMI), or combination) or mortality at 12 months between the groups who underwent angiography, PCI, or treated medically on univariate and multivariate analysis.ConclusionsThe opportunity to intervene in prior CABG patients presenting with NSTEMI is often low. Initial medical management may be a reasonable option in carefully selected patients particularly in the absence of ongoing symptoms, ECG changes or very high GRACE scores. Further studies are required to evaluate the safety of non-invasive strategies in managing this population.
Results: 444 patients presented with STEMI. 73.6% patients were thrombolysed and 26.4% patients underwent pPCI. Males represented 76.3% of thrombolysis and 78.6% of pPCI patients. Post-thrombolysis, there were significantly more major bleeds (11.8% vs 2.8%, RR 4.25, 95% CI 1.64-11.0, p < 0.01) and higher rates of mortality (10.5% vs 3.6%, RR 2.94, 95% CI 1.17-7.34, p = 0.02) in women vs men respectively. Post-pPCI, there were no differences in major bleeding (0% vs 3.3%, RR 0.51, 95% CI 0.027-9.6, p = 0.65) or mortality (4% vs 7.6%, RR 0.52, 95% CI 0.068-4.08, p = 0.54) in women vs men respectively. In comparing thrombolysis vs pPCI in women using both co-primary outcomes, the number needed to harm is 6.9. Conclusions: Thrombolysis is less safe in women than men. Primary PCI should be undertaken in women where possible.
ObjectiveSignificant gender disparities exist in some medical specialties, particularly cardiology. We assessed work, personal life and work-life balance in women in cardiology in Australia and New Zealand (NZ), compared with other specialties, to determine factors that may contribute to the lack of women in the specialty.MethodsThis study is a prospective survey-based cohort study comparing cardiology and non-cardiology specialties. An online survey was completed by female doctors in Australia and NZ, recruited via email lists and relevant social media groups. The survey included demographics, specialty, stage of training, work hours/setting, children and relationships, career satisfaction, income and perceptions of specialty.Results452 participants completed the survey (median age 36 years), of which 57 (13%) worked in cardiology. Of all respondents, 84% were partnered and 75% had children, with no difference between cardiology and non-cardiology specialties. Compared with non-cardiology specialties, women in cardiology worked more hours per week (median 50 hours vs 40 hours, p<0.001), were more likely to be on call more than once per week (33% vs 12%, p<0.001) and were more likely to earn an annual income >$3 00 000 (35% vs 10%, p<0.001). Women in cardiology were less likely to agree that they led a balanced life (33% vs 51%, p=0.03) or that their specialty was female friendly (19% vs 75%, p<0.001) or family friendly (20% vs 63%, p<0.001).ConclusionsCompared with other specialties, women in cardiology reported poorer work-life balance, greater hours worked and on-call commitments and were less likely to perceive their specialty as female friendly or family friendly. Addressing work-life balance may attract and retain more women in cardiology.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.