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A pooled analysis showed a statistically significant gender bias against female case reports 0. The Annals of Internal Medicine was the only journal with a point estimate non significant in the direction of a bias against male patients. The text analysis identified no substantive difference in the focus of the case reports and no obvious explanation for the bias. Gender bias, previously identified in clinical research and in clinical authorship, extends into the patients presented in clinical case reports.

Whether it is driven by authors or editors is not clear, but it likely contributes to and supports an overall male bias of clinical medicine.

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The late s saw an acceleration in efforts to highlight and address the gender bias in science and medical research. A recent review of progress on gender equality was undertaken across a range of indicators. Nonetheless the clinical case report maintains a key role in the medical literature as a vehicle for reporting unusual disease presentations or outbreaks,[ 8 , 9 ] as a hypothesis generator,[ 10 , 11 ] and most typically as a pedagogic tool.

A case report could be about any patient or any clinical condition, and it is unreasonable to expect that a single case report is gender balanced. In their specificity they are necessarily biased. As a corpus of case reports within a general and internal medicine journal, however, one would hope to see a representative sample of the patient population, gender balanced. The search terms combined each journal's PubMed abbreviation for its name e.

The complete Lancet search, for example, was:. The retrieved records from the searches formed the data for the subsequent analyses. We defined a bias in case reports in favour of one or other gender by a proportion of female case reports significantly different from 0. A mixed effects logistic model was estimated with random intercepts and fixed effect for the journals.

We took into account that a gender bias in case reports might be explicable by the type of clinical condition being reported. A text analysis of the MeSH of the case reports was therefore conducted. Specifically, the MeSH within each case report were combined and any repeat words were removed. By gender, the MeSH text for all case reports were combined and a count made of the occurrence of each word. Disagreements were resolved by discussion and the results tabulated.

Bibliographic details of individual case report were downloaded from PubMed using the RISmed package in the R statistical environment. The R script for extracting the relevant data is publicly available. The initial search identified 2, case reports. Forty 40 case reports were excluded because the gender of the patient was not identified; and a further case reports were excluded because they related to patients of both sexes.

The final sample of case reports was 2,, accounting for The flow diagram of case report inclusion is shown in Fig 1. Of the 2, case reports, just under half Of the case reports, 1, Table 1 shows the sex distribution of the case reports for each journal.

Gender bias in clinical case reports: A cross-sectional study of the “big five” medical journals

A series of logistic regression models were developed with the sex in the case report as a dichotomous outcome variable, and the journal as a potential explanatory factor for observed variation in the proportion of female case reports. A random intercepts logistic regression model was developed to estimate the variance associated with journal as a random intercept. The associated variance was extremely small 4. The pooled result is shown last.


Squares and the horizontal lines represent the measures of effect, e. The NEJM. The Annals of Internal Medicine was the only journal that had a point estimate in the direction of a bias against male patients. The remaining two journals had point estimates in the direction of a bias against female patients; however, neither of the individual estimates were significantly different from 0.

In the pooled analysis, there was a statistically significant gender bias in case reports against female patients 0. The bias remains, albeit slightly smaller, and with wider confidence intervals because of the smaller sample size. The frequencies were calculated separately for case reports of male and female patients. What appears to be a relatively small effect in cross-section should really be seen as a potentially accumulating effect over time; and small accumulating effects can have a substantial impact. The concern is that a bias in clinical perception and decision making may be reinforced with continuous exposure towards an over representation of case reports involving male patients—supporting historical biases in clinical medicine and clinical research.

What is surprising, is that the textual analysis of the MeSH words identified a remarkable similarity between case reports about male and female patients. If similar kinds of clinical cases are catching the eyes of authors and editors, is there a need to represent those clinical cases with a gender imbalance? Are there inherently more interesting characteristics in male than in female patients?

It is impossible to know the source of the observed bias, but there are three potential explanations. We get more of the back-story, helping us to understand the characters reactions to their circumstances. The secondary characters get some good face time and help to string the different story lines together. While the story itself was a good one, I had some issues. There were editing errors that should have been caught and did, to some extent, inhibit my enjoyment of the story. There were three characters with some derivative of the name Sam, two of whom were central to the plot.

Some scenes just made me scratch my head and ask where that came from. All the people save one on the island had become vampires as teenagers, thus maintaining the look of a teenager. I had no problem with that, but they also seemed to maintain the mentality of a teenager. All that aside, I did enjoy the book; I just could have enjoyed it more had these issues not existed. This book would appeal to the young adult reader who enjoys darker side of urban fantasy. I would recommend reading at least Book 2 or you might have problems following the plot. Be warned, there is a cliffhanger ending.

View 1 comment. Apr 27, Alyssa rated it liked it. I was going to review this book after I finished reading it I find myself rolling my eyes constantly throughout this book. Once again, with this book, I think it's a good plot But the actual execution of it isn't up to par. The only thing that keeps me go I was going to review this book after I finished reading it The only thing that keeps me going is wanting to know what happens. I mean it when I sincerly say thay that I hope this book ends at the next one.

They sound I don't know. And the whole vampire war is just a little stupid to me. I also don't like the way the POV switches basically at every chapter. I hate when books do that. That sentence doesn't make sense right? Kyle says they're stuck together. I think the wording needs to be worked on. I also think the editor needs to edit better! I really was hoping that this one would be better, but She sees the guy for 2 seconds, mind you, they're not even face to face and she knows they're bad for each other and that she likes him.

Wake up and smell the freaking coffee Caitlin, you may see someone you're attracted to but stop being so conceited and thinking everyone is automatically attracted to you! I almost have a feeling that Caleb will end up hating her, blah blah blah. I hope he just doesn't and gets over it. She saw him Oh well. I hope the next one is better. Sorry to be so cynical to you who love this book. Apr 15, Steph rated it it was amazing Shelves: kindle-read. This is the third book in the series and it was easily the best. I read it in one day because I just couldn't seem to separate the Kindle from my hand.

This book starts a few days after the last book finished, and we discover that Caleb accepted her wishes and turned her into a full blooded vampire! And instead of going straight back out to look for the sword that was stolen from them he stays with Caitlin while she turns and recovers from her fatal stabbing. Caitlin and Calebs relationship h This is the third book in the series and it was easily the best. Caitlin and Calebs relationship hit a rough patch in this book because of a major misunderstanding, caused by Caleb's estranged wife Sera.

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Because of their fight, Caitlin stays on Pollepel island where she is trained to fight and Caleb leaves to try and warn his coven of the upcoming war. Kyle has possesion of the sword and kills Rexius leader of Blacktide coven and takes his place. After unleashing the Black plague on Manhatten!

We see some of Caitlins brother Sam, who is alsoturned in this book by Samantha.

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He is maybe now the most poweful vampire there is! He also harnesses the great power of shape-shifting. This part of Sam plays a massive part in the end of the story. Caitlin has already been tricked by her brother who had shifted to look like Caleb and tells herself that Caleb is a prisoner and if she sees him walking freely, that it's not really him, and to kill him! Elsewhere Sam frees Caleb and he then goes in search for Caitlin I won't go any further but I will just say that this book had so much action and some brilliant sideline characters some old and new The story was fantastic and the massive shock ending has left me desperate for the next book!

I can't wait to read it May 05, Kasaundra Snow rated it really liked it. If I hadn't recently read the other two books in the series, I believe I would have had to go back and read them. The author doesn't really narrate much about the circumstances surrounding the previous books. And in between reading those and this one, I had read several other books and had to refamilarize myself with the characters in the series.

I can say that the development of the characters was much better in this book than in the others. The author took great care to familiarize the readers If I hadn't recently read the other two books in the series, I believe I would have had to go back and read them. The author took great care to familiarize the readers with the inner-workings of each character. This wasn't a book, however, that I could read non-stop, without putting down. It was good in its own right, but not something that I couldn't have read any time. I can say, without a doubt and without spoiling the ending for any future readers, that this book ended leaving me ready to start the next book which isn't available yet.

But to get to that point, I had to read enough to get to the last 3 or 4 chapters of the book. The rest I simply read to get through the book. And some paragraphs I skipped altogether just to finish it. And I mean no disrespect to the author. I just think that tihs book was pushed too hard or that it was expected to get as much in this book as the previous two, which were packed and I couldn't put them down from start to finish.

This was a good book and I can hardly wait for the next, but I do think that most of the paragraphs of the book could have been left out and seemed to be mostly for filler because there wasn't anything relevant to say. My Blurb: Caitlin awakens to find herself a full fledged Vampire, turned by her love Caleb, and on a island not so far from home.

The one person she did not expect to awaken to is Sera, Caleb's wife, and is shocked to find them back together again. Heartbroken Caitlin vows to never see Caleb again as Caleb professes his love for her and only her before flying off into a Vampire War that may end the lives of everyone, human and Vampire. Caitlin's journey has just begun as she finds new friends, s My Blurb: Caitlin awakens to find herself a full fledged Vampire, turned by her love Caleb, and on a island not so far from home.

Caitlin's journey has just begun as she finds new friends, starts training and receives a letter that changes everything.

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  • Lets Talk About It: This book had so many twists and turns to it that kept me on the edge of my seat! I immensely enjoyed the different characters that were brought to light. Polly, Aiden, Blake, I even ended up enjoying Sera. It felt like Caitlin really found a home with the Pollepel Coven and the time she spent there was enjoyable to read.

    The ending of this book had me in tears. So much death. So much grief. Such heartache. And what a fantastic cliff hanger ending. I am SO happy I had book 4 on my hands to start reading immediately after otherwise it probably would have driven me mad having to wait to find out what happens next. I'm a huge fan now of Morgan Rice and hope that The Vampire Journal series continues to churn out many more books. There are no discussion topics on this book yet. Readers also enjoyed. Young Adult. About Morgan Rice. Morgan Rice. Morgan loves to hear from you, so please feel free to visit www.

    Other books in the series. The Vampire Journals 1 - 10 of 12 books. Books by Morgan Rice. Trivia About Betrayed The Vam No trivia or quizzes yet. Quotes from Verraten. Haz que funcione para ti. Brill Sandra S. Brill Stephen R. Brill Volume 8 n. Elsie Austin. McLean Volume 8 n. Thomas Graham Hassall. Morgan Volume 7 n. Barker M. Muttart Volume 7 n. McLean Julio Savi Volume 6 n. Hoff Conow. Danesh, MD Rhett Diessner.

    Danesh, MD Brad Pokorny. Hatcher Gordon Dicks. Hatcher Philip Belove. Hatcher Volume 6 n. Van Den Hoonaard.

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