RESUMO
Aims: This study investigated the perceptions of medical students regarding the barriers to pursuing a career in trauma and orthopaedics (T&O); and whether these perceptions were altered by attending an event promoting women in T&O. Methods: An event consisting of presentations and interactive sessions from two female T&O trainees was hosted online. Attendees completed pre and post-event questionnaires. Students were asked about their previous exposure to T&O, perceptions of gender imbalances in T&O and what barriers they perceived prevented women from entering T&O. Univariate analysis was performed to identify changes in perceptions following the event. Results: Pre-event questionnaires were completed by 102 people; and post-event by 52. Although 64/102 respondents were considering a career in T&O, 26/102 were dissuaded by perceived gender disparities. Perceptions of gender disparities were significantly higher in UK based attendees compared to other nationalities (p = 0.047). Attendees were more likely to want to pursue a career in T&O if they had been directly exposed at medical school (p = 0.044), but exposure did not alter perceptions of women in T&O. The most common perceived barrier was the orthopaedic stereotype followed by male dominated workplace culture, and lack of female role models. Pre and post-event responses did not differ significantly for any areas examined. Conclusion: There are significant concerns amongst medical students regarding gender based discrimination within T&O, and these perceptions were not altered by attending a one-off women in T&O event. Early exposure to T&O appears important to improve interest in orthopaedics, whereas negative stereotyping is a barrier.
RESUMO
INTRODUCTION: Prehabilitation prior to major surgery has increased in popularity over recent years and aims to improve pre-operative conditioning of patients to improve post-operative outcomes. The beneficial effect of such protocols is not well established with conflicting results reported. This review aimed to assess the effect of prehabilitation on post-operative outcome after major abdominal surgery. METHODS: EMBASE, Medline, PubMed and the Cochrane database were searched in August 2018 for trials comparing outcomes of patients undergoing prehabilitation involving prescribed respiratory and exercise interventions prior to abdominal surgery. Study characteristics, overall and pulmonary morbidity, length of stay (LOS), maximum inspiratory pressure and change in six-minute walking test (6MWT) distance were obtained. The primary outcome was post-operative overall morbidity within 30 days. Dichotomous data were analysed by fixed or random effects odds ratio. Continuous data were analysed with weighted mean difference. RESULTS: Fifteen RCTs were included in the analysis with 457 prehabilitation patients and 450 control group patients. A significant reduction in overall (OR 0.63 95% CI 0.46-0.87 I2 34%, p = 0.005) and pulmonary morbidity (OR 0.4 95% CI 0.23-0.68, I2 = 0%, p = 0.0007) was observed in the prehabilitation group. No significant difference in LOS (WMD -2.39 95% CI -4.86 to 0.08 I2 = 0%, p = 0.06) or change in 6MWT distance (WMD 9.06 95% CI -35.68, 53.81 I2 = 88%, p = 0.69) was observed. CONCLUSIONS: Prehabilitation can reduce overall and pulmonary morbidity following surgery and could be utilised routinely. The precise protocol of prehabilitation has not been completely established. Further work is required to tailor optimal prehabilitation protocols for specific operative procedures.
