RESUMO
BACKGROUND: Neurosurgery exhibits notably lower representation of Black, Hispanic, and female surgeons compared to various other medical and surgical specialties. Existing research focuses on medical students' views on surgeons, factors influencing female medical students' preferences in surgical fields, and the perceived interests and concerns of students contemplating a career in neurosurgery. However, there is a significant gap in understanding the unique concerns and perspectives of female medical students interested in neurosurgery. METHODS: Semi-structured interviews with female medical students were recruited from medical schools in the DC area. Interview questions were based on Lent and Brown's Social Cognitive Career Theory. Transcripts were analyzed thematically into codes. RESULTS: In total, 8 female medical students from our institution participated. We identified three major themes that influenced medical students decision making: sense of belonging (diversity, mentorship, passionate), self-efficacy (ambitious/"gunner", intense/competitive), and outcome expectations (innovation/research, immediate impact, procedural/surgical aspect, salary, work-life balance). CONCLUSION: Female medical students face distinct challenges and factors to consider when choosing a career in neurological surgery. The biggest concern for female students was a sense of belonging. It is imperative to enhance the diversity within the neurosurgical specialty and boost the representation of female neurosurgeons. Early interventions designed to tackle and alleviate their specific concerns are pivotal in achieving this goal.
RESUMO
OBJECTIVE: Closed suction drains, often used after posterior spinal surgery, pose a potential risk of infection. To combat this risk, many surgeons opt for a prolonged prophylactic antibiotic regimen. Since 2015, several studies have shown that prolonged prophylactic systemic antibiotics (PPSA) for drains provides no additional benefit in reducing surgical site infection (SSI) rates. However, most of these studies lacked sufficient power to make reliable conclusions. To date, there has been no meta-analysis conducted to further investigate this issue. The aim of this study was to investigate whether a regimen of PPSA reduces the incidence of deep SSIs in adult patients with closed suction drains following posterior spinal surgeries. METHODS: The protocol of the current systematic review was registered with PROSPERO. A systematic review of the literature in PubMed (Medline), Europe PMC, Embase, and Cochrane Review databases was conducted for all relevant literature with the keywords "spine," "antibiotics," "surgical site infection," "prophylaxis," and "drain." Retrospective and prospective studies investigating the effectiveness of PPSA in patients 18 years or older who underwent posterior cervical or thoracolumbar surgery and had postoperative wound drains were included. The primary outcome was the odds ratio for deep SSI based on the intervention (PPSA vs non-PPSA). The secondary outcomes were the rates of superficial and overall SSIs. RESULTS: From a total of 2558 titles identified from the search, 7 studies were chosen for final analysis. Three were randomized controlled trials (RCTs), and 4 were retrospective reviews. A total of 2446 patients were analyzed; 1149 received a PPSA regimen and 1297 received a non-PPSA regimen. Deep SSIs occurred in 45 patients (3.9%) and 46 patients (3.5%) in the PPSA and non-PPSA groups, respectively. The odds ratio for deep SSIs in the PPSA group compared with the non-PPSA group was 1.10 (95% CI 0.69-1.74), which was not statistically significant. Additionally, there were no differences in the rates of superficial and overall SSIs. There was a trend toward increased infections with multidrug-resistant bacteria (Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus) in the PPSA group; however, it was not possible to perform a durable statistical analysis because of the small number of reported organisms in the selected publications. CONCLUSIONS: This meta-analysis demonstrates that there is no reduction in rate of deep, superficial, and overall SSIs with prolonged prophylactic antibiotics after posterior spinal surgery involving the use of closed suction drains.