ObjectivesBecause culture reflects leadership, the making of diverse and inclusive medical schools begins with diversity among leaders. The inclusion of women leaders remains elusive, warranting a systematic exploration of scholarship in this area. We ask: (1) What is the extent of women’s leadership in academic medicine? (2) What factors influence women’s leadership? (3) What is the impact of leadership development programmes?DesignSystematic review.Data sourcesA systematic search of six online databases (OvidMEDLINE, EMBASE, CINAHL, PsycINFO, the Cochrane Library and ERIC) from the earliest date available to April 2018 was conducted. Bridging searches were conducted from April 2018 until October 2019.Eligibility criteria(1) Peer-reviewed; (2) English; (3) Quantitative studies (prospective and retrospective cohort, cross-sectional and preintervention/postintervention); evaluating (4) The extent of women’s leadership at departmental, college and graduate programme levels; (5) Factors influencing women’s leadership; (6) Leadership development programmes. Quantitative studies that explored women’s leadership in journal editorial boards and professional societies and qualitative study designs were excluded.Data extraction and synthesisTwo reviewers screened retrieved data of abstracts and full-texts for eligibility, assessment and extracted study-level data independently. The included studies were objectively appraised using the Medical Education Research Quality Study Instrument with an inter-rater reliability of (κ=0.93).ResultsOf 4024 records retrieved, 40 studies met the inclusion criteria. The extent of women’s leadership was determined through gender distribution of leadership positions. Women’s leadership emergence was hindered by institutional requirements such as research productivity and educational credentials, while women’s enactment of leadership was hindered by lack of policy implementation. Leadership development programmes had a positive influence on women’s individual enactment of leadership and on medical schools’ cultures.ConclusionsScholarship on women’s leadership inadvertently produced institute-centric rather than women-centric research. More robust contextualised scholarship is needed to provide practical-recommendations; drawing on existing conceptual frameworks and using more rigorous research methods.
The aim of this study was to assess patients' satisfaction based on gender and age using the Rhinoplasty Outcomes Evaluation (ROE) post-rhinoplasty from both functional and aesthetic outcomes. The study design was a prospective observational study. A total of 103 patients who underwent Rhinoplasty were prospectively investigated from January 2011 through December 2013 at King Abdulaziz University Hospital in Riyadh, Saudi Arabia. The sample included 61 males (59.2%) and 42 females (40.7%). The overall mean age was (25.2 ± 5.9) years (range 17-48 years). ROE was distributed pre- and post-surgery. The overall difference in satisfaction was significant (p < 0.0001). The mean satisfaction difference of function was increased by 21.5%, raising the satisfaction percentage from 57.1% initially to 78.5% post-surgery (mean -0.215, CI -0.269, -0.161). Satisfaction of shape post-rhinoplasty showed that the mean satisfaction increased by 31.3% (mean -0.313, CI -0.369, -0.256), which changed the satisfaction from a mean of 44.2% before surgery to 75.5% post-rhinoplasty (p = 0.000). There was no significant difference in satisfaction between males and females, nor was there a significant difference in satisfaction among different age groups (p > 0.05). There was a significant overall increase in patients' satisfaction from functional and aesthetic outcomes post-surgery based on ROE. Our study showed that age and gender did not significantly affect satisfaction. The ROE was a useful tool to implement for assessing the quality-of-life post-rhinoplasty.
BACKGROUND: Thyroid malignancy, the most diagnosed cancer of the endocrine system, represents 2% of all malignancies worldwide. The increasing incidence of thyroid cancer has been linked to the increasing sensitivity of modern diagnostic methods which overdiagnosis small thyroid tumors.OBJECTIVES: Assess the distribution and trends in thyroid cancer among thyroidectomy patients.DESIGN: Descriptive, based on medical record review.SETTINGS: Two tertiary care centers in Riyadh.PATIENTS AND METHODS: We included patients who underwent thyroid surgery from January 1, 2004 to December 31, 2016 who ranged in age from 9–90 years regardless of initial diagnosis.MAIN OUTCOME MEASURES: Distribution of thyroid carcinomas by type, age and sex and trends over the time period.SAMPLE SIZE: 979 patients.RESULTS: Of 979 patients, 84.5% were <55 years old, with the majority being female. Thyroid malignancy ranked second to benign tumors, and the most common type of thyroid cancer was papillary thyroid carcinoma (91% of malignant tumors), followed by follicular thyroid cancer (4.7% of malignant tumors). After thyroid microcarcinomas were isolated from the sample and studied separately, we found the overall trend for thyroid cancer to be stable, and that the annual increases in rates were due to increased diagnosis of thyroid microcarcinoma in the period from 2010 to 2016.CONCLUSION: Our study shows that increases in thyroid cancers may be attributed to a rise in the rates of diagnosis of thyroid microcarcinomas.LIMITATIONS: The main limitation is the retrospective nature of this design. Also, a multicenter collaboration would prove beneficial in evaluating the trends of thyroid cancer in Saudi Arabia on a much larger scale.CONFLICT OF INTEREST: None.
To investigate the safety and cost-effectiveness of outpatient thyroidectomy and provide a systematic postoperative protocol for safe discharge. Methods: In this retrospective review, the medical records of all patients who underwent total, hemi, or completion thyroidectomy from July 2017 to April 2019 at 2 tertiary care hospitals were reviewed. Multivariable analysis was performed on the potential predictors of postoperative complications. Healthcare costs were calculated by the type of admission based on the average costs at the 2 centers. Results: One hundred twenty-two patients were enrolled in this study. The majority of cases were in the outpatient group (n=76, 62.3%). Total Original Article thyroidectomy was the most prevalent type of surgery (n=90, 73.7%). There were a total of 20 complications in 18 patients (inpatient=9 versus [vs.] outpatient=9). No cases of cervical hematoma or bilateral vocal cord paralysis were encountered. No significant difference was found between the type of admission (outpatient vs. inpatient) and postsurgical complications (p=0.24). The multivariable regression model retained significance for male gender and American Society of Anesthesiologists Classification III as potential predictors of postoperative complications. Healthcare costs would be reduced by at least 15.5% with the implementation of outpatient surgery. Conclusion: Outpatient thyroidectomy is as safe as inpatient thyroidectomy given the proper selection of cases. We project cost containment of over $711 thousand per 1,000 cases for outpatient thyroid surgeries.
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