Gender diversity in UK surgical specialties: a national observational study.

OBJECTIVES: To compare gender diversity between UK surgical specialties, assess trends over time, and estimate when gender parity might be achieved. DESIGN: Observational study. SETTING: National Health Service, UK. PARTICIPANTS: NHS Hospital & Community Health Service workforce statistics for 2011 to 2020 MAIN OUTCOME MEASURES: Logistic regression was used to compare female representation in 2020 between surgical specialties, and to examine for any significant trends between 2011 and 2020. The method of least squares was used to estimate when female representation of specialty registrars would reach 50% ('gender parity') for specialties with 45%) and Vascular Surgery (representation consistently <30%). General Surgery was estimated to achieve gender parity of their specialty registrars by 2028, Urology by 2033, Neurosurgery by 2064, Trauma and Orthopaedics by 2070, and Cardiothoracic Surgery by 2082. CONCLUSIONS: Despite improvements over the last decade, gender disparity persists in the UK surgical workforce and there are significant differences between surgical specialties. Further work is necessary to establish the reasons for these observed differences with a specific focus on Vascular Surgery, Cardiothoracic Surgery, Neurosurgery, and Trauma and Orthopaedics

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Vezetői és beszállítói vélemények a mezőgazdaság és a turizmus összekapcsolódásának lehetőségeiről Zala megyében

After the change of regime, Hungary's economy changed fundamentally. In adapting to the new system, many hitherto unexperienced sectors have gained ground and occupied a worthy position in some segment of the economy. Along with the strengthening of the economy, some farmers have developed rural tourism by taking advantage of the tourist attraction of agriculture and creating a new sector. With our thesis we would like to prove, that the new, but already existing types of Short Supply System based on catering enterprises in Zala county are sustainable and has a significant place on the field. To demonstrate this, we made interviews with entrepreneurs and their suppliers. We examined what special difficulties do they have to vanquish to make their enterprises sustainable and operable. First and last, it seems that a new autonomous market segment is forming, that combines old traditions and new trends.A rendszerváltást követően&nbsp; magyarország ipari és mezőgazdasági termelése jelentősen visszaesett. Az elmúlt egy évtized folyamán a mutatók lassan újra emelkedni kezdtek a mezőgazdaság területén, elsősorban a kutatásnak, fejlesztésnek, a példaértékű nyugati mintáknak és az Uniós támogatásoknak köszönhetően. Jelentős szerepet töltenek be ebben a fellendülésbenzok a gazdálkodók, akik, termékeiket turisztikai vonzerővé képesek formálni. A termelők között egyre többen ismerték fel a gasztronómia és a borturizmus jelentőségét. Gondoljunk például a glokalizációra, amelynek lényege a globális áruk helyi környezethez való igazodás utáni újra lokálissá válása. Ilyen például napjainkban a hamburger, amely világszerte elterjedt és elérhetővé vált minden kontinensen, garantálva mindig ugyanazt az ismert ízvilágot. A termelők azonban egy idő után elkezdtek kísérletezni és különböző változatokat készítettek, amely széleskörű termékpalettát eredményezett a fent említett kategórián belül, és az egyre bővülő kínálati struktúrák is azt támasztják alá, hogy igény van ezekre az újításokra. Az újonnan létrejövő lokális értékekre építő éttermek, gasztro bárok és egyéb vendéglátó egységek vonzzák a turistákat, akik azért indulnak útnak, hogy kipróbálják a világban ismert ételek egyénileg újra gondolt, átformált verzióit, valamint helyi jellegzetességek hagyományok szerinti változatait, amelyek minden vidéken más és más ízvilágot képviselnek. Az urbanizálódott ember annyira elszokott az agrárkörnyezettől, hogy a termékek előállításán túl az állatok látványa is élményekkel tölti el, ígygazda megnyitotta kapuit a látogatók előtt. A legtöbb látványgazdaságban az állatok, a különféle kézműves élelmiszerek előállításának kipróbálása, a termékek vásárlási lehetősége adja a hozzáadott értéket, de van, ahol ezek mellett falusias környezetben biztosítanak szállást a feltöltődni vágyó turistáknak. A fentebb leírtakat figyelembe véve kutatásunk céljaként tűztük ki, hogy részletes vizsgálatok segítségével feltárjuk a mezőgazdaság valamint a turizmus kapcsolatából adódó kiaknázott és kiaknázatlan lehetőségeket, mintegy perspektívát adva a téma iránt érdeklődő olvasók számára

The Perceived Impact of Equality and Equity in Medical Education by Junior Doctors in the UK

Purpose of the Study: This exploratory study was undertaken to provide an insight into issues of equality and equity that UK junior doctors perceive in relation to being able to achieve a work life balance within educational and clinical practice. Study Design: A survey with 443 UK junior doctors was conducted between May 2018 and September 2019. Thematic analysis of open question responses alongside correlative analyses were used to highlight issues in equity and equality faced by junior doctors. Results: 77% were junior doctors in HEE posts. 59% were not in personal relationships, 60% had no children, 38% perceived the national recruitment process as helpful and 70% perceived HEE did not impact on their training. 72% had no personal barriers and 77% felt the role was not a barrier. 1% identified no barriers. Conclusions: The research raised implications for redress of equality and equity issues for all within inclusive postgraduate training in the UK

Changing the norm towards gender equity in surgery:the women in surgery working group of the Association of Surgeons of Great Britain and Ireland's perspective

Competition ratios for surgical specialty applications have declined. To ensure that all individuals attracted to surgery are enabled to flourish and enjoy their surgical careers, we need to change the “surgical norm”. This particularly applies for women, since currently 54% of the foundation trainees in surgery are female (Moberly, 2018), and even if most of the challenges to succeed in a high competitive field are common to both sexes, there are barriers, hidden or evident, peculiar to women. We report the Association of Surgeons of Great Britain and Ireland (ASGBI) women in surgery (WiS) working group’ perspective on changing the norm of the surgical environment, so that recruitment and investment in retention of surgical trainees of both genders could flourish