orm_june-2024 - 19

Safety
Takeaways
* Although women comprise half the population, they were left out of medical research on major causes of death for both
women and men-cancer, heart disease, and stroke-until 1990.
* Using surgical tools designed by men, for men can impact every aspect of a woman surgeon's work, from learning new
procedures to avoiding discomfort and injury.
* Awareness is the first step toward action. For instance, patients and caregivers alike might lack understanding of nuances
in cardiac care and outcomes for women.
Women in surgery, Belli
Continued from page 1
MPH, FACS, a trauma
surgeon at Cooper University
Health Care in
New Jersey. At a recent
surgical conference
she attended, a gender
equity session packed
the room. " People
want to hear and talk
about solutions, " she
says. " They want to know: How do we
fix this? "
Nicole Fox,
MD, MPH,
FACS
Improving working conditions for female
surgeons is likely to filter down
into patient outcomes as well. However,
getting beyond " one-size-fits-all " care
also requires surgeons-including the
men-to take action, beginning with
improving their understanding of how
women of various backgrounds and ethnicities
present with certain conditions
and how they respond to treatments.
Closing data gaps
Although women comprise half
the
population, they were left entirely out
of medical research around the major
causes of death for both women,
and men-cancer, heart disease and
stroke-until 1990, when the National
Institutes of Health (NIH) established
the Office of Research on Women's
Health (ORWH). Women were a rarity in
medical professions as recently as the
1970s, and women of childbearing age
were excluded from clinical trials per
a 1977 Food and Drug Administration
policy, resulting in all-male trials and
a dearth of information on how drugs
www.ormanager.com
impact women. It was not until 1994
that the NIH required all clinical trials to
include women and minorities in clinical
research.
However, research is slowly catching
up-and shows signs of accelerating.
In November 2023, President Biden
and First Lady Jill Biden announced
the White House Initiative on Women's
Health Research. Then in March 2024,
President Biden called on Congress to
invest $12 billion into the cause, signing
an executive order to ensure " women's
health is integrated and prioritized
across the federal research portfolio
and budget " and to " galvanize new research
on a wide range of topics, including
women's midlife health. "
Although these efforts
might take time to
materialize, researchers
are taking steps to get
more women from underrepresented
groups
to engage in clinical trials
to provide the data
needed to best serve
those populations. For
Heather Yeo,
MD, MHS,
MBA, MS
example, Heather Yeo, MD, MHS, MBA,
MS, associate professor of surgery and
population health sciences at Weill Cornell
Medicine, developed an app called
mHeals that allows patients recovering
from abdominal cancer surgery to
track various health measures-mobility,
pain, fluid intake, and diet-using a
Fitbit and daily surveys to monitor their
own health and signal doctors when intervention
is needed.
" We're looking at recovery after surgery
and whether an app can help them
return to baseline at a faster rate than
those without it, " Dr Yeo says. She
adds that her team has focused on
ensuring a diverse patient population,
which can be challenging. " The Hispanic
population is very wary of sharing data,
as we know from other studies, " she
says. " So, we've tried to over-enroll that
population. "
Getting beyond 'one size fits all'
As a colorectal surgeon, Dr Yeo uses
a colonoscope-a surgical device with
a control end and a long flexible tube
containing a camera-frequently in her
work and training. However, colonoscopes
can be cumbersome. " These
devices come in one size, " she says.
" Sometimes, in order to train a female
resident or a male one with smaller
hands, I have to have them use two
hands to maneuver because it's difficult
to do with smaller hands. "
When researchers used electrodes
to track muscle movement during surgical
procedures, they found women surgeons
had increased muscle activation
and higher fatigue levels compared with
men. Women with smaller hand sizes
are also more likely to be injured from
the use of laparoscopic instruments.
Wrong-sized tools can impact everything
from a surgeon's ability to learn a procedure,
to passing required tests, to
performing her duties without injury.
In a story from the Cleveland Clinic
looking at women and surgical tools,
Amy Park, MD, section head of female
pelvic medicine and reconstructive surgery
at Cleveland Clinic's OB/GYN &
Women's Health Institute, noted she
has experienced frequent soreness in
her forearm and the place where her
thumb and hand connect (the thenar
eminence) from using the laparoscope
because of the force required to close
it. " Due to the size of my hand, I cannot
extend it enough to generate the force
to easily operate the tool, " she said.
OR Manager | June 2024
19
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