Faculty Bibliography

PURPOSE: Although nearly half of American medical school classes are comprised of women, less than 5% of female medical students enter the surgical subspecialties compared to nearly 20% of male students. Many women are concerned that a career in a surgical field will limit their personal choices. In an effort to evaluate if urology is conducive to a satisfying lifestyle, we surveyed all 365 board certified women urologists in the United States in 2007 to find out how satisfied they are with their choice of urology. MATERIALS AND METHODS: A 114 item anonymous survey was mailed to all 365 American Board Certified female urologists in 2007. Results were analyzed. RESULTS: Of the 244 women (69%) who responded, 86.8% (211) reported being satisfied with their decision to enter urology. Given the choice to repeat the decision, 81% (198) said that they would remain in medicine and 91.4% (222) would choose a surgical subspecialty again. The majority of respondents who stated they would choose a career outside of medicine also stated their family life had been significantly compromised by their career. Those who did not think their family life was compromised reported they would remain in medicine. There was a positive correlation between the level of satisfaction with the work itself and with income level (p = 0.006). CONCLUSIONS: Despite the small number of women who choose a career in urology, the number of satisfied women indicates urology is a career conducive to having a balanced and fulfilling life; professionally, personally and financially.

Historians of medicine generally credit the hospital standardization movement of the early 20th century with establishing the record as a sign of hospital and staff quality. The medical record's role had already been the subject of intense interest at the New York Hospital several decades before, however. In the 1880s malpractice and insurance concerns caused the administration to attempt to supervise record creation, quality, and access, over the objections of physicians. Contemporary concerns about the uses of the medical record were in play well before 1910.

Objective: Symptomatic vaginal atrophy affects one out of three menopausal women. Hormone therapy, both systemic and local, is effective and indicated for the relief of this problem but may not be acceptable to all patients. DT56a (Femarelle), a selective estrogen receptor modulator derived from botanical source, was found to be effective at decreasing menopausal hot flushes and increasing bone mass. We performed a pilot study testing the use of DT56a for vaginal atrophy. Design: 12 post-menopausal women with vaginal atrophy (<5% superficial cells on cervical cytology) with at least one moderate-to-severe symptom, were recruited for an TRB-approved 12-week open-label pilot study. DT56a (322mg) was given by mouth 2X/day for 12 weeks. At each visit (0&q4 weeks) subjects had a vaginal atrophy assessment (speculum exam, vaginal pH) and completed questionnaires on atrophy symptoms and quality of life (Utian QoL scale).At weeks 0 and 12, a pap smear with maturation index and vaginal cultures were performed. Results: The main bothersome symptoms were: Dyspareunia- 5 Patients,Vaginal soreness- 3 Patients.Vaginal dryness- 2 Patients.Vaginal irritation-1 Patient and Bleeding with coitus-1 Patient. All patients reported significant improvement in their most bothersome symptom. All women had a significant reduction in vaginal pH. The average pH went from baseline 7.7+/-2.2 to 4.9+/-1.4 on week 12,p<0.0001. The maturation index also improved as shown in the figure below: Parabasal cells that were 100% at entry were 43% following 12 weeks of treatment, Intermediate cells were changed from 0 to 47% and Superficial cells that were 0 at entry, were 10% following 12 weeks of treatment with DT56a (all statistically significant, p<0.001). A significant improvement was found in UQoL index from mean pre-treatment of 75.4+/-22.7 points to mean post-treatment of 88.9+/-26.8, p<0.001.In the sexual domains of the UQoL there was a significant improvement from 6.5+2 points (mean pre-treatment) to 10.6+ 3.2 (mean post-treatment), p<0.001. Conclusion: In this open-label prospective study DT56a was effective against symptomatic vulvo-vaginal atrophy in both subjective and objective measures. The changes in symptoms and pH were prompt and paralleled symptomatic relief. DT56a furnished a significant improvement in UQoL. As the placebo effect on the maturation index and vaginal pH is negligible, this 12 patient study provides an indicative measurement of the positive effect of DT56a for the treatment of vulvo-vaginal atrophy and a large double blind placebo controlled trial is planned. (Table presented)