Teeter-Totter or Tapestry: A Life in Academic Medicine.

Constructing a career in academic medicine involves more than a focus on work-life balance. That image of a teeter-totter suggests that life is what happens when you are not working. The nature of the scope of interests (clinical, research, teaching) and values (service, leadership, curiosity, transparency, and honesty) creates a larger framework through which home life and work life become one interwoven tapestry. The author reflects on these perspectives as she looks back on a career in academic medicine.

Gynecologic care in hematopoietic stem cell transplant patients: a review.

UNLABELLED: Over 4500 hematopoietic stem cell transplants (HSCT) are performed on patients in the United States each year. As HSCT patients shift their survivorship care from large transplant centers to community health care providers, many gynecologists are assuming their pre- and post-HSCT gynecologic care. This article reviews recommendations, current research, and expert opinions on the gynecologic care of HSCT patients. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completing this educational activity, the physician should be better able to implement strategies for the prevention and management of menstrual bleeding during hematopoietic stem cell transplants; educate female patients regarding Fertility Preservation options before hematopoietic stem cell transplantation; and apply posthematopoietic stem cell transplant reproductive care screening and treatment recommendations for bone health, sexual health, and secondary cancer development.

Characterization of therapy and costs for patients with uterine fibroids in Utah Medicaid.

OBJECTIVES: To determine in an eligible Utah Medicaid population (1) medical and drug costs associated with treating uterine fibroids (UFs) and (2) the cost and incidence of hysterectomy complications. METHODS: Medical and drug cost analyses were based on data from 897 premenopausal patients with UFs included in the Utah Medicaid database from 1996 to 2004. UF-related medical and pharmacy costs were determined from first diagnosis of UFs until a related procedure or until estimated menopause. Outcomes for patients treated with a procedure (hysterectomy, myomectomy, or embolization), medication, and watchful waiting (no procedure, no UF-related drug) were compared. When determining hysterectomy complication rates for the population of women in the Medicaid database, a total of 1,323 pre- or postmenopausal patients with UFs were included. RESULTS: Overall, 20% of patients were treated with medication, 33% with a procedure, and 47% with watchful waiting. Mean total UF costs were: $11,996 (procedure), $2,703 (medication), and $2,118 (watchful waiting). Mean eligibility months were 8.8, 28.8, and 14.1, respectively. Costs/eligible month were: $1,358 (procedure), $151 (watchful waiting), and $94 (medication). The mean hysterectomy cost was $12,107. CONCLUSION: Treatment for UFs is expensive with a mean cost of $5,504 per study patient. The highest costs are seen in patients receiving procedures, which can lead to complications; 15% in this study. Costs for watchful waiting are similar to costs in patients receiving UF-related drugs. Consideration should be given to using non-surgical therapies for the treatment of UFs before procedures are performed.