NIH Looks for Best Practices in Promoting Sustained Career Success for Women in Biomedical Research
By Barbara M. Alving, MD
Dr. Alving is Director of the National Center for Research Resources at NIH.
ASH members are at the forefront of addressing the challenge to ensure opportunities for sustained career success for women entering biomedical research fields. At a recent NIH conference titled "Women in Biomedical Careers: Best Practices for Sustaining Career Success," Nancy Andrews, MD, PhD, the Dean at Duke University School of Medicine, not only described the reasons why women are leaving academic medicine after beginning promising careers as assistant professors, but also stressed the urgency of ensuring that an extremely valuable and robust talent pool is maintained and cultivated.
In addition, Timothy Ley, MD, Professor of Medicine at the Washington University School of Medicine, provided data to show that women are as successful as men in obtaining research grants, but are less likely to continue to seek renewed funding. He described the current academic culture as "patriarchal, developed by men for men."
Speakers from other organizations, such as Ernst & Young and Deloitte & Touche, discussed their successful programs for ensuring continued advancement of talented women in the workplace. Both described aggressive efforts to recruit and retain women, such as training them for executive positions and providing flexible career paths and opportunities for telecommuting. Both organizations stated that they have been actively addressing the need to retain women in the workforce and enhance diversity for the past 15 years. As a result, in 2007, 33 percent of new partner/principal promotions at Ernst & Young were women.
Representatives from the academic health centers, one of whom was Andrew Schafer, MD, Chair of the Department of Medicine at Weill Cornell, current president of the Association of Professors of Medicine, and immediate past president of ASH, discussed how they were promoting sustained career success through providing or advocating for flexibility in the time for tenure to be achieved and promoting executive leadership programs and initiatives to enhance work/life balance.
The NIH, through its Working Group on Women in Biomedical Careers, co-chaired by Drs. Elias Zerhouni and Vivian Pinn, is developing policies that are in concert with those in universities.
What should professional societies do? Societies and organizations need to include diversity at all levels. The NIH will work with professional organizations and universities to track the career development of women in biomedical research/academic medicine and develop policies that provide family balance, extension of time in tenure track positions, and opportunities for executive training. The loss of talent from the biomedical research workforce is a national issue of the highest priority and must be addressed by the leaders at academic health centers, professional organizations, and the federal government working together. To review the agenda from the meeting and the speaker presentations, visit the Women in Biomedical Careers Web site.
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Computed Tomographic Pulmonary Angiography – Too Good to Be True?
By Charles S. Abrams, MD
Dr. Abrams indicated no relevant conflicts of interest.
Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs. ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA. 2007;298:2743-53.
For several decades, ventilation-perfusion (V/Q) scans have been used to detect pulmonary embolisms in patients. It is clear that a normal V/Q scan excludes the diagnosis of a pulmonary embolism, and a high probability V/Q scan essentially confirms the diagnosis. The challenge is what to do with patients who have a non-diagnostic (i.e., low to intermediate probability) V/Q scan.
Computed tomographic pulmonary angiography (CTPA) is an alternative test used to detect pulmonary embolisms that has several advantages over the V/Q scan. It provides a clear (yes or no) result, and it is also capable of detecting non-thrombotic causes for a patient's symptoms. The downsides of CTPA are that this technique exposes the patient to more radiation than V/Q scans and that it may cause dye-induced nephrotoxicity. In spite of these tradeoffs, CTPA has largely replaced V/Q testing for pulmonary embolic disease. Although CTPA has become widely accepted as a standard test for this disease, there is controversy over whether small-vessel disease can be imaged as well by CTPA as by V/Q scans.
In this single-blinded, noninferiority, multicenter clinical trial, 701 patients were randomized to undergo CTPA and 716 were randomized to V/Q scanning. The results showed that 19.2 percent of the CTPA group and 14.2 percent of the V/Q group were diagnosed with a pulmonary embolism and treated with anticoagulation. Of the patients who were not initially diagnosed with a pulmonary embolism, 0.4 percent of the patients in the CTPA group and 1.0 percent of the patients in the V/Q scan were subsequently diagnosed to have thromboembolic disease.
This study by Anderson and colleagues convincingly demonstrates that CTPA is at least as effective as V/Q scans at diagnosing pulmonary embolisms. In fact, the incidence of detected pulmonary embolisms was 30 percent higher in the group randomized to be analyzed by CTPA ― a statistically significant difference. Some patients who had negative V/Q scans were subsequently diagnosed as having a pulmonary embolism once they had a CTPA; this suggests that CTPA might be an even more sensitive diagnostic test than V/Q scans.
These findings raise the interesting question about whether our technology is getting too good. Is CTPA capable of diagnosing emboli that are too small to be clinically significant? In the Anderson study, approximately 7 percent of patients diagnosed as having a thromboembolism by CTPA had emboli only in small subsegmental pulmonary vessels. Do we really know that these small clots require therapy? It should be noted that eight patients in the Anderson trial who had no obvious pulmonary embolism diagnosed by either CTPA or V/Q scans ultimately developed a pulmonary embolism (including one patient who died of a clot). This implies that these eight symptomatic patients probably had very small pulmonary emboli that were missed by their initial imaging study. We need to keep in mind that the true value of treating a pulmonary embolism with anticoagulation is to prevent the next one, rather than the thromboembolism that has already occurred. Using this rationale and the currently available data, we should be treating all pulmonary emboli regardless of their size, and perhaps even seeking out technologies that diagnose smaller and smaller clots.
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