Tait Shanafelt

..Physicians should strictly adhere to established criteria to initiate treatment for CLL patients who are not participating in clinical trials...

..Additional studies are needed to determine the optimal management of these malignancies in patients with CLL and whether more aggressive screening or alternative approaches to adjuvant therapy are needed...

..Despite extensive data about physician burnout, to our knowledge, no national study has evaluated rates of burnout among US physicians, explored differences by specialty, or compared physicians with US workers in other fields...

..The objective of the current study was to follow up the results of phase 1 testing by evaluating the clinical efficacy of the green tea extract Polyphenon E for patients with early stage chronic lymphocytic leukemia (CLL)...

..In this mini-review, we summarize Mayo Clinic's recent efforts to improve CIT for patients with CLL...

..To evaluate the health habits, routine medical care practices, and personal wellness strategies of American surgeons and explore associations with burnout and quality of life (QOL)...

..In this review, we examine the causes, consequences, and personal ramifications of oncologist burnout and explore the steps oncologists can take to promote personal well-being and professional satisfaction...

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..An understanding of the factors contributing to professionalism may allow the development of more effective approaches to promoting this quality in medical education...

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..In this paper, we provide a state of the art review on the prevalence, nomenclature, biology, natural history and clinical management of MBL...

..Importantly, anti-CD49d antibodies are already approved for treatment of other human diseases. Clinical testing of anti-CD49d therapy in CLL appears warranted...

..To evaluate the relationship between burnout and perceived major medical errors among American surgeons...

..The natural history of clinically identified MBL is unclear. The goal of this study was to explore the outcome of patients with MBL relative to that of individuals with Rai stage 0 chronic lymphocytic leukemia (CLL)...

..The pretreatment VEGF:TSP ratio also correlated with overall survival (P = 0.008). A pro-angiogenic profile appears associated with diminished response and inferior survival in CLL patients receiving CIT...

..The effectiveness with which physicians help patients adjust to the physical, intellectual, and emotional challenges of CLL appears to impact patient QOL...

..The effects of CLL on QOL appear to differ from that of other malignancies with a more marked impact on emotional QOL. Research identifying efficacious psycho-oncologic support interventions for patients with CLL is needed...

..Although chemoimmunotherapy (CIT) has dramatically improved response rates in patients with CLL, some CIT regimens are not well tolerated by many patients >or=70 years of age...

..Using clinically relevant criteria to distinguish between monoclonal B-cell lymphocytosis (MBL) and CLL could minimize patient distress caused by labeling asymptomatic people at low risk for adverse clinical consequences as having CLL...

..This index requires validation in an independent series of patients before widespread use can be recommended...

..Additional studies are needed to determine whether the clinical outcome of patients with MBL differs from that of patients with Rai stage 0 CLL and to identify what B-cell threshold optimally distinguishes between these conditions...

..To define the optimal dose of Polyphenon E for chronic daily administration and tolerability in patients with chronic lymphocytic leukemia (CLL)...

..Suicide is a disproportionate cause of death for US physicians. The prevalence of suicidal ideation (SI) among surgeons and their use of mental health resources are unknown...

..The in vitro observation that statins reduce rituximab efficacy does not appear to have clinical significance in CLL care...

..A study was undertaken to analyze the survival of chronic lymphocytic leukemia (CLL) patients relative to age-matched individuals in the general population and determine the age-stratified utility of prognostic testing...

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..To evaluate the efficacy of rituximab for the treatment of adult patients with immune cytopenia, including idiopathic thrombocytopenic purpura (ITP), autoimmune hemolytic anemia, and Evans syndrome...

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..The average prolongation in survival with chemotherapy compared with best supportive care has not been well described...

..Further preclinical development of adaphostin as a novel agent for the treatment of CLL appears warranted...

..In this article, we review the literature on surgeon burnout, discuss potential personal and professional consequences, and consider steps individual surgeons can take to promote personal and professional satisfaction...

..While much is known about oncologist distress, little is known about oncologist well-being. We set out to evaluate oncologist well-being and the personal wellness promotion strategies used by oncologists...

..No complete or partial remissions were observed. Individually and collectively, these studies indicate that single-agent anti-VEGF therapy has minimal clinical activity for patients with relapsed/refractory CLL...

..The use of clonidine, methyldopa, and belladonna should be discouraged because of their modest efficacy and adverse effects...

..An NCI sponsored phase I/II trial of de-caffeinated green tea extracts for patients with asymptomatic, early stage CLL opened at Mayo Clinic in August 2005...

..While resident distress and its potential to negatively effect patient care have been well documented, little is known bout resident well-being or its potential to enhance care...

..Clinical trials evaluating treatments that are designed to be tolerated by patients who do not meet traditional clinical trial eligibility criteria are needed...

..This pilot trial suggests that citalopram may be an effective non-hormonal treatment for hot flashes in women who can tolerate it...

..6-fold increase in activity (P = .004). CONCLUSION: Our data suggest serum BLyS levels are elevated in patients with familial B-CLL and that elevated BLyS levels correlate with the presence of a T at -871 in the BLyS promoter...

..It is of physiologic interest that this older antidepressant, classified as a tricyclic, did not achieve a clinically significant reduction in hot flash scores in this pilot trial...

..Future studies are warranted to elucidate the role of serum FLC as biomarkers of disease, for monitoring of minimal residual disease, and as a prognostic factor for response and survival...

..Thus, a VEGF-VEGF receptor pathway in CLL B cells can be linked to activation of STAT proteins that are able to enhance their apoptotic resistance...

..In this phase 2 study, the authors tested the safety and efficacy of early treatment for patients with high-risk CLL using alemtuzumab and rituximab...

..Deletions in IGHv occurred in 25% of patients and correlated with IGHv gene expression. Probes for 6q23 detected more deletions in 6q than probes for 6q21...

..Revisions of the National Cancer Institute Working Group 96 criteria should consider the aetiology of cytopenia in staging CLL patients...

..These characteristics can be modified and continued evaluation of immunomodulatory drugs, vaccination strategies and cellular therapies to delay/prevent disease progression are warranted...

..The Accreditation Council for Graduate Medical Education resident work hour limitations were implemented in July, 2003. Effects on faculty are not well understood...

..Little is known about the prevalence of suicidal ideation among U.S. medical students or how it relates to burnout...

..To study the effectiveness of peripheral blood (PB) and bone marrow flow cytometric immunophenotyping (FCIP) in predicting the histologic B-cell lymphoma type...

..The review is intended to discuss and simplify first-line therapy selection for patients with CLL in the era of new prognostic indicators and the better understanding of disease biology...

..In contrast, CD38 predicted TTT (p=0.02) regardless of the proposed new classification. Molecular characteristics of the leukemic clone are a better predictor of progression than an arbitrary ALC or B lymphocyte count threshold...

..These results indicate the interaction between CLL B-cells and marrow stromal elements regulates angiogenic switching and may be linked to disease progression...

..To determine the well-being of minority medical students in a multicenter sample of US medical students...

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..Medical errors are associated with feelings of distress in physicians, but little is known about the magnitude and direction of these associations...

..The authors sought to identify the prevalence of burnout, variation of its prevalence during medical school, and the impact of personal life events on burnout and other types of student distress...

..To systematically review articles reporting on depression, anxiety, and burnout among U.S. and Canadian medical students...

..Overall, most residents (65%) approved of WHLs. CONCLUSIONS: Internal medicine residents approve of WHLs overall and report benefits to their well-being. However, they also report negative effects on patient care and resident education...

..In this article, we review the manifestations and causes of student distress, its potential adverse personal and professional consequences, and proposed institutional approaches to decrease student distress...

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..Thus, these results suggest that VEGF signaling regulates survival signals in CLL cells and that interruption of this autocrine pathway results in caspase activation and subsequent leukemic cell death...

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..001). The percentage of smudge cells as a continuous variable correlated with overall survival (P=.04). The estimation of smudge cells on a blood smear could be a universally available prognostic test in early-stage CLL...

..To explore residents' competency in medical knowledge and in empathy, one element of professionalism, and to evaluate the relationship between competencies in these domains...

..Three-year survival was 41% (95% CI: 26 - 66%). HDMP-rituximab is an active regimen in patients with relapsed, refractory, and cytogenetically high-risk CLL. Further evaluation of this regimen in controlled trials appears warranted...

..In addition, these data support the concept that antigen-driven selection of specific Ig receptors plays a role in the clinical course of B-CLL...

..We explore differences in the prevalence of burnout, depressive symptoms, and quality of life (QOL) among minority and nonminority medical students as well as the role race/ethnicity plays in students' experiences...

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..Studies show that 30-50% of medical oncologists experience burnout, but little is known about burnout among surgical oncologists. We hypothesized that wide variation in burnout and career satisfaction exist among surgical oncologists...

..CONCLUSION: Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices...

..To compare how different institutional review boards (IRBs) process and evaluate the same multiinstitutional educational research proposal of medical students' quality of life...

..The management of CLL is in a dynamic phase of rapid evolution. Risk stratification using biological prognostic markers can improve current patient care and direct future clinical research...

..199) were noted with lower TCL-1 expression. These data suggest TCL-1 expression may help predict treatment outcome in CLL patients following chemoimmunotherapy, and examination in larger studies is warranted...

..Translocations or isochromosome formations at sites of low-copy DNA repeats in 17p10 to 17p12 appear to be the mechanism for the loss of TP53 in B-CLL...

..In this article, we review the current literature on the symptoms, signs, and possible therapies available to men who cannot take replacement testosterone...

..These findings have important implications for both clinical management and trials of early treatment for patients with high-risk, early-stage CLL...

..Recommendations for patient counseling, follow-up, supportive care, and initial treatment are presented for each risk category...

..As a result of this study, we report evidence that B-CLL metaphases with 13q- are not detected because these deletions are often cryptic and not visible by standard G-banding...