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Melo VD, Saifuddin H, Peng LT, Wolanskyj-Spinner AP, Marshall AL, Leep Hunderfund AN. Signs, Sources, Coping Strategies, and Suggested Interventions for Burnout Among Preclerkship Students at a U.S. Medical School: A Qualitative Focus Group Study. Acad Med 2024:00001888-990000000-00842. [PMID: 38648293 DOI: 10.1097/acm.0000000000005744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Research suggests that burnout can begin early in medical school, yet burnout among preclerkship students remains underexplored. This study aimed to characterize burnout signs, sources, coping strategies, and potential interventions among preclerkship students at one U.S. medical school. METHOD The authors conducted a qualitative study of preclerkship students at Mayo Clinic Alix School of Medicine (MCASOM) during June 2019. Participants completed 2 Maslach Burnout Inventory (MBI) items (measuring frequency of emotional exhaustion and depersonalization) and 2 free-text questions on burnout before participating in 1 of 3 semistructured focus groups. Focus group questions were derived from a literature review on medical student burnout with input from the MCASOM Student Life and Wellness Committee. Group discussions were recorded, transcribed, coded inductively, and analyzed iteratively (along with free-text comments) using a general inductive approach from a constructivist perspective. RESULTS Eighteen of 111 eligible students (16%) participated, with 5/18 (28%) reporting weekly emotional exhaustion and/or depersonalization on MBI items. Analysis of focus group transcripts showed that most students had experienced burnout symptoms during their first or second year, corresponding with school-related stressors and manifesting in cognitive-emotional, physical, and verbal-behavioral ways. Students identified systemic, institutional, and individual burnout drivers and discussed how these drivers interacted (e.g., high standards of excellence at the system level interacted with anxiety and maladaptive thinking at the individual level, creating pressure to always do more). Students used various coping strategies (e.g., self-care, peer support, reframing, and compartmentalization) but emphasized limitations of these strategies and recommended interventions directed toward systemic and institutional burnout drivers. CONCLUSIONS This study offers insights into burnout signs and sources among preclerkship medical students that can inform future large-scale studies. Results suggest that burnout emerges from dynamic interactions among systemic, institutional, and individual factors and may benefit from multipronged interventions.
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Affiliation(s)
- Valeria D Melo
- V.D. Melo was a medical student at Mayo Clinic Alix School of Medicine, Rochester, Minnesota, at the time of this writing and is now a resident physician, Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California
| | - Hiba Saifuddin
- H. Saifuddin was a medical student at Mayo Clinic Alix School of Medicine, Rochester, Minnesota, at the time of this writing and is now a resident physician, Division of Plastic and Reconstructive Surgery, Louisiana State University, New Orleans, Louisiana
| | - Lillian T Peng
- L.T. Peng was a medical student, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, at the time of this writing and is now a resident physician, Department of Internal Medicine, University of California San Francisco, San Francisco, California
| | - Alexandra P Wolanskyj-Spinner
- A.P. Wolanskyj-Spinner is medical director, Office of Wellness and Academic Support, and regional director of well-being, Mayo Clinic College of Medicine and Science, and professor of medicine, Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ariela L Marshall
- A.L. Marshall is associate professor of medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is associate professor of neurology and medical director, Office for Applied Scholarship and Education Science, Mayo Clinic, Rochester, Minnesota
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Hunt KN, Kelly AG, Faubion L, Melikian R, Pearson C, Plowden TC, Files JA, Chamorro Dauer LV, Marshall AL, Blakemore JK. Fertility Knowledge and Educational Experiences of Graduating Medical Students: A Multi-Institution Survey. J Womens Health (Larchmt) 2024. [PMID: 38578025 DOI: 10.1089/jwh.2023.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Objective: Our goal was to assess the fertility knowledge and educational experiences of graduating U.S. medical students to evaluate areas of improvement for future educational interventions. Design: Web-based cross-sectional survey. Subjects: Medical students graduating in 2023 from the University of Miami Miller School of Medicine (SOM), New York University (NYU) Grossman SOM, Wayne State University SOM, Perelman SOM at the University of Pennsylvania, and Mayo Clinic Alix SOM. Main Outcome Measures: Fertility-related knowledge and educational experiences of U.S. medical students in their final year of school. Results: In total, 117 students (14.4%) completed the survey. The average knowledge score was 78%. Twenty-three (22%) overestimated the age of most precipitous fertility decline, and 50 (52%) overestimated the chance of getting pregnant for a 40-year-old person with ovaries. One-third of students (30, 32%) incorrectly believe that physicians have equivalent infertility rates to the general population. Students were less cognizant of male fertility issues, incorrectly believing there was no negative impact on male fertility by age (43, 42%) among other factors. Seventy-five (81%) reported less than 5 hours of fertility-related education in medical school. Only one-third (32%) were satisfied or very satisfied with the fertility education they received. In an open-response question, students expressed interest in additional education on transgender and cancer patient care, fertility preservation, assisted reproductive technologies, and reproductive life planning in medicine. Conclusions: There is a need and an opportunity for medical education programs to enhance fertility education. Giving students and trainees the knowledge required to make informed decisions for their family-building purposes and improving their ability to counsel patients adequately should be a goal of future educational endeavors. The data collected in this study will serve as a guide for the development of fertility-related learning modules for medical students and trainees.
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Affiliation(s)
- Kelby N Hunt
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amelia G Kelly
- NYU Langone Fertility Center, NYU Langone Health, New York, New York, USA
| | - Laura Faubion
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | | | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Detroit, Michigan, USA
| | - Torie C Plowden
- Department of Gynecologic Surgery and Obstetrics, USU, Bethesda, Maryland, USA
| | - Julia A Files
- Department of Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Laura V Chamorro Dauer
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ariela L Marshall
- Department of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
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Marshall AL, Masselink LE, Kouides PA, Davies FE, Farooqui A, Nagalla S, Herrera A, Mortier N, Brodsky R, Erikson CE. Advanced practice providers in hematology: actionable findings from national paired APP and physician surveys. Blood Adv 2024; 8:1179-1189. [PMID: 38127271 PMCID: PMC10910059 DOI: 10.1182/bloodadvances.2023011927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT Advanced practice providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of 2 national surveys, 1 for APPs and 1 for physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology, and the physician survey was distributed to physician members of ASH. A total of 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. A total of 42.1% of APPs and 29.3% of physicians reported burnout, and >50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.
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Affiliation(s)
- Ariela L. Marshall
- Division of Hematology Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Leah E. Masselink
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | | | - Faith E. Davies
- Pearlmutter Cancer Center, New York University Langone Health, New York, NY
| | - Azam Farooqui
- Department of Hematology and Oncology, Ironwood Cancer & Research Centers, Chandler, AZ
| | | | - Alex Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA
| | - Nicole Mortier
- Sickle Cell Disease Clinical Trials Network, ASH Research Collaborative, Washington, DC
| | - Robert Brodsky
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clese E. Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
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King Z, Zhang Q, Liang JW, Levy MS, Plowden TC, Jeelani R, Marshall AL, Barnett R, Caban-Martinez AJ, Brown A, Mueller CM, Brown-Johnson C, Salles A. Barriers to Family Building Among Physicians and Medical Students. JAMA Netw Open 2023; 6:e2349937. [PMID: 38153730 PMCID: PMC10755597 DOI: 10.1001/jamanetworkopen.2023.49937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/14/2023] [Indexed: 12/29/2023] Open
Abstract
Importance Physicians and medical students who desire to build families face significant barriers due to the structure and culture of medicine. Objective To understand the barriers and facilitators to family building for all people in medicine-not only individuals who can become pregnant-through an open-ended, qualitative analysis of survey responses. Design, Setting, and Participants This qualitative study used a survey conducted in April and May 2021 with a broad sample of physicians and medical students. Participants were recruited through social media, targeting physician and medical student communities. Physicians (residents, fellows, and physicians in independent practice) and medical students of all gender identities and sexual orientations were included. Informed by a postpositivist approach, coding reliability thematic analysis was performed on 3 open-ended survey questions on family-building experiences (what they would do differently, what advice they have for others, and anything else they wished to share). Main Outcomes and Measures Identified themes were mapped to the social-ecological model, a model used in public health to examine how a spectrum of factors is associated with health outcomes. Results A total of 2025 people (1860 [92%] women; 299 [15%] Asian, 151 [8%] Black, and 1303 [64%] White; 1730 [85%] heterosexual; and 1200 [59%] physicians who had completed training) responded to at least 1 of 3 open-ended questions. Themes mapped to social-ecological model levels included: (1) cultural, eg, medical training being at odds with family building; (2) organizational, eg, lack of institutional support for the range of family-building routes; (3) interpersonal, eg, impact of social support on family building; and (4) individual, eg, socioeconomic status and other individual factors that facilitate or inhibit family building. Recommendations to improve family-building experiences include implementing family-building curricula at medical schools, providing adequate parental leave for all physicians and medical students who become parents, and providing insurance coverage for all family-building routes. Conclusions and Relevance In this qualitative study of physicians and medical students, self-reported barriers to family building were identified at each level of the social-ecological model. Addressing these barriers is critical to creating a more equitable family-building environment for physicians and medical students.
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Affiliation(s)
- Zoe King
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California
| | - Qiang Zhang
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles
| | - Jane W. Liang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Morgan S. Levy
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Torie C. Plowden
- Department of Gynecologic Surgery and Obstetrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Roohi Jeelani
- Department of OB/GYN, Division of Reproductive Endocrinology and Infertility Wayne State University School of Medicine, Detroit, Michigan
- Kindbody Fertility Clinic, Chicago, Illinois
| | - Ariela L. Marshall
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis
| | - Rebecca Barnett
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Alberto J. Caban-Martinez
- University of Miami Miller School of Medicine, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Alyssa Brown
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Claudia M. Mueller
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Arghavan Salles
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
- Clayman Institute for Gender Research, Stanford University School of Medicine, Palo Alto, California
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van Tienhoven XA, Pishko AM, Chiang E, Cuker A, Marshall AL. Documentation of Menstrual Concerns in Women with Inherited Bleeding Disorders: A Single Center Retrospective Cohort Study. J Obstet Gynaecol Can 2023; 45:637-641. [PMID: 37209785 DOI: 10.1016/j.jogc.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | - Allyson M Pishko
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - Elaine Chiang
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - Adam Cuker
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA
| | - Ariela L Marshall
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, USA.
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Abstract
In this narrative medicine essay, a hematologist redirects her long-embraced ideal career as an academic physician for a more balanced life and for the work she loves in a part-time position.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Oncology and Transplantation (HOT), Department of Medicine, University of Minnesota, Minneapolis
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Lee AI, Masselink LE, De Castro LM, Marshall AL, Connell NT, Dent GA, Fritz J, Homer M, Lucas TL, Naik RP, Nelson M, O’Connell CL, Rajasekhar A, Reynolds RJ, Sharma D, Smith M, Weeks LD, Erikson CE. Burnout in US hematologists and oncologists: impact of compensation models and advanced practice provider support. Blood Adv 2023; 7:3058-3068. [PMID: 35476017 PMCID: PMC10331414 DOI: 10.1182/bloodadvances.2021006140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/20/2022] Open
Abstract
Burnout is prevalent throughout medicine. Few large-scale studies have examined the impact of physician compensation or clinical support staff on burnout among hematologists and oncologists. In 2019, the American Society of Hematology conducted a practice survey of hematologists and oncologists in the AMA (American Medical Association) Masterfile; burnout was measured using a validated, single-item burnout instrument from the Physician Work-Life Study, while satisfaction was assessed in several domains using a 5-point Likert scale. The overall survey response rate was 25.2% (n = 631). Of 411 respondents with complete responses in the final analysis, 36.7% (n = 151) were from academic practices and 63.3% (n = 260) from community practices; 29.0% (n = 119) were female. Over one-third (36.5%; n = 150) reported burnout, while 12.0% (n = 50) had a high level of burnout. In weighted multivariate logistic regression models incorporating numerous variables, compensation plans based entirely on relative value unit (RVU) generation were significantly associated with high burnout among academic and community physicians, while the combination of RVU + salary compensation showed no significant association. Female gender was associated with high burnout among academic physicians. High advanced practice provider utilization was inversely associated with high burnout among community physicians. Distinct patterns of career dissatisfaction were observed between academic and community physicians. We propose that the implementation of compensation models not based entirely on clinical productivity increased support for women in academic medicine, and expansion of advanced practice provider support in community practices may address burnout among hematologists and oncologists.
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Affiliation(s)
- Alfred Ian Lee
- Section of Hematology, Yale School of Medicine, New Haven, CT
| | - Leah E. Masselink
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Laura M. De Castro
- Division of Hematology/Oncology, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Nathan T. Connell
- Hematology Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Georgette A. Dent
- Department of Pathology & Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Josel Fritz
- American Society of Hematology, Washington, DC
| | | | | | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - Marquita Nelson
- Division of Hematology/Oncology, University of Tennessee Health Science Center, Memphis, TN
| | - Casey L. O’Connell
- Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anita Rajasekhar
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL
| | | | - Deva Sharma
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Melody Smith
- Division of Blood & Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA
| | | | - Clese E. Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
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Martin K, Marshall AL, Mazure CM. The value of teaching the influence of sex and gender on health outcomes. Lancet Haematol 2023; 10:e318-e319. [PMID: 37142343 PMCID: PMC10154001 DOI: 10.1016/s2352-3026(23)00055-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Kelsey Martin
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA.
| | - Ariela L Marshall
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA; Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA
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Melo VD, Liseth OY, Schmidt WM, Pruthi RK, Marshall AL, Shenoy CC. Risk of thrombosis in women with cancer undergoing controlled ovarian hyperstimulation for fertility preservation. J Assist Reprod Genet 2022; 39:2847-2856. [PMID: 36427171 PMCID: PMC9790832 DOI: 10.1007/s10815-022-02661-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/11/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The study aims to evaluate the risk factors and incidence of thromboembolic events among adult women with cancer who underwent controlled ovarian hyperstimulation (COH) for fertility preservation. METHODS Retrospective, descriptive cohort analysis of patient demographics, medical history, cancer type/treatment, laboratory values, thrombosis within 6 months of COH. RESULTS 4 of 127 study participants experienced a venous thromboembolic event within 6 months of COH. The median time between oocyte aspiration and the event was 0.25 years (range = 0.10-0.50). The average age at time of event was 25.3 years (SD = 5.3). Three of four thrombotic patients had ovarian cancer, one had breast cancer. All had received surgery and chemotherapy for treatment. All underwent an antagonist cycle ovarian stimulation protocol - none developed ovarian hyperstimulation syndrome. The average anti-mullerian hormone level at the time of hyperstimulation in the thrombosis group was 1.6 (SD = 1.3), compared to 3.6 in the non-thrombosis group. The average max estradiol level reached during ovarian stimulation was 1281.3 (SD = 665.3) in the thrombosis group and 1839.1 (SD = 1513.9) in the non-thrombosis group. Thromboembolic events were not directly associated with mortality. CONCLUSIONS Within this small descriptive study, the incidence of thromboembolic events in women with cancer undergoing COH for fertility preservation is high. Cancer may play a greater role than COH in thrombosis risk. Ovarian cancer patients who undergo ovarian stimulation may have an increased risk compared to other cancer types. These findings may inform future, prospective studies to determine the role of thromboprophylaxis.
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Affiliation(s)
- Valeria D Melo
- Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Ariela L Marshall
- Division of Hematology, University of Pennsylvania, Philadelphia, PA, USA
| | - Chandra C Shenoy
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Marshall AL, Sharma D, Hsu G, Pecker LH, Cushman M. Abortion access and the US medical workforce: a looming crisis for haematology. The Lancet Haematology 2022; 9:e874-e875. [PMID: 36244351 DOI: 10.1016/s2352-3026(22)00324-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
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Marshall AL, Halfdanarson TR, Alkhateeb H, Hobday T. Pilot Study Characterizing the Hematology-Oncology Fellow Job Search Process: Tools Used and Identification of Potential New Resources. J Cancer Educ 2022; 37:1385-1388. [PMID: 33517561 PMCID: PMC7847292 DOI: 10.1007/s13187-021-01967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 06/12/2023]
Abstract
While the search for post-fellowship employment is an essential part of early career development, little is known about the tools and techniques fellows use during their job search and the specific challenges they face during the process. In this pilot survey study of hematology-oncology (HO) fellows at a large academic training program, the majority of 20 respondents (43% of all fellows) reported a plan to specialize in medical oncology, and most planned to practice in an academic setting. Fellows who had started the job search process reported using several tools/techniques including online job centers and email distribution lists, word of mouth, prior connections with other institutions, and their HO fellowship program leadership, and most reported that their current institution provided help for their job search in at least one way. Job search challenges included learning about available positions, lack of mentorship on the process, lack of sufficient time for the process, and lack of preparation for negotiation. Fellows suggested additional resources that could be helpful to future job searchers including access to information about prior HO fellowship graduates, training in negotiation and interviewing, and career development mentorship. We plan to use this information to expand our own Career Development program for fellows enacting many of these suggestions, and we encourage the use of this information as pilot data for the development of larger studies across other medical and surgical specialties.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Hassan Alkhateeb
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy Hobday
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology-Oncology, Department of Internal Medicine, University of Pennsylvania, Philadelphia
| | - Arghavan Salles
- Department of Medicine, Stanford University, Palo Alto, California
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Velazquez AI, Durani U, Weeks LD, Major A, Reynolds R, Kumbamu A, Das DG, Murphy MC, Henry E, Lee AI, Marshall AL. Impact of COVID-19 on Hematology-Oncology Fellowship Programs: A Quantitative and Qualitative Survey Assessment of Fellowship Program Directors. JCO Oncol Pract 2022; 18:e551-e563. [PMID: 35015586 PMCID: PMC9014421 DOI: 10.1200/op.21.00634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/27/2021] [Accepted: 11/30/2021] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The COVID-19 pandemic led to unprecedented challenges in medical training, and we sought to assess the specific impact of COVID-19 on hematology-oncology (HO) fellowship programs. METHODS We conducted a cross-sectional anonymous online survey of 103 HO program directors (PDs) in conjunction with the American Society of Hematology (ASH) and ASCO. We sought to assess the specific impact of COVID-19 on HO fellowship programs' clinical, educational, and research activities, evaluate perceptions regarding PD and trainee emotional and mental health, and identify ways to support programs. Data were analyzed using descriptive statistics, parametric and nonparametric tests, and multivariable logistic regression models. Responses to open-ended questions were analyzed with thematic analysis. RESULTS Significant changes to fellowship activities included transitioning fellow training from outpatient clinics to telehealth (77.7%), shifting to virtual education (94.2%), and moving to remote research work (63.1%). A minority (21.4%) of PDs reported that their fellows were redeployed to cover non-HO services. Most PDs (54.4%) believed COVID-19 had a slight negative impact on fellowship training. PD self-reported burnout increased significantly from 15.5% prepandemic to 44.7% during the pandemic, and most PDs witnessed minor signs of fellow burnout (52.4%). Common PD concerns included inadequate supervision for telehealth activities, reduced opportunities for fellow advancement and promotion, lack of professional development activities, limited research operations and funding, program financial constraints, and virtual recruitment. CONCLUSION We encourage institutions and national societies to allocate resources and develop programs that can support fellowships and mitigate the potential negative effects of COVID-19 on trainee and PD career development.
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Affiliation(s)
- Ana I. Velazquez
- Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
| | - Urshila Durani
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Ajay Major
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | | | - Ashok Kumbamu
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Devika G. Das
- Division of Hematology and Oncology, University of Alabama Medical Center, Birmingham, AL
| | - Martina C. Murphy
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Elizabeth Henry
- Department of Medical Education, Loyola University Medical Center, Maywood, IL
- Division of Hematology and Oncology, Loyola University Medical Center, Maywood, IL
| | - Alfred I. Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Ariela L. Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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14
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O’Laughlin DJ, Bartlett MA, Fischer KM, Marshall AL, Pruthi RK, Casey PM. Bleeding Complications Associated With Intrauterine Contraception in Women Receiving Anticoagulation Therapy. Mayo Clin Proc Innov Qual Outcomes 2022; 6:98-105. [PMID: 35498393 PMCID: PMC9043296 DOI: 10.1016/j.mayocpiqo.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective Patients and Methods Results Conclusion
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15
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Marshall AL, Wolanskyj-Spinner AP. Stuck in the Strug Era. Mayo Clin Proc 2022; 97:447-448. [PMID: 35135694 DOI: 10.1016/j.mayocp.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
| | - Alexandra P Wolanskyj-Spinner
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN
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16
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Riaz IB, Fuentes HE, Naqvi SAA, He H, Sipra QUAR, Tafur AJ, Padranos L, Wysokinski WE, Marshall AL, Vandvik PO, Montori V, Bryce AH, Liu H, Badgett RG, Murad MH, McBane RD. Direct Oral Anticoagulants Compared With Dalteparin for Treatment of Cancer-Associated Thrombosis: A Living, Interactive Systematic Review and Network Meta-analysis. Mayo Clin Proc 2022; 97:308-324. [PMID: 34172290 DOI: 10.1016/j.mayocp.2020.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To maintain living, interactive evidence (LIvE) on the benefits and harms of different treatment options in adults with cancer-associated thrombosis (CAT). METHODS We have used a novel LIvE synthesis framework to maintain this living, interactive systematic review since September 19, 2018. Randomized controlled trials evaluating the efficacy and safety of direct oral anticoagulants (DOACs) compared with low-molecular-weight heparin for CAT are included in this analysis. Details of LIvE synthesis framework are available at the website https://cat.network-meta-analysis.com. RESULTS The results are constantly updated as new information becomes available (https://cat.network-meta-analysis.com/CAT.html). The living, interactive systematic review currently includes 4 randomized controlled trials (N=2894). Direct comparisons show that DOACs significantly decrease recurrent venous thromboembolism (VTE) events compared with dalteparin (odds ratio [OR], 0.59; 95% CI, 0.41 to 0.86; I2, 25%) without significantly increasing major bleeding (OR, 1.34; 95% CI, 0.83 to 2.18; I2, 28%). Mixed treatment comparisons show that apixaban (OR, 0.41; 95% credible interval [CrI], 0.16 to 0.95) and rivaroxaban (OR, 0.58; 95% CrI, 0.37 to 0.90) significantly decrease VTE recurrent events compared with dalteparin. Edoxaban significantly increases major bleeding compared with dalteparin (OR, 1.73; 95% CrI, 1.04 to 3.16), and rivaroxaban significantly increases clinically relevant nonmajor bleeding compared with dalteparin and other DOACs. There are no significant differences between DOACs in terms of VTE recurrences and major bleeding. CONCLUSION DOACs should be considered a standard of care for the treatment of CAT except in patients with a high risk of bleeding. Current evidence favors the use of apixaban for the treatment of CAT among other DOACs. REGISTRATION Open Science Framework (https://osf.io/dth86).
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Affiliation(s)
| | | | | | | | | | - Alfonso J Tafur
- Pritzker School of Medicine, University of Chicago, Chicago, IL
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17
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Durani U, Major A, Velazquez AI, May J, Nelson M, Zheng Z, Hall AG, Alam ST, Reynolds R, Thompson JC, Kumbamu A, Das DG, Murphy MC, Henry E, Lee AI, Marshall AL, Wun T, Weeks LD. Impact of COVID-19 on Hematology-Oncology Trainees: A Quantitative and Qualitative Assessment. JCO Oncol Pract 2022; 18:e586-e599. [PMID: 34990292 PMCID: PMC9014488 DOI: 10.1200/op.21.00630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Graduate medical and research training has drastically changed during the COVID-19 pandemic, with widespread implementation of virtual learning, redeployment from core rotations to the care of patients with COVID-19, and significant emotional and physical stressors. The specific experience of hematology-oncology (HO) fellows during the COVID-19 pandemic is not known. METHODS We conducted a mixed-methods study using a survey of Likert-style and open-ended questions to assess the training experience and well-being of HO fellows, including both clinical and postdoctoral trainee members of the American Society of Hematology and ASCO. RESULTS A total of 2,306 surveys were distributed by e-mail; 548 (23.8%) fellows completed the survey. Nearly 40% of fellows felt that they had not received adequate mental health support during the pandemic, and 22% reported new symptoms of burnout. Pre-existing burnout before the pandemic, COVID-19-related clinical work, and working in a primary research or nonclinical setting were associated with increased burnout on multivariable logistic regression. Qualitative thematic analysis of open-ended responses revealed significant concerns about employment after training completion, perceived variable quality of virtual education and board preparation, loss of clinical opportunities to prepare for independent clinical practice, inadequate grant funding opportunities in part because of shifting research priorities, variable productivity, and mental health or stress during the pandemic. CONCLUSION HO fellows have been profoundly affected by the pandemic, and our data illustrate multiple avenues for fellowship programs and national organizations to support both clinical and postdoctoral trainees.
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Affiliation(s)
- Urshila Durani
- Department of Hematology and HCT, City of Hope, Duarte, CA
| | - Ajay Major
- Section of Hematology-Oncology, Department of Medicine, The University of Chicago, Chicago, IL
| | - Ana I Velazquez
- Division of Hematology-Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA.,National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA
| | - Jori May
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham Medical Center, Birmingham, AL
| | - Marquita Nelson
- Division of Hematology and Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Ze Zheng
- Division of Endocrinology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.,Blood Research Institute, Versiti Blood Center of Wisconsin, Milwaukee, WI
| | - Anurekha G Hall
- Division of Hematology and Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Sara Taveras Alam
- Division of Hematology and Oncology, Baylor College of Medicine, Houston, TX
| | | | | | - Ashok Kumbamu
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Devika G Das
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham Medical Center, Birmingham, AL
| | - Martina C Murphy
- Division of Hematology and Oncology, University of Florida, Gainesville, FL
| | - Elizabeth Henry
- Department of Medical Education, Loyola University Medical Center, Maywood, IL.,Division of Hematology and Oncology, Loyola University Medical Center, Maywood, IL
| | - Alfred Ian Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - Ariela L Marshall
- Division of Hematology, Mayo Clinic, Rochester, MN.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Ted Wun
- Division of Hematology and Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Lachelle Dawn Weeks
- Division of Hematologic Malignancies, Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA
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18
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Merfeld EC, Blitzer GC, Kuczmarska-Haas A, Pitt SC, Chino F, Le T, Allen-Rhoades WA, Cole S, Marshall AL, Carnes M, Jagsi R, Duma N. Women Oncologists' Perceptions and Factors Associated With Decisions to Pursue Academic vs Nonacademic Careers in Oncology. JAMA Netw Open 2021; 4:e2141344. [PMID: 34967880 PMCID: PMC8719237 DOI: 10.1001/jamanetworkopen.2021.41344] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Women outnumber men in US medical school enrollment, but they represent less than 40% of academic oncology faculty. OBJECTIVE To identify the key factors associated with female oncologists' decision to pursue academic or nonacademic oncology practice and to characterize their perceptions about their current career. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional survey study was distributed through email and social media to female physicians in academic and nonacademic oncology practice in the United States. The survey was open for 3 months, from August 1 to October 31, 2020. MAIN OUTCOMES AND MEASURES No single primary study outcome was established because of the cross-sectional nature of the survey. Data were collected anonymously and analyzed using t tests for continuous variables and χ2 tests for categorical variables. RESULTS Among the 667 female respondents, 422 (63.2%) identified as academic oncologists and 245 (36.8%) identified as nonacademic oncologists. Approximately 25% of respondents reported that their spouse or partner (156 [23.5%]) and/or family (176 [26.4%]) extremely or moderately affected their decision to pursue academic practice. Academic oncologists perceived the biggest sacrifice of pursuing academics to be time with loved ones (181 [42.9%]). Nonacademic oncologists perceived the biggest sacrifice of pursuing academics to be pressure for academic promotion (102 [41.6%]). Respondents had different perceptions of how their gender affected their ability to obtain a chosen job, with 116 academic oncologists (27.6%) and 101 nonacademic oncologists (41.2%) reporting a positive or somewhat positive impact (P = .001). More than half of the women surveyed (54.6% academic oncologists [230]; 50.6% nonacademic oncologists [123]; P = .61) believed they were less likely to be promoted compared with male colleagues. Academic and nonacademic oncologists reported rarely or never having a sense of belonging in their work environment (33 [7.9%] and 5 [2.0%]; P < .001). Most respondents reported that they would choose the same career path again (301 academic oncologists [71.3%]; 168 nonacademic oncologists [68.6%]); however, 92 academic oncologists (21.9%) reported they were likely to pursue a career outside of academic oncology in the next 5 years. CONCLUSIONS AND RELEVANCE This survey study found that a spouse or partner and/or family were factors in the career choice of both academic and nonacademic oncologists and that female gender was largely perceived to adversely affect job promotion. Given that more than 20% of female academic oncologists were considering leaving academia, gender inequality is at high risk of continuing if the culture is not addressed.
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Affiliation(s)
- Emily C. Merfeld
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison
| | - Grace C. Blitzer
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison
| | | | - Susan C. Pitt
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Trang Le
- Department of Biostatistics, University of Wisconsin-Madison, Madison
| | | | - Suzanne Cole
- Department of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas
| | | | - Molly Carnes
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Narjust Duma
- Department of Medical Oncology, University of Wisconsin Hospital and Clinics, Madison
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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19
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Hazim AZ, Ruan GJ, Khodadadi RB, Slusser JP, Marshall AL, Pruthi RK. A single-institution retrospective study of causes of prolonged prothrombin time and activated partial thromboplastin time in the outpatient setting. Int J Lab Hematol 2021; 44:209-215. [PMID: 34612006 DOI: 10.1111/ijlh.13727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION An algorithmic approach, termed the prolonged clot time profile (PROCT), consisting of initial screening with prothrombin time (PT) and activated partial thromboplastin time (aPTT), reflexive mixing studies if indicated, and follow-up assays depending on initial testing results, offers an efficient approach to delineate the etiology of a prolonged PT/aPTT. Herein, we present the outcomes of the PROCT in the outpatient setting. METHODS In this retrospective study, we reviewed medical records of consecutive outpatients who had prolonged PT and/or aPTT noted in the routine coagulation laboratory and who had PROCT ordered in our institutional Special Coagulation Laboratory between 2010 and 2017. RESULTS One hundred and six patients, median age 55 years (IQR 30-67), met our study criteria. Twenty-nine patients had normal PT/aPTT, while 77 had persistent abnormalities and underwent reflexive testing. A prolonged PT, aPTT, or PT and aPTT was noted in 27 (35%), 27 (35%), and 23 (30%) respectively. Forty-nine (64%) had an acquired condition, 17 (22%) had a congenital condition, 7 (9%) had unclear etiology, and 4 (5%) were the result of laboratory artifact. The most common known cause of an isolated prolonged PT in our study was vitamin K deficiency in 8 (10%), the most common cause of an isolated prolonged aPTT was lupus anticoagulant in 4 (5%), and the most common cause of prolonged PT and aPTT was liver disease in 11 (14%). CONCLUSION Prolonged PT/aPTT have a wide range of causes, including artifactual prolongation or abnormalities in secondary hemostasis due to both inherited and acquired conditions.
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Affiliation(s)
- Antonious Z Hazim
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gordon J Ruan
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan B Khodadadi
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Joshua P Slusser
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Ariela L Marshall
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv K Pruthi
- Division of Hematology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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20
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Saliba AN, Xie Z, Higgins AS, Andrade‐Gonzalez XA, Fuentes‐Bayne HE, Hampel PJ, Kankeu Fonkoua LA, Childs DS, Rakshit S, Bezerra ED, Kommalapati A, Lou Y, Rivera CE, Price KA, Chintakuntlawar A, Yan Y, Schwecke AJ, Block MS, Thanarajasingam U, Thanarajasingam G, Wolanskyj‐Spinner AP, Marshall AL, Kottschade LA, Go RS, Al‐Kali A. Immune-related hematologic adverse events in the context of immune checkpoint inhibitor therapy. Am J Hematol 2021; 96:E362-E367. [PMID: 34137072 DOI: 10.1002/ajh.26273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Antoine N. Saliba
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Zhuoer Xie
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Alexandra S. Higgins
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Xavier A. Andrade‐Gonzalez
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Harry E. Fuentes‐Bayne
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Paul J. Hampel
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Lionel A. Kankeu Fonkoua
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Daniel S. Childs
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Sagar Rakshit
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Evandro D. Bezerra
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Anuhya Kommalapati
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Yanyan Lou
- Division of Hematology and Oncology Mayo Clinic Jacksonville Florida USA
| | - Candido E. Rivera
- Division of Hematology and Oncology Mayo Clinic Jacksonville Florida USA
| | - Katharine A. Price
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Ashish Chintakuntlawar
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Yiyi Yan
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Anna J. Schwecke
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Matthew S. Block
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | | | | | | | - Ariela L. Marshall
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Lisa A. Kottschade
- Division of Medical Oncology, Department of Oncology Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Aref Al‐Kali
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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21
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Marshall AL, Dines V, Wahner Hendrickson A, Warsame R, Thanarajasingam G, Thompson C, Petterson T, Wolanskyj-Spinner A. Parental health in fellowship trainees: Fellows' satisfaction with current policies and interest in innovation. ACTA ACUST UNITED AC 2021; 16:1745506520949417. [PMID: 32990525 PMCID: PMC7534076 DOI: 10.1177/1745506520949417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Parenthood during medical training is common and impacts trainee well-being. However, current graduate medical education parental health policies are often limited in scope. We explored current fellowship trainees' knowledge of/satisfaction with current policies as well as interest in potential changes/additions to existing policies. METHODS Fellowship program directors/coordinators at a three-site academic institution were surveyed and information was collected from 2015 to 2019 regarding fellow demographics and parental health policies. We distributed an electronic survey to fellows containing Likert-type-scale questions rating knowledge/level of satisfaction with current parental health policies and interest in potential additions/modifications to current policies. RESULTS Thirty-five of 47 (74%) fellowship programs responded. An average of 11% of female fellows and 15% of male fellows took parental leave during the study period. Three (9%) of the programs had at least one additional parental health policy beyond institutional graduate medical education policies. In the fellow survey, 175 of 609 fellows responded (28.7%), of which 84 (48.6%) were female. Although 89.1% agreed/strongly agreed that parental health is an important part of health and well-being for fellows, only 32% were satisfied/very satisfied with current policies (no significant sex-related differences). Fellows reported the following potential interventions as important/very important: 79.2% increased (paid) maternity leave (72.7% male, 86.7% female, p = 0.02), 78% increased (paid) paternity leave (76.4% male, 81.9% female, p = 0.37), 72.3% part-time return to work (60.2% male, 84.3% female, p = 0.0005), 63% coverage for workup/management of infertility (52.3% male, 74.7% female, p = 0.002), and 79.9% on-site day care (70.7% male, 89.2% female, p = 0.003). CONCLUSIONS Parental health includes multiple domains, not all of which are covered by current policies. Fellows feel that parental health is an important part of overall health and well-being, but most are not satisfied with current policies. Expanded access to parental leave and new policies (part-time return to work, infertility management, and on-site day care) are opportunities for innovation.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Rahma Warsame
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gita Thanarajasingam
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Carrie Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tanya Petterson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Alexandra Wolanskyj-Spinner
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
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22
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Marshall AL, Elafros M, Duma N. Work Patterns of Women Physicians During Vacation: A Cross-Sectional Study. J Womens Health (Larchmt) 2021; 31:573-579. [PMID: 34166095 DOI: 10.1089/jwh.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Burnout and poor work-life integration (WLI) are prevalent among women physicians. Vacation may help alleviate burnout and improve WLI but working while on vacation may negate these potential benefits. Little is known about the work patterns of women physicians on vacation, and we attempted to further characterize it in this study. Methods: In this online cross-sectional study of 498 members of the Physician Women in Leadership Facebook Group, we collected demographic information, information regarding burnout/WLI, self-reported work patterns while on vacation, and perceived impact of working during vacation on burnout/WLI. We also asked about the impact of the COVID-19 pandemic on these behaviors. Results: At baseline, 37.5% of respondents reported burnout and 58.4% reported lack of satisfaction with WLI. About 94.4% of respondents reported engaging in some level of work-related behavior while on vacation (primarily answering work-related emails and participating in work-related meetings), but 73.3% reported that such engagement was detrimental to their mental health and WLI. About 66.3% reported an increase in at least one work-related behavior on vacation during the COVID-19 pandemic. Respondents identified and/or endorsed multiple strategies to reduce work-related engagement on vacation, many involving good modeling by leadership and/or national associations. Conclusions: Engagement in work-related behavior while on vacation is almost universal among women physicians, but most feel that it has negative effects on mental health and WLI. Strategies to encourage reduced engagement should be developed/strengthened and endorsed/modeled by those in leadership.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa Elafros
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Narjust Duma
- Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, Wisconsin, USA
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23
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Marshall AL, Holzer J, Stejskal P, Stephens CJ, Vystavěl T, Whiting MJ. The EBSD spatial resolution of a Timepix-based detector in a tilt-free geometry. Ultramicroscopy 2021; 226:113294. [PMID: 33991964 DOI: 10.1016/j.ultramic.2021.113294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/09/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
Performing EBSD with a horizontal sample and a parallel EBSD detector sensor, enables safer specimen movements for data collection of large specimen areas and improves the longitudinal spatial resolution. The collection of electron backscattering patterns (EBSPs) at normal incidence to the electron beam has been revisited via the use of a direct electron detection (DED) sensor. In this article we present a fully operational DED EBSD detection system in this geometry, referred to as the tilt-free geometry. A well-defined Σ=3[101]{121} twin boundary in a Molybdenum bicrystal was used to measure the physical spatial resolution of the EBSD detector in this tilt-free geometry. In this study, two separate methods for estimating the spatial resolution of EBSD, one based on a pattern quality metric and the other on a normalised cross correlation coefficient were used. The spatial resolution was determined at accelerating voltages of 8 kV, 10 kV, 12 kV, 15 kV and 20 kV ranging from ~22-38 nm using the pattern quality method and ~31-46 nm using the normalised cross correlation method.
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Affiliation(s)
- A L Marshall
- Department of Mechanical Engineering Sciences, The University of Surrey, Guildford, GU2 7XH; Thermo Fisher Scientific, Unit 24 Birches Industrial Estate, East Grinstead, UK, RH19 1UB.
| | - J Holzer
- Institute of Physics of Materials & CEITEC IPM, Academy of Sciences of the Czech Republic, Žižkova 22, 61600 Brno, Czech Republic; Thermo Fisher Scientific, Vlastimila Pecha 1282/12, 62700 Brno, Czech Republic
| | - P Stejskal
- Thermo Fisher Scientific, Vlastimila Pecha 1282/12, 62700 Brno, Czech Republic
| | - C J Stephens
- Thermo Fisher Scientific, Unit 24 Birches Industrial Estate, East Grinstead, UK, RH19 1UB
| | - T Vystavěl
- Thermo Fisher Scientific, Vlastimila Pecha 1282/12, 62700 Brno, Czech Republic
| | - M J Whiting
- Department of Mechanical Engineering Sciences, The University of Surrey, Guildford, GU2 7XH
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Smith CJ, Kluck LA, Ruan GJ, Ashrani AA, Marshall AL, Pruthi RK, Shah MV, Wolanskyj-Spinner A, Gangat N, Litzow MR, Hogan WJ, Sridharan M, Go RS. Leukocytosis and Tobacco Use: An Observational Study of Asymptomatic Leukocytosis. Am J Med 2021; 134:e31-e35. [PMID: 32682870 DOI: 10.1016/j.amjmed.2020.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to characterize the white blood cell differential of tobacco smoking-induced leukocytosis and describe the longitudinal impact of smoking cessation on this peripheral blood abnormality. METHODS Medical records of patients undergoing evaluation by hematologists for persistent leukocytosis were reviewed. Patients in whom leukocytosis was determined to be secondary to tobacco use after exclusion of other causes were identified. Demographic and laboratory data were collected at time of diagnosis. Patients were longitudinally followed and information regarding smoking cessation and follow-up white blood cell values were recorded. RESULTS Forty patients were determined to have smoking-induced leukocytosis. The median age was 49.5 years (range: 28-75 years), 24 patients were female, and the mean body mass index (BMI) was 31.5 kg/m2. The mean white blood cell count was 13.3 × 109/L (range: 9.8-20.9 × 109/L); 39 patients had absolute neutrophilia (98%), 21 had lymphocytosis (53%), 20 had monocytosis (50%), and 19 had basophilia (48%). During follow-up, 11 patients either quit (n = 9) or reduced (n = 2) tobacco use. Reduction in tobacco smoking led to a significant decrease in mean white blood cell count (13.2 × 109/L vs 11.1 × 109/L, P = 0.02). The median time to decrease in white blood cell count following reduction in tobacco use was 8 weeks (range: 2-49 weeks). CONCLUSIONS Tobacco-induced leukocytosis was characterized by a mild elevation in total white blood cell count and was most commonly associated with neutrophilia, lymphocytosis, monocytosis, and basophilia. Cessation of smoking led to improvement in leukocytosis. Tobacco history should be elicited from all patients presenting with leukocytosis to limit unnecessary diagnostic testing, and counseling regarding smoking cessation should be offered.
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Affiliation(s)
| | | | | | - Aneel A Ashrani
- Division of Hematology; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Ariela L Marshall
- Division of Hematology; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Rajiv K Pruthi
- Division of Hematology; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
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McBane RD, Torres Roldan VD, Niven AS, Pruthi RK, Franco PM, Linderbaum JA, Casanegra AI, Oyen LJ, Houghton DE, Marshall AL, Ou NN, Siegel JL, Wysokinski WE, Padrnos LJ, Rivera CE, Flo GL, Shamoun FE, Silvers SM, Nayfeh T, Urtecho M, Shah S, Benkhadra R, Saadi SM, Firwana M, Jawaid T, Amin M, Prokop LJ, Murad MH. Anticoagulation in COVID-19: A Systematic Review, Meta-analysis, and Rapid Guidance From Mayo Clinic. Mayo Clin Proc 2020; 95:2467-2486. [PMID: 33153635 PMCID: PMC7458092 DOI: 10.1016/j.mayocp.2020.08.030] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/04/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
A higher risk of thrombosis has been described as a prominent feature of coronavirus disease 2019 (COVID-19). This systematic review synthesizes current data on thrombosis risk, prognostic implications, and anticoagulation effects in COVID-19. We included 37 studies from 4070 unique citations. Meta-analysis was performed when feasible. Coagulopathy and thrombotic events were frequent among patients with COVID-19 and further increased in those with more severe forms of the disease. We also present guidance on the prevention and management of thrombosis from a multidisciplinary panel of specialists from Mayo Clinic. The current certainty of evidence is generally very low and continues to evolve.
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Key Words
- aptt, activated thromboplastin time
- covid-19, coronavirus disease 2019
- dic, disseminated intravascular coagulation
- doac, direct oral anticoagulant
- dvt, deep venous thrombosis
- icu, intensive care unit
- lmwh, low-molecular-weight heparin
- or, odds ratio
- pe, pulmonary embolism
- pt, prothrombin time
- sars-cov, severe acute respiratory syndrome coronavirus
- sc, subcutaneously
- vte, venous thromboembolism
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Affiliation(s)
- Robert D McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Victor D Torres Roldan
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Alexander S Niven
- Division of Pulmonary and Critical Care, Center for Sleep Medicine, Mayo Clinic, Rochester, MN
| | - Rajiv K Pruthi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | - Ana I Casanegra
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Lance J Oyen
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | - Damon E Houghton
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ariela L Marshall
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Division of Hematology, Mayo Clinic, Rochester, MN
| | - Narith N Ou
- Department of Pharmacy, Mayo Clinic, Rochester, MN
| | | | - Waldemar E Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | - Candido E Rivera
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Gayle L Flo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Fadi E Shamoun
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
| | - Scott M Silvers
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL
| | - Tarek Nayfeh
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Meritxell Urtecho
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Sahrish Shah
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Raed Benkhadra
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Samer Mohir Saadi
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mohammed Firwana
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Tabinda Jawaid
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mustapha Amin
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - M Hassan Murad
- Evidence-based Practice Center and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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Marshall AL, Halfdanarson TR, Nowakowski GS, Lacy MQ, Thompson CA, Hobday T. Holistic review for hematology-oncology fellowship applicants: A new paradigm? Am J Hematol 2020; 95:1124-1126. [PMID: 32628292 DOI: 10.1002/ajh.25930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | | | - Grzegorz S Nowakowski
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Martha Q Lacy
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carrie A Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy Hobday
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Smith CJ, Kluck LA, Ruan GJ, Ashrani AA, Hook CC, Marshall AL, Pruthi RK, Shah MV, Wolanskyj‐Spinner A, Gangat N, Go RS. The differential diagnosis of basophilia in patients undergoing BCR-ABL testing. Am J Hematol 2020; 95:E216-E217. [PMID: 32314427 DOI: 10.1002/ajh.25830] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Caleb J. Smith
- Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Gordon J. Ruan
- Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Aneel A. Ashrani
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - C. Christopher Hook
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Ariela L. Marshall
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Rajiv K. Pruthi
- Division of Hematology Mayo Clinic Rochester Minnesota USA
- Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | | | | | - Naseema Gangat
- Division of Hematology Mayo Clinic Rochester Minnesota USA
| | - Ronald S. Go
- Division of Hematology Mayo Clinic Rochester Minnesota USA
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28
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Marshall AL, Dyrbye LN, Shanafelt TD, Sinsky CA, Satele D, Trockel M, Tutty M, West CP. Disparities in Burnout and Satisfaction With Work-Life Integration in U.S. Physicians by Gender and Practice Setting. Acad Med 2020; 95:1435-1443. [PMID: 32459677 DOI: 10.1097/acm.0000000000003521] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To explore the interaction between practice setting (academic practice [AP], private practice [PP]) and gender in relation to physician burnout and satisfaction with work-life integration (WLI). METHOD In 2017, the authors administered a cross-sectional survey of U.S. physicians and characterized rates of burnout and satisfaction with WLI using previously validated and/or standardized tools. They conducted multivariable logistic regression to determine the interaction between the included variables. RESULTS Of the 3,603 participants in the final analysis, female physicians reported a higher prevalence of burnout than male physicians in both AP (50.7% vs 38.2%, P < .0001) and PP (48.1% vs 40.7%, P = .001). However, the multivariable analysis found no statistically significant gender-based differences in burnout (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.76-1.17, P = .60). Women and men in AP were less likely to report burnout than men in PP (OR 0.70, 95% CI 0.52-0.94, P = .01 and OR 0.69, 95% CI 0.53-0.90, P < .01, respectively); women in PP did not report different burnout rates from men in PP (OR 0.89, 95% CI 0.68-1.16, P = .38). Women in both AP and PP were less likely to be satisfied with WLI than men in PP (OR 0.62, 95% CI 0.47-0.83, P < .01 and OR 0.75, 95% CI 0.58-0.97, P = .03, respectively); men in AP did not report different satisfaction with WLI than men in PP (OR 1.05, 95% CI 0.82-1.33, P = .71). CONCLUSIONS Gender differences in rates of burnout are related to practice setting and other differences in physicians' personal and professional lives. These results highlight the complex relationships among gender, practice setting, and other personal and professional factors in their influence on burnout and satisfaction with WLI.
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Affiliation(s)
- Ariela L Marshall
- A.L. Marshall is associate professor of medicine, Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: http://orcid.org/0000-0001-7388-0422
| | - Liselotte N Dyrbye
- L.N. Dyrbye is professor of medicine and medical education, Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tait D Shanafelt
- T.D. Shanafelt is Jeanie and Stewart Ritchie Professor of Medicine and associate dean, Stanford School of Medicine, Stanford, California
| | - Christine A Sinsky
- C.A. Sinsky is vice president of professional satisfaction, American Medical Association, Chicago, Illinois
| | - Daniel Satele
- D. Satele is a statistician, Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Mickey Trockel
- M. Trockel is clinical associate professor, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Michael Tutty
- M. Tutty is group vice president of professional satisfaction and practice sustainability, American Medical Association, Chicago, Illinois
| | - Colin P West
- C.P. West is professor of medicine, medical education, and biostatistics, Division of General Internal Medicine, Department of Internal Medicine, and Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1628-5023
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29
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Marshall AL, Thompson CA, Cullen MW, Raffals LE, Oxentenko AS. Medical Education Interest, Exposure, and Career Planning in Subspecialty Trainees. Med Sci Educ 2020; 30:1011-1014. [PMID: 34457761 PMCID: PMC8368290 DOI: 10.1007/s40670-020-01007-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We conducted a survey of subspecialty fellows at a three-site academic institution and characterized fellows' perception of, interest, and training in medical education. One hundred sixty-nine of 530 (31.9%) fellows responded. Most (78.2%) planned careers in academic medicine. Fellows' conception of medical education involved supervising trainees clinically (93.5%), classroom teaching (89.3%), and providing mentorship (87.6%). While only 30.2% had received formal training in medical education, 61.5% felt it should be required for careers with strong educational components. This study provides evidence for the creation and promotion of educational training programs for trainees interested in careers involving medical education.
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Affiliation(s)
- Ariela L. Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th Floor, 10-90E, 200 First Street SW, Rochester, MN 55905 USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
- Mayo Clinic Alix School of Medicine, Rochester, MN USA
| | - Carrie A. Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th Floor, 10-90E, 200 First Street SW, Rochester, MN 55905 USA
| | - Michael W. Cullen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Laura E. Raffals
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Amy S. Oxentenko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN USA
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30
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Riaz IB, Marshall AL, Badgett RG. In cancer-associated VTE, apixaban was noninferior to dalteparin for recurrence and did not increase major bleeding. Ann Intern Med 2020; 173:JC21. [PMID: 32805168 DOI: 10.7326/acpj202008180-021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382:1599-607. 32223112.
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Affiliation(s)
- Irbaz Bin Riaz
- Mayo Clinic, Rochester, Minnesota, USA (I.B.R., A.L.M.).,University of Kansas School of Medicine, Wichita, Kansas, USA (I.B.R., R.G.B.)
| | | | - Robert G Badgett
- University of Kansas School of Medicine, Wichita, Kansas, USA (I.B.R., R.G.B.)
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31
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Razonable RR, Pennington KM, Meehan AM, Wilson JW, Froemming AT, Bennett CE, Marshall AL, Virk A, Carmona EM. A Collaborative Multidisciplinary Approach to the Management of Coronavirus Disease 2019 in the Hospital Setting. Mayo Clin Proc 2020; 95:1467-1481. [PMID: 32622450 PMCID: PMC7260518 DOI: 10.1016/j.mayocp.2020.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/09/2020] [Accepted: 05/14/2020] [Indexed: 02/06/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which presents an unprecedented challenge to medical providers worldwide. Although most SARS-CoV-2-infected individuals manifest with a self-limited mild disease that resolves with supportive care in the outpatient setting, patients with moderate to severe COVID-19 will require a multidisciplinary collaborative management approach for optimal care in the hospital setting. Laboratory and radiologic studies provide critical information on disease severity, management options, and overall prognosis. Medical management is mostly supportive with antipyretics, hydration, oxygen supplementation, and other measures as dictated by clinical need. Among its medical complications is a characteristic proinflammatory cytokine storm often associated with end-organ dysfunction, including respiratory failure, liver and renal insufficiency, cardiac injury, and coagulopathy. Specific recommendations for the management of these medical complications are discussed. Despite the issuance of emergency use authorization for remdesivir, there are still no proven effective antiviral and immunomodulatory therapies, and their use in COVID-19 management should be guided by clinical trial protocols or treatment registries. The medical care of patients with COVID-19 extends beyond their hospitalization. Postdischarge follow-up and monitoring should be performed, preferably using telemedicine, until the patients have fully recovered from their illness and are released from home quarantine protocols.
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Key Words
- agp, aerosol-generating procedure
- aki, acute kidney injury
- alt, alanine aminotransferase
- ards, acute respiratory distress syndrome
- ast, aspartate aminotransferase
- cbc, complete blood cell
- cdc, centers for disease control and prevention
- covid-19, coronavirus disease 2019
- crp, c-reactive protein
- ct, computed tomography
- ecg, electrocardiogram
- esr, erythrocyte sedimentation rate
- fda, food and drug administration
- ggo, ground-glass opacity
- hrct, high-resolution computed tomography
- icu, intensive care unit
- il, interleukin
- ldh, lactate dehydrogenase
- lft, liver function test
- pcr, polymerase chain reaction
- rsv, respiratory syncytial virus
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
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Affiliation(s)
| | - Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Anne M Meehan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | - John W Wilson
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | | | | | | | - Abinash Virk
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN
| | - Eva M Carmona
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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32
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Marshall AL, Recht M, Sridharan M, Nichols WL, Ashrani AA, Fischer KM, Miles M, Riedel A, Pruthi RK. A study of dedicated haemophilia carrier clinics in the United States: Prevalence, services offered and barriers to development. Haemophilia 2020; 26:e253-e255. [PMID: 32537802 DOI: 10.1111/hae.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Comprehensive Hemophilia Center, Mayo Clinic, Rochester, MN, USA.,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael Recht
- The Hemophilia Center, Oregon Health & Science University, Portland, OR, USA.,American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Meera Sridharan
- Division of Hematology, Department of Internal Medicine, Comprehensive Hemophilia Center, Mayo Clinic, Rochester, MN, USA.,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William L Nichols
- Division of Hematology, Department of Internal Medicine, Comprehensive Hemophilia Center, Mayo Clinic, Rochester, MN, USA.,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, Comprehensive Hemophilia Center, Mayo Clinic, Rochester, MN, USA.,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Karen M Fischer
- Department of Biostatistics and Medical Informatics, Mayo Clinic, Rochester, MN, USA
| | - Moses Miles
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Angela Riedel
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Rajiv K Pruthi
- Division of Hematology, Department of Internal Medicine, Comprehensive Hemophilia Center, Mayo Clinic, Rochester, MN, USA.,Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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MESH Headings
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/epidemiology
- Coronavirus Infections/psychology
- Curriculum
- Education/methods
- Education, Distance/ethics
- Education, Distance/methods
- Education, Distance/standards
- Education, Medical/methods
- Education, Medical/organization & administration
- Education, Medical/trends
- Faculty, Medical/psychology
- Faculty, Medical/standards
- Humans
- Leadership
- Mentoring
- Pandemics
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/psychology
- Psychological Distress
- SARS-CoV-2
- Students, Medical/psychology
- Teaching/trends
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN; Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN.
| | - Alexandra Wolanskyj-Spinner
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN
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34
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Riaz IB, Siddiqi R, Zahid U, Durani U, Fatima K, Sipra QUAR, Raina AI, Farooq MZ, Chamberlain AM, Wang Z, Go RS, Marshall AL, Khosa F. Gender Differences in Faculty Rank and Leadership Positions Among Hematologists and Oncologists in the United States. JCO Oncol Pract 2020; 16:e507-e516. [DOI: 10.1200/op.19.00255] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Gender disparity persists in academic medicine. Female faculty are underrepresented in leadership positions and have lower research output. We studied gender differences in faculty rank and departmental leadership and contributing factors among academic hematologists and oncologists in the United States. METHODS: For clinical faculty at 146 hematology or oncology fellowship programs listed in the Fellowship and Residency Electronic Interactive Database, we collected data on demographics, academic rank, and research output using the Doximity and Scopus databases. We compared unadjusted characteristics of men and women by using 2-sided t tests and χ2 tests where appropriate. To predict probability of full professorship or leadership position among men versus women, we performed multivariable logistic regression analysis adjusted for clinical experience in years, number of publications, h-index, clinical trial investigator status, National Institutes of Health funding, and workplace ranking (top 20 v not). RESULTS: Two thousand one hundred sixty academic hematologists and oncologists were included. Women composed 21.9% (n = 142) of full professors, 35.7% (n = 169) of associate professors, and 45.4% (n = 415) of assistant professors. Thirty percent (n = 70) of departmental leaders were women. Female faculty, compared with male faculty, had a lower mean h-index (12.1 v 20.9, respectively; P < .001) and fewer years of professional experience since fellowship (10 v 16 years, respectively; P < .001). After adjusting for duration of clinical experience, academic productivity, and workplace ranking, the odds of obtaining professorship (odds ratio [OR], 1.05; 95% CI, 0.71 to 1.57; P = .85) or divisional leadership (OR, 0.57; 95% CI, 0.20 to 1.58; P = .28) for female physicians were not different compared with male physicians. CONCLUSION: Gender disparity exists in senior ranks of academic hematology and oncology; however, gender is not a significant predictor in achieving professorship or department leadership position.
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Affiliation(s)
- Irbaz Bin Riaz
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Umar Zahid
- Department of Medicine, John Hopkins, Baltimore, MD
| | - Urshila Durani
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kaneez Fatima
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ammad I. Raina
- Department of Internal Medicine, Midwestern University, Glendale, AZ
| | | | - Alanna M. Chamberlain
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Zhen Wang
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Ronald S. Go
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ariela L. Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
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35
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Gonzalez Velez M, Duma N, Cabrera D, Marshall AL, Attai DJ, Markham MJ, Fonseca R. Patterns of Twitter use among trainees in hematology-oncology related areas. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.11041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11041 Background: Twitter (TW) is an essential tool in the medical community. Few studies have examined the use of TW by medical trainees. We aimed to assess its utilization among trainees in hematology-oncology related areas (HORAs). Methods: 576 training programs in HORAs were obtained. We contacted a potential pool of 3,142 trainees. A 50 item survey was distributed between 2/2019-5/2019, focusing on: demographics, professional use, attitudes toward TW, and patient interactions. Responses were analyzed using parametric descriptive statistics. Results: 442 responses (14% response rate) were received; 203 (46%) used a TW account for professional activities. See table for demographics. The most common reasons for using TW were: continuous education (73%), dissemination of information (62%), and networking (62%). > 80% of users have positive views on using TW for: promoting academic discussions (92%), trainees education (89%), and conference networking (83%). 50 (25%) have used TW for collaborations, with abstracts and papers being the most common (20%). Most agreed or strongly agreed that TW: is a useful education tool (89%), and might be useful for career advancement (85%). The most common challenges were: the value of TW content can be decreased by irrelevant content and biased sources (64%), not peer-reviewed (51%), and difficulty searching information (50%). 68% considered that programs should promote the engagement of trainees, but only 21% reported instruction in the use of TW. 83% agree or strongly agree that TW is useful for physicians and patient interactions, but 82% have concerns about legal repercussions. Conclusions: Almost half of trainees in HORAs use TW for professional activities. The most common uses are for education, dissemination of information and networking. Most trainees that use TW have positive views regarding education and academic collaborations. Use of Twitter may strengthen trainees’ education, provide mentorship opportunities, and promote career advancement. Challenges on TW use should continue to be addressed. [Table: see text]
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Hwa YL, Shelly JL, Zblewski DL, Spychalla MT, Udenberg DM, Cieslak KR, Nowakowski GS, Lacy MQ, Marshall AL. Mayo Clinic Hematology Fellowship for Advanced Practice Providers. J Adv Pract Oncol 2020; 11:395-400. [PMID: 33604099 PMCID: PMC7863122 DOI: 10.6004/jadpro.2020.11.4.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), are part of a growing cancer care workforce. Current hematology-specific education provided by most graduate NP and PA school educations is limited. Mayo Clinic School of Health Sciences launched a hematology-specific fellowship in 2018 to provide APPs with the skills and knowledge required to deliver high-quality specialty care in hematology and blood and marrow transplant (BMT). The fellowship curriculum was developed based on a needs-based assessment study as well as the qualitative reported experiences of current hematology-specific APPs. The curriculum contains didactic in-class education, research opportunities, and mentored clinical rotations in both inpatient and outpatient practice in hematology and BMT. This 12-month fellowship, one of the only postgraduate training programs dedicated to benign and malignant hematology practice, provides structured training for highly qualified graduate APPs interested in developing a rewarding career in hematology.
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Affiliation(s)
- Yi L Hwa
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Jessica L Shelly
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Darci L Zblewski
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Megan T Spychalla
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Dawn M Udenberg
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Kathryn R Cieslak
- Mayo Clinic School of Health Sciences Education Administration, Rochester, Minnesota
| | - Grzegorz S Nowakowski
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Martha Q Lacy
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | - Ariela L Marshall
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Abstract
Infertility is more prevalent in female physicians than in the U.S. general population. While pregnancy and its potential medical and career development consequences among physicians have been explored in the literature, infertility and its consequences remain understudied and unaddressed. Fertility issues are important for all physicians hoping to start families, including male physicians, transgender physicians, single physicians, and physicians with same-sex partners.Infertility has numerous physical, emotional, and financial consequences and may have a negative impact on physician well-being. Options to preserve fertility (such as egg, embryo, and sperm cryopreservation) are available, yet physicians may not be aware of or have the financial ability to make use of such resources. Physician reproductive health, including the ability to build a family if and when a physician chooses, is a vital aspect of well-being. The risks and consequences of infertility and the management of fertility should be studied and addressed from policy and advocacy standpoints.The authors, who have experienced and sought treatment for infertility, bring attention to the challenges around both physician infertility and preservation of fertility. They propose 3 strategies to address physician infertility: increasing fertility education and awareness starting at the undergraduate medical education level and continuing throughout training and practice, providing insurance coverage for and access to fertility assessment and management, and offering support for those undergoing fertility treatments. The authors believe that implementing these suggestions would make a significant positive impact on trainees and practicing physicians and help build a health care workforce that is healthy and well physically, emotionally, and financially.
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Affiliation(s)
- Ariela L Marshall
- A.L. Marshall is associate professor of medicine, Division of Hematology, Department of Internal Medicine, and assistant professor, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; ORCID: http://orcid.org/0000-0001-7388-0422. V.M. Arora is professor and associate chief medical officer-clinical learning environment, University of Chicago Medicine, Chicago, Illinois. A. Salles is a scholar in residence, Stanford University School of Medicine, Stanford, California
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Bubik RJ, Barth DM, Hook C, Wolf RC, Muth JM, Mara K, Patnaik MS, Pruthi RK, Marshall AL, Litzow MR, Elliott MA, Hogan WJ, Shah MV, Begna KH, Alkhateeb H, Pardanani A, Ashrani AA, Call TG, Rivera CE, Camoriano JK, Go RS, Wolanskyj-Spinner AP, Parikh SA. Clinical outcomes of adults with hemophagocytic lymphohistiocytosis treated with the HLH-04 protocol: a retrospective analysis. Leuk Lymphoma 2020; 61:1592-1600. [PMID: 32157935 DOI: 10.1080/10428194.2020.1737684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of pathologic immune activation in children that is increasingly being recognized in adults. Efficacy data for the HLH-04 protocol in adults is lacking. This study retrospectively analyzed 31 adult patients, median age 46 years, who received HLH-04 from 1/1/2004 to 5/1/2018. HLH etiology included malignancy (n = 9), autoimmune (n = 8), infection (n = 8), and idiopathic (n = 6). Eighteen patients were evaluable for response at week 4 with 7 having no response, 11 reaching partial response, and 0 reaching complete response (CR). Six patients eventually achieved CR at a median 195 days. The 1-year overall survival (OS) was 35% and median OS was 3.2 months. Univariate analysis showed shorter survival for hemoglobin <9 g/dL (HR 4.29, p = 0.003), platelets <100 × 109/L (HR 4.06, p = 0.027), ANC <1 × 109/L (HR 5.24, p = 0.001), and total bilirubin >1.2 mg/dL (HR 3.30, p = 0.022). Outcomes of adults treated with HLH-04 remain dismal and newer treatment modalities are needed.
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Affiliation(s)
| | - Dylan M Barth
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | | | - Robert C Wolf
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ariela L Marshall
- Division of Hematology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mark R Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Mithun V Shah
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
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Azer SM, Eckerman AL, Rodriguez V, Nichols WL, Ashrani AA, Hook CC, Marshall AL, Pruthi RK. Hemostatic prophylaxis and colonoscopy outcomes for patients with bleeding disorders: A retrospective cohort study and review of the literature. Haemophilia 2020; 26:257-268. [PMID: 32141697 PMCID: PMC7154734 DOI: 10.1111/hae.13954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Hemostatic prophylaxis (HP) is recommended for patients with bleeding disorders (PWBD) before invasive procedures. However, evidence-based guidelines are needed to determine optimal HP strategies. AIM To determine outcomes of HP for PWBD undergoing colonoscopy. METHODS We undertook a retrospective cohort study of HP and outcomes of colonoscopy procedures performed between 9 November 1993 and 13 February 2018 for PWBD who received care in the Mayo Clinic Comprehensive Hemophilia Treatment Center. RESULTS During the study period, 73 PWBD (58 with milder phenotypes: haemophilia, von Willebrand disease [subtypes 1 and 2; II, VII and XI deficiency]) underwent 141 procedures. Preprocedural HP was given to 61%, and interventions were performed in 47%. Of the 39% without preprocedural HP, postprocedural HP was given for 11%. One major (0.7%; 6 days postprocedure despite HP) and 10 minor (7%) bleeding complications occurred, which tended to be in patients with severe disease and/or after excision of larger polyps. There was no significant difference in the rate of bleeding complications with or without preprocedural HP (8.1% vs 5.5%, respectively; P = .74, Fisher's exact test). CONCLUSION The low bleeding rates in our cohort suggest that preprocedure HP may be withheld for patients with mild bleeding disorders who undergo colonoscopy with a low likelihood of requiring an intervention or who require only low-risk intervention. This strategy may be best used in experienced centres, provided optimal local hemostasis measures are undertaken and postprocedural HP is rapidly available if high-risk intervention is required. Further studies are needed to determine optimal evidence-based HP strategies for PWBD undergoing colonoscopy.
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Affiliation(s)
- Sarah M Azer
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, United States
| | - Amy L Eckerman
- Comprehensive Hemophilia Center, Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States
| | - Vilmarie Rodriguez
- Comprehensive Hemophilia Center, Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States.,Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, United States
| | - William L Nichols
- Comprehensive Hemophilia Center, Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States.,Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, United States
| | - Aneel A Ashrani
- Comprehensive Hemophilia Center, Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States.,Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, United States
| | - C Christopher Hook
- Comprehensive Hemophilia Center, Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States
| | - Ariela L Marshall
- Comprehensive Hemophilia Center, Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States
| | - Rajiv K Pruthi
- Comprehensive Hemophilia Center, Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States.,Division of Hematopathology, Mayo Clinic, Rochester, Minnesota, United States
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Marshall AL, Durani U, Mikhael J. Women in academic medicine leadership: correlation between sex of medical school deans and affiliated academic hospital system CEOs. leader 2020. [DOI: 10.1136/leader-2019-000151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundWomen are currently under-represented in ‘C-suite’ leadership positions at academic medical centres, including medical school deans, department chairs and hospital chief executive officers (CEOs). There are many potential reasons for the low percentage of women in academic medical leadership, including lack of mentorship and sponsorship, increased non-work responsibilities compared with men, implicit bias, and others.MethodsWe collected data from 136 fully accredited US allopathic medical schools regarding sex of the medical school dean and sex of the CEO of the largest academic medical centre/teaching hospital affiliate. Schools where students rotate at non-academic centres were excluded from the final analysis, leaving 124 schools where we investigated the relationship between sex of US medical school dean and affiliated academic medical centre CEO.Results16.9% of current medical school deans and 17.7% of affiliated academic medical centre CEOs were female. Systems with one female leader were significantly (6.25-fold, 95% CI 2.22 to 17.56, p=0.001) more likely to have a second female leader, regardless of geographical region or institution type (public vs private).ConclusionsThere is a significant positive association between medical school dean and affiliated academic hospital centre CEO sex. There are many potential factors that could contribute to this positive association, including mentorship, sponsorship and medical system consciousness about gender equity, among others. This relationship is important to recognise as we strive for more gender parity for women in positions of leadership in academic medicine.
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Khodadadi RB, Ogden JR, Marshall AL. 91-Year-Old Man With Upper Extremity Ecchymoses. Mayo Clin Proc 2020; 95:e23-e29. [PMID: 32138895 DOI: 10.1016/j.mayocp.2019.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/23/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Ryan B Khodadadi
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - John R Ogden
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Ariela L Marshall
- Advisor to residents and Consultant in Hematology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
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Abstract
Mentorship is essential for career development, personal development, and job satisfaction for physicians in academic medicine. Women in academic medicine face unique challenges including significant gender disparities in positions of leadership as well as difficulty finding mentors. As leaders in academic medicine, we have collated several structured recommendations for physicians of both genders seeking to be better mentors to female trainees and early career physicians. We discuss each of these recommendations in detail including the following: acknowledging your own strengths and limitations as a mentor, addressing issues of work-life integration, helping your mentee set long-term career goals, and acting as a sponsor as well as a mentor. We hope these suggestions are helpful for current and aspiring mentors and provide a platform to improve career development for female physicians and reduce gender inequities in academic medicine.
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Affiliation(s)
- Ariela L Marshall
- Department of Medicine, Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Renee K Dversdal
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Martina Murphy
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Donna M Prill
- Research Family Medicine Residency, Kansas City, MO, USA
| | - Tian Zhang
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC, USA
| | - Shikha Jain
- Division of Hematology, Oncology, and Cellular Therapy, Rush University Medical Center, Chicago, IL, USA
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Aiello G, Rinaldo L, Marshall AL, Vine RL, Lanzino G. Incidence of hereditary thrombophilia in patients with cranial dural arteriovenous fistulae. J Clin Neurosci 2020; 73:136-139. [PMID: 31932187 DOI: 10.1016/j.jocn.2020.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022]
Abstract
Dural arteriovenous fistulas (DAVFs) can develop as consequence of prior venous sinus thrombosis. However, the prevalence of prothrombotic conditions in patients with intracranial DAVFs is unknown and there is no consensus on the indications to screen for procoagulable conditions in these patients. We performed a retrospective review of patients presenting to our institution for management of cranial DAVF. Patient and DAVF characteristics were noted, in particular the incidence of hereditary thrombophilia (HT) detected by laboratory evaluation. Respective comparisons of patients with and without HT were performed using comparative statistics. There were 165 patients presenting for management of 171 DAVFs. A large proportion of DAVF were located at a large dural sinus (42.7%), which included superior sagittal, transverse, and sigmoid sinuses. On multivariate logistic regression analysis cortical venous drainage was independently associated with hemorrhagic presentation (OR 8.23, 95% CI 1.78-38.08; p = 0.007). A HT was detected in 18 of 61 patients (29.5%) who underwent a thrombophilia work-up. Location at a large dural sinus was not more common in patients with a HT (55.0% vs 54.5%; p = 0.97). There was also no difference in the presence of cortical venous drainage (56.5% vs 38.6%; p = 0.22) or hemorrhage on presentation (15.9% vs 5.0%; p = 0.22) in patients with and without a HT. In HT were found to be highly prevalent in our cohort, though our results do not suggest their presence greatly influences DAVF pathophysiology. Screening for procoagulable states is indicated in selected patients with an intracranial DAVF.
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Affiliation(s)
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Roanna L Vine
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Marshall AL, Gupta R, Grill D, Mann S, Freidline K, Nowakowski G, Thompson C, Hobday T. Identification of Factors Associated with Hematology-Oncology Fellow Academic Success and Career Choice. J Cancer Educ 2019; 34:1219-1224. [PMID: 30267295 DOI: 10.1007/s13187-018-1432-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Factors affecting hematology-oncology trainees' academic success and career choices have not been well characterized. We performed a retrospective study of 57 hematology-oncology fellows trained at Mayo Clinic between 2008 and 2017 in an attempt to identify factors associated with success during fellowship and with career choice (academic versus private). Sex, age, residency quality, and letters of recommendation indicating a "top" applicant were not associated with hematology or oncology in-training examination (ITE) scores, research productivity (abstracts/publications during fellowship), or career choice (academic versus private). Fellows with higher United States Medical Licensing Examination (USMLE) scores were more likely to perform well on ITE, but examination scores did not predict academic productivity or academic versus private career choice. More academically productive fellows were more likely to choose academic careers. Both ITE scores and productivity were associated with receipt of national and/or institutional awards. Finally, fellows who were non-US citizens and/or international medical graduates (IMG) had higher academic productivity both pre-fellowship and during fellowship and as per the observations above were more likely to choose academic careers. In conclusion, predictors of superior knowledge differ from predictors of academic productivity/career choice, and it is important to take multiple factors into account when selecting candidates most likely to succeed during fellowship.
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Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Ruchi Gupta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Diane Grill
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Susan Mann
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kimberly Freidline
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
| | - Grzegorz Nowakowski
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carrie Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
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Duma N, Durani U, Woods CB, Kankeu Fonkoua LA, Cook JM, Wee C, Fuentes HE, Gonzalez-Velez M, Murphy MC, Jain S, Marshall AL, Graff SL, Knoll MA. Evaluating Unconscious Bias: Speaker Introductions at an International Oncology Conference. J Clin Oncol 2019; 37:3538-3545. [PMID: 31603705 DOI: 10.1200/jco.19.01608] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In a professional setting, the introduction of female speakers without their professional title may have an impact on the public's perception of the female speaker. We examined how professional titles were used during speakers' introductions at the ASCO Annual Meeting. METHODS We conducted a retrospective, observational study of video-archived speaker introductions at the 2017 and 2018 ASCO Annual Meetings. A "professional address" was defined as the professional title followed by the speaker's full name or last name. Multivariable logistic regressions were used to identify factors associated with the form of address. RESULTS Of 2,511 videos reviewed, 781 met inclusion criteria. Female speakers were addressed less often by their professional title compared with male speakers (62% v 81%; P < .001). Males were less likely to use a professional address when introducing female speakers compared with females when introducing male speakers (53% v 80%; P < .01). When women performed speaker introductions, no gender differences in professional address were observed (75% v 82%; P = .13). Female speakers were more likely to be introduced by first name only (17% v 3%; P < .001). Male introducers were more likely to address female speakers by first name only compared with female introducers (24% v 7%; P < .01). In a multivariable regression including gender, degree, academic rank, and geographic location of the speaker's institution, male speakers were more likely to receive a professional address compared with female speakers (odds ratio, 2.43; 95% CI, 1.71 to 3.47; P < .01). CONCLUSION When introduced by men, female speakers were less likely to receive a professional address and more likely to be introduced by first name only compared with their male peers.
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Affiliation(s)
- Narjust Duma
- University of Wisconsin Carbone Cancer Center, Madison, WI
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Hsieh RW, Ravindran A, Hook CC, Begna KH, Ashrani AA, Pruthi RK, Marshall AL, Hogan W, Litzow M, Hoyer J, Oliveira JL, Vishnu P, Call TG, Al-Kali A, Patnaik M, Gangat N, Pardanani A, Tefferi A, Go RS. Etiologies of Extreme Thrombocytosis: A Contemporary Series. Mayo Clin Proc 2019; 94:1542-1550. [PMID: 31378229 DOI: 10.1016/j.mayocp.2019.01.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/25/2018] [Accepted: 01/23/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy. PATIENTS AND METHODS We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×109/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts. RESULTS A total of 44,490 patients had thrombocytosis, and 305 patients (0.7%) had EXT. In 242 patients (79.3%), EXT was multifactorial. Surgical complications (54.1%) and hematologic malignancies (27.9%) were the 2 most dominant causes. Thirty-eight patients (12.5%) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9%), concurrent/previous splenectomy (50.5%), and infections (44.9%) were the most common causes, whereas hematologic malignancies (56.9%), iron deficiency (36.7%), and previous splenectomy (28.4%) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9% vs 16.8%), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6% vs 8.2%). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT. CONCLUSION Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.
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Affiliation(s)
- Ronan W Hsieh
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA
| | - Aishwarya Ravindran
- Division of Hematology, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | | | - Mark Litzow
- Division of Hematology, Mayo Clinic, Rochester, MN
| | - James Hoyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | | | | | | | - Aref Al-Kali
- Division of Hematology, Mayo Clinic, Rochester, MN
| | | | | | | | | | - Ronald S Go
- Division of Hematology, Mayo Clinic, Rochester, MN.
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Hwa YL, Marshall AL, Shelly JL, Colborn LK, Nowakowski GS, Lacy MQ. Assessment of the Need for a Hematology-Specific Fellowship Curriculum for Advanced Practice Providers Using a Needs-Based Survey. J Oncol Pract 2019; 15:e593-e599. [DOI: 10.1200/jop.18.00697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Subspecialty training programs rarely are available for advanced practice providers (APPs). New curricula are needed to prepare APPs with the skills and knowledge required to deliver high-quality care in hematology and blood and marrow transplantation (BMT). METHODS: A Web-based needs assessment survey was distributed to APPs currently working in hematology and BMT at three Mayo Clinic sites (Rochester, MN; Scottsdale, AZ; and Jacksonville, FL). The survey assessed participants’ perceptions of readiness to practice in hematology after completion of their APP education and identified APP learning needs. RESULTS: Of 68 APPs, 49 (72%; 34 nurse practitioners, 15 physician assistants) completed the survey. Twenty-eight APPs (57%) were new graduates, and 17 (35%) had no prior experience in hematology/BMT. All APPs held a master’s degree or higher (doctorate, 31%). Thirty-nine (80%) reported that less than 5% of their APP school curriculum was hematology focused. More than 90% felt unprepared to practice in hematology or BMT after their APP education and believed that hematology-specific training could improve their competency as providers and positively affect job satisfaction. APPs reported that they would like more formal training in the following areas of clinical focus: malignant and benign hematologic disorders, hematopathology, palliative care, transfusion medicine, infectious disease, and hematology-related pharmacology. They also preferred the following learning strategies: active learning from patient care, case-based teaching, and experience during hospital rounds. CONCLUSION: This needs-based assessment project confirmed the necessity to develop a hematology-specific fellowship for APPs and helped to optimize the curriculum.
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Maguire M, Fuh L, Goldstein JN, Marshall AL, Levine M, Howell ML, Parry BA, Rosovsky R, Hayes BD. Thromboembolic Risk of 4-Factor Prothrombin Complex Concentrate versus Fresh Frozen Plasma for Urgent Warfarin Reversal in the Emergency Department. West J Emerg Med 2019; 20:619-625. [PMID: 31316701 PMCID: PMC6625686 DOI: 10.5811/westjem.2019.4.41649] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Warfarin is a potent anticoagulant used for the prevention and treatment of venous and arterial thrombosis. Occasionally, patients require emergent warfarin reversal due to active bleeding, supratherapeutic international normalized ratio, or emergent diagnostic or therapeutic interventions. Various agents can be used for emergent warfarin reversal, including fresh frozen plasma (FFP) and 4-factor prothrombin complex concentrate (4F-PCC). Both FFP and 4F-PCC are generally considered safe; however, both agents contain coagulation factors and have the potential to provoke a thromboembolic event. Although clinical trials have compared the efficacy and safety of FFP and 4F-PCC, data are limited comparing the risk of thromboembolism between the two agents. Methods A retrospective chart review was performed at a single, urban, academic medical center comparing the incidence of thromboembolism with FFP or 4F-PCC for warfarin reversal during a three-year period in the emergency department (ED) at Massachusetts General Hospital. Patients were included in the study if they were at least 18 years of age and were on warfarin per electronic health records. Patients were excluded if they had received both FFP and 4F-PCC during the same visit. The primary outcome was the frequency of thromboembolism within 30 days of 4F-PCC or FFP. Secondary outcomes included time to thromboembolic event and in-hospital mortality. Results Three hundred and thirty-six patients met the inclusion criteria. Thromboembolic events within 30 days of therapy occurred in seven patients (2.7%) in the FFP group and 14 patients (17.7%) in the 4F-PCC group (p=<0.001). Death occurred in 39 patients (15.2%) who received FFP and 18 patients (22.8%) who received 4F-PCC (p=0.115). Since the 4F-PCC group was treated disproportionately for central nervous system (CNS) bleeding, a subgroup analysis was performed including patients requiring reversal due to CNS bleeds that received vitamin K. The primary outcome remained statistically significant, occurring in four patients (4.1%) in the FFP group and nine patients (14.1%) in the 4F-PCC group (p=0.02). Conclusion Our study found a significantly higher risk of thromboembolic events in patients receiving 4F-PCC compared to FFP for urgent warfarin reversal. This difference remained statistically significant when controlled for CNS bleeds and administration of vitamin K.
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Affiliation(s)
- Michelle Maguire
- Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts
| | - Lanting Fuh
- Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts
| | - Joshua N Goldstein
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Ariela L Marshall
- Mayo Clinic, Division of Hematology, Department of Internal Medicine, Rochester, Minnesota.,Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, Minnesota
| | - Michael Levine
- University of Southern California, Department of Emergency Medicine, Department of Medical Toxicology, Los Angeles, California
| | - Melissa L Howell
- University of the South, The School of Theology, Sewanee, Tennessee
| | - Blair A Parry
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Massachusetts General Hospital, Center for Vascular Emergencies, Boston, Massachusetts
| | - Rachel Rosovsky
- Massachusetts General Hospital, Division of Hematology, Department of Internal Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Internal Medicine, Boston, Massachusetts
| | - Bryan D Hayes
- Massachusetts General Hospital, Department of Pharmacy, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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Marshall AL, Wolanskyj‐Spinner AP. Importance of and strategies for achieving gender equity in hematology. Am J Hematol 2019; 94:E174-E175. [PMID: 30900766 DOI: 10.1002/ajh.25468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Ariela L. Marshall
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
- Department of Laboratory Medicine and PathologyMayo Clinic Rochester Minnesota
| | - Alexandra P. Wolanskyj‐Spinner
- Division of Hematology, Department of Internal MedicineMayo Clinic Rochester Minnesota
- Mayo Clinic Alix School of MedicineMayo Clinic Rochester Minnesota
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DeLoughery EP, Ravindran A, Ashrani AA, Begna KH, Hook CC, Marshall AL, Pruthi RK, Wolanskyj-Spinner AP, Go RS. Patterns and utility of vitamin B12 and folate testing in patients with isolated thrombocytopenia. Ann Hematol 2019; 98:1993-1994. [PMID: 30877374 DOI: 10.1007/s00277-019-03666-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 11/25/2022]
Affiliation(s)
| | - Aishwarya Ravindran
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Aneel A Ashrani
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kebede H Begna
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - C Christopher Hook
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ariela L Marshall
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rajiv K Pruthi
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Ronald S Go
- Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
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