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Mayer AP, Blair JE, Ko MG, Patel SI, Files JA. Long-term follow-up of a facilitated peer mentoring program. MEDICAL TEACHER 2014; 36:260-6. [PMID: 24286367 DOI: 10.3109/0142159x.2013.858111] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Mentoring plays an important role in career success of academic medical faculty. New mentoring models such as peer mentoring have emerged. AIM To evaluate the long-term impact of a facilitated peer mentoring program on academic achievements. METHOD Women faculty at the instructor or assistant professor rank were recruited to voluntarily participate in a facilitated peer mentoring program. Recruitment occurred over 3.8 years between 2005 and 2009. A 26-item questionnaire to assess academic skill, career satisfaction, and self-efficacy was administered before program participation and again with seven additional questions in 2011. Curriculum vitae were reviewed retrospectively to tally peer-reviewed publications, other academic activities, and promotions. RESULTS Participants had long-term improvement in their perceived mastery of academic skills. Peer-reviewed publications, book chapters, abstracts, posters, and other academic activities increased when activities before the program were compared to those in the five years after program enrollment. At follow-up, participants reported positive perceptions of the program and 44% continued to work with their original peer mentor groups. CONCLUSIONS Involvement in the facilitated peer mentoring program was associated with increased skills and academic activities for most participants. Future studies are needed to assess its applicability and success among various demographic groups in academic medicine.
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Mayer AP, Blair JE, Ko MG, Hayes SN, Chang YHH, Caubet SL, Files JA. Gender distribution of U.S. medical school faculty by academic track type. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:312-317. [PMID: 24362384 DOI: 10.1097/acm.0000000000000089] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Over the past 30 years, the number and type of academic faculty tracks have increased, and researchers have found differences in promotion rates between track types. The authors studied the gender distribution of medical school faculty on the traditional tenure track (TTT) and clinician-educator track (CET) types. METHOD The authors analyzed gender and academic track type distribution data from the March 31, 2011, snapshot of the Association of American Medical Colleges' Faculty Roster. Their final analysis included data from the 123 medical schools offering the TTT type and the 106 offering the CET type, which excluded any schools with 10 or fewer faculty on each track type. RESULTS The original dataset included 134 medical schools representing 138,508 full-time faculty members, 50,376 (36%) of whom were women. Of the 134 medical schools, 128 reported at least one of four track types: TTT, CET, research track, and other. Of the 83 medical schools offering the CET type, 64 (77%) had a higher proportion of female than male faculty on that track type. Of the 102 medical schools offering the TTT type, only 20 (20%) had a higher proportion of female than male faculty on that track type. CONCLUSIONS Medical schools offering the CET type reported higher proportions of female faculty on that track type. Given that faculty on the CET type lag behind their TTT colleagues in academic promotion, these findings may contribute to continued challenges in gaining academic and leadership parity for women in academic medicine.
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Moats CC, Edwards FD, Files JA. More than meets the eye: the importance of screening for intimate partner violence. J Womens Health (Larchmt) 2014; 23:275-7. [PMID: 24428175 DOI: 10.1089/jwh.2013.4693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Kransdorf LN, Vegunta S, Files JA. Everything in Moderation: What the Female Athlete Triad Teaches Us About Energy Balance. J Womens Health (Larchmt) 2013; 22:790-2. [DOI: 10.1089/jwh.2013.4515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The development of pharmacologic agents for the prevention of breast cancer is a significant milestone in medical and laboratory research. Despite these advances, the endorsement of preventive options has become challenging and complex, as physicians are expected to counsel and tailor their recommendations using a personalized approach taking into account medical comorbidities, degree of risk and patient preferences. This article provides a comprehensive overview of the major breast cancer prevention trials, review of the pharmacologic options available for breast cancer prevention, and strategies for integrating chemoprevention of breast cancer in high-risk women into clinical practice.
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Casey PM, Files JA, Mayer AP. Drospirenone-Related Venous Thromboembolism Risk: “The Rest of the Story”. J Womens Health (Larchmt) 2013; 22:467-8. [DOI: 10.1089/jwh.2013.4308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Carey EJ, Mayer AP, Files JA. Tired of Being Tired. J Womens Health (Larchmt) 2013; 22:289-90. [DOI: 10.1089/jwh.2012.4225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mayer AP, Files JA, Foxx-Orenstein AE. If You Don't Ask Her, She Won't Tell You: Fecal Incontinence in Women. J Womens Health (Larchmt) 2013; 22:104-5. [DOI: 10.1089/jwh.2012.4125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lloyd RM, Files JA, Mayer AP. Perimenopause: Counting Sheep and Still No Sleep. J Womens Health (Larchmt) 2012; 21:1209-10. [DOI: 10.1089/jwh.2012.3939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Allen SV, Solberg Nes L, Marnach ML, Polga K, Jenkins SM, Files JA, Croghan IT, Ghosh K, Pruthi S. Patient understanding of the revised USPSTF screening mammogram guidelines: need for development of patient decision aids. BMC WOMENS HEALTH 2012; 12:36. [PMID: 23051022 PMCID: PMC3517367 DOI: 10.1186/1472-6874-12-36] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 10/01/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND The purpose of the study was to examine patients' understanding of the revised screening mammogram guidelines released by the United States Preventive Services Task Force (USPSTF) in 2009 addressing age at initiation and frequency of screening mammography. METHODS Patients from the Departments of Family Medicine, Internal Medicine, and Obstetrics and Gynecology (n = 150) at a tertiary care medical center in the United States completed a survey regarding their understanding of the revised USPSTF guidelines following their release, within four to six months of their scheduled mammogram (March 2010 to May 2010). RESULTS Of the patients surveyed, 97/147 (67%) indicated increased confusion regarding the age and frequency of screening mammography, 61/148 (41%) reported increased anxiety about mammograms, and 58/146 (40%) reported anxiety about their own health status following the release of the revised screening guidelines. Most of the patients surveyed, 111/148 (75%), did not expect to change their timing or frequency of screening mammograms in the future. CONCLUSION Results from this survey suggested increased confusion and possibly an increase in patients' anxiety related to screening mammography and their own health status following the release of the revised USPSTF screening mammogram guidelines to the public and subsequent media portrayal of the revised guidelines. Although the study did not specifically address causality for these findings, the results highlight the need for improvements in the communication of guidelines to patients and the public. Development of shared decision-making tools and outcomes should be considered to address the communication challenge.
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Mayer AP, Vegunta S, Files JA. Human papillomavirus vaccine for women over forty: it's not just for kids. J Womens Health (Larchmt) 2012; 21:982-3. [PMID: 22816506 DOI: 10.1089/jwh.2012.3811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mayer AP, Morris MF, Panse PM, Ko MG, Files JA, Ruddy BE, Blair JE. Does the presence of mediastinal adenopathy confer a risk for disseminated infection in immunocompetent persons with pulmonary coccidioidomycosis? Mycoses 2012; 56:145-9. [DOI: 10.1111/j.1439-0507.2012.02224.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ko MG, Files JA, Pruthi S. Reducing the risk of breast cancer: A personalized approach. THE JOURNAL OF FAMILY PRACTICE 2012; 61:340-347. [PMID: 22670237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Files JA, Allen SV, Pruthi S. Hormone therapy for management of menopausal symptoms: understanding [corrected] breast cancer risk. MINERVA GINECOLOGICA 2012; 64:223-230. [PMID: 22635017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Since the publication of the Women's Health Initiative, women seeking relief from menopausal symptoms often express concerns about the risk of hormone therapy (HT). In women at increased risk for breast cancer or with a personal history of breast cancer, the decision to use HT for the treatment of menopausal symptoms must be carefully considered in the context of the most recent literature. It is well established that HT is the most effective treatment for climacteric symptoms and sexual dysfunction. The evidence to date on the use of HT in women with a history of breast cancer is complicated by the fact that the majority of breast cancers are estrogen responsive and the concern about risk of recurrence. Over the past decade, survival after breast cancer treatment has continued to improve resulting in millions of survivors worldwide. As a result of breast cancer therapies, the prevalence of menopausal symptoms is increasing in survivors, and both clinicians and patients are seeking safe and effective therapies for symptom management. This article will review the role of HT in the treatment of menopausal symptoms in women without breast cancer and those with a personal history of breast cancer or those who are at increased risk of breast cancer. Management of menopause-related symptoms will be reviewed with a focus on strategies to improve quality of life.
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Files JA, Mayer AP, Pruthi S. Anything Goes: Discontinuation of Hormone Therapy. J Womens Health (Larchmt) 2012; 21:567-8. [DOI: 10.1089/jwh.2012.3602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Mayer AP, Files JA, David PS. You Can't Fool Mother Nature: New Directions in Oral Contraception. J Womens Health (Larchmt) 2012; 21:366-7. [DOI: 10.1089/jwh.2012.3511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hayes SN, Mayer AP, Files JA. Let's (Not) Do It Again: Secondary Prevention of Cardiovascular Disease in Women. J Womens Health (Larchmt) 2012; 21:108-9. [DOI: 10.1089/jwh.2011.3341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Files JA, Mayer AP, Paripati HR. Lung cancer in women. J Womens Health (Larchmt) 2011; 20:1759-60. [PMID: 21933005 DOI: 10.1089/jwh.2011.3235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Files JA, Frey KA, David PS, Hunt KS, Noble BN, Mayer AP. Developing a reproductive life plan. J Midwifery Womens Health 2011. [PMID: 23181644 DOI: 10.1111/j.1542-2011.2011.00048.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this article is 2-fold: to emphasize the importance of a reproductive life plan and to define its key elements. We review the 2006 recommendations from the Centers for Disease Control and Prevention (CDC) regarding ways to improve the delivery of preconception health care to women in the United States, with particular focus on encouraging individual reproductive responsibility throughout the life span and on encouraging every woman to develop a reproductive life plan. We propose recommendations for the content of a reproductive life plan and explore ways to incorporate the guidelines from the CDC into clinical practice. By encouraging women to consider their plans for childbearing before they become pregnant, clinicians have the opportunity to influence behavior before pregnancy, which may decrease the incidence of unintended pregnancies and adverse pregnancy outcomes.
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Abstract
The change in hormonal milieu associated with perimenopause and menopause can lead to a variety of symptoms that can affect a woman's quality of life. Postmenopausal hormone therapy (HT) is an effective, well-tolerated treatment for these symptoms. However, combined HT consisting of conjugated equine estrogen and medroxyprogesterone acetate has been associated with an increased number of health risks when compared with conjugated equine estrogen alone or placebo. As a result, some women are turning to alternative hormonal formulations known as compounded bioidentical HT because they perceive them to be a safer alternative. This article defines compounded bioidentical HT and explores the similarities and differences between it and US Food and Drug Administration-approved HT. We will examine the major claims made by proponents of compounded bioidentical HT and recommend strategies for management of patients who request bioidentical HT from physicians.
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Braddy CM, Files JA. Female Genital Mutilation: Cultural Awareness and Clinical Considerations. J Midwifery Womens Health 2010; 52:158-163. [PMID: 17336823 DOI: 10.1016/j.jmwh.2006.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinicians in the United States are increasingly encountering girls and women who have undergone female genital mutilation. To foster a more trusting relationship with such patients, health care providers must have an accurate understanding of the cultural background surrounding this practice, a working knowledge of the different types of female genital mutilation procedures that may be encountered, and an awareness of both the acute and long-term complications. Some of these complications are potentially fatal, and the correct clinical diagnosis can be lifesaving.
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Files JA, Ko MG, Pruthi S. Managing aromatase inhibitors in breast cancer survivors: not just for oncologists. Mayo Clin Proc 2010; 85:560-6; quiz 566. [PMID: 20511486 PMCID: PMC2878260 DOI: 10.4065/mcp.2010.0137] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The role of the general internist in the care of breast cancer survivors is increasing as the number of women living with breast cancer continues to rise. Most breast cancers occurring in women older than 50 years are estrogen receptor- and/or progesterone receptor-positive, and adjuvant endocrine therapy plays an important role in the treatment plan. Aromatase inhibitors are becoming the preferred endocrine therapy, and general internists caring for breast cancer survivors need to be familiar with their use and adverse effect profile. This article reviews the use of aromatase inhibitors, the frequency of common adverse effects, and strategies for their management.
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Blair JE, Mayer AP, Currier J, Files JA, Wu Q. Coccidioidomycosis in elderly persons. Clin Infect Dis 2008; 47:1513-8. [PMID: 18990061 DOI: 10.1086/593192] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Coccidioidomycosis is a fungal infection acquired via inhalation of airborne fungal arthrospores of Coccidioides species in regions of endemicity in the deserts of the southwestern United States and northern Mexico. In recent years, the incidence of coccidioidomycosis has increased in areas of endemicity, and previous studies have found the highest incidence of coccidioidal infection in Arizona among persons in older age groups. METHODS We conducted a retrospective review of data for all patients with coccidioidomycosis who were treated at our institution that compared clinical manifestations of coccidioidomycosis in patients aged >or=60 years with those in patients aged <60 years. RESULTS We compared 210 patients aged >or=60 years with 186 patients aged <60 years. No significant differences were observed with regard to manifestations of coccidioidomycosis, even after adjustment for comorbid conditions, excluding immunosuppression. Regardless of age, when coccidioidal illnesses in immunosuppressed patients were compared with those in nonimmunosuppressed patients, immunosuppressed patients were significantly more likely to have extrapulmonary dissemination of infection, to require hospitalization, and to have progressive infection or to die of coccidioidomycosis. Univariate logistic regression identified immunosuppression as the only marker that increased risk of extrapulmonary dissemination of infection (odds ratio, 2.13;P=.05), hospitalization (odds ratio, 2.68; P<.001), and death (odds ratio, 8.39; P<.001). Multivariate analysis revealed that neither age nor an interaction of age and immunosuppression had a significant impact on coccidioidal manifestations. CONCLUSIONS Coccidioidomycosis is a serious illness in all patients, but its different manifestations in older-aged persons, compared with those in younger-aged persons, may be related to immunosuppression rather than age alone.
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Files JA, David PS, Frey KA. The patient-centered medical home and preconception care: an opportunity for internists. J Gen Intern Med 2008; 23:1518-20. [PMID: 18506543 PMCID: PMC2518012 DOI: 10.1007/s11606-008-0657-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Revised: 04/04/2008] [Accepted: 04/25/2008] [Indexed: 10/22/2022]
Abstract
The patient-centered medical home is defined by the American College of Physicians as a comprehensive approach for delivering medical care to patients. Internists have the role of caring for patients from adolescence through adulthood and have the opportunity to deliver preconception care. Preconception care is the promotion of the health and well-being of a woman and her partner before pregnancy. The goal is to improve pregnancy-related outcomes through interventions that occur before conception and before the patient would ordinarily seek prenatal care. Using the model of the patient-centered medical home, internists can provide comprehensive preconception care to improve the health of women before pregnancy and thus to decrease the risk of adverse pregnancy outcomes.
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