Department of Family Medicine and Rural Health

: ACU Workforce Column; Keywords: minority faculty, underrepresented, underserved, medical education, leadership, health care, workforce, Note: Originally published in Journal of Health Care for the Poor and Underserved., Citation: Richert A, Campbell K, Rodríguez J, Borowsky IW, Parikh R, Colwell A. (2013). ACU workforce column: expanding and supporting the health care workforce. J Health Care Poor Underserved, 24(4):1423-31.

: Addressing Disparities in Academic Medicine; Background The proportion of black, Latino, and Native American faculty in U.S. academic medical centers has remained almost unchanged over the last 20 years. Some authors credit the "minority tax"—the burden of extra responsibilities placed on minority faculty in the name of diversity. This tax is in reality very complex, and a major source of inequity in academic medicine. Discussion The “minority tax” is better described as an Underrepresented Minority in Medicine (URMM) faculty responsibility disparity. This disparity is evident in many areas: diversity efforts, racism, isolation, mentorship, clinical responsibilities, and promotion. Summary The authors examine the components of the URMM responsibility disparity and use information from the medical literature and from human resources to suggest practical steps that can be taken by academic leaders and policymakers to move toward establishing faculty equity and thus increase the numbers of black, Latino, and Native American faculty in academic medicine., Keywords: Underrepresented minority, Black, Latino, Hispanic, Native american, Minority tax, Publication Note: Publisher's Version also available at http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-015-0290-9, Preferred Citation: Rodríguez, J. E., Campbell, K. M., & Pololi, L. H. (2015). Addressing disparities in academic medicine: what of the minority tax?. BMC medical education, 15(1), 1.

: Are Group Visits Effective for the Treatment of Obesity?; Weight loss therapy consisting of 20 to 30 lifestyle-modification group visits is associated with modest (4–8 kg) weight loss. (SOR A, based on homogeneous randomized controlled trials [RCTs].) For patients who participate in group visits, use of sibutramine (15 mg p.o. daily) and compliance with food journaling are both associated with greater weight loss. (SOR B, based on an RCT and an outcomes study.), Keywords: obesity, treatment, counseling, Note: Originally published in Evidence Based Practice, Citation: Hofmann, M., Rodríguez, J. E., & Shearer, B. (2010). Are group visits effective for the treatment of obesity? Evidence Based Practice, 13(2): 6-7.

: Collaboration with Pharmacy Services in a Family Practice for the Medically Underserved; Objectives: Pharmacist-managed collaborative services in a family practice setting are described, and diabetes and hypertension outcomes are assessed. Methods: Pharmacist-managed clinics, pharmacotherapy consultations, and drug information services are provided for a medically underserved, predominantly African American population. A pharmacy residency director, an ambulatory care pharmacy resident and three PharmD candidate student pharmacists work directly with physicians, nurse practitioners, nurses, and social workers to form an interdisciplinary health care team. Providers utilize pharmacy services through consultations and referrals. Collaboration outcomes were evaluated in twentytwo patients with diabetes and thirty hypertensive patients. Patients were retrospectively followed throughout their history with pharmacy service. Hemoglobin A1c (A1C) was tracked before referral to pharmacy services, 3 to 6 months after, and as the most current measure after at least 6 months. Blood pressure (BP) was observed before pharmacy involvement, 2 to 4 months later, and then currently for at least 4 months with the service. The mean of the most current markers was calculated, and the percent of patients at their goal marker was compared to national averages. Results: Fifty percent of pharmacy service patients met the American Diabetes Association hemoglobin A1c goal of less than 7% in our evaluation compared to the national mean of 49.8% overall and 44% in African Americans. Thirty percent of patients were at their BP goal while 33.1% of patients without diabetes and 33.2% of patients with diabetes nationally are at goal. Conclusion: The medically underserved patients under the care of pharmacy services achieved a higher percentage at their A1C goal than the national mean. The percentage of patients who achieved their BP goals was comparable to the national average. Increasing utilization of pharmacy services in the family practice setting allows for pharmacists and providers to form a trusted relationship while providing enhanced care and potentially improved outcomes for patients., Keywords: poverty, homeless, ambulatory care, medication therapy management, pharmacists, Note: Originally published in Pharmacy Practice., Citation: Enfinger F, Campbell K, Taylor JR. Collaboration with pharmacy services in a family practice for the medically underserved. Pharmacy Practice (Internet) 2009 Oct-Dec;7(4):248-253.

: Communities Committed to Underserved Care; Keywords: community health, underserved, uninsured, primary care, WeCare, Medicaid, Neighborhood Health Services, Florida, Note: Copyright © 2012 Meharry Medical College. This article first appeared in Journal of Health Care for the Poor and Underserved 23:4 (2012), 1494–1496. Reprinted with permission by The Johns Hopkins University Press., Citation: Rodriguez, JE. (2012). Communities committed to underserved care. Journal of Health Care for the Poor and Underserved, 23(4): 1494-1496.

: Does Dietary Fat Reduction Alter the Risk of Cardiovascular Events in Women?; A decrease in dietary fat does not alter the risk of coronary heart disease (CHD), stroke, or cardiovascular disease (CVD) in postmenopausal women (SOR: B, based on a single RCT), nor does it significantly alter CHD in women aged 30 to 55. (SOR: B, based on a single cohort study.) However, CVD in women is epidemiologically linked to higher trans-fat consumption and lower polyunsaturated fat consumption., Keywords: dietary fat, cardiovascular disease, Note: Originally published in Evidence Based Practice, Citation: Smith, J. B., & Rodríguez, J. E. (2010). Does dietary fat reduction alter the risk of cardiovascular events in women? Evidence Based Practice, 13(9): 8.

: Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action.; Recent studies have identified that levonorgestrel administered orally in emergency contraception (LNG-EC) is only efficacious when taken before ovulation. However, the drug does not consistently prevent follicular rupture or impair sperm function. The present systematic review is performed to analyze and more precisely define the extent to which pre-fertilization mechanisms of action may explain the drug's efficacy in pregnancy avoidance. We also examine the available evidence to determine if pre-ovulatory drug administration may be associated with post-fertilization effects. The mechanism of action of LNG-EC is reviewed. The drug has no ability to alter sperm function at doses used and has limited ability to suppress ovulation. Our analysis estimates that the drug's ovulatory inhibition potential could prevent less than 15 percent of potential conceptions, thus making a pre-fertilization mechanism of action significantly less likely than previously thought. Luteal effects (such as decreased progesterone, altered glycodelin levels, and shortened luteal phase) present in the literature may suggest a pre-ovulatory induced post-fertilization drug effect. Plan B is the most widely used emergency contraceptive available. It is important for patients and physicians to clearly understand the drug's mechanism of action (MOA). The drug was originally thought to work by preventing fertilization. Recent research has cast doubt on this. Our review of the research suggests that it could act in a pre-fertilization capacity, and we estimate that it could prevent ovulation in only 15 percent or less of cases. The drug has no ability to alter sperm function and limited ability to suppress ovulation. Further, data suggest that when administered pre-ovulation, it may have a post-fertilization MOA., Keywords: Inhibition of ovulation, Levonorgestrel emergency contraception, Luteal dysfunction, Mechanism of action, Pre- and post-fertilization effects, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102184.

: Four Years of Group Visits Treating Obesity in an Under Served Urban Community; Keywords: obesity, Bronx, treatment, weight loss, Note: Originally published in The Bariatrician, Citation: Rodríguez, J. E., Painter, K., & Bent, G. (2007). Four years of group visits treating obesity in an under served urban community: Health not cosmetics. The Bariatrician, 17.

: How Are Thyroid Function Tests Altered by Thyroid Replacement Medications?; Small changes in the dosing of levothyroxine (±25 mcg) are associated with large changes in serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations, but not with measurable changes in hypothyroid symptoms, well-being, or quality of life. (SOR: B, based on a single RCT.) Taking levothyroxine while fasting is associated with a higher serum FT4 and lower serum TSH compared with administration after a meal, but these differences are small. (SOR: C, based on a single RCT using disease-oriented outcomes.), Keywords: thyroid replacement medications, levothyroxine, thyroid function tests, Note: Originally published in Evidence Based Practice, Citation: Shah, S., & Rodríguez, J. E. (2010). How are thyroid function tests altered by thyroid replacement medications? Evidence Based Practice, 14(10): 12-13.

: How Long Should Antibiotic Therapy Be Continued for an Uncomplicated, Symptomatic Lower UTI in an Elderly Woman?; Elderly women with symptomatic lower urinary tract infections (UTIs) should be treated for 3 to 6 days with oral antibiotics. This duration provides better short-term outcomes than 1-day therapy and has long-term outcomes equivalent to 7- to 14-day therapy. (SOR B, based on a systematic review of heterogeneous RCTs.), Keywords: urinary tract infection, antibiotics, elderly, Note: Originally published in Evidence Based Practice, Citation: Radkay, L., & Rodríguez, J. E. (2010). How long should antibiotic therapy be continued for an uncomplicated, symptomatic lower UTI in an elderly woman? Evidence Based Practice, 13(6): 10-11.

: How Safe and Effective is Pramlintide in Improving Long-Term Glycemic Control and Weight Loss in Patients with Type 2 Diabetes Mellitus Receiving Insulin?; Keywords: glycemic control, pramlintide, treatment, weight, diabetes, type 2, Note: Originally published in Evidence Based Practice., Citation: Iyengar S, Love, KM, Bauerband B, Rodríguez, JE. (2013). How safe and effective is pramlintide in improving long-term glycemic control and weight loss in patients with type 2 diabetes mellitus receiving insulin? Evidence Based Practice 16(9): 12-13.

: Impact of a Creative Arts Journal on a Medical School Community; The Florida State University College of Medicine (FSUCOM) has created a new creative arts journal called HEAL: Humanism Evolving through Arts and Literature. This study was designed to evaluate the influence creative arts publications may have on students, faculty, and staff of a medical school. The investigators randomly selected 17 participants from 25 volunteers in the HEAL project who agreed to be interviewed. They used consensual qualitative research methods to analyze the data, identifying major areas of impact HEAL had on the faculty, students, and staff. Three major themes were identified: Strengthening Professional Relationships (SPR), Educational Enhancement (EE), and Self-Expression (SE). The following sub-themes were identified: SPR—changed perceptions; SE—artistic self-expression; EE—faculty example, and positive reinforcement of career choice. HEAL is perceived as a valuable part of medical education, and the identified themes can be tested in further research., Keywords: creative arts journals, humanism, medical education, medical humanities, medicine, professionalism, Note: Originally published in Journal of Poetry Therapy, available at: http://dx.doi.org/10.1080/08893675.2012.736179., Citation: Rodriguez JE, Welch TJ, & Edwards JC. (2012). Impact of a creative arts journal on a medical school community: A qualitative study. Journal of Poetry Therapy, 25 (4): 197-204.

: Inner City Community Oriented Primary Care to Improve Medical Student Skills and Combat Obesity; Background: Efforts to increase medical student knowledge regarding obesity are needed in medical school curriculum. This article examines a third year medical student intervention utilizing obesity group visits. Description: In our third-year family medicine clerkship, we implemented the Health not Cosmetics pilot intervention as part of a Community Oriented Primary Care experience. The intervention consisted of weekly group visits run by third and fourth year medical students to teach lifestyle modification. To evaluate the intervention, medical students filled out an anonymous departmental evaluation form and patients were surveyed using a short questionnaire during a group visit. Evaluation: Medical students rated the intervention as meeting or exceeding expectations and as improving Community Oriented Primary Care skills, especially in the following areas: identifying community needs, participating in an intervention, collecting data and presenting results. Patients adopted more active lifestyles and healthier eating habits. Conclusion: This intervention was well received by medical students and patients., Keywords: obesity, medical curriculum, health, intervention study, Note: Originally published in Medical Education Online eISSN 1087-2981 This journal is published under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License. Responsible editor: David J Solomon., Citation: Rodríguez, J. E., & Fornari, A. B. (2006). Inner City Community Oriented Primary Care to Improve Medical Student Skills and Combat Obesity. Medical Education, 1-4.

: Interventions for Heart Failure; The following interventions improve important outcomes in patients with systolic heart failure (all SORs: A, based on meta-analyses): • Angiotensin converting enzyme (ACE) inhibitors reduce mortality, repeat myocardial infarction (MI), and hospitalization rates • Beta-blockers and aldosterone blockers reduce mortality and hospitalization rates • Diuretics reduce mortality and hospitalization rates and improve exercise capacity • Digitalis treatment decreases hospitalization rates and clinical deterioration • Aerobic exercise rehabilitation of at least 6 months in duration decreases hospitalization rates and improves quality of life. The following intervention improves important outcomes in African American patients with systolic heart failure (SOR: B, based on a single RCT): • Isosorbide dinitrate and hydralazine combination therapy reduces mortality and hospitalization rates and improves quality of life., Keywords: heart failure, prevention, angiotensin converting enzyme inhibitors, beta-blockers, aldosterone, diuretics, digitalis, Note: Originally published in Evidence Based Practice, Citation: Glickman, M., & Rodríguez, J. E. (2011). Interventions for heart failure. Evidence Based Practice, 14 (12): 1-2.

: Is Calcitonin Useful for Reducing the Pain of Acute Osteoporotic Fractures?; Calcitonin has been shown to improve acute pain at rest in patients with osteoporotic vertebral fractures, when compared with placebo, and reduce the use of other analgesic medications (SOR A, based on a meta-analysis of randomized controlled trials [RCTs]). However, calcitonin is not superior to placebo in patients with hip fracture who have undergone surgical repair. (SOR B, based on an RCT.), Keywords: osteoporotic fractures, treatment, pain, calcitonin, Note: Originally published in Evidence Based Practice, Citation: Parker, A., Soberon, A., & Rodríguez, J. E. (2009). Is calcitonin useful for reducing the pain of acute osteoporotic fractures? Evidence Based Practice, 12(12): 12-13.

: Is Laparoscopic or Open Surgery Better to Prevent Recurrence of an Inguinal Hernia in an Adult Man?; The risk of recurrence of inguinal hernia is reduced by the use of synthetic mesh, but does not depend on the specific surgical procedure. Compared with the open approach, laparoscopy requires a longer operation (15 minutes longer on average), but decreases recovery time and reduces persistent pain and numbness. (SOR A, based on a systematic review.) Recurrence rates with laparoscopic inguinal hernia repair are highly operator dependent. (SOR A, based on 2 large randomized controlled trials [RCTs].), Keywords: inguinal hernia, laparoscopy, open surgery, Note: Originally published in Evidence Based Practice, Citation: Bada, A., & Rodríguez, J. E. (2009). Is laparoscopic or open surgery better to prevent recurrence of an inguinal hernia in an adult man?: Update. Evidence Based Practice, 12(9): 9-10.

: Is Uterine Artery Embolization (UAE) Safe and Effective for Treatment of Uterine Fibroids?; Compared with hysterectomy or myomectomy, UAE for treating fibroids results in similar patient satisfaction. UAE is associated with fewer blood transfusions, shorter hospital stays, and quicker resumption of normal activities than surgical treatment. However, patients undergoing UAE are more likely to require further intervention at 2 and 5 years and are more likely to have minor complications than patients treated surgically (SOR: A, systematic review of RCTs)., Keywords: uterine fibroids, surgical intervention, embolization, patient outcomes, Uterine artery embolization, Uterine fibroid embolization, Note: Originally published in Evidence Based Practice., Citation: Davis L., Provost B., & Rodriguez JE. (2012). Is uterine artery embolization (UAE) safe and effective for treatment of uterine fibroids? Evidence Based Practice, 15(12): 28-29.

: Letter to the Editor; Keywords: minorities, medical faculty, academic medicine, retention, Note: Copyright © 2013 Meharry Medical College. This article first appeared in Journal of Health Care for the Poor and Underserved 24:1 (2013), viii-ix. Reprinted with permission by The Johns Hopkins University Press., Citation: Campbell K. (2013). A letter to the editor: under-represented minority faculty in academic medical centers. Journal of Health Care for the Poor and Underserved, 24(1): viii-ix.

: Medical Residents' and Practicing Physicians' e-Cigarette Knowledge and Patient Screening Activities; The purpose of this study was to compare medical residents and practicing physicians in primary care specialties regarding their knowledge and beliefs about electronic cigarettes (e-cigarettes). We wanted to ascertain whether years removed from medical school had an effect on screening practices, recommendations given to patients, and the types of informational sources utilized. A statewide sample of Florida primary care medical residents (n = 61) and practicing physicians (n = 53) completed either an online or paper survey, measuring patient screening and physician recommendations, beliefs, and knowledge related to e-cigarettes. χ tests of association and linear and logistic regression models were used to assess the differences within- and between-participant groups. Practicing physicians were more likely than medical residents to believe e-cigarettes lower cancer risk in patients who use them as an alternative to cigarettes ( = .0003). Medical residents were more likely to receive information about e-cigarettes from colleagues ( = .0001). No statistically significant differences were observed related to e-cigarette knowledge or patient recommendations. Practicing primary care physicians are accepting both the benefits and costs associated with e-cigarettes, while medical residents in primary care are more reticent. Targeted education concerning the potential health risks and benefits associated with the use of e-cigarettes needs to be included in the current medical education curriculum and medical provider training to improve provider confidence in discussing issues surrounding the use of this product., Keywords: Clinical guidelines, Electronic cigarettes, Medical education, Primary care, Smoking, Publication Note: This NIH-funded author manuscript originally appeared in PubMed Central at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266463.

: Metformin Therapy and Diabetes Prevention in Adolescents Who Are Obese; No studies have addressed the question of whether metformin reduces development of diabetes among adolescents who are obese. Metformin treatment in adolescents who are obese can modestly reduce risk factors for type 2 diabetes, including elevated body mass index (BMI), fasting insulin levels, and fasting glucose levels. (Strength of Recommendation [SOR]: C). However, metformin treatment is associated with nausea, abdominal pain, and diarrhea. (SOR: A). Because of the limited available data, metformin is not recommended for diabetes prevention in adolescents. (SOR: C)., Keywords: diabetes, obesity, metformin therapy, hypoglycemic agents, Note: Originally published in American Family Physician eISSN 1532-0650, Citation: Rodríguez, J. E., Shearer, B., & Slawson, D. C. (2007). FPIN's clinical inquiries. Metformin therapy and diabetes prevention in adolescents who are obese. American family physician, 76(9), 1357-8.

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