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Clare CA, Woodland MB, Buery-Joyner S, Whetstone S, Ogunyemi D, Sims SM, Moxley M, Baecher-Lind LE, Hampton BS, Pradhan A, Katz NT. Educational guidelines on sexual orientation, gender identity and expression, and sex characteristics biases in medical education. Am J Obstet Gynecol 2024:S0002-9378(24)00422-8. [PMID: 38432411 DOI: 10.1016/j.ajog.2024.02.309] [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] [Received: 11/29/2023] [Revised: 02/25/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
A commitment to diversity, equity, inclusion, and belonging in medical education requires addressing both explicit and implicit biases based on sexual orientation, gender identity and expression, and sex characteristics and the intersectionality with other identities. Heterosexism and heteronormative attitudes contribute to health and healthcare disparities for lesbian, gay, bisexual, transgender and queer or questioning, intersex, asexual individuals. Student, trainee, and faculty competencies in medical education curricula regarding the care of lesbian, gay, bisexual, transgender and queer or questioning, intersex, asexual patients and those who are gender nonconforming or born with differences of sex development allow for better understanding and belonging within the clinical learning environment of lesbian, gay, bisexual, transgender and queer/questioning, intersex, asexual learners and educators. The Association of Professors of Gynecology and Obstetrics issued a call to action to achieve a future free from racism and bias through inclusivity in obstetrics and gynecology education and healthcare, which led to the creation of the Association of Professors of Gynecology and Obstetrics Diversity, Equity, and Inclusion Guidelines Task Force. The task force initially addressed racism, racial- and ethnicity-based bias, and discrimination in medical education and additionally identified other groups that are subject to bias and discrimination, including sexual orientation, gender identity and expression, and sex characteristic identities, persons with disabilities, and individuals with various religious and spiritual practices. In this scholarly perspective, the authors expand on previously developed guidelines to address sexual orientation, gender identity and expression, and sex characteristics bias, heterosexism, and heteronormative attitudes in obstetrics and gynecology educational products, materials, and clinical learning environments to improve access and equitable care to vulnerable individuals of the lesbian, gay, bisexual, transgender and queer or questioning, intersex, asexual community.
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Affiliation(s)
- Camille A Clare
- Department of Obstetrics and Gynecology, Downstate Health Sciences University College of Medicine and Department of Health Policy and Management, School of Public Health, Brooklyn, NY.
| | - Mark B Woodland
- Department of OBGYN, Drexel University College of Medicine, Philadelphia, PA
| | - Samantha Buery-Joyner
- Department Ob/Gyn, Inova Fairfax Medical Campus, Division of Medical Education, University of Virginia School of Medicine, Inova Campus, Fairfax, VA
| | - Sara Whetstone
- Division of Obstetrics, Gynecology, and Gynecologic Surgery, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
| | - Dotun Ogunyemi
- Division of Graduate Medical Education, Department of Obstetrics & Gynecology, Charles Drew University of Medicine and Science, Los Angeles, CA
| | - Shireen Madani Sims
- Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Michael Moxley
- Department of Obstetrics/Gynecology, Roper St. Francis Healthcare, Division of Diversity, Inclusion and Health Equity, Georgetown University School of Medicine, Washington, DC
| | - Laura E Baecher-Lind
- Division of Educational Affairs, Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA
| | - B Star Hampton
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Archana Pradhan
- Rutgers Robert Wood Johnson Medical School, Department of Obstetrics, Gynecology and Reproductive Sciences, General Division, New Brunswick, NJ
| | - Nadine T Katz
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Bailey EJ, Tita ATN, Leach J, Boggess K, Dugoff L, Sibai B, Lawrence K, Hughes BL, Bell J, Aagaard K, Edwards RK, Gibson K, Haas DM, Plante L, Metz TD, Casey BM, Esplin S, Longo S, Hoffman M, Saade GR, Foroutan J, Tuuli MG, Owens MY, Simhan HN, Frey HA, Rosen T, Palatnik A, Baker S, August P, Reddy UM, Kinzler W, Su EJ, Krishna I, Nguyen N, Norton ME, Skupski D, El-Sayed YY, Ogunyemi D, Galis ZS, Harper L, Ambalavanan N, Oparil S, Kuo HC, Szychowski JM, Hoppe K. Perinatal Outcomes Associated With Management of Stage 1 Hypertension. Obstet Gynecol 2023; 142:1395-1404. [PMID: 37769314 PMCID: PMC10840706 DOI: 10.1097/aog.0000000000005410] [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: 05/19/2023] [Accepted: 06/29/2023] [Indexed: 09/30/2023]
Abstract
OBJECTIVE To evaluate the association between maternal blood pressure (BP) below 130/80 mm Hg compared with 130-139/80-89 mm Hg and pregnancy outcomes. METHODS We conducted a planned secondary analysis of CHAP (Chronic Hypertension and Pregnancy), an open label, multicenter, randomized controlled trial. Participants with mean BP below 140/90 mm Hg were grouped as below 130/80 mm Hg compared with 130-139/80-89 mm Hg by averaging postrandomization clinic BP throughout pregnancy. The primary composite outcome was preeclampsia with severe features, indicated preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The secondary outcome was small for gestational age (SGA). RESULTS Of 2,408 patients in CHAP, 2,096 met study criteria; 1,328 had mean BP 130-139/80-89 mm Hg and 768 had mean BP below 130/80 mm Hg. Participants with mean BP below 130/80 mm Hg were more likely to be older, on antihypertensive medication, in the active treatment arm, and to have lower BP at enrollment. Mean clinic BP below 130/80 mm Hg was associated with lower frequency of the primary outcome (16.0% vs 35.8%, adjusted relative risk 0.45; 95% CI 0.38-0.54) as well as lower risk of severe preeclampsia and indicated birth before 35 weeks of gestation. There was no association with SGA. CONCLUSION In pregnant patients with mild chronic hypertension, mean BP below 130/80 mm Hg was associated with improved pregnancy outcomes without increased risk of SGA. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT02299414.
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Affiliation(s)
- Erin J Bailey
- Departments of Obstetrics and Gynecology, University of Wisconsin, Madison, and Medical College of Wisconsin, Milwaukee, Wisconsin, University of Alabama at Birmingham, Birmingham, and University of South Alabama, Mobile, Alabama, University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina, University of Pennsylvania and Drexel University College of Medicine, Philadelphia, St. Luke's University Health Network, Fountain Hill, and Magee Women's Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania, University of Texas at Houston, Baylor College of Medicine, and Texas Children's Hospital, Houston, UTSouthwestern Medical Center, Dallas, and University of Texas Medical Branch, Galveston, Texas, Columbia University, New York, NYU Langone Hospital-Long Island, Mineola, and NewYork-Presbyterian Queens Hospital, Queens, New York, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma, Indiana University, Indianapolis, Indiana, University of Utah Health, Salt Lake City, Utah, Washington University in St. Louis, St. Louis, Missouri, University of Mississippi Medical Center, Jackson, Mississippi, The Ohio State University, Columbus, Ohio, Rutgers University-Robert Wood Johnson Medical School, New Brunswick, New Jersey, Yale University, New Haven, Connecticut, University of Colorado, Aurora, and Denver Health, Denver, Colorado, Emory University, Atlanta, Georgia, University of California, San Francisco, San Francisco, Stanford University, Palo Alto, and Arrowhead Regional Medical Center, Colton, California, and Beaumont Hospital, Royal Oak, Michigan; the Department of Biostatistics, the Division of Neonatology, Department of Pediatrics, the Division of Cardiovascular Disease, Department of Medicine, and the Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama; MetroHealth System, Cleveland, Ohio; Intermountain Healthcare, Salt Lake City, Utah; Ochsner Baptist Medical Center, New Orleans, Louisiana; Christiana Care Health Services, Newark, Delaware; St. Peter's University Hospital, New Brunswick, New Jersey; Weill Cornell Medicine, New York, New York; Zuckerberg San Francisco General Hospital, San Francisco, California; the Division of Cardiovascular Sciences, NHLBI, Bethesda, Maryland; and the Department of Women's Health, University of Texas at Austin, Austin, Texas
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Ogunyemi D, Thind BS, Chang K, Mohammed S, Osumah M, Flores R, Lee T, Sovory LH, Arabian S, Raval N. Using a Virtual Simulation Workshop to Teach Interns Evidence-Based Feedback Techniques. Cureus 2023; 15:e49709. [PMID: 38161910 PMCID: PMC10757457 DOI: 10.7759/cureus.49709] [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] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background The Accreditation Council for Graduate Medical Education requires residents to demonstrate competence in integrating feedback into their daily practice. With the shift to virtual medical education during the pandemic, the need for new skills in delivering effective feedback through virtual media has emerged. Methodology This study aimed to assess the feasibility of a virtual bootcamp for interns, utilizing virtual simulation workshops to teach effective feedback skills. The curriculum employed a situated learning-guided participation framework. Virtual standardized students participated, and interns engaged in activities such as providing virtual feedback, completing self-assessments, and receiving instruction on feedback principles, including the one-minute preceptor's five micro-skills. Interns repeated the feedback process, with virtual students providing assessments. Data were collected from 105 incoming interns at Arrowhead Regional Medical Center in June 2021 and June 2022, using Zoom® as the online platform. Results Competency assessments revealed a significant post-training increase in proficiency/expert milestones (88% versus 47%, p = 0.007). Interns' self-assessments also significantly improved (18.02 versus 16.74, p = 0.001), particularly for previously trained interns (18.27 versus 16.7). Non-primary care interns outperformed primary care interns in milestone scores. The majority of interns (80%) reported valuable learning experiences during the workshop, with 70% expressing confidence in using the one-minute preceptor technique during residency. The one-minute preceptor step "reinforce what was right" was deemed the easiest, while "obtain commitment" and "explore emotional reaction" presented significant challenges. Conclusions This study demonstrates the potential of virtual workshops to enhance intern competency in delivering effective feedback through formal processes and the one-minute preceptor. These virtual approaches offer innovative alternatives to in-person teaching, enabling evaluation at higher levels of Miller's pyramid of clinical competence.
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Affiliation(s)
- Dotun Ogunyemi
- Graduate Medical Education, Arrowhead Regional Medical Center, Colton, USA
| | - Birpartap S Thind
- Medical Education, California University of Science and Medicine, Colton, USA
| | - Kelly Chang
- Medical Education, California University of Science and Medicine, Colton, USA
| | | | - Mariamu Osumah
- Medical Education, University of California Riverside School of Medicine, Riverside, USA
| | - Roberto Flores
- Medical Education, University of California Riverside School of Medicine, Riverside, USA
| | - Tommy Lee
- General Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - Lisa Herring Sovory
- Neurology, Arrowhead Regional Medical Center, Colton, USA
- Neurology, California University of Science and Medicine, Colton, USA
| | - Sarkis Arabian
- Critical Care, Arrowhead Regional Medical Center, Colton, USA
| | - Niren Raval
- Family Medicine, California University of Science and Medicine, Colton, USA
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Phan AT, Ucar A, Malkoc A, Nagori E, Qadir A, Khosravi C, Tseng A, Nguyễ˜ên JPT, Modi AP, Deshpande O, Lay J, Ku A, Dong F, Ogunyemi D, Arabian S. The impact of impaired insulin regulation on severity of SARS-CoV-2 infection: a 2-year retrospective single-center analysis. Ann Med Surg (Lond) 2023; 85:5350-5354. [PMID: 37915687 PMCID: PMC10617851 DOI: 10.1097/ms9.0000000000001306] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Background The COVID-19 pandemic has caused an international healthcare crisis and produced a large healthcare burden. Diabetes mellitus (DM) is a common disease that can be controlled via pharmacologic agents; however, many patients have poor glycemic control, leading to disease-related complications. DM has been reported in the literature to be associated with increasing morbidity and mortality in COVID-19 patients. The authors aim to assess the associations between glucose homoeostasis and COVID-19 disease severity and mortality. Methods A retrospective chart review of patients ages 18-100 years of age admitted with COVID-19 between January 2020 and December 2021 was performed. The primary outcome was COVID-19 mortality with respect to haemoglobin A1C levels of less than 5.7%, 5.7-6.4%, and 6.5% and greater. Disease severity was determined by degree of supplemental oxygen requirements (ambient air, low-flow nasal cannula, high-flow nasal cannula, non-invasive mechanical ventilation, and invasive mechanical ventilation). COVID-19 mortality and severity were also compared to blood glucose levels on admission as grouped by less than 200 mg/dl and greater than or equal to 200 mg/dl. Results A total of 1156 patients were included in the final analysis. There was a statistically significant association between diabetic status and mortality (P=0.0002). Statistical significance was also noted between admission blood glucose ≥200 mg/dl and mortality (P=0.0058) and respiratory disease severity (P=0.0381). A multivariate logistic regression for predicting mortality showed increasing haemoglobin A1C was associated with increased mortality (odds ratio 1.72 with 95% CI of 1.122-2.635). Conclusions In our 2-year retrospective analysis, there was an association between a diagnosis of DM and COVID-19-related mortality. Hyperglycaemia on admission was found to be statistically significant with mortality in patients diagnosed with COVID-19. Glucose homoeostasis and insulin dysregulation likely play a contributing factor to COVID-19 disease severity and mortality.
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Affiliation(s)
- Alexander T. Phan
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Ari Ucar
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Aldin Malkoc
- General Surgery, Arrowhead Regional Medical Center
| | - Essam Nagori
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Aftab Qadir
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Chayanne Khosravi
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Alan Tseng
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Julie P. T. Nguyễ˜ên
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Arnav P. Modi
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Ojas Deshpande
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Johnson Lay
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Andrew Ku
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Fanglong Dong
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Dotun Ogunyemi
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
| | - Sarkis Arabian
- Departments of Internal Medicine
- Critical Care Medicine
- California University of Science and Medicine, Colton, CA
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Phan AT, Ucar AA, Malkoc A, Hu J, Buxton L, Tseng AW, Dong F, Nguyễn JP, Modi AP, Deshpande O, Lay J, Ku A, Ogunyemi D, Arabian S. ABO blood group and rhesus factor association with inpatient COVID-19 mortality and severity: a two-year retrospective review. Blood Res 2023; 58:138-144. [PMID: 37751922 PMCID: PMC10548287 DOI: 10.5045/br.2023.2023122] [Citation(s) in RCA: 1] [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: 06/25/2023] [Revised: 09/06/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Background Early reports have indicated a relationship between ABO and rhesus blood group types and infection with SARS-CoV-2. We aim to examine blood group type associations with COVID-19 mortality and disease severity. Methods This is a retrospective chart review of patients ages 18 years or older admitted to the hospital with COVID-19 between January 2020 and December 2021. The primary outcome was COVID-19 mortality with respect to ABO blood group type. The secondary outcomes were 1. Severity of COVID-19 with respect to ABO blood group type, and 2. Rhesus factor association with COVID-19 mortality and disease severity. Disease severity was defined by degree of supplemental oxygen requirements (ambient air, low-flow, high-flow, non-invasive mechanical ventilation, and invasive mechanical ventilation). Results The blood type was collected on 596 patients with more than half (54%, N=322) being O+. The ABO blood type alone was not statistically associated with mortality (P=0.405), while the RH blood type was statistically associated with mortality (P<0.001). There was statistically significant association between combined ABO and RH blood type and mortality (P=0.014). Out of the mortality group, the O+ group had the highest mortality (52.3%), followed by A+ (22.8%). The combined ABO and RH blood type was statistically significantly associated with degree of supplemental oxygen requirements (P=0.005). The Kaplan-Meier curve demonstrated that Rh- patients had increased mortality. Conclusion ABO blood type is not associated with COVID-19 severity and mortality. Rhesus factor status is associated with COVID-19 severity and mortality. Rhesus negative patients were associated with increased mortality risk.
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Affiliation(s)
- Alexander T. Phan
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Ari A. Ucar
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Aldin Malkoc
- Department of General Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Janie Hu
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Luke Buxton
- Department of Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Alan W. Tseng
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Fanglong Dong
- Department of Graduate Medical Education, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Julie P.T. Nguyễn
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Arnav P. Modi
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Ojas Deshpande
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Johnson Lay
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Andrew Ku
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Dotun Ogunyemi
- Department of Graduate Medical Education, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Sarkis Arabian
- Department of Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
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Alhousseini A, Farr C, Ogunyemi D, Wharton K, Fawaz A, Bazzi N, Andrews-Johnson T, Bahado-Singh R. Delivery of a Fetus with a Non-Reassuring Status Is Associated with Significant Maternal Morbidity. Gynecol Obstet Invest 2023; 88:359-365. [PMID: 37751727 DOI: 10.1159/000534189] [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: 11/16/2022] [Accepted: 08/14/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES When a labor process is complicated by non-reassuring fetal status (NRFS), obstetricians focus on delivery to optimize neonatal status. We explored maternal morbidity in the setting of NRFS. Our hypothesis is that delivery of a live newborn with NRFS is associated with significant maternal morbidity. Design, Participants, Setting, and Methods: A large retrospective cohort study of 27,886 women who delivered between January 2013 and December 2016 in a single health system was studied. Inclusion criteria included (1) women over the age of 18 at the time of admission; (2) singleton pregnancy; (3) live birth; and (4) gestational age greater than or equal to 37 weeks at the time of admission. NRFS was defined as umbilical cord pH less than or equal to 7.00, fetal bradycardia, late decelerations, and/or umbilical artery base excess ≤-12. Univariate and multivariate logistic regression and propensity score analyses were performed, and propensity score adjusted odds ratios (AORPS) were derived. p values <0.05 were considered statistically significant. Primary outcomes are maternal blood transfusion, maternal readmission, maternal intensive care unit (ICU) admission, and cesarean delivery in relation to umbilical artery pH, fetal bradycardia, and late decelerations. RESULTS Umbilical artery pH less than or equal to 7 was associated with maternal blood transfusion (AORPS 6.83 [95% CI 2.22-21.0, p < 0.001]), maternal readmission (AORPS 12.6 [95% CI 2.26-69.8, p = 0.0039]), and cesarean delivery (AORPS 5.76 [95% CI 3.63-9.15, p < 0.0001]). Fetal bradycardia was associated with transfusion (AORPS 2.13 [95% CI 1.26-3.59, p < 0.005]) and maternal ICU admission (AORPS 3.22 [95% CI 1.23-8.46, p < 0.017]). Late decelerations were associated with cesarean delivery (AORPS 1.65 [95% CI 1.55-1.76, p < 0.0001]), clinical chorioamnionitis (AORPS 2.88 [95% CI 2.46-3.37, p < 0.0001]), and maternal need for antibiotics (AORPS 1.89 [95% CI 1.66-2.15, p < 0.0001]). Umbilical artery base excess less than or equal to -12 was associated with readmission (AORPS 6.71 [95% CI 2.22-20.3, p = 0.0007]), clinical chorioamnionitis (AORPS 1.89 [95% CI 1.24-2.89, p = 0.0031]), and maternal need for antibiotics (AORPS 1.53 [95% CI 1.03-2.26, p = 0.0344]). LIMITATIONS The retrospective design contributes to potential bias compared to the prospective design. However, by utilizing multivariate logistic regression analysis with a propensity score method, specifically inverse probability of treatment weighting, we attempted to minimize the impact of confounding variables. Additionally, only a portion of the data set had quantitative blood losses recorded, while the remainder had estimated blood losses. CONCLUSION NRFS is associated with significant maternal complications, in the form of increased need for blood transfusions, ICU admissions, and increased infection and readmission rates. Strategies for minimizing maternal complications need to be proactively considered in the management of NRFS.
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Affiliation(s)
- Ali Alhousseini
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
- Department of Obstetrics and Gynecology, Michigan State University, Lansing, Michigan, USA
| | - Carly Farr
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Dotun Ogunyemi
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Kurt Wharton
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Aya Fawaz
- Department of Obstetrics and Gynecology, Michigan State University, Lansing, Michigan, USA
| | - Nagham Bazzi
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
- Department of Surgery, Lebanese University, Beirut, Lebanon
| | - Tonyie Andrews-Johnson
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Ray Bahado-Singh
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
- Department of Obstetrics and Gynecology, Corewell William Beaumont Hospital, Royal Oak, Michigan, USA
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7
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Goulding AN, Antoniewicz L, Leach JM, Boggess K, Dugoff L, Sibai B, Lawrence K, Hughes BL, Bell J, Edwards RK, Gibson K, Haas DM, Plante L, Metz TD, Casey B, Esplin S, Longo S, Hoffman M, Saade GR, Hoppe KK, Foroutan J, Tuuli M, Owens MY, Simhan HN, Frey H, Rosen T, Palatnik A, Baker S, Reddy UM, Kinzler W, Su E, Krishna I, Nguyen N, Norton ME, Skupski D, El-Sayed YY, Ogunyemi D, Harper LM, Ambalavanan N, Oparil S, Szychowski JM, Tita AT. Breastfeeding initiation and duration among people with mild chronic hypertension: a secondary analysis of the Chronic Hypertension and Pregnancy trial. Am J Obstet Gynecol MFM 2023; 5:101086. [PMID: 37437694 PMCID: PMC10528420 DOI: 10.1016/j.ajogmf.2023.101086] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Increased duration of breastfeeding improves maternal cardiovascular health and may be especially beneficial in high-risk populations, such as those with chronic hypertension. Others have shown that individuals with hypertension are less likely to breastfeed, and there has been limited research aimed at supporting breastfeeding goals in this population. The impact of perinatal blood pressure control on breastfeeding outcomes among people with chronic hypertension is unknown. OBJECTIVE This study aimed to evaluate whether breastfeeding initiation and short-term duration assessed at the postpartum clinic visit differed according to perinatal blood pressure treatment strategy (targeting blood pressure <140/90 mm Hg vs reserving antihypertensive treatment for blood pressure ≥160/105 mm Hg). STUDY DESIGN We performed a secondary analysis of the Chronic Hypertension and Pregnancy trial. This was an open-label, multicenter, randomized trial where pregnant participants with mild chronic hypertension were randomized to receive antihypertensive medications with goal blood pressure <140/90 mm Hg (active treatment) or deferred treatment until blood pressure ≥160/105 mm Hg (control). The primary outcome was initiation and duration of breastfeeding, assessed at the postpartum clinic visit. We performed bivariate analyses and log-binomial and cumulative logit regression models, adjusting models for variables that were unbalanced in bivariate analyses. We performed additional analyses to explore the relationship between breastfeeding duration and blood pressure measurements at the postpartum visit. RESULTS Of the 2408 participants from the Chronic Hypertension and Pregnancy trial, 1444 (60%) attended the postpartum study visit and provided breastfeeding information. Participants in the active treatment group had different body mass index class distribution and earlier gestational age at enrollment, and (by design) were more often discharged on antihypertensives. Breastfeeding outcomes did not differ significantly by treatment group. In the active and control treatment groups, 563 (77.5%) and 561 (78.1%) initiated breastfeeding, and mean durations of breastfeeding were 6.5±2.3 and 6.3±2.1 weeks, respectively. The probability of ever breastfeeding (adjusted relative risk, 0.99; 95% confidence interval, 0.93-1.05), current breastfeeding at postpartum visit (adjusted relative risk, 1.01; 95% confidence interval, 0.94-1.10), and weeks of breastfeeding (adjusted odds ratio, 0.87; 95% confidence interval, 0.68-1.12) did not differ by treatment group. Increased duration (≥2 vs <2 weeks) of breastfeeding was associated with slightly lower blood pressure measurements at the postpartum visit, but these differences were not significant in adjusted models. CONCLUSION In a secondary analysis of the cohort of Chronic Hypertension and Pregnancy trial participants who attended the postpartum study visit and provided breastfeeding information (60% of original trial participants), breastfeeding outcomes did not differ significantly by treatment group. This suggests that maintaining goal blood pressure <140/90 mm Hg throughout the perinatal period is associated with neither harm nor benefit for short-term breastfeeding goals. Further study is needed to understand long-term breastfeeding outcomes among individuals with chronic hypertension and how to support this population in achieving their breastfeeding goals.
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Affiliation(s)
- Alison N Goulding
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Goulding and Antoniewicz).
| | - Leah Antoniewicz
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX (Drs Goulding and Antoniewicz)
| | - Justin M Leach
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL (Drs Leach and Szychowski)
| | - Kim Boggess
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC (Dr Boggess)
| | - Lorraine Dugoff
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA (Dr Dugoff)
| | - Baha Sibai
- Department of Maternal-Fetal Medicine, The University of Texas Health Science Center at Houston, Houston, TX (Dr Sibai)
| | - Kirsten Lawrence
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT (Dr Lawrence)
| | - Brenna L Hughes
- Department of Obstetrics and Gynecology, Duke University, Durham, NC (Dr Hughes)
| | - Joseph Bell
- Department of Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA (Dr Bell)
| | - Rodney K Edwards
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK (Dr Edwards)
| | - Kelly Gibson
- Department of Obstetrics and Gynecology, MetroHealth, Case Western Reserve University, Cleveland, OH (Dr Gibson)
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN (Dr Haas)
| | - Lauren Plante
- Department of Obstetrics and Gynecology, Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA (Dr Plante)
| | - Torri D Metz
- Department of Obstetrics and Gynecology, The University of Utah, Salt Lake City, UT (Dr Metz)
| | - Brian Casey
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey and Tita)
| | - Sean Esplin
- Department of Obstetrics and Gynecology, Intermountain Healthcare, Salt Lake City, UT (Dr Esplin)
| | - Sherri Longo
- Ochsner Baptist Medical Center, New Orleans, LA (Dr Longo)
| | | | - George R Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX (Dr Saade)
| | - Kara K Hoppe
- Department of Obstetrics and Gynecology, UnityPoint Health-Meriter Hospital/Marshfield Clinic, Madison, WI (Dr Hoppe)
| | - Janelle Foroutan
- Saint Peter's University Hospital, New Brunswick, NJ (Dr Foroutan)
| | - Methodius Tuuli
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI (Dr Tuuli)
| | - Michelle Y Owens
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, MS (Dr Owens)
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, UPMC Magee-Women's Hospital, University of Pittsburgh, Pittsburgh, PA (Dr Simhan)
| | - Heather Frey
- Department of Obstetrics and Gynecology, Ohio State University College of Medicine, Columbus, OH (Dr Frey)
| | - Todd Rosen
- Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ (Dr Rosen)
| | - Anna Palatnik
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI (Dr Palatnik)
| | - Susan Baker
- Department of Obstetrics and Gynecology, University of South Alabama, Mobile, AL (Dr Baker)
| | - Uma M Reddy
- Department of Obstetrics and Gynecology, Columbia University, New York, NY (Dr Reddy)
| | - Wendy Kinzler
- Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY (Dr Kinzler)
| | - Emily Su
- Department of Obstetrics and Gynecology, University of Colorado, Boulder, CO (Dr Su)
| | - Iris Krishna
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA (Dr Krishna)
| | - Nicki Nguyen
- Department of Obstetrics and Gynecology, Denver Health, Denver, CO (Dr Nguyen)
| | - Mary E Norton
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, and Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA (Dr Norton)
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, NewYork-Presbyterian Queens Hospital, New York, NY (Dr Skupski)
| | - Yasser Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA (Dr El-Sayed)
| | - Dotun Ogunyemi
- Department of Obstetrics and Gynecology, Arrowhead Regional Medical Center, Colton, CA (Dr Ogunyemi); Beaumont Internal Medicine, Southfield, MI (Dr Ogunyemi)
| | - Lorie M Harper
- Department of Women's Health, The University of Texas at Austin, Austin, TX (Dr Harper)
| | - Namasivayam Ambalavanan
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Division of Neonatology, Department of Pediatrics, The University of Alabama at Birmingham, Birmingham, AL (Dr Ambalavanan)
| | - Suzanne Oparil
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL (Dr Oparil)
| | - Jeff M Szychowski
- Department of Biostatistics, The University of Alabama at Birmingham, Birmingham, AL (Drs Leach and Szychowski); Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita)
| | - Alan T Tita
- Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey, Ambalavanan, Oparil, Szychowski, and Tita); Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, Birmingham, AL (Drs Casey and Tita)
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Buery-Joyner SD, Baecher-Lind L, Clare CA, Hampton BS, Moxley MD, Ogunyemi D, Pradhan AA, Madani Sims SM, Whetstone S, Woodland MB, Katz NT. Educational guidelines for diversity and inclusion: addressing racism and eliminating biases in medical education. Am J Obstet Gynecol 2023; 228:133-139. [PMID: 36113577 DOI: 10.1016/j.ajog.2022.09.014] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
Racism and bias contribute to healthcare disparities at a patient and population health level and also contribute to the stagnation or even regression of progress toward equitable representation in the workforce and in healthcare leadership. Medical education and healthcare systems have expended tremendous efforts over the past several years to address these inequities. However, systemic racism continues to impact health outcomes and the future physician workforce. The Association of Professors of Gynecology and Obstetrics called for action to achieve a future free from racism in obstetrics and gynecology education and healthcare. As a result of this call to action, the Diversity, Equity, and Inclusion Guidelines Task Force was created. The mission of the Task Force was to support educators in their efforts to identify and create educational materials that augment antiracist educational goals and prepare, recruit, and retain a talented and diverse workforce. In this Special Report, the authors share these guidelines that describe best practices and set new standards to increase diversity, foster inclusivity, address systemic racism, and eliminate bias in obstetrics and gynecology educational products, materials, and environments.
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Affiliation(s)
- Samantha D Buery-Joyner
- University of Virginia School of Medicine Inova Campus, Falls Church, VA; Department of Obstetrics and Gynecology, Inova Fairfax Medical Campus, Falls Church, VA.
| | | | - Camille A Clare
- Department of Obstetrics and Gynecology, College of Medicine and School of Public Health, Downstate Health Sciences University, Brooklyn, NY
| | - B Star Hampton
- Departments of Obstetrics and Gynecology and Medical Sciences, Warren Alpert Medical School of Brown University, Providence, RI
| | - Michael D Moxley
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, DC; Roper St. Francis Healthcare, Charleston, SC
| | - Dotun Ogunyemi
- Arrowhead Regional Medical Center and California University of Science and Medicine, Colton CA; University of California, Riverside, CA
| | - Archana A Pradhan
- Department of Obstetrics, Gynecology, and Reproductive Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Sara Whetstone
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA
| | - Mark B Woodland
- Department of Obstetrics and Gynecology, Reading Hospital/Tower Health, West Reading, PA; Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA; Pennsylvania State Board of Medicine, Harrisburg, PA
| | - Nadine T Katz
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, New York City, NY; Montefiore Medical Center, Einstein Hospital Campus, Bronx, NY
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9
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Ogunyemi D, Westermeyer C, Eghbali M, Patel P, Struble S, Arogyaswamy S, Teixeira A, Raval N, Gentry M, Lee T, Arabian S. Seeking Equity; Pathway Programs in Liaison Committee on Medical Education Medical Schools for Minoritized Students. J Med Educ Curric Dev 2023; 10:23821205231177181. [PMID: 37324048 PMCID: PMC10265357 DOI: 10.1177/23821205231177181] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/04/2023] [Indexed: 06/17/2023]
Abstract
Objectives There is a paucity of data on pathway programs that seek to increase underrepresented in medicine (URiM) students in medicine. Therefore, this investigation aimed to describe the status and associations of pathway programs at US medical schools. Methods From May to July 2021, the authors obtained information by (1) accessing pathway programs listed on the Association of American Medical Colleges (AAMC) website, (2) reviewing websites of US medical schools, (3) calling medical schools to obtain further information. The data retrieved from the medical school websites was compiled into a 27-item checklist based on the maximum number of different items that was extracted from any of the medical school websites. The data included program characteristics, curricula, activities, and outcomes. Each program was assessed on the number of categories of which information was available. Statistical analyses determined significant associations of URiM-focused pathways and other factors. Results The authors identified 658 pathway programs: 153 (23%) listed on AAMC website and 505 (77%) identified from medical school websites. Only 88 (13%) programs listed outcomes and 143 (22%) had adequate website information. URiM-focused programs (48%) were independently associated with AAMC website listing (adjusted odds ratio [aOR] = 2.62, P = .001), no fees requirement (aOR = 3.33, P = .001), oversight by diversity departments (aOR = 2.05, P = .012), Medical College Admission Test preparations (aOR = 2.70, P = .001), research opportunities (aOR = 1.51, P = .022), and mentoring (aOR = 2.58., P < .001). Programs targeting K1-12 were less likely to offer mentoring, shadowing or research or include URiM students. Programs with outcomes were more likely to be college programs with longer durations and offer research, while programs listed on AAMC website provided more resources. Conclusion Although pathway programs are available for URiM students, accessibility issues due to inadequate websites information and early exposure are barriers. Most programs have insufficient data on their website, including a lack of outcome data which is detrimental in today's virtual climate. Medical schools should update their websites to ensure that students requiring support to matriculate into medical school have adequate and relevant information to make informed decisions regarding participation.
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Affiliation(s)
- Dotun Ogunyemi
- Graduate Medical Education, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Claire Westermeyer
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Mason Eghbali
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Priyesh Patel
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Sarah Struble
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Sagarika Arogyaswamy
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Amir Teixeira
- School of Medicine, California University of Science and Medicine, Colton, CA, USA
| | - Niren Raval
- Department of Family Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Michael Gentry
- Department of Radiology, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Tommy Lee
- Department of Surgery, Arrowhead Regional Medical Center, Colton, CA, USA
| | - Sarkis Arabian
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA, USA
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10
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Struble SL, Ohno A, Barthelmass M, Ogunyemi D. Prevalence and Nature of Sexist Microaggressions Against Female Medical Students. Academic Medicine 2022; 97:S178. [PMID: 37838906 DOI: 10.1097/acm.0000000000004825] [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] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Sarah L Struble
- Author affiliations: S.L. Struble, A. Ohno, M. Barthelmass, California University of Science and Medicine; D. Ogunyemi, Arrowhead Regional Medical Center
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11
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Ogunyemi D, Lee T, Ma M, Osuma A, Eghbali M, Bouri N. Improving wellness: Defeating Impostor syndrome in medical education using an interactive reflective workshop. PLoS One 2022; 17:e0272496. [PMID: 35925925 PMCID: PMC9352101 DOI: 10.1371/journal.pone.0272496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Impostor syndrome is characterized by fraudulent self-doubt and correlates with burnout, and adverse mental health. Objective The objective was to investigate correlates of Impostor syndrome in a medical education cohort and determine if an interactive workshop can improve knowledge and perception of Impostor syndrome. Methods From June 2019 to February 2021 interactive educational workshops were conducted for medical education cohorts. Participants completed baseline knowledge and Impostor syndrome self-identification surveys, participated in interactive presentations and discussions, followed by post-intervention surveys. Results There were 198 participants including 19% residents, 10% medical students, 30% faculty and 41% Graduate Medical Education (GME) administrators. Overall, 57% were positive for Impostor syndrome. Participants classified as the following Impostor syndrome competence subtypes: Expert = 42%; Soloist = 34%; Super-person = 31%; Perfectionist = 25%; and Natural Genius = 21%. Self-identified contributors of IS included: parent expectations = 72%, female gender = 58%, and academic rat race = 37%. GME administrators compared to physicians/medical students had significantly higher number of self-identified contributors to Impostor syndrome. Knowledge survey scores increased from 4.94 (SD = 2.8) to 5.78 (2.48) post intervention (p = 0.045). Participants with Impostor syndrome competence subtypes had increased perceptions of Impostor syndrome as a cause of stress, failure to reach full potential, and negative relationships/teamwork (p = 0.032 -<0.001). Conclusion Impostor syndrome was common in this medical education cohort, and those with Impostor syndrome significantly attributed negative personal and professional outcomes to Impostor syndrome. An interactive workshop on Impostor syndrome can be used to increase perceptions and knowledge regarding Impostor syndrome. The materials can be adapted for relevance to various audiences.
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Affiliation(s)
- Dotun Ogunyemi
- Arrowhead Regional Medical Center, Colton, California, United States of America
- * E-mail:
| | - Tommy Lee
- Arrowhead Regional Medical Center, Colton, California, United States of America
| | - Melissa Ma
- California University of Science and Medicine, Colton, California, United States of America
| | - Ashley Osuma
- University of Illinois College of Medicine, Peoria, IL, United States of America
| | - Mason Eghbali
- California University of Science and Medicine, Colton, California, United States of America
| | - Natalie Bouri
- California University of Science and Medicine, Colton, California, United States of America
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12
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Miller DT, Wilkins KM, Ogunyemi D. Addressing Patients as Sources of Microaggressions for Residents, Fellows, and Faculty. J Grad Med Educ 2022; 14:493-494. [PMID: 35991092 PMCID: PMC9380629 DOI: 10.4300/jgme-d-22-00472.1] [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] [Indexed: 11/06/2022] Open
Affiliation(s)
- Danielle T. Miller
- Danielle T. Miller, MD, MEd, is Assistant Professor of Emergency Medicine, University of Colorado School of Medicine
| | - Kirsten M. Wilkins
- Kirsten Wilkins, MD, is Professor of Psychiatry, Yale School of Medicine
| | - Dotun Ogunyemi
- Dotun Ogunyemi, MD, is Designated Institutional Official and Associate Chief Medical Officer, Arrowhead Regional Medical Center, and Associate Editor, Journal of Graduate Medical Education
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13
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Ogunyemi D, Darwish AG, Young G, Cyr E, Lee C, Arabian S, Challakere K, Lee T, Wong S, Raval N. Graduate medical education-led continuous assessment of burnout and learning environments to improve residents' wellbeing. BMC Med Educ 2022; 22:292. [PMID: 35436893 PMCID: PMC9016951 DOI: 10.1186/s12909-022-03366-y] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Promoting residents' wellbeing and decreasing burnout is a focus of Graduate Medical Education (GME). A supportive clinical learning environment is required to optimize residents' wellness and learning. OBJECTIVE To determine if longitudinal assessments of burnout and learning environment as perceived by residents combined with applying continuous quality Model for Improvement and serial Plan, Do, Study, Act (PDSA) cycles to test interventions would improve residents' burnout. METHODS From November 2017 to January 2020, 271 GME residents in internal medicine, general surgery, psychiatry, emergency medicine, family medicine and obstetrics and gynecology, were assessed over five cycles by Maslach Burnout Inventory (MBI), and by clinical learning environment factors (which included personal/social relationships, self-defined burnout, program burnout support, program back-up support, clinical supervision by faculty, and sleep difficulties). The results of the MBI and clinical learning environment factors were observed and analyzed to determine and develop indicated Institutional and individual program interventions using a Plan, Do, Study, Act process with each of the five cycles. RESULTS The response rate was 78.34%. MBI parameters for all GME residents improved over time but were not statistically significant. Residents' positive perception of the clinical supervision by faculty was significantly and independently associated with improved MBI scores, while residents' self-defined burnout; and impaired personal relations perceptions were independently significantly associated with adverse MBI scores on liner regression. For all GME, significant improvements improved over time in residents' perception of impaired personal relationships (p < 0.001), self-defined burnout (p = 0.013), program burn-out support (p = 0.002) and program back-up support (p = 0.028). For the Internal Medicine Residency program, there were statistically significant improvements in all three MBI factors (p < 0.001) and in clinical learning environment measures (p = 0.006 to < 0.001). Interventions introduced during the PDSA cycles included organization-directed interventions (such as: faculty and administrative leadership recruitment, workflow interventions and residents' schedule optimization), and individual interventions (such as: selfcare, mentoring and resilience training). CONCLUSION In our study, for all GME residents, clinical learning environment factors in contrast to MBI factors showed significant improvements. Residents' positive perception of the clinical learning environment was associated with improved burnout measures. Residents in separate programs responded differently with one program reaching significance in all MBI and clinical learning environment factors measured. Continuous wellbeing assessment of all GME residents and introduction of Institutional and individual program interventions was accomplished.
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Affiliation(s)
- Dotun Ogunyemi
- Arrowhead Regional Medical Center, Colton, CA, USA.
- California University of Science & Medicine, Colton, CA, USA.
| | | | | | - Erica Cyr
- Arrowhead Regional Medical Center, Colton, CA, USA
| | - Carol Lee
- Arrowhead Regional Medical Center, Colton, CA, USA
| | - Sarkis Arabian
- Arrowhead Regional Medical Center, Colton, CA, USA
- California University of Science & Medicine, Colton, CA, USA
| | - Kedar Challakere
- Arrowhead Regional Medical Center, Colton, CA, USA
- California University of Science & Medicine, Colton, CA, USA
| | - Tommy Lee
- Arrowhead Regional Medical Center, Colton, CA, USA
- California University of Science & Medicine, Colton, CA, USA
| | - Shirley Wong
- Arrowhead Regional Medical Center, Colton, CA, USA
- California University of Science & Medicine, Colton, CA, USA
| | - Niren Raval
- Arrowhead Regional Medical Center, Colton, CA, USA
- California University of Science & Medicine, Colton, CA, USA
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14
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Ogunyemi D, Okekpe CC, Barrientos DR, Bui T, Au MN, Lamba S. United States Medical School Academic Faculty Workforce Diversity, Institutional Characteristics, and Geographical Distributions From 2014-2018. Cureus 2022; 14:e22292. [PMID: 35350486 PMCID: PMC8933272 DOI: 10.7759/cureus.22292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Academic healthcare workforce diversity is important in addressing health disparities. Our goal was to evaluate trends and associations in faculty diversity of United States (US) medical schools over a five-year period. Methods We analyzed the Association of American Medical Colleges (AAMC) Faculty Roster data of 151 US medical schools from 2014-2018. Outcome faculty variables were female gender, underrepresented in medicine (UiM), age, and professorial representation. Predictor variables included geographical distributions, and institutional characteristics. Statistical analysis included Jonckheere-Terpstra test, ANOVA, and regression analysis. Results Female faculty increased from 37.6% to 40.4% (p<0.001), senior faculty (age >60 years) from 22.6% to 25.9% (p=0.001) while UiM faculty stayed relatively flat from 9.74% to 10.08% (p=0.773). UiM [adjusted odds ratio (aOR) = 0.39, p=0.015], and female faculty (aOR=0.3, p=0.001) had independently significantly decreased associations with professorial representation, while senior faculty had increased associations (aOR=3.82, p<0.001). Significant independent differences occurred in female, UiM, and professorial faculty distributions within US regions; Hispanic faculty were highest in Southwest (6.57%) and lowest in Midwest region (1.59%), while African-American faculty were highest in Southeast (8.15%) but lowest in the West (3.12%). UiM faculty had significantly independent decreased associations with MD/PhD degree (aOR=0.30, p=0.004) and higher US ranking institutions (aOR=0.45, p=0.009). Conclusions From 2014 to 2018, female faculty increased modestly while the UiM faculty trend remained flat. Female and UiM faculty were less represented at the professor level. UiM faculty were less represented in higher-ranking institutions. Geographic location is associated with faculty diversity.
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15
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Sotto-Santiago S, Poll-Hunter N, Trice T, Buenconsejo-Lum L, Golden S, Howell J, Jacobs N, Lee W, Mason H, Ogunyemi D, Crespo W, Lamba S. A Framework for Developing Antiracist Medical Educators and Practitioner-Scholars. Acad Med 2022; 97:41-47. [PMID: 34469355 DOI: 10.1097/acm.0000000000004385] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With an increasing awareness of the disparate impact of COVID-19 on historically marginalized populations and acts of violence on Black communities in 2020, academic health centers across the United States have been prioritizing antiracism strategies. Often, medical students and residents have been educated in the concepts of equity and antiracism and are ready to tackle these issues in practice. However, faculty are not prepared to respond to or integrate antiracism topics into the curriculum. Leaders in faculty affairs, education, diversity, and other departments are seeking tools, frameworks, expertise, and programs that are best suited to meet this imminent faculty development need. In response to these demands for guidance, the authors came together to explore best practices, common competencies, and frameworks related to antiracism education. The focus of their work was preparing faculty to foster antiracist learning environments at traditionally predominantly White medical schools. In this Scholarly Perspective, the authors describe their collaborative work to define racism and antiracism education; propose a framework for antiracism education for faculty development; and outline key elements to successfully build faculty capacity in providing antiracism education. The proposed framework highlights the interplay between individual learning and growth and the systemic and institutional changes needed to advance antiracist policies and practices. The key elements of the framework include building foundational awareness, expanding foundational knowledge on antiracism, embedding antiracism education into practice, and dismantling oppressive structures and measuring progress. The authors list considerations for program planning and provide examples of current work from their institutions. The proposed strategies aim to support all faculty and enable them to learn, work, and educate others in an antiracist learning environment.
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Affiliation(s)
- Sylk Sotto-Santiago
- S. Sotto-Santiago is assistant professor of medicine and vice chair, Faculty Affairs, Development, and Diversity, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Norma Poll-Hunter
- N. Poll-Hunter is senior director, Workforce Diversity, Equity, and Inclusion, Association of American Medical Colleges, Washington, DC
| | - Traci Trice
- T. Trice is clinical assistant professor, Department of Family and Community Medicine, and assistant dean, Diversity and Student Diversity Programs, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lee Buenconsejo-Lum
- L. Buenconsejo-Lum is professor, Department of Family Medicine, designated institutional official, and director of graduate medical education, University of Hawai'i at Manoa, Honolulu, Hawai'i
| | - Sherita Golden
- S. Golden is professor of medicine, Department of Medicine, and vice president and chief diversity officer, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joy Howell
- J. Howell is associate professor, Department of Pediatrics, and assistant dean for diversity and student life, Weill Cornell Medicine, New York, New York
| | - Nicole Jacobs
- N. Jacobs is associate professor, Department of Psychiatry and Behavioral Sciences, and associate dean of diversity and inclusion, University of Nevada, Reno, Reno, Nevada
| | - Winona Lee
- W. Lee is associate professor, Department of Native Hawaiian Health, University of Hawai'i at Manoa, Honolulu, Hawai'i
| | - Hyacinth Mason
- H. Mason is associate professor, Department of Medical Education, and assistant dean, Student Support and Inclusion, Albany Medical College, Albany, New York
| | - Dotun Ogunyemi
- D. Ogunyemi is professor of medical education, Department of Obstetrics and Gynecology, and chief equity, diversity, and inclusion officer, California University of Science and Medicine, Colton, California
| | - Waleska Crespo
- W. Crespo is president, Universidad Central del Caribe, Bayamón, Puerto Rico
| | - Sangeeta Lamba
- S. Lamba is professor, Department of Emergency Medicine, and vice chancellor for diversity and inclusion, Rutgers Biomedical and Health Sciences, Newark, New Jersey
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16
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Ogunyemi D, Mantilla R, Markus A, Reeves A, Win S, Barrientos DR, Lim D, Lanum D, Raval N. Associations Between Structural and Social Determinants of Health With COVID Infection Rates at a Safety Net Hospital. Cureus 2021; 13:e17397. [PMID: 34584806 PMCID: PMC8457892 DOI: 10.7759/cureus.17397] [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] [Accepted: 08/23/2021] [Indexed: 01/10/2023] Open
Abstract
Background: The reported disproportionate impact of COVID-19 infections on minority populations may be due to living in disinvested communities with a high level of poverty, pollution, inadequate unsafe employment, and overcrowded housing. Objective: To determine the association of county, city, and individual risk factors with COVID-19 infection rates. Methods: Retrospective chart review on COVID-19 tests performed from March through July 2020 at Arrowhead Regional Medical Center (ARMC), Colton, California. Results: A total of 7104 tests were performed with 69% in the drive-through testing center. The mean duration of test-to-results time was 2.36 (+0.02) days. COVID-19 positive tests occurred in 1095 (15.4%). At least one symptom occurred in 414 (33%) with a sensitivity of 37.8, specificity of 86.02, a positive predictive value of 33.01, and a negative predictive value of 72.76. Individual factors significantly associated with testing positive for COVID-19 were diabetes, Hispanic ethnicity, and male gender. Younger age was significantly associated with testing COVID positive with the highest risk in children <10 years. COVID-19 positive persons significantly resided in cities with higher population density, household members, poverty, non-English speaking homes, disability, lower median household income, lack of health insurance and decreased access to a computer and Wi-Fi services. County health rankings showed a significant positive association between testing positive for COVID-19 with increased smoking, air pollution, violent crimes, physical inactivity, decreased education, and access to exercise. Conclusion: Adverse county health rankings, socially and economically disadvantaged cities are associated with an increased risk of testing positive for COVD-19. This information can be used in strategic planning and invention mitigation.
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Affiliation(s)
- Dotun Ogunyemi
- Obstetrics and Gynecology, Arrowhead Regional Medical Center, Colton, USA
| | - Rolando Mantilla
- Healthcare Program/Population Health, Arrowhead Regional Medical Center, Colton, USA
| | - Abhinav Markus
- Family Medicine, Arrowhead Regional Medical Center, Colton , USA
| | - Aubrey Reeves
- Family Medicine, California University of Science and Medicine, Colton, USA
| | - Suyee Win
- Family Medicine, California University of Science and Medicine, Colton, USA
| | - Devin R Barrientos
- Family Medicine, California University of Science and Medicine, Colton, USA
| | - Dandrich Lim
- Family Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - David Lanum
- Family Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Niren Raval
- Family Medicine, Arrowhead Regional Medical Center, Colton, USA
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Kim SK, Vishweswaraiah S, Macknis J, Yilmaz A, Lalwani A, Mishra NK, Guda C, Ogunyemi D, Radhakrishna U, Bahado-Singh RO. New-onset postpartum preeclampsia: epigenetic mechanism and prediction. J Matern Fetal Neonatal Med 2021; 35:7179-7187. [PMID: 34374309 DOI: 10.1080/14767058.2021.1946504] [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: 10/20/2022]
Abstract
OBJECTIVE Placental cytosine (CpG) methylation was measured to predict new-onset postpartum preeclampsia (NOPP) and interrogate its molecular pathogenesis. METHODS NOPP was defined as patients with a new diagnosis of postpartum preeclampsia developing ≥48 h to ≤6 weeks after delivery with no prior hypertensive disorders. Placental tissue was obtained from 12 NOPP cases and 12 normotensive controls. Genome-wide individual cytosine (CpG) methylation level was measured with the Infinium MethylationEPIC BeadChip array. Significant differential methylation (NOPP vs. controls) for individual CpG loci was defined as false discovery rate (FDR) p value <.05. Gene functional enrichment using Qiagen's ingenuity pathway analysis (IPA) was performed to help elucidate the molecular pathogenesis of NOPP. A logistic regression model for NOPP prediction based on the methylation level in a combination of CpG loci was generated. The area under the receiver operating characteristic curves (AUC [95% CI]) sensitivity, and specificity for NOPP prediction based on the CpG methylation level was calculated for each locus. RESULTS There were 537 (in 540 separate genes) significantly (FDR p<.05 with a ≥ 2.0-fold methylation difference) differentially methylated CpG loci between the groups. A total of 143 individual CpG markers had excellent individual predictive accuracy for NOPP prediction (AUC ≥0.80), of which 14 markers had outstanding accuracy (AUC ≥0.90). A logistic regression model based on five CpG markers yielded an AUC (95% CI)=0.99 (0.95-0.99) with sensitivity 95% and specificity 93% for NOPP prediction. IPA revealed dysregulation of critical pathways (e.g., angiogenesis, chronic inflammation, and epithelial-mesenchymal transition) known to be linked to classic preeclampsia, in addition to other previously undescribed genes/pathways. CONCLUSIONS There was significant placental epigenetic dysregulation in NOPP. NOPP shared both common and unique molecular pathways with classic preeclampsia. Finally, we have identified novel potential biomarkers for the early post-partum prediction of NOPP.
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Affiliation(s)
- Sun Kwon Kim
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA.,Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, MI, USA
| | | | | | - Ali Yilmaz
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA
| | - Ashna Lalwani
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA
| | - Nitish K Mishra
- Department of Genetics, Cell Biology & Anatomy College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Chittibabu Guda
- Department of Genetics, Cell Biology & Anatomy College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dotun Ogunyemi
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA.,School of Medicine, California University of Science & Medicine, San Bernardino, CA, USA
| | - Uppala Radhakrishna
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA
| | - Ray O Bahado-Singh
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA
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Affiliation(s)
- Dotun Ogunyemi
- Dotun Ogunyemi, MD, is Designated Institutional Official and Associate Chief Medical Officer, Arrowhead Regional Medical Center, and Associate Editor, Journal of Graduate Medical Education
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19
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Ogunyemi D. Defeating Unconscious Bias: The Role of a Structured, Reflective, and Interactive Workshop. J Grad Med Educ 2021; 13:189-194. [PMID: 33897951 PMCID: PMC8054602 DOI: 10.4300/jgme-d-20-00722.1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/02/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Unconscious or implicit biases are universal and detrimental to health care and the learning environment but can be corrected. Historical interventions used the Implicit Association Test (IAT), which may have limitations. OBJECTIVE We determined the efficacy of an implicit bias training without using the IAT. METHODS From April 2019 to June 2020, a 90-minute educational workshop was attended by students, residents, and faculty. The curriculum included an interactive unconscious biases presentation, videoclips using vignettes to demonstrate workplace impact of unconscious biases with strategies to counter, and reflective group discussions. The evaluation included pre- and postintervention surveys. Participants were shown images of 5 individuals and recorded first impressions regarding trustworthiness and presumed profession to unmask implicit bias. RESULTS Of approximately 273 participants, 181 were given the survey, of which 103 (57%) completed it with significant increases from pre- to postintervention assessments for perception scores (28.87 [SEM 0.585] vs 32.73 [0.576], P < .001) and knowledge scores (5.68 [0.191] vs 7.22 [0.157], P < .001). For a White male physician covered in tattoos, only 2% correctly identified him as a physician, and 60% felt he was untrustworthy. For a smiling Black female astronaut, only 13% correctly identified her as an astronaut. For a brooding White male serial killer, 50% found him trustworthy. CONCLUSIONS An interactive unconscious bias workshop, performed without the use of an IAT, was associated with increases in perceptions and knowledge regarding implicit biases. The findings also confirmed inaccurate first impression stereotypical assumptions based on ethnicity, outward appearances, couture, and media influences.
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Affiliation(s)
- Dotun Ogunyemi
- Dotun Ogunyemi, MD, FACOG, MFM, is Chief Diversity Officer and Professor of Medical Education, Obstetrics & Gynecology, California University of Science and Medicine, and Designated Institutional Official and Associate Chief Medical Officer, Arrowhead Regional Medical Center
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20
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Hassamal S, Dong F, Hassamal S, Lee C, Ogunyemi D, Neeki MM. The Psychological Impact of COVID-19 on Hospital Staff. West J Emerg Med 2021; 22:346-352. [PMID: 33856322 PMCID: PMC7972387 DOI: 10.5811/westjem.2020.11.49015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The coronavirus 2019 (COVID-19) pandemic has created a mental health crisis among hospital staff who have been mentally and physically exhausted by uncertainty and unexpected stressors. However, the mental health challenges and complexities faced by hospital staff in the United States has not been fully elucidated. To address this gap, we conducted this study to examine the prevalence and correlates of depression and anxiety among hospital staff in light of the COVID-19 pandemic. METHODS The design is a single-center, cross-sectional, online survey evaluating depression and anxiety among all hospital employees (n = 3,500) at a safety-net hospital with a moderate cumulative COVID-19 hospitalization rate between April 30-May 22, 2020. We assessed depression with the Patient Health Questionnaire-9. Anxiety was measured with the Generalized Anxiety Disorder-7 scale. Logistic regression analyses were calculated to identify associations with depression and anxiety. RESULTS Of 3,500 hospital employees, 1,246 (36%) responded to the survey. We included 1,232 individuals in the final analysis. Overall, psychological distress was common among the respondents: 21% and 33% of staff reported significant depression and anxiety, respectively, while 46% experienced overwhelming stress due to COVID-19. Notably, staff members overwhelmed by the stress of COVID-19 were seven and nine times more likely to suffer from depression and anxiety, respectively. In addition to stress, individuals with six to nine years of work experience were two times more likely to report moderate or severe depression compared to those with 10 or more years of work experience. Moreover, ancillary staff with direct patient contact (odds ratio [OR] 8.9, confidence interval (CI), 1.46, 173.03) as well as administrative and ancillary staff with indirect patient contact (OR 5.9, CI, 1.06, 111.01) were more likely to be depressed than physicians and advanced providers. CONCLUSION We found that a considerable proportion of staff were suffering from psychological distress. COVID-19-associated depression and anxiety was widespread among hospital staff even in settings with comparatively lower COVID-19 hospitalization rates. Ancillary staff, administrative staff, staff with less job experience, and staff overwhelmed by the stress of COVID-19 are particularly susceptible to negative mental health outcomes. These findings will help inform hospital policymakers on best practices to develop interventions to reduce the mental health burden associated with COVID-19 in vulnerable hospital staff.
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Affiliation(s)
- Sameer Hassamal
- Arrowhead Regional Medical Center, Department of Psychiatry, Colton, California
| | - Fanglong Dong
- Western University of Health Sciences, Graduate College of Biomedical Sciences, Pomona, California
| | - Sunita Hassamal
- Arrowhead Regional Medical Center, Department of Internal Medicine, Colton, California
| | - Carol Lee
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
| | - Dotun Ogunyemi
- Arrowhead Regional Medical Center, Graduate Medical Education, Colton, California
| | - Michael M Neeki
- Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California
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Ogunyemi D, Haltigin C, Vallie S, Ferrari TM. Evolution of an obstetrics and gynecology interprofessional simulation-based education session for medical and nursing students. Medicine (Baltimore) 2020; 99:e22562. [PMID: 33120744 PMCID: PMC7581067 DOI: 10.1097/md.0000000000022562] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Simulation and Objective Structured Clinical Examination assessment of learners can teach clinical skills proficiency in a safe environment without risk to patients. Interprofessional simulation-based education (IPSE) contributes to a transformation in students' understanding of teamwork and professional roles. Long term outcomes for stimulation and IPSE sessions, are less well studied. We hypothesized that a progressive interprofessional education simulation program incorporating both faculty and interprofessional student collaboration would improve medical students' knowledge retention, comfort with procedural skills, positive teamwork and respectful interaction between students.An Obstetrics and Gynecology IPSE for medical and nursing students (NS) was developed in collaboration between a school of medicine and a school of nursing from 2014 to 2017. By 2017, content includedFrom 2014 to 2016, medical students completed attitude, knowledge, and perception surveys both pre and immediately post simulation, at 4 months, and 8 months. In 2017; all students completed self-assessments and received faculty-assessments.The program trained 443 medical and 136 NS. Medical students' knowledge, comfort, and interest increased significantly post simulation. Outcome scores decreased but were still significantly improved at 4 months but nearly dissipated by 8 months. There were no significant differences between medical and NS self-assessment or faculty-assessment scores regarding IUD insertion, cervical examination, or contraception quiz scores. Medical students' birth simulation self-assessment versus faculty-assessment scores were 8.6 vs 8.9, P < .001.Simulation improved students' short-term medical knowledge, comfort, and perception with some long-term persistence at 4-8 months. Medical and NS learned obstetrics and gynecology skills in a collaborative environment and in role-specific situations. Medical students had the opportunity to learn from NS. Positive teamwork and respectful interaction occurred between the students.
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Affiliation(s)
- Dotun Ogunyemi
- Arrowhead Regional Medical Center
- California University of Science and Medicine, Colton, California
| | - Christopher Haltigin
- Beaumont Health, Department of Obstetrics and Gynecology, Royal Oak
- Oakland University William Beaumont School of Medicine
| | - Stephanie Vallie
- Oakland University, School of Nursing, Rochester Hills, Michigan
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Ogunyemi D. A Professional Development Workshop to Facilitate Self-Forgiveness. J Grad Med Educ 2020; 12:335-339. [PMID: 32595855 PMCID: PMC7301949 DOI: 10.4300/jgme-d-19-00570.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/17/2019] [Accepted: 02/25/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence suggests that forgiving one's self, others, and events improves relationships and self-esteem; reduces anxiety, depression, and stress; lowers blood pressure; improves cardiovascular health; and boosts immune function. OBJECTIVE We determined the efficacy of a workshop to facilitate forgiveness in medical education professionals. METHODS A 1-hour self-forgiveness workshop conducted by 4 facilitators was presented at a medical education conference in 2018. The workshop included a didactic presentation on forgiveness and Internal Family Systems, small group discussion on self-forgiveness concepts, a 15-minute guided imagery audio meditation on self-forgiveness, and postintervention small group discussion. The 18-item Heartland Forgiveness Scale (HFS), which measures forgiveness for self, others, and situations, was completed preintervention and postintervention (score range, 18-126). RESULTS There were 91 participants, including graduate medical education managers and directors (61%), deans/clerkship directors (19%), and academic faculty/others (20%). Participants were from the South (20%), West (17%), Midwest (31%), and Northeast (32%) US regions. Baseline HFS scores showed that 53% were forgiving, 47% were neutral, and no participants had unforgiving tendencies. Total HFS score significantly increased (90.31 pre versus 95.7 post, P = .013), with significant increases in forgiveness of self (53% pre versus 73% post; P = .012; odds ratio = 2.47) and forgiveness of others (49% pre versus 69% post; P = .020; odds ratio = 2.3). Preintervention group discussion topics focused on guilt, shame, and barriers to forgiving, while postintervention discussions centered on challenges and benefits. CONCLUSIONS A brief guided meditation intervention with focused discussions was feasible and improved the immediate tendency to forgive.
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Kwon Kim S, Vishweswaraiah S, Macknis J, Lalwani A, Mishra NK, Guda C, Ogunyemi D, Radhakrishna U, Bahado-Singh R. 511: New-onset postpartum preeclampsia: Mechanisms and Prediction. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2018.11.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ogunyemi D, Jovanovski A, Liu J, Friedman P, Sugiyama N, Creps J, Madan I. The Contribution of Untreated and Treated Anxiety and Depression to Prenatal, Intrapartum, and Neonatal Outcomes. AJP Rep 2018; 8:e146-e157. [PMID: 29998037 PMCID: PMC6039295 DOI: 10.1055/s-0038-1661379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 02/23/2018] [Indexed: 12/02/2022] Open
Abstract
Objective To determine independent perinatal associations of anxiety and depression in women who were and were not treated with psychotropic drugs in comparison to unaffected pregnancies. Study Design From 2013 to 2014, 978 (6.3%) cases of anxiety/depression, of which 35% used psychotropic drugs, were compared with 14,514 (93.7%) unaffected pregnancies using logistic regression. Results Subjects were more likely to be Non-Hispanic Whites, use tobacco and illegal substances, be unmarried, use public insurance, and have medical complications of pregnancy. For independent maternal outcomes, untreated anxiety/depression was associated with labor induction (adjusted odds ratio [aOR] = 2.02), cesarean deliveries (aOR = 1.69), longer length of stay (aOR = 1.96), readmission (aOR = 2.40), fever (aOR = 2.03), magnesium exposure (aOR = 1.82), and postpartum hemorrhage (aOR = 2.57), whereas treated cases were associated with increased blood transfusion (aOR = 4.81), severe perineal lacerations (aOR = 2.93), and postpartum hemorrhage (aOR = 3.85), but decreased risk of cesarean deliveries (aOR = 0.59). Independent neonatal outcomes included small for gestational age (aOR = 3.04), meconium-stained fluid (aOR = 1.85; 2.61), respiratory failure (aOR = 5.84), neonatal adaptation syndrome (aOR = 11; 10.2), and neonatal seizures (aOR = 12.3) in treated cases, whereas untreated cases were associated with hypoxia (aOR = 2.83), low Apgar score (aOR = 3.82), and encephalopathy (aOR = 18.3). Exposure to multiple psychotropic medications independently increased the risk of neonatal adaptation syndrome, neonatal length of stay, and hypoglycemia. Conclusion Untreated cases were associated with increased maternal adverse outcomes, whereas treated cases were associated with more adverse neonatal outcomes when compared with unaffected pregnancies.
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Affiliation(s)
- Dotun Ogunyemi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Andrew Jovanovski
- Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - James Liu
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Perry Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Nathaniel Sugiyama
- University of Vermont Robert Larner College of Medicine, Burlington, Vermont
| | - James Creps
- Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
| | - Ichchha Madan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beaumont Hospital, Royal Oak, Michigan.,Department of Obstetrics and Gynecology, Oakland University, William Beaumont School of Medicine, Rochester Hills, Michigan
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Ogunyemi D, Jovanovski A, Friedman P, Sweatman B, Madan I. Temporal and quantitative associations of electronic fetal heart rate monitoring patterns and neonatal outcomes †. J Matern Fetal Neonatal Med 2018; 32:3115-3124. [PMID: 29621921 DOI: 10.1080/14767058.2018.1456523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/17/2022]
Abstract
Objective: The objective of this study is to evaluate the associations of electronic fetal heart rate monitoring (EFM) patterns and adverse neonatal outcomes Study design: From 2013 to 2016; 12,067 term, singleton deliveries in labor ≥2 h with abnormal EFM defined as absent accelerations, variable, late or prolonged decelerations, tachycardia, bradycardia, or minimal variability were analyzed as any documentation during labor, in first hour and last hour of labor. Outcomes were composite neonatal adverse outcomes, neonatal intensive care unit (NICU) admission, neonatal hypoxia, neonatal hypoglycemia, umbilical artery pH, and base excess. Independent associations were ascertained using regression analysis. Results: Significant independent associations occurred between any abnormal EFM during the last hour and five adverse neonatal outcomes; between abnormal EFM at any time and one adverse neonatal outcome while there was none with the first hour of labor. In the last hour, accelerations had significant negative associations with three adverse neonatal outcomes, while prolonged decelerations, late decelerations, tachycardia, and bradycardia had significant positive associations with three adverse neonatal outcomes. Throughout labor, increasing accelerations events were significantly negatively correlated with all adverse neonatal outcomes, while increasing frequency of late, variable, and prolonged decelerations were positively associated with five adverse neonatal outcomes. Hierarchical analysis showed that bradycardia/tachycardia contributed only 0.8%, while all EFM periodic changes contributed 1%; the addition of the frequencies of abnormal EFM events contributed 0.6% to the variance in umbilical artery pH and base excess. Conclusions: Terminal EFM patterns are independently associated with neonatal outcomes. Accelerations are protective of adverse neonatal outcomes. Increasing frequency of EFM patterns overtime contributes to neonatal outcome.
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Affiliation(s)
- Dotun Ogunyemi
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA.,b William Beaumont School of Medicine , Oakland University , Rochester Hills , MI , USA
| | - Andrew Jovanovski
- b William Beaumont School of Medicine , Oakland University , Rochester Hills , MI , USA
| | - Perry Friedman
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA.,b William Beaumont School of Medicine , Oakland University , Rochester Hills , MI , USA
| | - Brittany Sweatman
- b William Beaumont School of Medicine , Oakland University , Rochester Hills , MI , USA
| | - Ichchha Madan
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA.,b William Beaumont School of Medicine , Oakland University , Rochester Hills , MI , USA
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Kim SK, Papalekas E, Friedman P, Hage N, Zhao J, Ogunyemi D. 908: A system-based multidisciplinary severe maternal morbidity (SMM) committee review from a single facility. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kim SK, Friedman P, Madan I, Jovanovski A, Dzubnar J, Gamsky S, Lee Y, Ogunyemi D. 929: Risk factors for postpartum hospital readmission. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.11.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Friedman P, Kim SK, Madan I, Awrow M, Ogunyemi D. 297: Chronic hypertension: Is there an optimal delivery time? Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.10.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ogunyemi D, McGlynn S, Ronk A, Knudsen P, Andrews-Johnson T, Raczkiewicz A, Jovanovski A, Kaur S, Dykowski M, Redman M, Bahado-Singh R. Using a multifaceted quality improvement initiative to reverse the rising trend of cesarean births. J Matern Fetal Neonatal Med 2017; 31:567-579. [DOI: 10.1080/14767058.2017.1292244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dotun Ogunyemi
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Sara McGlynn
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Anne Ronk
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Patricia Knudsen
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Tonyie Andrews-Johnson
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Angeline Raczkiewicz
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Andrew Jovanovski
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Sangeeta Kaur
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Mark Dykowski
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Mark Redman
- Division of Maternal-Fetal Medicine, Beaumont Hospital, Royal Oak, MI, USA
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
| | - Ray Bahado-Singh
- William Beaumont Hospital – Royal Oak, Royal Oak, MI, USA
- Department of Obstetrics and Gynecology, Beaumont Health System, Royal Oak, MI, USA
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Ogunyemi D, Friedman P, Betcher K, Whitten A, Sugiyama N, Qu L, Kohn A, Paul H. Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants. J Matern Fetal Neonatal Med 2016; 30:1372-1377. [PMID: 27427266 DOI: 10.1080/14767058.2016.1214127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/21/2022]
Abstract
OBJECTIVE To determine independent perinatal and intrapartum factors associated with neonatal hypoglycemia. METHOD Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls with regression analysis. RESULTS Regression analysis showed that independent prenatal factors were multiparity (odds-ratio [OR] = 1.61), gestational age (OR = 0.68), gestational diabetes (OR = 0.22), macrosomia (OR = 4.87), small for gestational age neonate [SGA] (OR = 6.83) and admission cervical dilation (OR = 0.79). For intrapartum factors, only cesarean section (OR = 1.57) and last cervical dilation (OR = 0.92) were independently significantly associated with neonatal hypoglycemia. For biologically plausible risk factors, independent factors were cesarean section (OR = 4.18), gentamycin/clindamycin in labor (OR = 5.35), gestational age (OR = 0.59) and macrosomia (OR = 5.62). Mothers of babies with neonatal hypoglycemia had more blood loss and longer hospital stays, while neonates with hypoglycemia had worse umbilical cord gases, more neonatal hypoxic conditions, neonatal morbidities and NICU admissions. CONCLUSION Diabetes was protective of neonatal hypoglycemia, which may be explained by optimum maternal glucose management; nevertheless macrosomia was independently predictive of neonatal hypoglycemia. Cesarean section and decreasing gestational age were the most consistent independent risk factors followed by treatment for chorioamnionitis and SGA. Further studies to evaluate these observations and develop preventive strategies are warranted.
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Affiliation(s)
- D Ogunyemi
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - P Friedman
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - K Betcher
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - A Whitten
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - N Sugiyama
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - L Qu
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - Amitai Kohn
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
| | - Holtrop Paul
- a Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology , Beaumont Hospital , Royal Oak , MI , USA and.,b William Beaumont School of Medicine, Oakland University , Rochester Hills , MI , USA
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Bahado-Singh RO, Syngelaki A, Mandal R, Graham SF, Akolekar R, Han B, Bjondahl TC, Dong E, Bauer S, Alpay-Savasan Z, Turkoglu O, Ogunyemi D, Poon LC, Wishart DS, Nicolaides KH. Metabolomic determination of pathogenesis of late-onset preeclampsia. J Matern Fetal Neonatal Med 2016; 30:658-664. [PMID: 27569705 DOI: 10.1080/14767058.2016.1185411] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 10/21/2022]
Abstract
OBJECTIVE Our primary objective was to apply metabolomic pathway analysis of first trimester maternal serum to provide an insight into the pathogenesis of late-onset preeclampsia (late-PE) and thereby identify plausible therapeutic targets for PE. METHODS NMR-based metabolomics analysis was performed on 29 cases of late-PE and 55 unaffected controls. In order to achieve sufficient statistical power to perform the pathway analysis, these cases were combined with a group of previously analyzed specimens, 30 late-PE cases and 60 unaffected controls. Specimens from both groups of cases and controls were collected in the same clinical centers during the same time period. In addition, NMR analyses were performed in the same lab and using the same techniques. RESULTS We identified abnormalities in branch chain amino acids (valine, leucine and isoleucine) and propanoate, glycolysis, gluconeogenesis and ketone body metabolic pathways. The results suggest insulin resistance and metabolic syndrome, mitochondrial dysfunction and disturbance of energy metabolism, oxidative stress and lipid dysfunction in the pathogenesis of late PE and suggest a potential role for agents that reduce insulin resistance in PE. CONCLUSIONS Branched chain amino acids are known markers of insulin resistance and strongly predict future diabetes development. The analysis provides independent evidence linking insulin resistance and late-PE and suggests a potentially important therapeutic role for pharmacologic agents that reduce insulin resistance for late-PE.
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Affiliation(s)
- Ray O Bahado-Singh
- a Department of Obstetrics and Gynecology , Beaumont Health , Royal Oak , MI , USA
| | - Argyro Syngelaki
- b Harris Birthright Research Centre for Fetal Medicine , Division of Women's Health, King's College Hospital , London , UK
| | - Rupsari Mandal
- c Department of Biological Sciences , University of Alberta , Edmonton, Alberta , Canada , and
| | - Stewart F Graham
- a Department of Obstetrics and Gynecology , Beaumont Health , Royal Oak , MI , USA
| | - Ranjit Akolekar
- b Harris Birthright Research Centre for Fetal Medicine , Division of Women's Health, King's College Hospital , London , UK
| | - Beomsoo Han
- c Department of Biological Sciences , University of Alberta , Edmonton, Alberta , Canada , and
| | - Trent C Bjondahl
- c Department of Biological Sciences , University of Alberta , Edmonton, Alberta , Canada , and
| | - Edison Dong
- c Department of Biological Sciences , University of Alberta , Edmonton, Alberta , Canada , and
| | - Samuel Bauer
- a Department of Obstetrics and Gynecology , Beaumont Health , Royal Oak , MI , USA
| | - Zeynep Alpay-Savasan
- a Department of Obstetrics and Gynecology , Beaumont Health , Royal Oak , MI , USA
| | - Onur Turkoglu
- a Department of Obstetrics and Gynecology , Beaumont Health , Royal Oak , MI , USA
| | - Dotun Ogunyemi
- a Department of Obstetrics and Gynecology , Beaumont Health , Royal Oak , MI , USA
| | - Liona C Poon
- b Harris Birthright Research Centre for Fetal Medicine , Division of Women's Health, King's College Hospital , London , UK
| | - David S Wishart
- c Department of Biological Sciences , University of Alberta , Edmonton, Alberta , Canada , and.,d Department of Computing Sciences , University of Alberta , Edmonton, Alberta , Canada
| | - Kypros H Nicolaides
- b Harris Birthright Research Centre for Fetal Medicine , Division of Women's Health, King's College Hospital , London , UK
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Abstract
BACKGROUND A robust selection process is critical to residents' "cultural fit" and success in their program. Traditional selection methods have shortcomings. OBJECTIVE We describe a novel residency interview process for obstetrics-gynecology residents that incorporates behavioral, group, and surgical simulation multiple mini interviews (MMIs). METHODS In 2010, the Cedars-Sinai Medical Center obstetrics-gynecology residency program developed surgical simulation, role play, ethics group interview, and Accreditation Council for Graduate Medical Education competency-based behavioral interview stations. RESULTS From 2010 to 2012, a total of 199 applicants were interviewed, 62 ranked in the top 20, and 18 matched into the program. The MMI scores for interview stations were used in compiling our rank list and were found to adequately differentiate candidates. The MMI mean scores for role play, ethics interview, surgical simulation, and the behavioral interview for the top 20 ranked candidates were statistically significantly higher than those for other applicants. Standardized tests minimally correlated with various interview modalities. Applicants found the interview process acceptable. Implementing these MMI stations increased the total applicant interview time for the day by 15% (from 5.5 to 6.5 hours) and increased the face-to-face interview time from 2 to 4 hours. Approximately 42 hours of coordinator time was required for the yearly interview cycle. CONCLUSIONS A multifaceted interview process utilizing MMI, group interview, and surgical simulation MMI is feasible and acceptable. The approach may decrease subjectivity and reliance on traditional interview methods and facilitate the selection of "compatible" residents into the program.
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Affiliation(s)
| | | | | | - David Seil Kim
- Corresponding author: David Seil Kim, MD, PhD, MBA, Cedars-Sinai Medical Center, 160 West Tower, 8635 West 3rd Street, Los Angeles, CA 90048, 310.423.2914, fax 310.423.0140,
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Citil Dogan A, Wayne S, Bauer S, Ogunyemi D, Kulkharni SK, Maulik D, Carpenter CF, Bahado-Singh RO. The Zika virus and pregnancy: evidence, management, and prevention. J Matern Fetal Neonatal Med 2016; 30:386-396. [PMID: 27052666 DOI: 10.3109/14767058.2016.1174210] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [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]
Abstract
OBJECTIVE To comprehensively review the available evidence and existing consensus reports and guidelines regarding the pregnancy and reproductive implications of the mosquito-transmitted Zika virus (ZIKV) infection. A primary focus was to provide pertinent information to aid clinicians in the management of pregnancies at risk for, exposed to, or with confirmed ZIKV infection. METHOD An extensive literature review was performed using Pubmed. Practice guidelines and consensus reports were accessed from international, national, and professional organizations' websites. The clinical articles for ZIKV infection testing varied from case reports to small epidemiologic studies. RESULTS A ZIKV epidemic has been declared in several countries in the Americas. Fifty-two travel-associated ZIKV infection cases have been reported throughout the USA (as of February 10, 2016). The consequences of congenital fetal/newborn ZIKV infection could potentially have devastating consequences including miscarriage, fetal death, and major anomalies such as microcephaly, brain and brain-stem defects, and long-term neurologic sequelae. While not definitive, current evidence suggests the existence of nonvector-borne transmission through sexual activity with an infected male partner. For women at risk for sexual transmission, condom use is advised, especially during pregnancy. CONCLUSION While ZIKV infection appears to be a mild disease in the general population the potential consequences to the fetus and newborn could be profound. Management guidelines are currently evolving and will be significantly impacted as new evidence develops. It is therefore imperative that obstetric health-care providers keep abreast of this rapidly evolving information landscape that has so far characterized this outbreak.
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Affiliation(s)
- Ayse Citil Dogan
- a Department of Obstetrics and Gynecology , William Beaumont Hospital , Royal Oak , MI , USA
| | - Sandra Wayne
- b Grosse Pointe Shores, William Beaumont Hospital , Royal Oak , MI , USA
| | - Samuel Bauer
- c Department of Obstetrics and Gynecology , School of Medicine, William Beaumont Hospital, Oakland University , Royal Oak , MI , USA
| | - Dotun Ogunyemi
- c Department of Obstetrics and Gynecology , School of Medicine, William Beaumont Hospital, Oakland University , Royal Oak , MI , USA
| | - Santosh K Kulkharni
- d Department of Obstetrics and Gynecology , Faculty of Medicine, University of the West Indies , Kingston , Jamaica
| | - Devika Maulik
- e Department of Obstetrics and Gynecology , UMKC School of Medicine , Kansas City , MO , USA , and
| | - Christopher F Carpenter
- f Department of Internal Medicine , School of Medicine, William Beaumont Hospital, Oakland University , Royal Oak , MI , USA
| | - Ray O Bahado-Singh
- c Department of Obstetrics and Gynecology , School of Medicine, William Beaumont Hospital, Oakland University , Royal Oak , MI , USA
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Bahado-Singh RO, Citil-Dogan A, Wayne S, Bauer S, Ogunyemi D, Kulkarni SK, Maulik D, Carpenter CF. Zika virus and pregnancy. J Matern Fetal Neonatal Med 2016; 30:1539. [PMID: 27285308 DOI: 10.1080/14767058.2016.1199295] [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] [Indexed: 10/21/2022]
Affiliation(s)
- R O Bahado-Singh
- a Oakland University - William Beaumont School of Medicine , Rochester, MN , USA
| | - A Citil-Dogan
- a Oakland University - William Beaumont School of Medicine , Rochester, MN , USA
| | - S Wayne
- a Oakland University - William Beaumont School of Medicine , Rochester, MN , USA
| | - S Bauer
- a Oakland University - William Beaumont School of Medicine , Rochester, MN , USA
| | - D Ogunyemi
- a Oakland University - William Beaumont School of Medicine , Rochester, MN , USA
| | - S K Kulkarni
- b University of the West Indies , Mona , Jamaica , and
| | - D Maulik
- c Children's Mercy Hospital and Cllinics , Kansas City, MO , USA
| | - C F Carpenter
- a Oakland University - William Beaumont School of Medicine , Rochester, MN , USA
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Ogunyemi D, Aurioles A, Olson R, Sugiyama N, Bahado-Singh R. 638: Current status of the OBGYN hospitalist workforce in the United States. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mahesan AM, Ogunyemi D, Kim E, Paul ABM, Chen YDI. Insulin Resistance in Pregnancy Is Correlated with Decreased Insulin Receptor Gene Expression in Omental Adipose: Insulin Sensitivity and Adipose Tissue Gene Expression in Normal Pregnancy. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/jdm.2016.61011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pokropek C, Sobolewski P, Getachew R, Paul A, Boura J, Ogunyemi D. 621: Dietary intake patterns and insulin resistance in women with a history of gestational diabetes in the National Health and Nutrition Examination Survey (NHANES) 2000-2010. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rad S, Mugyenyi G, Ganyaglo G, Sobolewski P, Sugiyama N, Josaphat B, Ogunyemi D. 112: An international collaboration for the prevention of severe maternal morbidity and mortality. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Simon V, Quant C, Fong A, Pan D, Ogunyemi D. 880: Total parenteral nutrition in pregnancy – a strong association with venous thromboembolism and other obstetrical morbidities. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Eleje GU, Ezugwu EC, Ogunyemi D, Eleje LI, Ikechebelu JI, Igwegbe AO, Okonkwo JE, Ikpeze OC, Udigwe GO, Onah HE, Nwosu BO, Ezeama CO, Ezenkwele EP. Accuracy and cost-analysis of placental alpha-microglobulin-1 test in the diagnosis of premature rupture of fetal membranes in resource-limited community settings. J Obstet Gynaecol Res 2014; 41:29-38. [DOI: 10.1111/jog.12475] [Citation(s) in RCA: 15] [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: 02/19/2014] [Accepted: 04/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
- George Uchenna Eleje
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria
| | - Euzebus Chinonye Ezugwu
- Department of Obstetrics and Gynaecology; University of Nigeria Teaching Hospital; Enugu Nigeria
| | - Dotun Ogunyemi
- Department of Obstetrics and Gynecology; David Geffen School of Medicine at UCLA; Los Angeles California USA
| | - Lydia Ijeoma Eleje
- Measurement and Evaluation Unit; Department of Education Foundation; Nnamdi Azikiwe University; Awka Nigeria
| | | | - Anthony Osita Igwegbe
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria
| | - John E. Okonkwo
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria
| | | | - Gerald Okanandu Udigwe
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria
| | - Hyacinth Eze Onah
- Department of Obstetrics and Gynaecology; University of Nigeria Teaching Hospital; Enugu Nigeria
| | - Betrand Obi Nwosu
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University Teaching Hospital; Nnewi Nigeria
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Ogunyemi D, Mehta S, Turner A, Kim D, Alexander C. Emotional intelligence characteristics in a cohort of faculty, residents, and medical students. J Reprod Med 2014; 59:279-284. [PMID: 24937970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess emotional intelligence (EQ) and the construct validity of the EQ Appraisal survey among academic faculty, residents, and medical students. STUDY DESIGN From 2007 to 2011, 155 medical education personnel participated in 4 self-administered surveys. The EQ Appraisal survey measures Self-Awareness, Self-Management, Social Awareness, and Relationship Management. The DISC survey defines 4 personality domains: Dominance, Influence, Steadiness/ Submissiveness, and Conscientious/Compliance. The Thomas-Kilmann Conflict Instrument defines 5 conflict styles: Competing, Collaborating, Compromising, Accommodating, and Avoiding. The Interpersonal Influence Inventory categorizes 4 behavior styles: Openly Aggressive, Assertive, Concealed Aggressive, and Passive behaviors. Statistical analysis was done as indicated. The p value of < 0.05 was taken as significant. RESULTS The overall mean EQ score was 75.9 (SD 8.2), and components scores were: Self-Awareness = 74.6 (SD 10), Self-Management = 74.8 (SD 10.6), Social Awareness = 77.0 (SD 9.6), and Relationship Management = 76.8 (SD 9.9). Faculty and residents had higher Social Awareness scores as compared to medical students (79.33 [SD 8] vs. 75.59 [SD 10.3], p = 0.01). Mean EQ scores correlated positively with Collaborating conflict style, Assertive Behavior, Influence, and Steadiness/Submissiveness but correlated negatively with Dominance personality domain, Passive, and Concealed Aggressive behaviors. CONCLUSION EQ varied with level of training. EQ competence may occur by Collaborating and Assertive Behaviors utilizing Influence and Steadiness/Submissiveness personality domains.
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Pereira L, Petitt M, Fong A, Tsuge M, Tabata T, Fang-Hoover J, Maidji E, Zydek M, Zhou Y, Inoue N, Loghavi S, Pepkowitz S, Kauvar LM, Ogunyemi D. Intrauterine growth restriction caused by underlying congenital cytomegalovirus infection. J Infect Dis 2014; 209:1573-84. [PMID: 24403553 DOI: 10.1093/infdis/jiu019] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [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: 02/02/2023] Open
Abstract
BACKGROUND Human cytomegalovirus (HCMV) is the major viral etiology of congenital infection and birth defects. Fetal transmission is high (30%-40%) in primary maternal infection, and symptomatic babies have permanent neurological, hearing, and vision defects. Recurrent infection is infrequently transmitted (2%) and largely asymptomatic. Congenital infection is also associated with intrauterine growth restriction (IUGR). METHODS To investigate possible underlying HCMV infection in cases of idiopathic IUGR, we studied maternal and cord sera and placentas from 19 pregnancies. Anti-HCMV antibodies, hypoxia-related factors, and cmvIL-10 were measured in sera. Placental biopsy specimens were examined for viral DNA, expression of infected cell proteins, and pathology. RESULTS Among 7 IUGR cases, we identified 2 primary and 3 recurrent HCMV infections. Virus replicated in glandular epithelium and lymphatic endothelium in the decidua, cytotrophoblasts, and smooth muscle cells in blood vessels of floating villi and the chorion. Large fibrinoids with avascular villi, edema, and inflammation were significantly increased. Detection of viral proteins in the amniotic epithelium indicated transmission in 2 cases of IUGR with primary infection and 3 asymptomatic recurrent infections. CONCLUSIONS Congenital HCMV infection impairs placental development and functions and should be considered as an underlying cause of IUGR, regardless of virus transmission to the fetus.
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Affiliation(s)
- Lenore Pereira
- Department of Cell and Tissue Biology, School of Dentistry, University of California San Francisco, San Francisco, California
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Fong A, Lovell S, Gabby L, Pan D, Ogunyemi D, Hameed A. 254: Peripartum cardiomyopathy: demographics, antenatal factors, and a strong association with hypertensive disorders. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fong A, Serra A, Pan D, Ogunyemi D, Lagrew D. 590: Very advanced maternal age (45+ years) and associated obstetrical morbidities. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fong A, Serra A, Herrero T, Pan D, Ogunyemi D. Pre-gestational versus gestational diabetes: a population based study on clinical and demographic differences. J Diabetes Complications 2014; 28:29-34. [PMID: 24094665 PMCID: PMC3887473 DOI: 10.1016/j.jdiacomp.2013.08.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 12/30/2022]
Abstract
AIMS To assess the clinical and demographic differences in patients with pre-gestational diabetes mellitus (PGDM) compared to those with gestational diabetes (GDM). METHODS Using the 2001-2007 California Health Discharge Database, we identified 22,331 cases of PGDM and 147,097 cases of GDM via ICD-9-CM codes after excluding cases which were missing race or age data or with extremes of age. Data analyzed included demographics, pre-existing medical conditions, antepartum complications, and intrapartum complications. Logistic regression was used to adjust for potential confounders. RESULTS Both PGDM and GDM incidences increased during the study period. Advancing age was associated with increased prevalence of both diseases. Although Asians were found to have the highest prevalence of GDM, they, along with Caucasians, were found have the lowest prevalence of PGDM. Conditions with increased frequency in PGDM versus GDM included chronic hypertension, renal disease, thyroid dysfunction, fetal CNS malformation, fetal demise, pyelonephritis, and eclampsia. Subjects with PGDM were more likely than those with GDM to have a shoulder dystocia, failed induction of labor, or undergo cesarean delivery. CONCLUSIONS We have demonstrated clinical morbidities and demographic factors which differ in patients with PGDM compared to patients with GDM. Our findings suggest PGDM to be associated with significantly higher morbidity when compared to GDM. Our findings also suggest that races with the highest tendency for GDM during pregnancy may not necessarily have the highest tendency for PGDM outside of pregnancy.
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Affiliation(s)
- Alex Fong
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA.
| | - Allison Serra
- Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA
| | - Tiffany Herrero
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Deyu Pan
- Charles Drew University of Medicine and Science, Research Life Sciences Institute, Los Angeles, CA
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Turner A, Rad S, Herrero T, Sugiyama N, Pan D, Mahesan A, Ogunyemi D. 513: Demographic factors, heavy metals and industrial chemicals exposure in currently breast feeding women. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fong A, Lovell S, Rad S, Turner A, Pan D, Ogunyemi D. 433: Obstetrical complications of deliveries conceived by assisted reproductive technology in California. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kim DS, Madden A, Alexander C, Zois M, Ogunyemi D, Azziz R. Implementing a teaching service for voluntary faculty in obstetrics and gynecology: long-term results. J Reprod Med 2013; 58:371-376. [PMID: 24050024] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To ensure the highest quality of resident training, by engaging community private physicians (PMDs) as voluntary faculty, through implementing teaching services in both obstetrics (OB) and gynecology (Gyn) in July 2003. We now report on the long-term success and challenges of the strategy. STUDY DESIGN The case volume performed by residents was analyzed using the Accreditation Council for Graduate Medical Education self-reported resident statistics log, while resident educational satisfaction was analyzed using an anonymous survey. RESULTS Approximately 90% and 60% of eligible PMDs participated in the Gyn and OB teaching services, respectively. Following implementation of teaching services, resident vaginal delivery volume increased from 859 cases in 2003 to 1,750 in 2004 (104% increase). Gynecologic surgery volume increased from 2,397 cases in 2003 to 3,436 in 2004 (43% increase). Survey of the residents in 2009, 5 years after implementation, indicated that 61% felt the teaching services improved their training experience, 47% that it improved resident-nurse interaction, and 72% that it improved resident-medical staff interaction. However, 28% also felt that the presence of the teaching services frequently caused confusion regarding residents' roles and responsibilities. CONCLUSION The implementation of voluntary faculty teaching services in a residency training program enhanced the volume of cases available for training, with residents perceiving an improvement in their training and their interactions with attending staff. However, of concern was continued confusion regarding residents' patient care responsibilities.
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Affiliation(s)
- David Seil Kim
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West Third Street, Suite 160, West Tower, Los Angeles, CA 90048, USA.
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Simone B, De Stefano V, Leoncini E, Zacho J, Martinelli I, Emmerich J, Rossi E, Folsom AR, Almawi WY, Scarabin PY, den Heijer M, Cushman M, Penco S, Vaya A, Angchaisuksiri P, Okumus G, Gemmati D, Cima S, Akar N, Oguzulgen KI, Ducros V, Lichy C, Fernandez-Miranda C, Szczeklik A, Nieto JA, Torres JD, Le Cam-Duchez V, Ivanov P, Cantu-Brito C, Shmeleva VM, Stegnar M, Ogunyemi D, Eid SS, Nicolotti N, De Feo E, Ricciardi W, Boccia S. Risk of venous thromboembolism associated with single and combined effects of Factor V Leiden, Prothrombin 20210A and Methylenetethraydrofolate reductase C677T: a meta-analysis involving over 11,000 cases and 21,000 controls. Eur J Epidemiol 2013; 28:621-47. [PMID: 23900608 DOI: 10.1007/s10654-013-9825-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 07/02/2013] [Indexed: 12/16/2022]
Abstract
Genetic and environmental factors interact in determining the risk of venous thromboembolism (VTE). The risk associated with the polymorphic variants G1691A of factor V (Factor V Leiden, FVL), G20210A of prothrombin (PT20210A) and C677T of methylentetrahydrofolate reductase (C677T MTHFR) genes has been investigated in many studies. We performed a pooled analysis of case-control and cohort studies investigating in adults the association between each variant and VTE, published on Pubmed, Embase or Google through January 2010. Authors of eligible papers, were invited to provide all available individual data for the pooling. The Odds Ratio (OR) for first VTE associated with each variant, individually and combined with the others, were calculated with a random effect model, in heterozygotes and homozygotes (dominant model for FVL and PT20210A; recessive for C677T MTHFR). We analysed 31 databases, including 11,239 cases and 21,521 controls. No significant association with VTE was found for homozygous C677T MTHFR (OR: 1.38; 95 % confidence intervals [CI]: 0.98-1.93), whereas the risk was increased in carriers of either heterozygous FVL or PT20210 (OR = 4.22; 95 % CI: 3.35-5.32; and OR = 2.79;95 % CI: 2.25-3.46, respectively), in double heterozygotes (OR = 3.42; 95 %CI 1.64-7.13), and in homozygous FVL or PT20210A (OR = 11.45; 95 %CI: 6.79-19.29; and OR: 6.74 (CI 95 % 2.19-20.72), respectively). The stratified analyses showed a stronger effect of FVL on individuals ≤ 45 years (p value for interaction = 0.036) and of PT20210A in women using oral contraceptives (p-value for interaction = 0.045). In this large pooled analysis, inclusive of large studies like MEGA, no effect was found for C677T MTHFR on VTE; FVL and PT20210A were confirmed to be moderate risk factors. Notably, double carriers of the two genetic variants produced an impact on VTE risk significantly increased but weaker than previously thought.
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Affiliation(s)
- Benedetto Simone
- Institute of Public Health - Section of Hygiene, Department of Public Health, Università Cattolica del Sacro Cuore, L.go F.Vito 1, 00168, Rome, Italy
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