Publications by authors named "Oluwatosin Goje"

13 Publications

  • Page 1 of 1

Impact of the COVID-19 Pandemic and Obstetrician and Gynecologist Workforce Distribution on Vaccine Deployment and Predicting Women's Healthcare Shortages.

Cureus 2021 Apr 18;13(4):e14545. Epub 2021 Apr 18.

Obstetrics and Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, USA.

Background Obstetricians and gynecologists, who serve a vital role in providing women's healthcare in the United States, are at risk of COVID-19 exposure via asymptomatic patients and deliveries. This study analyzes state-level geographical distribution of COVID-19 cases and age distribution of Obstetricians and gynecologists (OB/GYNs) to project which US regions will experience a more significant COVID-19 patient burden and provides a guide for vaccine distribution in the OB/GYN workforce. Methods The Association of American Medical Colleges' state-level workforce data is combined with COVID-19 case data reported by Johns Hopkins University. All data and code are available at https://github.com/cxr244/covid-obgyn. Results Our findings illustrate that OB/GYNs in the Midwestern region of the US experience the highest number of COVID-19 patients per OB/GYN over 60 years of age: North Dakota, South Dakota, Iowa, Wisconsin, and Idaho have the highest burden of COVID-19 patients per OB/GYN, warranting vaccine distribution priority. Additionally, states with the highest proportion of OB/GYNs over the age of 60 like Florida (38%), New Mexico (37%), Alabama (36%), California (36%), and New Jersey (34%), should be strongly considered for priority vaccine allocation, to mitigate predicted OB/GYN workforce shortages.  Conclusion When planning and executing vaccine allocation, especially in the early stages of distribution, it is critical to evaluate which communities can benefit the greatest from the limited number of vaccines. A strategy of distribution of COVID-19 vaccines to older physicians with a more significant COVID-19 burden can minimize shortages of providers within these states and ensure adequate access to women's healthcare within the communities they serve.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.14545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130649PMC
April 2021

Preincision adjunctive prophylaxis for cesarean deliveries a systematic review and meta-analysis.

Am J Obstet Gynecol 2021 May 5. Epub 2021 May 5.

Department of Reproductive Infectious Diseases & Vulvovaginal Disorders, ObGyn & Women's Health Institute, Cleveland Clinic, Cleveland, OH. Electronic address:

Objective: This study aimed to systematically review the relative effectiveness of preincision cefazolin with or without adjunctive prophylaxis (macrolides or metronidazole) vs cefazolin alone in decreasing the incidence of postcesarean delivery surgical site infections.

Data Sources: We performed a systematic search on PubMed, Ovid EMBASE, Google Scholar, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials from October 25, 2020, to November 25, 2020, to identify studies comparing cefazolin with adjunctive macrolides or metronidazole with cefazolin alone. The reference lists were reviewed, and a manual search of articles published after the last database search was performed.

Study Eligibility Criteria: Overall, 3 randomized controlled trials and 1 prospective observational study of reproductive-age women undergoing cesarean deliveries were included in the study. We excluded studies of women who were immunocompromised (eg, patients who were HIV positive) or women with a diagnosis of chorioamnionitis before cesarean delivery. All patients received first-line cefazolin (either cefazolin 1 g or 2 g). We compared preincision cefazolin alone with preincision cefazolin plus adjunctive therapy (500 mg, oral or intravenous formulations of azithromycin, metronidazole, or clarithromycin).

Methods: A total of 6 review authors independently assessed the risk of bias for each study, using the Cochrane Risk of Bias criteria. Synthesis and further appraisal were done using the Grading of Recommendations, Assessment, Development, and Evaluation levels and the American College of Obstetricians and Gynecologists appraisal guidelines. Disagreements were resolved by discussion. Treatment effects were evaluated using meta-analysis, and pooled relative risks and 95% confidence intervals were generated using random-effects models using the Review Manager 5 software (version 5.4.1).

Results: Overall, 3 randomized controlled trials and 1 prospective observational study representing 2613 women met the criteria for inclusion. Significant reductions in surgical site infections (relative risk, 0.46; 95% confidence interval, 0.34-0.63; 3 randomized controlled trials) and the duration of hospital stay (weighted mean difference, -1.46; 95% confidence interval, -2.21 to -0.71; 2 randomized controlled trials) were observed with preincision cefazolin and adjunctive prophylaxis compared with cefazolin alone. No significant difference was observed in maternal febrile morbidity (relative risk, 0.38; 95% confidence interval, 0.11-1.25; 2 randomized controlled trials).

Conclusion: Our findings have provided evidence for the use of preincision adjunctive extended-spectrum prophylaxis with cefazolin over cefazolin alone. However, future investigations are required to establish the relative efficacies of different adjunctive antibiotic options.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2021.04.259DOI Listing
May 2021

Optimizing mother-baby wellness during the 2019 coronavirus disease pandemic: A case for telemedicine.

Womens Health (Lond) 2021 Jan-Dec;17:17455065211013262

Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.

Background: The 2019 coronavirus disease pandemic poses unique challenges to healthcare delivery. To limit the exposure of providers and patients to severe acute respiratory syndrome coronavirus 2, the Centers for Disease Control and Prevention encourages providers to use telehealth platforms whenever possible. Given the maternal mortality crisis in the United States and the compounding 2019 coronavirus disease public health emergency, continued access to quality preconception, prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.

Objective: This commentary explores unique opportunities to optimize virtual obstetric care for low-risk and high-risk mothers at each stage of pregnancy.

Methods: In this review paper, we present evidence-based literature and tools from first-hand experience implementing telemedicine in obstetric care clinics during the pandemic.

Results: Using the best evidence-based practices with telemedicine, health care providers can deliver care in the safest, most respectful, and appropriate way possible while providing the critical support necessary in pregnancy. In reviewing the literature, several studies endorse the implementation of specific tools outlined in this article, to facilitate the implementation of telemedicine. From a quality improvement standpoint, evidence-based telemedicine provides a solution for overburdened healthcare systems, greater confidentiality for obstetric services, and a personalized avenue for health care providers to meet maternal health needs in the pandemic.

Conclusion: During the COVID-19 pandemic, continued access to quality prenatal, intrapartum, and postpartum care are essential to the health and well-being of mother and baby.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/17455065211013262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111547PMC
May 2021

Outcomes of Minimally Invasive Management of Tubo-ovarian Abscess: A Systematic Review.

J Minim Invasive Gynecol 2021 03 28;28(3):556-564. Epub 2020 Sep 28.

Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina (Dr. Soper).

Objective: To compare the success rate, complications, and hospital length-of-stay of 3 modalities of minimally invasive management of tubo-ovarian abscesses (TOAs): laparoscopy, ultrasound-guided drainage, and computed tomography-guided drainage.

Data Sources: Electronic-based search in PubMed, EMBASE, Ovid MEDLINE, Google Scholar, and Cochrane Central Register of Controlled Trials, using the following Medical Subject Heading terms: "minimally invasive surgical procedures," "drainage," "abscess," "tubo-ovarian," "ovarian diseases," and "fallopian tube diseases."

Methods Of Study Selection: Of the 831 articles in the initial results, 10 studies were eligible for inclusion in our systematic review.

Tabulation, Integration, And Results: A total of 975 patients were included in our study; 107 (11%) had laparoscopic drainage procedures, and 406 (42%) had image-guided (ultrasound or computed tomography) drainage of TOAs. Image-guided TOA drainage had higher success rates (90%-100%) than laparoscopic drainage (89%-96%) and the use of antibiotic treatment alone (65%-83%). Patients treated with image-guided drainage had no complications (for up to 6 months of follow-up) and shorter lengths of hospital stay (0-3 days on average) compared with laparoscopic drainage (5-12 days) or conservative management with antibiotics alone (7-9 days).

Conclusion: Although conservative management of TOAs with antibiotics alone remains first-line, our review indicates that better outcomes in the management of TOA were achieved by minimally invasive approach compared with conservative treatment with antibiotics only. Of the minimally invasive techniques, image-guided drainage of TOAs provided the highest success rates, the fewest complications, and the shortest hospital stays compared with laparoscopy. The low magnitude of evidence in the included studies calls for further randomized trials. This systematic review was registered in the International Prospective Register of Systematic Review (register, http://www.crd.york.ac.uk/PROSPERO;CRD 42020170345).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2020.09.014DOI Listing
March 2021

Prospective Evaluation of Molecular Assays for Diagnosis of Vaginitis.

J Clin Microbiol 2019 12 23;58(1). Epub 2019 Dec 23.

Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA

Molecular tests to diagnose conditions involving the disruption of normal microbiota are difficult to optimize. Using Nugent-scored Gram stain (NS) as the reference standard, we evaluated the performance of 3 molecular assays for the diagnosis of bacterial vaginosis (BV) and examined the impact of an incremental increase in bacterial targets. The BD Affirm assay includes a DNA probe for , the Hologic transcription-mediated amplification (TMA) analyte-specific reagent (ASR) assay adds a second sp. target, and the recently cleared diagnostic use (IVD) Aptima BV assay includes a third target (). The diagnosis of vulvovaginal candidiasis (VVC) by the Affirm and vaginitis Hologic TMA ASR assays was assessed using microscopy for yeast as the reference standard. From May to December 2018, 111 women with vaginitis symptoms prompting the clinician to order an Affirm test were enrolled with informed consent for the collection of additional specimens. Clinicians accurately predicted BV as the most likely diagnosis for 71% of the 45 patients with BV. Coinfection occurred in 13.5% of patients. For BV, the specificity of the Aptima IVD assay (86.3%) was higher than the Affirm assay (60.6%,  = 0.0002), but sensitivities were not significantly different. For VVC, the sensitivity of the ASR assay (100%) was higher than Affirm (75.9%;  = 0.023) and the specificity of the Affirm assay (98.8%) was higher than the ASR assay (86.6%;  = 0.004).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/JCM.01264-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935898PMC
December 2019

Vulvar and gluteal manifestations of Crohn disease.

Cleve Clin J Med 2019 Oct;86(10):645-646

Ob/Gyn & Women's Health Institute, Cleveland Clinic; Associate Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland, OH; Steering Committee, Women's Preventive Services Initiative, American College of Obstetricians and Gynecologists and US Department of Health and Human Services, Health Resources & Services Administration; Clinical Guideline Committee of the American College of Physicians

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.86a.19062DOI Listing
October 2019

A model to predict risk of postpartum infection after Caesarean delivery.

J Matern Fetal Neonatal Med 2018 Sep 11;31(18):2409-2417. Epub 2017 Jul 11.

a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Desk A81 , Cleveland , OH , USA.

Purpose: The purpose of this study is to build and validate a statistical model to predict infection after caesarean delivery (CD).

Methods: Patient and surgical variables within 30 d of CD were collected on 2419 women. Postpartum infection included surgical site infection, urinary tract infection, endomyometritis and pneumonia. The data were split into model development and internal validation (1 January-31 August; N = 1641) and temporal validation subsets (1 September-31 December; N = 778). Logistic regression models were fit to the data with concordance index and calibration curves used to assess accuracy. Internal validation was performed with bootstrapping correcting for bias.

Results: Postoperative infection occurred in 8% (95% CI 7.3-9.9), with 5% meeting CDC criteria for surgical site infections (SSI) (95% CI 4.1-5.8). Eight variables were predictive for infection: increasing BMI, higher number of prior Caesarean deliveries, emergent Caesarean delivery, Caesarean for failure to progress, skin closure using stainless steel staples, chorioamnionitis, maternal asthma and lower gestational age. The model discriminated between women with and without infection on internal validation (concordance index = 0.71 95% CI 0.67-0.76) and temporal validation (concordance index = 0.70, 95% CI 0.62, 0.78).

Conclusions: Our model accurately predicts risk of infection after CD. Identification of patients at risk for postoperative infection allows for individualized patient care and counseling.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2017.1344632DOI Listing
September 2018

Surgical site infection after cesarean delivery: incidence and risk factors at a US academic institution.

J Matern Fetal Neonatal Med 2018 Jul 8;31(14):1873-1880. Epub 2017 Jun 8.

a Obstetrics, Gynecology and Women's Health Institute , Cleveland Clinic , Cleveland , OH , USA.

Purpose: To identify the rate of surgical site infection (SSI) after Cesarean delivery (CD) and determine risk factors predictive for infection at a large academic institution.

Methods: This was a retrospective cohort study in women undergoing CD during 2013. SSIs were defined by Centers for Disease Control (CDC) criteria. Chi square and t-tests were used for bivariate analysis and multivariate logistic regression was used to identify SSI risk factors.

Results: In 2419 patients, the rate of SSI was 5.5% (n = 133) with cellulitis in 4.9% (n = 118), deep incisional infection in 0.6% (n = 15) and intra-abdominal infection in 0.3% (n = 7). On multivariate analysis, SSI was higher among CD for labor arrest (OR 2.4; 95%CI 1.6-3.5; p <.001). Preterm labor (OR 2.8; 95%CI 1.3-6.0; p = .01) and general anesthesia (OR 4.4; 95%CI 2.0-9.8; p = .003) were predictive for SSI. Increasing BMI (OR 1.1; 95%CI 1.05-1.09; p = .02), asthma (OR 1.9; 95%CI 1.1-3.2; p = .02) and smoking (OR 1.9; 95%CI 1.1-3.2; p = .02) were associated with increased SSI.

Conclusions: Several patient and surgical variables are associated with increased rate of SSI after CD. Identification of risk factors for SSI after CD is important for targeted implementation of quality improvement measures and infection control interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2017.1330882DOI Listing
July 2018

Endomyometritis after cesarean delivery in the era of antibiotic prophylaxis: incidence and risk factors.

J Matern Fetal Neonatal Med 2018 May 26;31(9):1214-1219. Epub 2017 Apr 26.

a Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic , Cleveland , OH , USA.

Purpose: To identify the rate of postpartum endomyometritis (PPE) after cesarean delivery (CD) in the era of antibiotic prophylaxis and determine risk factors.

Methods: A single institution retrospective study was performed in women undergoing CD. Data regarding obstetrical and surgical variables were collected. Diagnosis of PPE was made clinically.

Results: Among 2419 patients, the rate of PPE was 1.6% (n = 38) and was associated with lower age (27.0 versus 31.0; p < .001). 65.7% of patients having chorioamnionitits developed PPE, but only 5.4% of patients without PPE had chorioamnionitis (p < .001). On multivariate analysis, PPE was higher in emergent versus scheduled CD (OR: 5.89; p = .0081). There was no difference in PPE for cefazolin 2 g versus 1 g (OR: 1.91; p = .17) or 3 g versus 1 g (OR: 3.69; p = .29), gentamicin/clindamycin versus cefazolin (OR: 5.60; p < .001) had higher PPE. Women with PPE were more likely to have labor arrest (OR: 4.336; p = .001), sexually transmitted infection during the pregnancy (OR: 4.197; p = .02) or blood transfusion (OR: 9.50; p < .0001).

Conclusions: While the overall rate of PPE was low, several risk factors were identified. Preoperative diagnosis of chorioamnionitits is associated with a higher rate of PPE. Further studies are needed to identify optimal regimens for antimicrobial prophylaxis in women undergoing CD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2017.1312330DOI Listing
May 2018

Vulvovaginitis: Find the cause to treat it.

Cleve Clin J Med 2017 Mar;84(3):215-224

OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.

Vulvar and vaginal disorders are among the most common problems seen in ambulatory care. The cause is usually infectious, but noninfectious causes should also be considered, and differentiating them can be challenging. Accurate diagnosis based on patient history, physical examination, and laboratory testing is necessary so that effective therapy can be chosen.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3949/ccjm.84a.15163DOI Listing
March 2017

Catheter-associated urinary tract infection (CAUTI) after term cesarean delivery: incidence and risk factors at a multi-center academic institution.

J Matern Fetal Neonatal Med 2018 Feb 14;31(3):395-400. Epub 2017 Feb 14.

a Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic , Cleveland , OH , USA.

Purpose: The purpose of this study is to identify the rate of catheter-associated urinary tract infection (CAUTI) after Cesarean delivery (CD) and to determine if any factors increase risk of infection.

Methods: A retrospective cohort study was performed at a multi-center institution for patients who underwent CD in 2013. All patients had urinary catheters inserted before surgery. Diagnosis followed IDSA guidelines with culture growing greater than 10 CFU of bacteria per mL with symptoms or symptomatic urinary tract infections treated at provider discretion. Statistical analysis was assessed with Chi-square and Student's t-test followed by logistic regression.

Results: Of 2419 patients, 36 patients developed CAUTI (1.5%). In the 24 (66.7%) cases diagnosed by IDSA guidelines, Escherichia coli was the most common causative organism (54.1%); followed by Enterococcus faecalis (16.7%), Streptococccus agalactiae (8.3%), and Group A Streptococcus (8.3%). Longer operative time (OR 1.013; 95% 1.002-1.023; p = .02) and pregnancies complicated by STI (OR 4.15; 95% CI 1.11-15.0; p < .05) were associated with higher rates of CAUTI.

Conclusions: The overall rate of CAUTI after CD was low at 1.5%. Escherichia coli was the most common causative pathogen. Identification of the patients at high risk for CAUTI allows for risk reduction measures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2017.1286316DOI Listing
February 2018

Mycoplasma genitalium: An Emerging Sexually Transmitted Infection.

Scientifica (Cairo) 2016 29;2016:7537318. Epub 2016 Feb 29.

Ob/Gyn and Women's Health Institute, Cleveland Clinic, 9500 Euclid Avenue A81, Cleveland, OH, USA.

Mycoplasma genitalium has been recognized as a cause of male urethritis, and there is now evidence suggesting that it causes cervicitis and pelvic inflammatory disease in women. M. genitalium is a slow growing organism, and, with the advent of nucleic acid amplification test (NAAT), more studies are being performed, and knowledge about the pathogenicity of this organism elucidated. With NAAT detection, treatment modalities have been studied, and the next challenge is to determine the most effective antimicrobial therapy. Doxycycline, the first-line antibiotic for urethritis, is largely ineffective in the treatment of M. genitalium and furthermore, resistance to macrolide has also emerged. The most effective drug is Moxifloxacin although there are emerging reports of resistance to it in various parts of the world. This paper not only highlights the current research and knowledge, but also reviews the diversity of health implications on the health of men and women infected with M. genitalium. Alternate antibiotics and the impact of M. genitalium on infertility are areas that require more studies as we continue to research into this microorganism.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2016/7537318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789526PMC
April 2016