1 00:00:10,061 --> 00:00:12,029 THIS MORNING FROM -- WELCOME, 2 00:00:12,029 --> 00:00:13,664 AGAIN, EVERYONE, I FEEL WE HAD A 3 00:00:13,664 --> 00:00:14,699 GREAT DAY YESTERDAY. 4 00:00:14,699 --> 00:00:16,567 A GREAT DAY OF BRAINSTORMING. 5 00:00:16,567 --> 00:00:18,536 THANK YOU ALL FOR YOUR 6 00:00:18,536 --> 00:00:18,869 PRESENTATION. 7 00:00:18,869 --> 00:00:23,174 SO WE ARE FOR THE PEOPLE 8 00:00:23,174 --> 00:00:24,909 VIRTUAL, WE ARE FROM 8:00 TO 9 00:00:24,909 --> 00:00:26,644 10:00 THIS MORNING, WE MET, WE 10 00:00:26,644 --> 00:00:27,678 HAD A WORKING GROUP REGARDING 11 00:00:27,678 --> 00:00:31,349 EACH OF THE SESSIONS WE 12 00:00:31,349 --> 00:00:32,817 PRESENTED YESTERDAY. 13 00:00:32,817 --> 00:00:33,517 THESE WORKING GROUPS ARE NOW 14 00:00:33,517 --> 00:00:38,055 GOING TO COME AND GIVE US FEW 15 00:00:38,055 --> 00:00:41,993 SLIDES THAT ARE GOING TO GIVE US 16 00:00:41,993 --> 00:00:47,498 SOME OF THE GAP PRIORITY AND 17 00:00:47,498 --> 00:00:49,600 FUTURE FOR EACH OF THESE 18 00:00:49,600 --> 00:00:51,268 SESSIONS, THEN WE WOULD LIKE TO 19 00:00:51,268 --> 00:00:51,535 CONSIDER. 20 00:00:51,535 --> 00:00:55,272 SO, WE'RE STILL WORKING ON A FEW 21 00:00:55,272 --> 00:00:55,506 THINGS. 22 00:00:55,506 --> 00:00:58,175 SO, MAYBE -- I DON'T KNOW IF 23 00:00:58,175 --> 00:01:02,480 DR. FOX IS IN THE ROOM FOR GROUP 24 00:01:02,480 --> 00:01:02,780 WORKING TWO. 25 00:01:02,780 --> 00:01:08,786 IF I CAN GET THE SLIDES FOR 26 00:01:08,786 --> 00:01:10,888 SESSION TWO, WHICH WAS ON TOP, 27 00:01:10,888 --> 00:01:12,089 THAT WOULD BE GOOD. 28 00:01:12,089 --> 00:01:18,662 YEAH, NO, IN THE MAINTAIN. 29 00:01:18,662 --> 00:01:25,569 MAINTIME. 30 00:01:25,569 --> 00:01:25,736 YES? 31 00:01:25,736 --> 00:01:36,213 IT IS GOING TO BE GROUP TWO. 32 00:01:37,281 --> 00:01:44,455 YES, BUT DO WE HAVE THE SLIDES 33 00:01:44,455 --> 00:01:46,090 FROM GROUP TWO? 34 00:01:46,090 --> 00:01:46,857 OKAY. 35 00:01:46,857 --> 00:01:47,291 NEXT ONE IS THE ONE. 36 00:01:47,291 --> 00:01:52,063 I WANT TO BE SURE THIS IS -- 37 00:01:52,063 --> 00:01:52,229 HMM. 38 00:01:52,229 --> 00:01:55,900 >> IT IS JUST NOT ADVANCING. 39 00:01:55,900 --> 00:01:57,868 THERE WE GO. 40 00:01:57,868 --> 00:01:58,469 ALL RIGHT. 41 00:01:58,469 --> 00:01:58,736 >> OKAY. 42 00:01:58,736 --> 00:01:59,870 ALL RIGHT. 43 00:01:59,870 --> 00:02:01,572 THANK YOU. 44 00:02:01,572 --> 00:02:03,174 YOU HAVE 10 MINUTES ON THAT. 45 00:02:03,174 --> 00:02:04,008 >> OKAY. 46 00:02:04,008 --> 00:02:05,709 THANK YOU SO MUCH. 47 00:02:05,709 --> 00:02:06,444 WELL, OKAY. 48 00:02:06,444 --> 00:02:11,015 SO, OUR GROUP, OF COURSE, WAS 49 00:02:11,015 --> 00:02:11,816 THE PREOPERATIVE PERIOPERATIVE 50 00:02:11,816 --> 00:02:12,583 CARE GROUP. 51 00:02:12,583 --> 00:02:15,219 WE SHIFTED SOMEWHAT TO 52 00:02:15,219 --> 00:02:18,189 PERIOPERATIVE BECAUSE A LOT OF 53 00:02:18,189 --> 00:02:20,091 WHAT WILL INFORM OUR 54 00:02:20,091 --> 00:02:23,761 PREOPERATIVE PLANNING DEPENDS ON 55 00:02:23,761 --> 00:02:25,429 THE PERIOPERATIVE PERIOD AND 56 00:02:25,429 --> 00:02:26,530 LONG-TERM OUTCOMES. 57 00:02:26,530 --> 00:02:28,966 SO FOR PRIORITIZED WE CAME UP 58 00:02:28,966 --> 00:02:30,134 WITH FIVE GENERAL COMMON GAPS WE 59 00:02:30,134 --> 00:02:32,403 WOULD LIKE TO ADDRESS. 60 00:02:32,403 --> 00:02:35,339 FOR OUR BIG OVERARCHING ONE THAT 61 00:02:35,339 --> 00:02:37,775 WE THINK HAS TOP PRIORITY IS 62 00:02:37,775 --> 00:02:39,176 PLACENTA ACCRETA SPECTRUM PAS 63 00:02:39,176 --> 00:02:42,046 LEVEL CARE BUNDLING, WHICH 64 00:02:42,046 --> 00:02:44,715 INCLUDES WITH THIS MUCH BIGGER, 65 00:02:44,715 --> 00:02:47,151 BROADER PICTURE, QUALITY METRICS 66 00:02:47,151 --> 00:02:48,886 THAT ARE DEFINED AND 67 00:02:48,886 --> 00:02:50,621 STANDARDIZED SO WE CAN REPORT TO 68 00:02:50,621 --> 00:02:51,222 THE TEAM, HOSPITAL, NATIONAL, 69 00:02:51,222 --> 00:02:53,924 AND STATE LEVELS SO WE'RE ALL 70 00:02:53,924 --> 00:02:54,625 SPEAKING THE SAME LANGUAGE. 71 00:02:54,625 --> 00:02:57,995 ONE OF THE KEY DRIVERS TO THIS 72 00:02:57,995 --> 00:02:59,563 GAP NEED IS THE PLEA THAT WE 73 00:02:59,563 --> 00:03:00,297 HEARD FROM REFERRING HOSPITALS 74 00:03:00,297 --> 00:03:02,800 AND FROM PATIENTS SAYING WE 75 00:03:02,800 --> 00:03:05,169 REALLY DO NOT KNOW WHERE TO GO. 76 00:03:05,169 --> 00:03:07,371 WE'RE KIND OF DEFINING THESE 77 00:03:07,371 --> 00:03:09,240 QUALITY METRICS AS WE WORK. 78 00:03:09,240 --> 00:03:11,442 WE'RE TRYING TO DO IT AT OUR 79 00:03:11,442 --> 00:03:13,177 INSTITUTIONAL LEVELS, BUT THERE 80 00:03:13,177 --> 00:03:16,514 IS NO STANDARD LEVEL OF CARE. 81 00:03:16,514 --> 00:03:19,049 WE HAVE WONDERFUL METRIC FOR 82 00:03:19,049 --> 00:03:20,184 SEVERE MATERNAL MORBIDITY, AS WE 83 00:03:20,184 --> 00:03:23,087 HEARD YESTERDAY, 50% OF OUR 84 00:03:23,087 --> 00:03:29,093 PATIENTS WILL HAVE ONE OF THOSE 85 00:03:29,093 --> 00:03:32,196 SUSPEAR MATERNAL MORBIDITY, SMS 86 00:03:32,196 --> 00:03:33,964 IS MORE FOR OVERALL QUALITY. 87 00:03:33,964 --> 00:03:35,166 SO WE NEED THE NEW DEFINITIONS. 88 00:03:35,166 --> 00:03:38,102 AND THE GOAL IS TO HELP 89 00:03:38,102 --> 00:03:39,336 PHYSICIANS AND PATIENT GET TO 90 00:03:39,336 --> 00:03:41,071 THE RIGHT CARE AT THE RIGHT TIME 91 00:03:41,071 --> 00:03:42,673 WITH THE RIGHT TEAM. 92 00:03:42,673 --> 00:03:44,475 THERE ARE BIG BARRIERS WE 93 00:03:44,475 --> 00:03:45,676 IDENTIFIED, SOME, OF COURSE, THE 94 00:03:45,676 --> 00:03:47,178 LACK OF DEFINITIONS. 95 00:03:47,178 --> 00:03:48,512 SO, DEFINITIONS IS A BIG ONE AND 96 00:03:48,512 --> 00:03:49,847 A DIG DRIVER. 97 00:03:49,847 --> 00:03:50,848 THE SECOND ONE IS THE ABILITY 98 00:03:50,848 --> 00:03:52,183 FOR PEOPLE TO REPORT. 99 00:03:52,183 --> 00:03:53,717 WE'VE IDENTIFY AD FEW WAYS WE 100 00:03:53,717 --> 00:03:54,285 CAN DO THIS. 101 00:03:54,285 --> 00:03:57,788 OF COURSE, WE HAVE CENTERS THAT 102 00:03:57,788 --> 00:03:58,556 ARE VOLUNTARILY TRYING TO 103 00:03:58,556 --> 00:04:01,559 COLLECT AND REPORT THEIR DATA. 104 00:04:01,559 --> 00:04:04,428 SOME STATES ARE MANDATING LEVEL 105 00:04:04,428 --> 00:04:05,563 OF CARE DESIGNATION, LIKE IN 106 00:04:05,563 --> 00:04:09,366 TEXAS, WHERE SOME REPORT UP TO 107 00:04:09,366 --> 00:04:11,468 MATERNAL QUALITY MORTALLY 108 00:04:11,468 --> 00:04:12,369 COMMITTEES HAPPENING B. DOUBT WE 109 00:04:12,369 --> 00:04:15,206 HAVE THE RIGHT DATA AND IT IS 110 00:04:15,206 --> 00:04:15,940 STANDARDIZED. 111 00:04:15,940 --> 00:04:16,807 THEN LOOKING AT THE NATIONAL 112 00:04:16,807 --> 00:04:18,609 LEVEL, WE DETERMINE IT WOULD BE 113 00:04:18,609 --> 00:04:20,511 POSSIBLE TO OVERCAME THAT 114 00:04:20,511 --> 00:04:21,879 BARRIER OF REPORTING IF WE WERE 115 00:04:21,879 --> 00:04:24,381 TO PUT A CHECK BOX ON A BIRTH OR 116 00:04:24,381 --> 00:04:26,083 DEATH CERTIFICATE TO SAY 117 00:04:26,083 --> 00:04:27,184 SOMETHING IS RELATED TO PAS. 118 00:04:27,184 --> 00:04:28,285 KNOWING THERE ARE LIMITATIONS 119 00:04:28,285 --> 00:04:31,021 WITH THAT KIND OF DATA. 120 00:04:31,021 --> 00:04:33,791 BUT BETTER THAN PERHAPS USING 121 00:04:33,791 --> 00:04:35,259 ONLY ICD CODING DATA. 122 00:04:35,259 --> 00:04:36,994 VERSUS HAVE A SYSTEM IN PLACE, 123 00:04:36,994 --> 00:04:38,162 WHERE THERE IS AN INFRASTRUCTURE 124 00:04:38,162 --> 00:04:39,396 IN ORDER TO COLLECT DATA LIKE IN 125 00:04:39,396 --> 00:04:43,234 FRANCE OR THE U.K. OBSTRUCTURES 126 00:04:43,234 --> 00:04:46,804 SURVEILLANCE SYSTEM OR USING CDC 127 00:04:46,804 --> 00:04:47,137 PROGRAMS DATA. 128 00:04:47,137 --> 00:04:47,671 WHERE WE ACTUALLY LOOK AT 129 00:04:47,671 --> 00:04:48,305 PLACENTA ACCRETA SPECTRUM AND 130 00:04:48,305 --> 00:04:53,377 THE OUTCOMES AS A MEANINGFUL, 131 00:04:53,377 --> 00:04:54,545 IMPORTANT PREGNANCY OUTCOME THAT 132 00:04:54,545 --> 00:04:55,913 SHOULD BE REPORTED AT A BIGGER 133 00:04:55,913 --> 00:04:56,947 LEVEL. 134 00:04:56,947 --> 00:05:00,851 THIS KIND OF, WE HAVE A MUCH 135 00:05:00,851 --> 00:05:02,620 MORE GRAINULAR SET OF THINGS WE 136 00:05:02,620 --> 00:05:03,187 WOULD LIKE TO ADDRESS WITHIN 137 00:05:03,187 --> 00:05:04,688 THIS GROUP. 138 00:05:04,688 --> 00:05:06,323 BUT AGAIN, A LOT OF IT GOES DOWN 139 00:05:06,323 --> 00:05:09,727 TO LOOKING AT THOSE STANDARDIZED 140 00:05:09,727 --> 00:05:10,027 DEFINITIONS. 141 00:05:10,027 --> 00:05:11,562 AND ESPECIALLY, IMPORTANT, THAT 142 00:05:11,562 --> 00:05:13,230 WE MENTIONED YESTERDAY THAT 143 00:05:13,230 --> 00:05:15,866 WE'RE LACK ARE THOSE LONG-TERM 144 00:05:15,866 --> 00:05:16,200 OUTCOME DATA. 145 00:05:16,200 --> 00:05:19,436 SO HAVING SOME KIND OF 146 00:05:19,436 --> 00:05:21,438 LONGITUDINAL LONG-TERM OUTCOMES 147 00:05:21,438 --> 00:05:25,142 DATA LOOKING AT THE REAL IMPACT 148 00:05:25,142 --> 00:05:26,043 ON LONG CERVICAL MORBIDITY, DO 149 00:05:26,043 --> 00:05:29,046 PATIENTS ACTUALLY NEED TO HAVE 150 00:05:29,046 --> 00:05:29,980 SURGERIES THREE, FOUR, 5 YEARS 151 00:05:29,980 --> 00:05:31,248 DOWN THE LINE THAT TIE BACK TO 152 00:05:31,248 --> 00:05:33,150 THEIR PLACENTA ACCRETA SPECTRUM 153 00:05:33,150 --> 00:05:33,384 SURGERY. 154 00:05:33,384 --> 00:05:35,152 IS THERE IMPACT ON HEART HEALTH, 155 00:05:35,152 --> 00:05:36,253 BONE HEALTH, CANCER HEALTH. 156 00:05:36,253 --> 00:05:38,956 LIKE WE LOOKED AT IN THE TRIALS. 157 00:05:38,956 --> 00:05:40,924 WE DO NOT LOOK THAT IN THE 158 00:05:40,924 --> 00:05:42,092 CONTEXT OF PAS YET. 159 00:05:42,092 --> 00:05:43,661 WE DON'T HAVE THAT DATA. 160 00:05:43,661 --> 00:05:45,663 THIS WILL HELP PREFORM OUR PAIR 161 00:05:45,663 --> 00:05:47,631 OPERATIVE PLANNING. 162 00:05:47,631 --> 00:05:49,600 AND OUR SECONDARY GOAL. 163 00:05:49,600 --> 00:05:50,234 PREOPERATIVE STAGING. 164 00:05:50,234 --> 00:05:51,902 THIS IS A REAL NEED. 165 00:05:51,902 --> 00:05:55,606 WE CANNOT, AGAIN, INFORM OUR 166 00:05:55,606 --> 00:05:57,508 CLINICAL PRACTICES IF WE CAN'T 167 00:05:57,508 --> 00:05:59,743 IDENTIFY WHO IS AT RISK, WHAT 168 00:05:59,743 --> 00:06:00,978 THE RISKS ARE, HOW DO WE GET 169 00:06:00,978 --> 00:06:03,814 PATIENTS TO THE RIGHT CENTER. 170 00:06:03,814 --> 00:06:05,449 AND THEN WHAT, WHAT MANAGE 171 00:06:05,449 --> 00:06:07,017 STRATEGY DO WE NEED. 172 00:06:07,017 --> 00:06:10,921 SO, WE REALLY NEED IMPROVED 173 00:06:10,921 --> 00:06:11,388 IMAGING, REPORTING AND 174 00:06:11,388 --> 00:06:15,159 CONSULTATION STAGING THAT HAS A 175 00:06:15,159 --> 00:06:15,726 POSITIVE IMPACT FOR REFERRAL 176 00:06:15,726 --> 00:06:16,560 TIMING AND LOCATION, THE 177 00:06:16,560 --> 00:06:19,730 REQUIRED RESOURCES NECESSARY OF 178 00:06:19,730 --> 00:06:22,333 THE GOOD LIVERY AND GUIDE 179 00:06:22,333 --> 00:06:23,834 DELIVERY TIMING, WITH OTHER 180 00:06:23,834 --> 00:06:24,401 PERRY OPERATIVE OUTCOME. 181 00:06:24,401 --> 00:06:26,904 WE TALKED ABOUT THE STUDIES THAT 182 00:06:26,904 --> 00:06:27,371 PREDICT BLOOD LOSS. 183 00:06:27,371 --> 00:06:30,574 ONE OF THE KEY DRIVERS, A LOT OF 184 00:06:30,574 --> 00:06:31,608 THE REPORTING OF STUDIES, THE 185 00:06:31,608 --> 00:06:34,378 PROTOCOLS THAT ARE USED FOR 186 00:06:34,378 --> 00:06:36,580 IMAGING ACQUISITION AND IMAGING 187 00:06:36,580 --> 00:06:37,247 REPORTING REMAIN UNCLEAR. 188 00:06:37,247 --> 00:06:38,982 AGAIN, HOW CAN WE HAVE 189 00:06:38,982 --> 00:06:40,751 MEANINGFUL IMAGING DATA IF WE 190 00:06:40,751 --> 00:06:42,453 DON'T KNOW WHAT MUTHENAL IS 191 00:06:42,453 --> 00:06:44,955 DOING USED, HOW THE IMAGE IS 192 00:06:44,955 --> 00:06:45,789 BEING ACQUIRED, WHO IS FOLLOWING 193 00:06:45,789 --> 00:06:49,360 ACCRETA OR WHAT THE SEVERITY IS. 194 00:06:49,360 --> 00:06:52,596 AND CAN THESE PROTOCOLS BE 195 00:06:52,596 --> 00:06:52,896 REPLICATED. 196 00:06:52,896 --> 00:06:55,065 SO AGAIN, HAVING THESE THINGS 197 00:06:55,065 --> 00:06:55,632 DEFINED, ACCEPTED AT THE 198 00:06:55,632 --> 00:06:57,735 STANDARD FOR REPORTING WOULD BE 199 00:06:57,735 --> 00:06:58,302 HELPFUL. 200 00:06:58,302 --> 00:06:59,403 AND HAVING AN INFRASTRUCTURE. 201 00:06:59,403 --> 00:07:00,771 SO THAT AS WE'RE STARTING TO 202 00:07:00,771 --> 00:07:02,940 BRING STUDIES ONLINE, PERHAPS WE 203 00:07:02,940 --> 00:07:05,442 HAVE A CENTER WHERE THEY DON'T 204 00:07:05,442 --> 00:07:07,711 DO THE SAME IMAGING PROTOCOL AT 205 00:07:07,711 --> 00:07:11,115 CENTER X AS DONE IN CENTER Y. 206 00:07:11,115 --> 00:07:14,752 BUT AN EXPERT AT CENTER X THAT 207 00:07:14,752 --> 00:07:15,452 CAN GUIDE, INFORM, AND COUNSEL 208 00:07:15,452 --> 00:07:17,588 THE TEAM AT FOR Y, PERHAPS WE 209 00:07:17,588 --> 00:07:21,258 CAN BRING CENTERS TO A STANDARD. 210 00:07:21,258 --> 00:07:21,992 AN ADDITIONAL PIECE OF 211 00:07:21,992 --> 00:07:25,162 INFORMATION THAT WILL BE 212 00:07:25,162 --> 00:07:27,598 HELPFUL, HOW DO WE STANDARDIZED 213 00:07:27,598 --> 00:07:28,866 OURSELVES FOR THE EXPERT CENTERS 214 00:07:28,866 --> 00:07:30,067 AND COMMUNITY SITES. 215 00:07:30,067 --> 00:07:32,836 CAN WE TEACH PEOPLE THAT YOU CAN 216 00:07:32,836 --> 00:07:38,442 GET CERTAIN IMAGES AND EXPECT WE 217 00:07:38,442 --> 00:07:39,843 ARE GOING TO SEE ALL OF THE 218 00:07:39,843 --> 00:07:40,778 PLACENTA ACCRETA. 219 00:07:40,778 --> 00:07:42,579 AND THEN HOW CAN WE MEANINGFULLY 220 00:07:42,579 --> 00:07:45,249 SHARE THAT DATA WHETHER IT IS 221 00:07:45,249 --> 00:07:45,883 ACROSS INSTITUTIONS, ACROSS 222 00:07:45,883 --> 00:07:48,419 STATE LINES SO THAT WE'RE NOT 223 00:07:48,419 --> 00:07:50,087 REPEATING STUDIES THAT HAVE 224 00:07:50,087 --> 00:07:51,121 ALREADY BEEN DONE, BUT LOOKING 225 00:07:51,121 --> 00:07:52,623 AT THE SAME STUDIES AND HAVING 226 00:07:52,623 --> 00:07:53,957 THAT DATABASE. 227 00:07:53,957 --> 00:07:56,360 WE DISCUSSED YESTERDAY ALSO 228 00:07:56,360 --> 00:07:58,695 BRIEFLY HAVING A BIG IMAGING 229 00:07:58,695 --> 00:08:00,431 DATA WAREHOUSE THAT WILL HOLD 230 00:08:00,431 --> 00:08:02,766 NOT ONLY IMPROVED QUALITY, 231 00:08:02,766 --> 00:08:05,102 IMPROVED EDUCATION, BUT IMPROVED 232 00:08:05,102 --> 00:08:06,904 ADVANCES IN IMAGING RESEARCH, 233 00:08:06,904 --> 00:08:09,206 SUCH AS AI, ACQUISITION IS A KEY 234 00:08:09,206 --> 00:08:13,177 NEED WHEN IT COMES TO 235 00:08:13,177 --> 00:08:14,111 PREOPERATIVE AND PERIOPERATIVE 236 00:08:14,111 --> 00:08:14,344 STAGING. 237 00:08:14,344 --> 00:08:15,646 SOME BEARING IS THAT EXIST, OF 238 00:08:15,646 --> 00:08:17,214 COURSE, WHERE DO WE HOUSE ALL OF 239 00:08:17,214 --> 00:08:17,481 THE DATA? 240 00:08:17,481 --> 00:08:19,316 HOW DO WE GET THE EDUCATION OUT? 241 00:08:19,316 --> 00:08:24,054 AND HOW DO WE GET THE FUNDING 242 00:08:24,054 --> 00:08:27,624 FOR ONGOING MENTORSHIP AND 243 00:08:27,624 --> 00:08:28,992 QUALITY CONTROL? 244 00:08:28,992 --> 00:08:31,228 KNOWLEDGE GAP NUMBER THREE, 245 00:08:31,228 --> 00:08:32,362 REALLY LOOKING AT VOLCOOLKER 246 00:08:32,362 --> 00:08:33,597 OCCLUSION TECHNIQUES. 247 00:08:33,597 --> 00:08:35,999 THIS ONE FELL OUT AS AN OUTLIER 248 00:08:35,999 --> 00:08:38,101 OF ALL OF THE OTHER TECHNIQUES, 249 00:08:38,101 --> 00:08:40,871 SIMPLY BECAUSE THERE ARE A LOT 250 00:08:40,871 --> 00:08:42,105 OF QUESTIONS THAT NEED TO BE 251 00:08:42,105 --> 00:08:42,372 ANSWERED. 252 00:08:42,372 --> 00:08:45,342 WE RELY UPON A LOT OF 253 00:08:45,342 --> 00:08:45,642 SPECIALISTS. 254 00:08:45,642 --> 00:08:47,110 SO, HIGH QUALITY DATA ABOUT 255 00:08:47,110 --> 00:08:49,279 COMPARATIVE USE OF VARIOUS 256 00:08:49,279 --> 00:08:51,148 VASCULAR OCCLUSION TECHNIQUES. 257 00:08:51,148 --> 00:08:53,750 WE HAVE UNCLEAR RESULTS ABOUT 258 00:08:53,750 --> 00:08:57,221 THE TRUE INDICATIONS, WHO NEEDS 259 00:08:57,221 --> 00:08:58,121 WHAT APPROACH, OPTIMAL TIMING, 260 00:08:58,121 --> 00:09:00,057 PROTOCOL AND LOCAL AND MATERIAL 261 00:09:00,057 --> 00:09:00,357 EXPERIENCE. 262 00:09:00,357 --> 00:09:02,860 THIS IS ANOTHER ARRAIGNY WE 263 00:09:02,860 --> 00:09:04,628 THINK HAVING ABSOLUTELY 264 00:09:04,628 --> 00:09:05,796 TRANSPARENCY AND PROTOCOLS, 265 00:09:05,796 --> 00:09:07,598 INFRASTRUCTURE FOR MENTORSHIP 266 00:09:07,598 --> 00:09:08,665 BETWEEN INSTITUTIONS CAN HELP 267 00:09:08,665 --> 00:09:12,002 FACILITATE NOT ONLY QUALITY 268 00:09:12,002 --> 00:09:14,805 OUTCOMES, BUT RESEARCH. 269 00:09:14,805 --> 00:09:16,807 AGAIN, THOSE WHO, IF THERE ARE 270 00:09:16,807 --> 00:09:17,641 CENTERS THAT HAVE EXPERIENCE IN 271 00:09:17,641 --> 00:09:20,511 ONE TECHNIQUE, THEY CAN BE THE 272 00:09:20,511 --> 00:09:21,245 KEY TRAINING CENTER. 273 00:09:21,245 --> 00:09:23,347 TRAINING CAN BE PERFORMED 274 00:09:23,347 --> 00:09:25,916 AMONGST INSTITUTIONS, GET PEOPLE 275 00:09:25,916 --> 00:09:26,550 ON BOARD, MONITOR QUALITY SO WE 276 00:09:26,550 --> 00:09:29,419 CAN ACTUALLY OPTIMIZE OUR 277 00:09:29,419 --> 00:09:30,087 OUTCOMES. 278 00:09:30,087 --> 00:09:33,757 THE BARRIERS, OF COURSE, TO THIS 279 00:09:33,757 --> 00:09:35,158 TYPE OF RESEARCH, WE MENTIONED 280 00:09:35,158 --> 00:09:37,194 BRIEFLY YESTERDAY, TO MEEDING OF 281 00:09:37,194 --> 00:09:41,331 EQUIPOSE, WE THINK THERE IS 282 00:09:41,331 --> 00:09:44,268 ANOTHER IN CENTERS, IF WE DO 283 00:09:44,268 --> 00:09:44,768 HIGH QUALITY PROSPECTIVE 284 00:09:44,768 --> 00:09:46,069 COMPARATIVE TRIALS THIS WILL BE 285 00:09:46,069 --> 00:09:47,037 HELPFUL. 286 00:09:47,037 --> 00:09:47,671 AND MEANINGFUL COMPARATIVE 287 00:09:47,671 --> 00:09:47,938 OUTCOMES. 288 00:09:47,938 --> 00:09:50,040 BECAUSE IF WE HAVE TWO CENTERS, 289 00:09:50,040 --> 00:09:50,807 MAYBE WE HAVE ONE CENTER THAT 290 00:09:50,807 --> 00:09:52,776 DOES ONE TECHNIQUE VERY, VERY 291 00:09:52,776 --> 00:09:53,911 WELL. 292 00:09:53,911 --> 00:09:56,046 IF WE HAVE COMPARABLE OUTCOMES 293 00:09:56,046 --> 00:09:58,849 WE CAN ACTUALLY COMPARE, WE CAN 294 00:09:58,849 --> 00:10:00,884 DO COMPARE SELVE STUDIES, IF 295 00:10:00,884 --> 00:10:02,052 WE'RE NOT RANDOMIZED, NOT 296 00:10:02,052 --> 00:10:04,855 OPTIMAL, BUT HELPS FACILITATE 297 00:10:04,855 --> 00:10:05,188 THE RESEARCH. 298 00:10:05,188 --> 00:10:10,494 WE THEN EXPANDED TO OUR FOURTH 299 00:10:10,494 --> 00:10:12,729 ARENA WHICH IS PARA OPERATIVE 300 00:10:12,729 --> 00:10:16,099 PLANNING IN A BROODER SENSE. 301 00:10:16,099 --> 00:10:21,204 THE NEED TO HAVE PREOPERATIVE 302 00:10:21,204 --> 00:10:25,475 AND INTRAOPERATIVE ADJUNCTS, 303 00:10:25,475 --> 00:10:25,943 INCLUDING NUTRITIONAL, 304 00:10:25,943 --> 00:10:27,778 HEMOGLOBIN OPTIMIZATION, E RAS 305 00:10:27,778 --> 00:10:31,148 PROTOCOLS, AND PREVENTION, 306 00:10:31,148 --> 00:10:35,385 PHYSICAL THERAPY, PELVIC FLOOR 307 00:10:35,385 --> 00:10:36,820 THERAPY, AND CHECKLISTS 308 00:10:36,820 --> 00:10:38,088 PROOPERATIVELY, AND A CHECKLIST 309 00:10:38,088 --> 00:10:39,890 TO GET PATIENTS WHERE THEY NEED 310 00:10:39,890 --> 00:10:40,157 TO GO. 311 00:10:40,157 --> 00:10:43,026 WE DEBATED WHETHER OR NOT THIS 312 00:10:43,026 --> 00:10:46,263 IS ITS OWN REALM, BUT 313 00:10:46,263 --> 00:10:47,998 ANESTHESIA, INCLUDED 314 00:10:47,998 --> 00:10:49,066 CARDIOVASCULAR RISK ASSESSMENT, 315 00:10:49,066 --> 00:10:51,635 AN SETTING APPROACH, AND IMPACTS 316 00:10:51,635 --> 00:10:53,870 ON THE MOTHER AND THE NEONATE, 317 00:10:53,870 --> 00:10:56,974 AND VASCULAR OCCLUSION AND AS 318 00:10:56,974 --> 00:10:57,474 SPECT TIMES. 319 00:10:57,474 --> 00:10:59,009 A CENTRAL LINE, A RIP LINE, AND 320 00:10:59,009 --> 00:10:59,376 PAIN CONTROL. 321 00:10:59,376 --> 00:11:03,180 WHEN IT COMES TO THE SURGERIES. 322 00:11:03,180 --> 00:11:05,482 THESE ARE MAJOR, MAJOR SURGERIES 323 00:11:05,482 --> 00:11:07,918 AND OTHER BIG SURGERIES, 324 00:11:07,918 --> 00:11:10,087 PATIENTS UNDERGOING RELATIVELY 325 00:11:10,087 --> 00:11:11,922 OR SEMI ELECTIVE PROVIDERS HAVE 326 00:11:11,922 --> 00:11:12,789 A CARDIOVASCULAR RISK 327 00:11:12,789 --> 00:11:15,359 ASSESSMENT, BUT WE DON'T DO THAT 328 00:11:15,359 --> 00:11:17,494 WITH OUR ACCRETA PATIENTS WHO 329 00:11:17,494 --> 00:11:19,696 MAY HAVE COMORBIDITIES. 330 00:11:19,696 --> 00:11:20,163 TRANSFUSION PROTOCOLS, 331 00:11:20,163 --> 00:11:22,933 CYSTOSCOPY, ALL OF THE THINGS WE 332 00:11:22,933 --> 00:11:25,302 LISTED, THE WHOLE HOST OF THINGS 333 00:11:25,302 --> 00:11:26,670 THAT ARE LOW-HANGING FRUIT AND 334 00:11:26,670 --> 00:11:28,338 EASY TO COMPARE STUDIES THAT 335 00:11:28,338 --> 00:11:33,543 NEED TO BE DONE WITHIN THE 336 00:11:33,543 --> 00:11:34,678 BIGGER UMBRELLA OF PERIOPERATIVE 337 00:11:34,678 --> 00:11:35,846 PLANNING, AND MORE LEARN TURN 338 00:11:35,846 --> 00:11:37,481 OUTCOME DATA TO BETTER INFORM 339 00:11:37,481 --> 00:11:40,717 OUR PATIENTS AND PROVIDERS. 340 00:11:40,717 --> 00:11:41,618 FINALLY, WE PULLED OUT 341 00:11:41,618 --> 00:11:43,720 ANESTHESIA PLANNING AS OUR FIFTH 342 00:11:43,720 --> 00:11:43,987 PRIORITY. 343 00:11:43,987 --> 00:11:46,790 BECAUSE AGAIN, THIS GOES BACK TO 344 00:11:46,790 --> 00:11:48,291 THE PREOPERATIVE RISK 345 00:11:48,291 --> 00:11:48,592 ASSESSMENT. 346 00:11:48,592 --> 00:11:53,330 BUT ALSO, ALL OF THE THINGS THAT 347 00:11:53,330 --> 00:11:55,132 OUR ANESTHESIOLOGISTS DO, THE 348 00:11:55,132 --> 00:11:56,466 OPTIMAL APPROACH, POSTOPERATIVE 349 00:11:56,466 --> 00:11:58,435 PAIN OPTIMIZATION, INCLUDING 350 00:11:58,435 --> 00:12:00,504 REDUCING THE OPIOID BURNING, 351 00:12:00,504 --> 00:12:05,042 AND, RAS PROTOCOL, SPECIFIC TO 352 00:12:05,042 --> 00:12:05,676 PLACENTA ACCRETA. 353 00:12:05,676 --> 00:12:09,346 AND THE UTILITY OF THINGS LIKE 354 00:12:09,346 --> 00:12:12,249 PAP OR -- BLOCKS VERSUS A 355 00:12:12,249 --> 00:12:14,251 PROLONGED EPIDURAL IN THIS 356 00:12:14,251 --> 00:12:14,484 SETTING. 357 00:12:14,484 --> 00:12:18,822 AGAIN, CLEARLY WE HAVE A LOT OF 358 00:12:18,822 --> 00:12:19,456 POTENTIAL FOR RESEARCH BARRIERS 359 00:12:19,456 --> 00:12:21,658 THAT WE NEED TO ADDRESS. 360 00:12:21,658 --> 00:12:24,461 WE IDENTIFIED KEY STAKEHOLDERS 361 00:12:24,461 --> 00:12:30,500 INCLUDING THE CDC FOR OUR BIG 362 00:12:30,500 --> 00:12:31,068 OVERARCHING FIRST PRIORITY. 363 00:12:31,068 --> 00:12:33,036 LOOKING AT STATE HEALTH AND 364 00:12:33,036 --> 00:12:33,503 HUMAN SERVICES GROUPS. 365 00:12:33,503 --> 00:12:37,908 CLEARLY WHEN WE'RE TALKING ABOUT 366 00:12:37,908 --> 00:12:39,810 ANESTHESIA PLANNING GROUPS FROM 367 00:12:39,810 --> 00:12:42,579 S.O.A.P. WOULD BE HELPFUL TO 368 00:12:42,579 --> 00:12:45,582 PARTNER WITH. 369 00:12:45,582 --> 00:12:46,850 OUR PERIOPERATIVE PLANNING, THIS 370 00:12:46,850 --> 00:12:53,623 IS WHERE WHERE WE NEED TO 371 00:12:53,623 --> 00:12:56,893 REALLY OUT OUR PSYCHOLOGIST, 372 00:12:56,893 --> 00:12:57,961 PSYCHIATRIST, AND PHYSICAL 373 00:12:57,961 --> 00:12:59,162 NURSING STAFF, AND THE CARE TEAM 374 00:12:59,162 --> 00:13:01,331 AND OTHERS. 375 00:13:01,331 --> 00:13:01,798 AND AGAIN, HAVING THAT 376 00:13:01,798 --> 00:13:04,000 INFRASTRUCTURE IN ORDER TO LOOK 377 00:13:04,000 --> 00:13:05,202 AT OUR LONG-TERM OUTCOMES 378 00:13:05,202 --> 00:13:06,670 STARTING WITH THE FIRST PRIORITY 379 00:13:06,670 --> 00:13:09,272 IS THE KEY TO BEING ABLE TO 380 00:13:09,272 --> 00:13:13,977 BUILD ON TO ALL OF THE OTHER 381 00:13:13,977 --> 00:13:15,445 PRIORITIES THAT FOLLOW. 382 00:13:15,445 --> 00:13:17,080 ARE THERE ANY QUESTIONS OR 383 00:13:17,080 --> 00:13:19,883 ANYBODY ELSE FROM GROUP TWO THAT 384 00:13:19,883 --> 00:13:23,754 WANTS TO ADD ANYTHING? 385 00:13:23,754 --> 00:13:25,822 >> DO PEOPLE FROM OTHER GROUPS 386 00:13:25,822 --> 00:13:27,491 HAVE ANY COMMENTS ABOUT THOSE 387 00:13:27,491 --> 00:13:32,929 PRIORITIES? 388 00:13:32,929 --> 00:13:33,196 >> YEAH? 389 00:13:33,196 --> 00:13:34,531 >> JUST FOR THE RECORD, I THINK 390 00:13:34,531 --> 00:13:36,867 ONE OF THE THINGS I DIDN'T 391 00:13:36,867 --> 00:13:38,301 ACTUALLY THINK ABOUT DURING OUR 392 00:13:38,301 --> 00:13:41,671 SESSION WAS THE AMERICAN COLLEGE 393 00:13:41,671 --> 00:13:43,140 OF RADIOLOGY DEVELOPS STANDARDS 394 00:13:43,140 --> 00:13:45,509 OF PRACTICE. 395 00:13:45,509 --> 00:13:46,743 AND SO, AND GUIDELINES. 396 00:13:46,743 --> 00:13:50,113 SO THAT MIGHT BE A GOOD PLACE TO 397 00:13:50,113 --> 00:13:52,916 START WITH THE MRI EVALUATION. 398 00:13:52,916 --> 00:13:53,984 AND MAYBE AFTER AS WELL. 399 00:13:53,984 --> 00:13:56,753 >> YEAH, I THINK THE OTHER THING 400 00:13:56,753 --> 00:13:58,955 THAT CAME UP IN HER 401 00:13:58,955 --> 00:14:00,223 CONVERSATION, THE RECOGNITION 402 00:14:00,223 --> 00:14:02,325 THAT PAS IS THE ONLY DISEASE 403 00:14:02,325 --> 00:14:03,293 ENTITY. 404 00:14:03,293 --> 00:14:04,060 THE OTHER GROUP THAT WE TALK 405 00:14:04,060 --> 00:14:05,428 ABOUT, TOO, THAT WE MENTIONED, 406 00:14:05,428 --> 00:14:08,398 BUT I FORGOT TO MENTION HERE, 407 00:14:08,398 --> 00:14:10,567 PARTNERING WITH THE ELECTRONIC 408 00:14:10,567 --> 00:14:11,735 MEDICAL RECORDS PROVIDERS AND 409 00:14:11,735 --> 00:14:12,903 BIG SERVICES WHERE WE COULD 410 00:14:12,903 --> 00:14:16,473 ACTUALLY, IF WE BUILT A -- THE 411 00:14:16,473 --> 00:14:19,209 DATA ACQUISITION INTO THEIR EMR 412 00:14:19,209 --> 00:14:21,444 SPECIFIC TO PLACENTA ACCRETA 413 00:14:21,444 --> 00:14:22,546 SPECTRUM, WE COULD CERTAINLY 414 00:14:22,546 --> 00:14:24,948 LEVERAGE THINGS LIKE SLICE AND 415 00:14:24,948 --> 00:14:26,716 DICE IN EPIC TO ANSWER THE 416 00:14:26,716 --> 00:14:27,884 RESEARCH QUESTIONS NICELY. 417 00:14:27,884 --> 00:14:29,219 BUT WE NEED TO PARTNER WITH 418 00:14:29,219 --> 00:14:34,758 THOSE FOLKS TO GET THE DATA MORE 419 00:14:34,758 --> 00:14:35,158 EXPEDIENTLY. 420 00:14:35,158 --> 00:14:38,662 OKAY. 421 00:14:38,662 --> 00:14:39,229 KNEE 422 00:14:39,229 --> 00:14:41,064 ANY 423 00:14:41,064 --> 00:14:42,666 ANY OTHER QUESTIONS OR THOUGHTS? 424 00:14:42,666 --> 00:14:43,233 OKAY. 425 00:14:43,233 --> 00:14:44,301 I THINK THAT IS IT. 426 00:14:44,301 --> 00:14:46,136 DO YOU HAVE A QUESTION? 427 00:14:46,136 --> 00:14:51,441 OH. 428 00:14:51,441 --> 00:14:55,178 >> I THINK A LOT OF THE GROUPS 429 00:14:55,178 --> 00:14:56,813 ARE GOING TO HAVE OVERLAP IN 430 00:14:56,813 --> 00:14:57,414 SOME OF THE CONTENT, WHICH I 431 00:14:57,414 --> 00:15:00,517 THINK IT IS IMPORTANT AND GOOD 432 00:15:00,517 --> 00:15:01,084 AND REHIGHLIGHT PRIORITIES. 433 00:15:01,084 --> 00:15:04,421 AND AS SUCH, I THINK, EACH GROUP 434 00:15:04,421 --> 00:15:05,856 SHOULD PREPARE, PRESENT WHAT 435 00:15:05,856 --> 00:15:07,157 THEY PREPARED AND NOT WORRY 436 00:15:07,157 --> 00:15:09,292 ABOUT THAT OVERLAP AND THEN WE 437 00:15:09,292 --> 00:15:11,261 CAN ALSO LEAVE ROOM FOR 438 00:15:11,261 --> 00:15:12,128 QUESTIONS AND ADDITIONAL 439 00:15:12,128 --> 00:15:16,700 PRIORITIES AT THE END ALSO. 440 00:15:16,700 --> 00:15:17,100 >> YEAH. 441 00:15:17,100 --> 00:15:18,501 AND MAYBE DR. SCAD CAN PRESENT 442 00:15:18,501 --> 00:15:19,836 FOR WORKING GROUP THREE. 443 00:15:19,836 --> 00:15:25,108 SORRY, WE'RE GOING A BIT OUT OF 444 00:15:25,108 --> 00:15:28,245 ORDER, BUT SOME LOGISTICS IN 445 00:15:28,245 --> 00:15:28,812 RECEIVING THE PRESENTATIONS. 446 00:15:28,812 --> 00:15:29,179 SO GROUP THREE. 447 00:15:29,179 --> 00:15:31,147 THANK YOU. 448 00:15:31,147 --> 00:15:31,781 THANK YOU. 449 00:15:31,781 --> 00:15:35,352 >> FIRST OF ALL, I WOULD LIKE TO 450 00:15:35,352 --> 00:15:37,153 THANK THE NICHD AND EVERYBODY 451 00:15:37,153 --> 00:15:39,489 HERE, THE MEMBERS OF EVERY 452 00:15:39,489 --> 00:15:41,491 SESSION, GROUPS, YOU KNOW, THIS 453 00:15:41,491 --> 00:15:43,193 IS A VERY NEEDY WORKSHOP. 454 00:15:43,193 --> 00:15:44,661 AND I THINK THERE'S A LOT, AS 455 00:15:44,661 --> 00:15:46,563 YOU CAN SEE, THERE IS A LOT OF 456 00:15:46,563 --> 00:15:49,666 THINGS THAT WE HAVE TO WORK 457 00:15:49,666 --> 00:15:51,134 FOR -- SUCH AN IMPORTANT 458 00:15:51,134 --> 00:15:53,103 CONDITION THAT IS REALLY CLOSE 459 00:15:53,103 --> 00:16:02,112 TO OUR MINDS AND HEARTS. 460 00:16:02,112 --> 00:16:06,816 SO-- SO I'M GOING TO START WITH 461 00:16:06,816 --> 00:16:07,450 THE KNOWLEDGE THAT WE CURRENTLY 462 00:16:07,450 --> 00:16:07,651 HAVE. 463 00:16:07,651 --> 00:16:10,820 WE NEED TO UNDERSTAND THERE IS A 464 00:16:10,820 --> 00:16:11,821 BIG GAP. 465 00:16:11,821 --> 00:16:14,824 AND KNOWLEDGE, IN KNOWLEDGE OF 466 00:16:14,824 --> 00:16:16,626 THE CURRENT STATUS QUO 467 00:16:16,626 --> 00:16:20,463 CONCERNING THE CONDITION, THE -- 468 00:16:20,463 --> 00:16:21,865 SCREENING, EVENTUALLY, 469 00:16:21,865 --> 00:16:22,632 DIAGNOSIS, AND MANAGEMENT. 470 00:16:22,632 --> 00:16:25,201 AS YOU ALL, WE HAVE BEEN 471 00:16:25,201 --> 00:16:26,970 DISCUSSING THIS FOR THE PAST DAY 472 00:16:26,970 --> 00:16:27,170 OR SO. 473 00:16:27,170 --> 00:16:30,407 SO THE PRACTICE THAT WE KNOW ON 474 00:16:30,407 --> 00:16:33,877 THE MANAGEMENT OF PAS IS THE 475 00:16:33,877 --> 00:16:34,277 STANDARD OF CARE. 476 00:16:34,277 --> 00:16:36,947 IN THE UNITED STATES, YOU KNOW, 477 00:16:36,947 --> 00:16:39,683 THE PRETERM C-SECTION IS WHAT IS 478 00:16:39,683 --> 00:16:44,020 THE MOST ACCEPTABLE APPROACH. 479 00:16:44,020 --> 00:16:46,323 AND, AGAIN, IN THE RISK, THERE 480 00:16:46,323 --> 00:16:48,725 IS A RISK FOR MATERNAL 481 00:16:48,725 --> 00:16:52,395 MORBIDITY, AND AGAIN, LOSS FOR 482 00:16:52,395 --> 00:16:52,662 FERTILITY. 483 00:16:52,662 --> 00:16:56,533 AND SO ACUTE AND LONG-TERM 484 00:16:56,533 --> 00:16:56,866 AFFECTS. 485 00:16:56,866 --> 00:16:58,234 THE CURRENT UTERINE SPARING 486 00:16:58,234 --> 00:16:58,768 OPTIONS THAT WE HAVE. 487 00:16:58,768 --> 00:17:01,071 AS THEY HAVE BEEN DISCUSSED IN 488 00:17:01,071 --> 00:17:03,740 THE PAST DATA THAT SHOWS, IS 489 00:17:03,740 --> 00:17:07,510 THAT SOME HIGH VOLUME CENTERS 490 00:17:07,510 --> 00:17:08,945 AND OUT OF EUROPEAN COUNTERPARTS 491 00:17:08,945 --> 00:17:11,214 ARE LEADING ON THAT, AND IN? 492 00:17:11,214 --> 00:17:13,883 CENTERS IN HOUSTON, IS THAT 493 00:17:13,883 --> 00:17:16,586 THERE IS ALSO ALTERNATIVE 494 00:17:16,586 --> 00:17:18,588 STRATEGY THAT INCLUDES 495 00:17:18,588 --> 00:17:19,289 CONSERVATIVE APPROACH AND THEN 496 00:17:19,289 --> 00:17:20,991 EXPECTED APPROACH. 497 00:17:20,991 --> 00:17:22,625 USUALLY CONSERVATIVE APPROACH 498 00:17:22,625 --> 00:17:23,994 MEANS THAT THE AREA EFFECTED IS 499 00:17:23,994 --> 00:17:25,895 RESECTED, TAKEN OUT AND CLOSED 500 00:17:25,895 --> 00:17:26,596 AGAIN. 501 00:17:26,596 --> 00:17:30,700 WHILE THE EXPECTED MANAGEMENT 502 00:17:30,700 --> 00:17:32,635 IS, JUST YOU DELIVER THE BABY, 503 00:17:32,635 --> 00:17:35,171 THE CORD HAS CLOSE TO THE 504 00:17:35,171 --> 00:17:36,272 PLACENTA, AND CLOSE IT OUT. 505 00:17:36,272 --> 00:17:40,577 LIKE WE DO IN ECTOPIC ABDOMINAL 506 00:17:40,577 --> 00:17:40,877 PREGNANCIES. 507 00:17:40,877 --> 00:17:41,978 THESE APPROACHES, OF COURSE, 508 00:17:41,978 --> 00:17:45,648 HAVE TO GO FOR FERTILITY. 509 00:17:45,648 --> 00:17:46,316 AGAIN, REDUCE THE CERVICAL RISKS 510 00:17:46,316 --> 00:17:49,652 AND THE STRESS OF THE PATIENT 511 00:17:49,652 --> 00:17:52,222 AND THE COMORBIDITIES THAT ARE 512 00:17:52,222 --> 00:17:55,158 ASSOCIATED WITH THE, PRETERM 513 00:17:55,158 --> 00:17:56,326 C-SECTION. 514 00:17:56,326 --> 00:17:59,262 AGAIN, IT REQUIRES A CENTER OF 515 00:17:59,262 --> 00:18:04,834 EXPERTISE AND, AGAIN, WHAT KIND 516 00:18:04,834 --> 00:18:06,603 OF CAREFUL, PATIENTS WILL BEACH 517 00:18:06,603 --> 00:18:09,506 FOR TRACK OF CONSERVATIVE OR 518 00:18:09,506 --> 00:18:14,477 EXPECTED MANAGEMENT. 519 00:18:14,477 --> 00:18:16,546 SO, THE GAP TO MANAGE PAS WILL 520 00:18:16,546 --> 00:18:18,214 FOCUS ON MAINLY ON FIVE POINTS. 521 00:18:18,214 --> 00:18:21,584 ONE IS MANY OF YOU HAVE 522 00:18:21,584 --> 00:18:23,286 MENTIONED, IS THE PATIENT 523 00:18:23,286 --> 00:18:23,653 STRATIFICATION. 524 00:18:23,653 --> 00:18:26,856 THERE IS NO REAL CONSENSUS ON 525 00:18:26,856 --> 00:18:28,892 HOW TO CERTIFY PATIENTS, WHAT 526 00:18:28,892 --> 00:18:29,392 ARE THE RISK FACTORS TO 527 00:18:29,392 --> 00:18:32,395 DETERMINE THAT, IN ORDER TO, 528 00:18:32,395 --> 00:18:35,165 OKAY, WHICH ONE IS THE MOST 529 00:18:35,165 --> 00:18:37,801 APPROPRIATE CERVICAL MANAGEMENT? 530 00:18:37,801 --> 00:18:42,172 FACTORS TO THE EXTENSION OF THE 531 00:18:42,172 --> 00:18:43,173 PLACENTA, COMORBIDITIES, PRIOR 532 00:18:43,173 --> 00:18:46,142 OB HISTORY, REALLY NEED TO BE 533 00:18:46,142 --> 00:18:47,177 STANDARDIZED AND COLLECTED. 534 00:18:47,177 --> 00:18:50,413 AGAIN, THE COMPARATIVE OUTCOMES 535 00:18:50,413 --> 00:18:52,882 IS VERY IMPORTANT TO DETERMINE 536 00:18:52,882 --> 00:18:54,217 THERE IS LACK OF ROBUST 537 00:18:54,217 --> 00:18:54,984 COMPARATIVE DATA ON THE 538 00:18:54,984 --> 00:18:57,487 SHORT-TERM AND LONG-TERM 539 00:18:57,487 --> 00:19:01,691 OUTCOMES IN THE DIFFERENT 540 00:19:01,691 --> 00:19:03,159 DISCUSSED SURGICAL APPROACHES. 541 00:19:03,159 --> 00:19:05,328 WHICH INCLUDE IMMEDIATE VERSUS 542 00:19:05,328 --> 00:19:06,896 DELAYED RESECTION VERSUS LEAVING 543 00:19:06,896 --> 00:19:08,798 THE PLACENTA INSIDE, TO LOCAL 544 00:19:08,798 --> 00:19:10,266 RESECTION AND CLOSER. 545 00:19:10,266 --> 00:19:13,803 SO THE GAP IS VERY CLOSURE TO 546 00:19:13,803 --> 00:19:15,171 DEVELOP THIS, TO DEVELOP AND 547 00:19:15,171 --> 00:19:17,307 CHANGE THE PRACTICE THAT WE'RE 548 00:19:17,307 --> 00:19:19,976 DOING, ESPECIALLY IN THE UNITED 549 00:19:19,976 --> 00:19:22,245 STATES. 550 00:19:22,245 --> 00:19:23,680 ALSO, THE EXCLUSION PRACTICE, 551 00:19:23,680 --> 00:19:24,114 THERE IS SIGNIFICANT 552 00:19:24,114 --> 00:19:24,414 VARIABILITY. 553 00:19:24,414 --> 00:19:28,184 AND REALLY THE ONLY THING I SEE 554 00:19:28,184 --> 00:19:30,520 CONSENSUS IN THIS WORKSHOP IS 555 00:19:30,520 --> 00:19:31,621 DEFINING IT AS PLACENTA ACCRETA 556 00:19:31,621 --> 00:19:32,755 SPECTRUM. 557 00:19:32,755 --> 00:19:35,058 AND THE SPECTRUM OF ALL OF THE 558 00:19:35,058 --> 00:19:35,358 DATA THERE. 559 00:19:35,358 --> 00:19:38,328 SO WE HAVE A HUGE SPECTRUM ON 560 00:19:38,328 --> 00:19:38,528 THAT. 561 00:19:38,528 --> 00:19:39,696 I THINK WE NEED TO NARROW THIS. 562 00:19:39,696 --> 00:19:43,900 AND, YOU KNOW, WE HAVE ALSO HIGH 563 00:19:43,900 --> 00:19:45,635 VOLUME CENTERS WITH SPECIALIZED 564 00:19:45,635 --> 00:19:47,003 EXPERTISE, OF COURSE, THEY MAY 565 00:19:47,003 --> 00:19:49,339 HAVE THE BEST OUTCOMES, BUT THE 566 00:19:49,339 --> 00:19:51,574 LOW VOLUME CENTERS MAY FACE SOME 567 00:19:51,574 --> 00:19:53,343 CHALLENGES IN MAINTAINING THE 568 00:19:53,343 --> 00:19:58,081 SKILLS AND RESOURCES. 569 00:19:58,081 --> 00:19:59,382 THE INTRAOPERATIVE TECHNIQUE ARE 570 00:19:59,382 --> 00:20:02,752 ALSO NOT STANDARDIZED 571 00:20:02,752 --> 00:20:03,052 EFFECTIVELY. 572 00:20:03,052 --> 00:20:03,620 AND EXPECTED MANAGEMENT OR 573 00:20:03,620 --> 00:20:06,322 CONSERVATIVE MANAGEMENT AND THE 574 00:20:06,322 --> 00:20:13,029 USE OF THAT THERAPIES ON, ON -- 575 00:20:13,029 --> 00:20:13,830 SORRY. 576 00:20:13,830 --> 00:20:22,972 ON-- WHICH ONE TO USE, THE 577 00:20:22,972 --> 00:20:29,312 BALLOON, THE EMBOLIZATION, 578 00:20:29,312 --> 00:20:29,846 STINTS, DEVICES, LIGASURE, 579 00:20:29,846 --> 00:20:31,614 HARMONICS, ALL OF THESE CAN COME 580 00:20:31,614 --> 00:20:34,417 INTO PLAY AND BY CENTERS AND 581 00:20:34,417 --> 00:20:35,518 CERTAIN EXPERTISE, ETC. 582 00:20:35,518 --> 00:20:37,854 THE OTHER THINGS THAT WE TALKED, 583 00:20:37,854 --> 00:20:43,560 WHICH IS ALSO VERY IMPORTANT IS 584 00:20:43,560 --> 00:20:45,094 SOME MEMBERS FROM THE SEA AND 585 00:20:45,094 --> 00:20:48,598 CANADA THAT WE ARE TALKING 586 00:20:48,598 --> 00:20:51,167 ABOUT, IS THE TRAINING AND SKILL 587 00:20:51,167 --> 00:20:52,035 MAINTENANCE REQUIRED FOR THE 588 00:20:52,035 --> 00:20:55,071 SURGICAL TEAMS TO MAINTAIN 589 00:20:55,071 --> 00:20:55,572 PROFICIENCIES, ARE THEY 590 00:20:55,572 --> 00:20:58,708 ADEQUATELY TRAINED TO HANDLE THE 591 00:20:58,708 --> 00:21:00,977 PAS CASES THAT ARE VERY 592 00:21:00,977 --> 00:21:01,277 CHALLENGING. 593 00:21:01,277 --> 00:21:02,312 ESPECIALLY IN THE LOW VOLUME 594 00:21:02,312 --> 00:21:03,012 CENTERS, HOW ARE THESE 595 00:21:03,012 --> 00:21:04,180 MAINTAINED. 596 00:21:04,180 --> 00:21:05,648 IT IS IMPORTANT TO CONTINUE 597 00:21:05,648 --> 00:21:07,083 PROFESSIONAL DEVELOPMENT AND TO 598 00:21:07,083 --> 00:21:08,885 KEEP TEAM TRAINING WHICH IS 599 00:21:08,885 --> 00:21:10,620 EFFECTIVE, WHICH IS CRITICAL AND 600 00:21:10,620 --> 00:21:14,624 CENTER FOR THE PAS MANAGEMENT. 601 00:21:14,624 --> 00:21:15,525 WE, SORRY ABOUT THE FONT BEING 602 00:21:15,525 --> 00:21:15,758 SMALL. 603 00:21:15,758 --> 00:21:19,162 BUT SO MANY POINTS TO PUT. 604 00:21:19,162 --> 00:21:20,630 SO IN SUMMARY, WE IDENTIFIED KEY 605 00:21:20,630 --> 00:21:22,532 GAPS OF KNOWLEDGE AND AREAS FOR 606 00:21:22,532 --> 00:21:27,170 RESEARCH THAT WE INCLUDED FIRST 607 00:21:27,170 --> 00:21:27,604 OF ALL. 608 00:21:27,604 --> 00:21:33,276 IDEALLY, IS -- WHAT WE SHOULD 609 00:21:33,276 --> 00:21:33,509 PURSUE. 610 00:21:33,509 --> 00:21:34,210 THERE'S CHALLENGES, OF COURSE, 611 00:21:34,210 --> 00:21:34,777 EVERYONE, YOU WILL FIND AND 612 00:21:34,777 --> 00:21:36,512 SOMETHING THAT IS GOING TO TELL 613 00:21:36,512 --> 00:21:38,114 YOU DON'T DO IT. 614 00:21:38,114 --> 00:21:40,316 BUT MOST, MAJOR RCTs THAT ARE 615 00:21:40,316 --> 00:21:40,950 DONE BEFORE, THAT CHANGE 616 00:21:40,950 --> 00:21:42,652 PRACTICE, THIS IS THE CHALLENGES 617 00:21:42,652 --> 00:21:44,520 THAT THEY FACE. 618 00:21:44,520 --> 00:21:46,789 AND AT THE END, THEY CHANGE 619 00:21:46,789 --> 00:21:50,760 PRACTICE OVER THE WORLD AND IN 620 00:21:50,760 --> 00:21:52,095 THE UNITED STATES. 621 00:21:52,095 --> 00:21:54,464 ANOTHER IMPORTANT THING THAT WE 622 00:21:54,464 --> 00:21:56,966 TONGED IS DEFINITELY WE'RE GOING 623 00:21:56,966 --> 00:21:58,768 TO COMPARE THE SURGICAL 624 00:21:58,768 --> 00:22:00,370 TECHNIQUES WE TALKED ABOUT THE 625 00:22:00,370 --> 00:22:03,172 STANDARD OF CARE AND PRIMARY, 626 00:22:03,172 --> 00:22:05,441 WHICH IS SIMPLE PRETERM 627 00:22:05,441 --> 00:22:05,775 HYSTERECTOMY. 628 00:22:05,775 --> 00:22:08,745 VERSES THE CONSERVATIVE AND 629 00:22:08,745 --> 00:22:09,479 EXPECTED APPROACHES. 630 00:22:09,479 --> 00:22:11,314 APPROPRIATE-- IT IS VERY 631 00:22:11,314 --> 00:22:14,517 IMPORTANT WHEN YOU DESIGN AN 632 00:22:14,517 --> 00:22:14,684 RCT. 633 00:22:14,684 --> 00:22:15,285 WE DISCUSSED THIS EXTENSIVELY 634 00:22:15,285 --> 00:22:15,852 ABOUT THIS. 635 00:22:15,852 --> 00:22:17,120 FIRST WE TALKED ABOUT THE TIME 636 00:22:17,120 --> 00:22:19,989 FRAMES AND MOST OF OUR OUTCOMES 637 00:22:19,989 --> 00:22:22,191 WILL BE AROUND CLOSE TO SIX 638 00:22:22,191 --> 00:22:23,426 MONTHS PER THE EXPERTISE PANEL 639 00:22:23,426 --> 00:22:26,362 VERSUS ONE YEAR, UP TO ONE YEAR. 640 00:22:26,362 --> 00:22:29,399 AND FOR THE, TO EVALUATE THE 641 00:22:29,399 --> 00:22:30,500 DIFFERENT TECHNIQUES, THERE WAS 642 00:22:30,500 --> 00:22:33,636 A NOVEL APPROACH ABOUT 643 00:22:33,636 --> 00:22:34,404 DESIRABILITY OF OUTCOMES 644 00:22:34,404 --> 00:22:37,540 RANKINGS FROM PATIENTS AND 645 00:22:37,540 --> 00:22:38,207 STAKEHOLDERS IN ORDER TO 646 00:22:38,207 --> 00:22:40,576 DETERMINE THE BEST OUTCOME, THAT 647 00:22:40,576 --> 00:22:42,145 IS USING PRIOR TRIALS. 648 00:22:42,145 --> 00:22:43,746 AND AGAIN, ADDING LONG-TERM 649 00:22:43,746 --> 00:22:47,083 OUTCOMES AND QUALITY OF LIFE 650 00:22:47,083 --> 00:22:49,719 OUTCOMES IN PATIENTS 651 00:22:49,719 --> 00:22:51,020 SATISFACTION AND THE MENTAL 652 00:22:51,020 --> 00:22:58,361 IMPACT ON THESE PATIENTS IS VERY 653 00:22:58,361 --> 00:22:59,228 IMPORTANT. 654 00:22:59,228 --> 00:23:00,029 AGAIN, OBTAINING THE ACCURATE 655 00:23:00,029 --> 00:23:04,267 DATA THROUGH EDUCATION TO REMOVE 656 00:23:04,267 --> 00:23:04,901 BIASES IN STUDY, WHICH CURRENTLY 657 00:23:04,901 --> 00:23:06,669 IN THE PAST KNOWN DATA THAT WE 658 00:23:06,669 --> 00:23:08,538 HAVE THAT EXISTS. 659 00:23:08,538 --> 00:23:10,740 AND ESPECIALLY, THESE CAN BE 660 00:23:10,740 --> 00:23:15,912 DONE THROUGH REGISTRY WHERE A 661 00:23:15,912 --> 00:23:19,782 PROPOSED IS NOT POSSIBLE. 662 00:23:19,782 --> 00:23:21,451 EVALUATING THE CRITERIA FOR 663 00:23:21,451 --> 00:23:23,986 SURGEON TRAINING OR COMPETENCY 664 00:23:23,986 --> 00:23:26,022 IN THESE COMPLEX PROCEDURES 665 00:23:26,022 --> 00:23:27,323 SHOULD BE INCLUDED IN THESE 666 00:23:27,323 --> 00:23:28,157 TRIALS. 667 00:23:28,157 --> 00:23:30,093 AND THE POTENTIAL TRIAL DESIGNS 668 00:23:30,093 --> 00:23:32,995 WITH THESE RCTs, WE DISCUSSED 669 00:23:32,995 --> 00:23:34,330 NONPRIORITY, VERSUS PRIORITY OR 670 00:23:34,330 --> 00:23:37,166 A MIXED MODEL WHERE IF ONE OF 671 00:23:37,166 --> 00:23:38,201 THESE ARE MET, THE OTHER ONE 672 00:23:38,201 --> 00:23:40,336 DOES NEED TO BE FOLLOWED. 673 00:23:40,336 --> 00:23:44,841 BUT THESE DETAILS CAN BE LATER 674 00:23:44,841 --> 00:23:45,108 EXPLORED. 675 00:23:45,108 --> 00:23:48,845 THERE ARE CHALLENGES TO DO AN 676 00:23:48,845 --> 00:23:49,011 RCT. 677 00:23:49,011 --> 00:23:50,313 PATIENT SELECTION, AND 678 00:23:50,313 --> 00:23:52,482 VISIBILITY, THESE WERE ALSO 679 00:23:52,482 --> 00:23:53,182 DISCUSSED. 680 00:23:53,182 --> 00:23:54,050 AND AGAIN, STANDARDIZED THE DATA 681 00:23:54,050 --> 00:23:56,519 COLLECTION ACROSS CENTERS IS 682 00:23:56,519 --> 00:23:57,653 VERY IMPORTANT AND CRUCIAL IN 683 00:23:57,653 --> 00:23:59,889 ORDER TO MAKE IT A VALID TRIAL 684 00:23:59,889 --> 00:24:02,458 AND TO INFORM FUTURE RESEARCH 685 00:24:02,458 --> 00:24:04,794 AND PRACTICES. 686 00:24:04,794 --> 00:24:06,362 SO WE ALSO TALKED EXTENSIVELY 687 00:24:06,362 --> 00:24:07,864 ABOUT SURGEON TRAINING AND 688 00:24:07,864 --> 00:24:09,732 ASSESSING SKILLS. 689 00:24:09,732 --> 00:24:13,636 WE DO THAT, YOU KNOW, IT IS VERY 690 00:24:13,636 --> 00:24:14,804 IMPORTANT TO IDENTIFY, 691 00:24:14,804 --> 00:24:15,838 CATEGORIZED DIAGNOSES OR 692 00:24:15,838 --> 00:24:17,740 SCREENING OF THE ACCRETA IN 693 00:24:17,740 --> 00:24:19,142 ORDER TO DETERMINE APPROPRIATE 694 00:24:19,142 --> 00:24:22,078 CARE AND TRAINING THE SURGEONS. 695 00:24:22,078 --> 00:24:24,647 AND THIS IS -- THIS INCLUDES 696 00:24:24,647 --> 00:24:27,550 ABLE TO PREDICT WHICH CASES ARE 697 00:24:27,550 --> 00:24:28,851 LOW RISK AND HIGH-RISK. 698 00:24:28,851 --> 00:24:30,420 CURRENT DIAGNOSTIC METHODS ARE 699 00:24:30,420 --> 00:24:31,154 LACKING BEHIND. 700 00:24:31,154 --> 00:24:31,754 WE KNOW THAT. 701 00:24:31,754 --> 00:24:34,957 AND THE NEED TO BE VALIDATED AND 702 00:24:34,957 --> 00:24:39,162 FURTHER EVOLUTION IN ORDER TO 703 00:24:39,162 --> 00:24:41,330 CLASSIFY THE SEVERITY AND RISK 704 00:24:41,330 --> 00:24:41,898 CLASSIFICATION. 705 00:24:41,898 --> 00:24:43,833 ENSURING THE SURGEONS TRAINED IN 706 00:24:43,833 --> 00:24:46,335 SCANNING PATIENTS THEMSELVES TO 707 00:24:46,335 --> 00:24:49,505 UNDERSTAND THE ANATOMY AND AID 708 00:24:49,505 --> 00:24:50,573 IN PREDICTING SURGICAL OUTCOMES 709 00:24:50,573 --> 00:24:51,874 WERE ALSO DISCUSSED AND 710 00:24:51,874 --> 00:24:55,311 SUGGESTED DURING OUR DISCUSSION. 711 00:24:55,311 --> 00:24:58,181 AND FOCUSING ON SURGICAL 712 00:24:58,181 --> 00:24:58,714 TRAINING AND EXPERIENCE, A 713 00:24:58,714 --> 00:25:01,717 SELECTED FEW SURGEON SAID FULLY 714 00:25:01,717 --> 00:25:03,453 RATHER THAN SPREADING LIMITED 715 00:25:03,453 --> 00:25:04,420 EXPERIENCE TO BROAD THE RESULTS 716 00:25:04,420 --> 00:25:07,356 WILL USUALLY LEAD TO SAFER AND 717 00:25:07,356 --> 00:25:09,725 MORE COMPETENT CARE. 718 00:25:09,725 --> 00:25:13,529 MAINTAINING SURGICAL SKILLS WITH 719 00:25:13,529 --> 00:25:15,097 A MINIMUM REGULAR CASE VOLUME IS 720 00:25:15,097 --> 00:25:17,333 IMPORTANT. 721 00:25:17,333 --> 00:25:18,935 NOT JUST ONE CASE ANNUALLY. 722 00:25:18,935 --> 00:25:20,269 OTHER SUBSPECIALTIES TO BE ALSO 723 00:25:20,269 --> 00:25:22,271 INVOLVED LIKE ANESTHESIA TO BE 724 00:25:22,271 --> 00:25:24,674 TRAINED ON THIS SPECIFIC 725 00:25:24,674 --> 00:25:26,275 CONDITIONS, TO SAFE WAY HANDLE 726 00:25:26,275 --> 00:25:29,846 COMPLEX CASES. 727 00:25:29,846 --> 00:25:31,214 AGAIN, COORDINATION OF CARE IN 728 00:25:31,214 --> 00:25:35,117 HIGH VOLUME CENTERS IS 729 00:25:35,117 --> 00:25:35,384 EMPIRICAL. 730 00:25:35,384 --> 00:25:38,754 AND AGAIN, CENTRALIZED ACCRETA 731 00:25:38,754 --> 00:25:40,623 CASES AT DESIGNATED HIGH VOLUME 732 00:25:40,623 --> 00:25:42,825 CENTERS WITH TEAMS COULD IMPROVE 733 00:25:42,825 --> 00:25:47,163 OUTCOMES IN LOW VOLUME COMMUNITY 734 00:25:47,163 --> 00:25:47,430 HOSPITALS. 735 00:25:47,430 --> 00:25:49,365 SO THE GAPS IN TRAINING, 736 00:25:49,365 --> 00:25:52,435 TRAINING IN GENERAL, THE 737 00:25:52,435 --> 00:25:53,402 SURGEONS, FELLOW, RESIDENTS IN 738 00:25:53,402 --> 00:25:55,805 PAS SURGERY IS CHALLENGING. 739 00:25:55,805 --> 00:25:57,673 AND THEY ARE UNLIKELY TO REACH 740 00:25:57,673 --> 00:25:59,342 COMPETENCY OR SAFETY EVEN AFTER 741 00:25:59,342 --> 00:26:01,344 MULTIPLE EXPOSURES DUE TO LOW 742 00:26:01,344 --> 00:26:02,011 CASE VOLUME. 743 00:26:02,011 --> 00:26:05,748 AND THIS IS SHOWN BY A LOT OF 744 00:26:05,748 --> 00:26:06,482 DATA PRESENTED YESTERDAY. 745 00:26:06,482 --> 00:26:08,918 IT WAS ALSO ARGUED THAT FOCUSING 746 00:26:08,918 --> 00:26:11,521 TRAINING ON A SELECT FEW PEOPLE 747 00:26:11,521 --> 00:26:13,322 RATHER THAN SPREADING LIMITED 748 00:26:13,322 --> 00:26:14,323 OPPORTUNITIES TOO BROADLY IS 749 00:26:14,323 --> 00:26:17,293 PREFERABLE TO ENSURE THAT THE 750 00:26:17,293 --> 00:26:19,161 ONES INVOLVED IN SURGERY LEADS 751 00:26:19,161 --> 00:26:23,165 TO A SAFE AND COMPETENT OR 752 00:26:23,165 --> 00:26:24,934 ENVIRONMENT. 753 00:26:24,934 --> 00:26:25,902 MAINTAINING SKILLS REQUIRES A 754 00:26:25,902 --> 00:26:28,504 MINIMAL REGULAR CASE VOLUME, SO 755 00:26:28,504 --> 00:26:33,709 RESIDENTS SEEING JUST ONE OR TWO 756 00:26:33,709 --> 00:26:35,211 CASE MAY NOT LEARN SKILLS, SINCE 757 00:26:35,211 --> 00:26:40,583 ACCRETA IS A LOW 758 00:26:40,583 --> 00:26:41,083 COUNTRYDITION -- THAT IS 759 00:26:41,083 --> 00:26:42,785 AVAILABLE DURING RESIDENCY. 760 00:26:42,785 --> 00:26:44,554 AND THE PHYSICIANS HAVE A SMALL 761 00:26:44,554 --> 00:26:45,621 GROUP OF HANDS-ON TRAINING, 762 00:26:45,621 --> 00:26:48,057 BETTER THAN RESIDENTS JUST 763 00:26:48,057 --> 00:26:50,192 OBSERVING, THOUGH GENERAL 764 00:26:50,192 --> 00:26:52,962 RESIDENTS DO NOT NEED TRAINING 765 00:26:52,962 --> 00:26:55,431 ON, IN COMPLEX HYSTERECTOMIES. 766 00:26:55,431 --> 00:27:00,336 THAT WAS OUR SUMMARY. 767 00:27:00,336 --> 00:27:00,670 ANY QUESTIONS? 768 00:27:00,670 --> 00:27:04,740 >> CAN YOU GO BACK TWO SLIDES P? 769 00:27:04,740 --> 00:27:05,708 MAYBE NOT. 770 00:27:05,708 --> 00:27:12,949 >> I THINK IT WAS TURNED OFF. 771 00:27:12,949 --> 00:27:13,983 >> THERE IS A COMMENT ABOUT 772 00:27:13,983 --> 00:27:14,517 SURGEONS SCANNING. 773 00:27:14,517 --> 00:27:16,352 I THINK IF WAS ONE SLIDE 774 00:27:16,352 --> 00:27:16,752 FORWARD. 775 00:27:16,752 --> 00:27:20,923 >> YES, THE SECOND POINT. 776 00:27:20,923 --> 00:27:23,993 >> SO I'M JUST CURIOUS WHAT -- 777 00:27:23,993 --> 00:27:24,760 WHAT IS ABOUT THAT? 778 00:27:24,760 --> 00:27:26,963 YOU KNOW, IF THE MAJORITY OF 779 00:27:26,963 --> 00:27:31,167 CENTERS, I MEAN, IN THE UNITED 780 00:27:31,167 --> 00:27:35,304 STATES, IS NOT ABOUT A 781 00:27:35,304 --> 00:27:37,974 TUSTRATION MFM DOING THE CASES, 782 00:27:37,974 --> 00:27:41,510 WHY DOES A G1 ONCOLOGIST, WHAT 783 00:27:41,510 --> 00:27:44,347 IS THE RATIONALE TO COMPLAIN A 784 00:27:44,347 --> 00:27:48,551 SURGEON TO DO ALL OF THE OTHERS? 785 00:27:48,551 --> 00:27:50,786 >> I THINK THIS WAS DR. HOBSON 786 00:27:50,786 --> 00:27:51,754 AND HIS GROUP IN CANADA. 787 00:27:51,754 --> 00:27:52,655 WHERE IT IS DIFFERENT. 788 00:27:52,655 --> 00:27:54,624 I THINK IN THE U.S., THIS WILL 789 00:27:54,624 --> 00:27:57,893 PROBABLY APPLY, IF IT IS 790 00:27:57,893 --> 00:27:58,661 ONCOLOGIST WHO DOESN'T DO 791 00:27:58,661 --> 00:27:59,161 ULTRASOUND. 792 00:27:59,161 --> 00:28:00,296 UNDERSTANDING THE IMPLANTS AND 793 00:28:00,296 --> 00:28:03,165 THE MRI AND HAVING REVIEWED IT. 794 00:28:03,165 --> 00:28:06,102 BUT PROBABLY NOT A REALISTIC 795 00:28:06,102 --> 00:28:06,836 EXPECTATION THERE. 796 00:28:06,836 --> 00:28:10,339 >> YEAH, IT WAS -- AGAIN, IF -- 797 00:28:10,339 --> 00:28:12,341 DEFINITELY IF A SURGEON KNOW 798 00:28:12,341 --> 00:28:13,643 EXACTLY WHERE THE PLACENTA, THE 799 00:28:13,643 --> 00:28:14,810 MORE INFORMATION THEY HAVE. 800 00:28:14,810 --> 00:28:16,245 IN OUR CENTERS THEY THERE WERE 801 00:28:16,245 --> 00:28:18,581 TIMES DOING IT, WE REALLY ASSESS 802 00:28:18,581 --> 00:28:21,751 IT RIGHT BEFORE THE SURGERY. 803 00:28:21,751 --> 00:28:24,553 THE ONCOLOGIST USUALLY ASKS FOR 804 00:28:24,553 --> 00:28:27,289 AN ULTRASOUND TO BE DONE WITHIN 805 00:28:27,289 --> 00:28:29,959 THAT WEEK TO DISCUSS IT CASE IF 806 00:28:29,959 --> 00:28:31,927 THEY EVOLVED EARLY OR AN MRI 807 00:28:31,927 --> 00:28:34,196 BEING DONE IN THE PAIRTIVAL, 808 00:28:34,196 --> 00:28:37,199 ESPECIALLY THINKING ABOUT THE 809 00:28:37,199 --> 00:28:39,168 ACCRETA INVADING THE AREAS OR 810 00:28:39,168 --> 00:28:39,969 THE BLADDER. 811 00:28:39,969 --> 00:28:40,436 THAT'S A GREAT POINT. 812 00:28:40,436 --> 00:28:43,005 >> I'M NOT QUESTIONS AT ALL THE 813 00:28:43,005 --> 00:28:43,406 ROLE FOR IMAGING. 814 00:28:43,406 --> 00:28:44,907 BE VERY CLEAR ABOUT THAT. 815 00:28:44,907 --> 00:28:47,476 BUT TO HAVE A STATEMENT THAT 816 00:28:47,476 --> 00:28:48,911 RECOMMENDATION FOR THE SURGEON 817 00:28:48,911 --> 00:28:51,847 ITSELF TO SCAN, THAT MAY BE, IT 818 00:28:51,847 --> 00:28:54,216 MAY BE CREEP THERE IN THE UNITED 819 00:28:54,216 --> 00:28:54,450 STATES. 820 00:28:54,450 --> 00:28:55,384 >> I THINK, THE COMMENT WAS TO 821 00:28:55,384 --> 00:28:59,355 HAVE SOMEBODY IN THE ROOM WHO 822 00:28:59,355 --> 00:29:00,723 KNOWS WHERE THE STRUCTURES ARE 823 00:29:00,723 --> 00:29:01,891 AND WHERE THE PLACENTA IS AND 824 00:29:01,891 --> 00:29:03,492 ALL OF THAT. 825 00:29:03,492 --> 00:29:05,428 NOT TO BE THE SURGEON ONCOLOGIST 826 00:29:05,428 --> 00:29:07,129 OR, BUT TO HAVE SOMEONE IN THE 827 00:29:07,129 --> 00:29:08,431 ROOM WHO KNOWS WHERE -- YOU 828 00:29:08,431 --> 00:29:12,334 KNOW, ALL OF THE DETAILS OF 829 00:29:12,334 --> 00:29:12,902 THE -- ULTRASOUND FINDINGS. 830 00:29:12,902 --> 00:29:14,704 >> I'M GOING TO ADD TO THAT, 831 00:29:14,704 --> 00:29:17,373 JUST REPORTING MECHANISMS, THERE 832 00:29:17,373 --> 00:29:19,575 IS REALLY ROBUST REPORTING 833 00:29:19,575 --> 00:29:21,310 MECHANISMS TO HELP PEOPLE KNOW 834 00:29:21,310 --> 00:29:23,179 EXACTLY WHERE THINGS ARE. 835 00:29:23,179 --> 00:29:25,181 THERE IS THE ONE COMMENT ABOUT 836 00:29:25,181 --> 00:29:27,283 NOT TRAINING YOUR REGULAR OBGYN 837 00:29:27,283 --> 00:29:31,153 ABOUT SOME OF THE SURGERIES, I 838 00:29:31,153 --> 00:29:31,587 DISAGREE WITH THAT 839 00:29:31,587 --> 00:29:33,022 FUNDAMENTALLY, THE MAJORITY OF 840 00:29:33,022 --> 00:29:34,990 RESIDENTS GO OUT INTO THE MIDDLE 841 00:29:34,990 --> 00:29:36,525 OF SMALL TOWN AND COMMUNITY AND 842 00:29:36,525 --> 00:29:37,827 COMMUNITY HOSPITALS, THEY ARE 843 00:29:37,827 --> 00:29:39,495 THE ONES FACED WITH THE DISASTER 844 00:29:39,495 --> 00:29:40,930 CASES THAT DROP IN, IN THE 845 00:29:40,930 --> 00:29:41,430 MIDDLE OF THE NIGHT. 846 00:29:41,430 --> 00:29:45,701 THEY NEED TO AT LEAST LEARN WHAT 847 00:29:45,701 --> 00:29:50,706 THE RECOGNIZE AND THAT WHOLE 848 00:29:50,706 --> 00:29:52,374 ALGORITHM THAT BRETT AND DANNY 849 00:29:52,374 --> 00:29:54,710 WORKED ON, THEY HAVE TO BE 850 00:29:54,710 --> 00:29:56,045 INVOLVED IN THE EDUCATION, NOT 851 00:29:56,045 --> 00:29:58,280 DOING THE STEPS, BUT 852 00:29:58,280 --> 00:29:59,215 RECOGNITION, WHAT YOU CAN DO AND 853 00:29:59,215 --> 00:30:01,016 START AND WHAT TO DO IN AN 854 00:30:01,016 --> 00:30:03,018 EMERGENCY IS CRITICAL FOR THE 855 00:30:03,018 --> 00:30:03,352 RESIDENTS. 856 00:30:03,352 --> 00:30:04,453 >> THIS CAME UP IN THE 857 00:30:04,453 --> 00:30:04,754 DISCUSSION. 858 00:30:04,754 --> 00:30:09,425 I THINK ALL OF US IN THE ROOM 859 00:30:09,425 --> 00:30:10,359 FELT THAT THERE IS MORE HARM IN 860 00:30:10,359 --> 00:30:14,363 TRAINING A RESIDENT WITH ONE OR 861 00:30:14,363 --> 00:30:15,397 TWO CASES FEELING THAT THEY'RE 862 00:30:15,397 --> 00:30:17,600 GOING TO GET ONE CASE THAT WAS 863 00:30:17,600 --> 00:30:19,201 NOT DIAGNOSED EARLY AND ONE OR 864 00:30:19,201 --> 00:30:21,003 TWO CASES FOR THE RESIDENT ARE 865 00:30:21,003 --> 00:30:23,339 NOT GOING TO HELP THEM MANAGE 866 00:30:23,339 --> 00:30:27,376 THE CASE ANYWAY. 867 00:30:27,376 --> 00:30:29,311 VERSUS DILUTING THE TRAINING FOR 868 00:30:29,311 --> 00:30:31,614 ONE PERSON WHO IS GOING BE ABLE 869 00:30:31,614 --> 00:30:34,617 TO TAKE OVER OR STAY AT THAT 870 00:30:34,617 --> 00:30:36,418 CENTER. 871 00:30:36,418 --> 00:30:38,120 WE ALSO FELT THAT THESE CASES 872 00:30:38,120 --> 00:30:40,389 THAT OCCUR IN THE COMMUNITY ARE 873 00:30:40,389 --> 00:30:42,625 REALLY A FAILURE OF THE SYSTEM 874 00:30:42,625 --> 00:30:44,260 OF EARLY DIAGNOSES AND TRANSFER 875 00:30:44,260 --> 00:30:47,329 AND THAT'S WHERE WE SHOULD BE 876 00:30:47,329 --> 00:30:47,997 FOCUSED RATHER IN THE TRAINING 877 00:30:47,997 --> 00:30:48,531 EVERY RESIDENT. 878 00:30:48,531 --> 00:30:51,667 I MEAN, WE HAVE IN OUR PROGRAM 879 00:30:51,667 --> 00:30:52,601 FIVE RESIDENTS, I THINK, IN YOUR 880 00:30:52,601 --> 00:30:53,803 PROGRAM YOU HAVE EIGHT 881 00:30:53,803 --> 00:30:55,471 RESIDENTS, IF THEY ARE LUCKY, 882 00:30:55,471 --> 00:30:57,773 THEY WILL DO TWO CASES DURING 883 00:30:57,773 --> 00:30:58,674 THEIR RESIDENCY, THAT IS NOT 884 00:30:58,674 --> 00:31:00,576 GOING TO TRAIN THEM TO TAKE CARE 885 00:31:00,576 --> 00:31:01,844 OF PATIENTS IN THE COMMUNITY. 886 00:31:01,844 --> 00:31:03,312 >> I THINK THERE IS ALSO A 887 00:31:03,312 --> 00:31:03,946 DIFFERENCE BETWEEN UNDERSTANDING 888 00:31:03,946 --> 00:31:05,381 HOW TO MANAGE A CONDITION AND 889 00:31:05,381 --> 00:31:08,884 BEING A PERSON WHO IS COMPETENT 890 00:31:08,884 --> 00:31:09,418 TO DO THE SURGERY. 891 00:31:09,418 --> 00:31:11,120 I DON'T THINK ANYONE WOULD ARGUE 892 00:31:11,120 --> 00:31:11,587 THAT RESIDENTS NEED TO 893 00:31:11,587 --> 00:31:13,556 UNDERSTAND THE MANAGE OF THIS 894 00:31:13,556 --> 00:31:16,058 CONDITION, MAYBE THEY ARE NOT A 895 00:31:16,058 --> 00:31:16,458 PRIMARY OPERATOR. 896 00:31:16,458 --> 00:31:19,795 >> I THINK THE FOCUS IS, WE WANT 897 00:31:19,795 --> 00:31:22,998 THE TEAM OF THE PAS IN THAT 898 00:31:22,998 --> 00:31:25,367 CENTER TO BE HOMMAL HAVING THOSE 899 00:31:25,367 --> 00:31:25,801 CASE VOLUMES. 900 00:31:25,801 --> 00:31:27,903 IF THEY INVOLVE MORE AND MORE 901 00:31:27,903 --> 00:31:30,039 OTHER PEOPLE, I HEARD A CASE 902 00:31:30,039 --> 00:31:32,641 THAT THERE WERE LIKE FIVE 903 00:31:32,641 --> 00:31:34,577 FACULTY SCRUBBED IN FOR A 904 00:31:34,577 --> 00:31:35,511 RESIDENT PAS, EVERYBODY WANTED 905 00:31:35,511 --> 00:31:36,178 TO LEARN. 906 00:31:36,178 --> 00:31:37,379 WHICH IS GREAT, BUT THE SKILL 907 00:31:37,379 --> 00:31:39,181 GOES DOWN AND DOWN AND DOWN. 908 00:31:39,181 --> 00:31:39,381 RIGHT? 909 00:31:39,381 --> 00:31:41,717 WE WANT FIRST TO GET THE TEAM UP 910 00:31:41,717 --> 00:31:44,320 AND RUNNING AND BE OPTIMIZED, 911 00:31:44,320 --> 00:31:46,121 THEN YOU CAN DONE DO MORE 912 00:31:46,121 --> 00:31:46,388 EDUCATION. 913 00:31:46,388 --> 00:31:51,160 EDUCATION IS -- OUR CENTERS ARE 914 00:31:51,160 --> 00:31:52,061 IMPERATIVE ON THAT. 915 00:31:52,061 --> 00:31:54,530 >> I 916 00:31:54,530 --> 00:31:57,600 >> I THINK THIS IS AN IMPORTANT 917 00:31:57,600 --> 00:31:58,367 AREA WE HAVE TO TALK AT THE 918 00:31:58,367 --> 00:32:00,135 BEGINNING ABOUT THE SPECTRUM. 919 00:32:00,135 --> 00:32:02,371 AND AGREE, RESIDENTS, AND 920 00:32:02,371 --> 00:32:03,539 SOMETIMES RESIDENTS COME TO A 921 00:32:03,539 --> 00:32:04,440 GRADE THREE TEACHES THAT AND 922 00:32:04,440 --> 00:32:06,609 REVIEW THIS, YOU'RE NOT GOING TO 923 00:32:06,609 --> 00:32:08,177 INTENTIONALLY TAKE A GRADE THREE 924 00:32:08,177 --> 00:32:10,012 TO THE OR. 925 00:32:10,012 --> 00:32:11,013 THEY BELIEVE THAT AFTER THEY 926 00:32:11,013 --> 00:32:12,848 HAVE BEEN AT THE CASES. 927 00:32:12,848 --> 00:32:14,617 THEY SHOULD PROBABLY DO A GRADE 928 00:32:14,617 --> 00:32:18,454 ONE, THEY WILL BE IN THE OR WITH 929 00:32:18,454 --> 00:32:19,922 A GRADE ONE PAS. 930 00:32:19,922 --> 00:32:22,291 IT IS GOOD EXPERIENCE TO DO A 931 00:32:22,291 --> 00:32:22,625 HYSTERECTOMY. 932 00:32:22,625 --> 00:32:27,162 IT IS IMPORTANT TO HAVING 933 00:32:27,162 --> 00:32:28,564 SOMEONE AT THE TABLE DOESN'T 934 00:32:28,564 --> 00:32:30,366 MEAN THE PERSON IS COMPETENT IN 935 00:32:30,366 --> 00:32:31,300 THE PROCEDURE, BUT WILL LEARN 936 00:32:31,300 --> 00:32:35,871 FROM ASSISTING AND WATCHING THE 937 00:32:35,871 --> 00:32:37,206 PROCEDURE, BUT THE POINTS HAVE 938 00:32:37,206 --> 00:32:42,411 TO BE SPELLED OUT. 939 00:32:42,411 --> 00:32:43,145 >> YEAH. 940 00:32:43,145 --> 00:32:48,751 THERE'S ALSO THE GAP IN HELPING 941 00:32:48,751 --> 00:32:50,653 THE COMMUNITY PHYSICIAN RIGHT 942 00:32:50,653 --> 00:32:54,957 WHEN DO THINGS EXTERNALLY LOOK 943 00:32:54,957 --> 00:32:57,092 BAD ENOUGH, YOU ARE NOT GOING TO 944 00:32:57,092 --> 00:32:58,560 SEE WHAT HAPPENS, BUT TRANSFER 945 00:32:58,560 --> 00:32:59,929 THAT PATIENT EITHER WITH OR 946 00:32:59,929 --> 00:33:01,163 WITHOUT A BABY DELIVERED. 947 00:33:01,163 --> 00:33:02,631 >> THIS IS VERY IMPORTANT. 948 00:33:02,631 --> 00:33:04,833 I CAN TELL YOU, ONE OF MY CASES 949 00:33:04,833 --> 00:33:07,403 I DO IN MY RESIDENT SAID ABOUT 950 00:33:07,403 --> 00:33:09,204 PAS, I GIVE THEM A SCENARIO 951 00:33:09,204 --> 00:33:11,507 YOU'RE IN A COMMUNITY HOSPITAL 952 00:33:11,507 --> 00:33:14,743 BY YOURSELF AT NIGHT, MIDNIGHT, 953 00:33:14,743 --> 00:33:15,377 AND SOMEBODY CAME BLEEDING, YOU 954 00:33:15,377 --> 00:33:17,446 OPEN UP AND SEE THIS, AND SHOW 955 00:33:17,446 --> 00:33:18,080 THEN THE PICTURE. 956 00:33:18,080 --> 00:33:19,148 WHAT DO YOU DO? 957 00:33:19,148 --> 00:33:24,920 90% OF THEM THE FIRST TIME, THEY 958 00:33:24,920 --> 00:33:27,156 SAY DELIVER THE BABY AND SEE 959 00:33:27,156 --> 00:33:29,425 WHAT IT IS. 960 00:33:29,425 --> 00:33:31,126 THEY DON'T SEE CLOSING THEM AND 961 00:33:31,126 --> 00:33:31,460 TRANSFERRING. 962 00:33:31,460 --> 00:33:35,197 IT IS ONE OF THE PEARLS OF 963 00:33:35,197 --> 00:33:35,464 EDUCATION. 964 00:33:35,464 --> 00:33:39,601 IT SHOULD DEFINITELY BE 965 00:33:39,601 --> 00:33:40,903 EMPHASIZED. 966 00:33:40,903 --> 00:33:42,705 >> I THINK HUMILITY IN THE FACE 967 00:33:42,705 --> 00:33:44,206 OF THE DISEASE COMES WITH 968 00:33:44,206 --> 00:33:45,507 EXPERIENCE FOR SURE. 969 00:33:45,507 --> 00:33:47,743 I ALSO WONDER, SO OUR CURRENT 970 00:33:47,743 --> 00:33:51,513 STRUCTURES ARE BUILT AROUND THE 971 00:33:51,513 --> 00:33:52,715 NOTION OF PERFORM C-SECTION AS 972 00:33:52,715 --> 00:33:57,886 YOU MENTIONED I WONDER IF 973 00:33:57,886 --> 00:33:58,520 ADDITIONAL OB/GYN NEED TO COME 974 00:33:58,520 --> 00:34:01,156 TO THE TABLE. 975 00:34:01,156 --> 00:34:02,124 AND MIXED STURGEONS WHO NOW NEED 976 00:34:02,124 --> 00:34:06,295 TO KNOW HOW TO DO RESECTIONS 977 00:34:06,295 --> 00:34:06,495 LATER. 978 00:34:06,495 --> 00:34:08,597 DANNY IS, SOMEBODY THAT SHE CAN 979 00:34:08,597 --> 00:34:10,966 DO A HYSTERECTOMY OF A RESECTION 980 00:34:10,966 --> 00:34:12,601 OF A PIECE OF SOMETHING LEFT 981 00:34:12,601 --> 00:34:14,703 OVER THAT I CAN'T DO. 982 00:34:14,703 --> 00:34:16,605 SO I WONDER IF WE NEED TO, THIS 983 00:34:16,605 --> 00:34:19,875 HAS BEEN AN INITIAL GREAT 984 00:34:19,875 --> 00:34:21,677 OPPORTUNITY FOR STAKEHOLDERS TO 985 00:34:21,677 --> 00:34:22,378 CONVENE, AS WE EXPAND OUR 986 00:34:22,378 --> 00:34:25,080 TOOLBOX, WE NEED TO EXPAND OUR 987 00:34:25,080 --> 00:34:25,547 FRIENDS IN THE ROOM. 988 00:34:25,547 --> 00:34:28,083 >> I THINK, ADDING TO THAT, YOU 989 00:34:28,083 --> 00:34:33,222 KNOW, I THINK THIS GROUP IS 990 00:34:33,222 --> 00:34:34,189 PROBABLY THE MOST VERSED, WELL 991 00:34:34,189 --> 00:34:37,292 VERSED IN WHAT THE NATURAL 992 00:34:37,292 --> 00:34:39,495 HISTORY OF CONSERVATIVE 993 00:34:39,495 --> 00:34:41,597 MANAGEMENT LOOKS LIKE, BUT MOST 994 00:34:41,597 --> 00:34:43,032 OB/GYNs ARE NOT. 995 00:34:43,032 --> 00:34:44,833 SO IF WE'RE, IF CONSERVATIVE 996 00:34:44,833 --> 00:34:46,068 MANAGEMENT IS IMPLEMENTED MORE 997 00:34:46,068 --> 00:34:48,504 BROADLY, WE NEED TO FURTHER 998 00:34:48,504 --> 00:34:51,840 EDUCATION THE GENERAL OB/GYN 999 00:34:51,840 --> 00:34:52,408 COMMUNITY AND THE RADIOLOGY 1000 00:34:52,408 --> 00:34:53,909 COMMUNITY ON WHAT TO EXPECT AND 1001 00:34:53,909 --> 00:34:54,676 HOW TO MANAGING COMPLICATIONS. 1002 00:34:54,676 --> 00:34:59,048 >> AGAIN, WHAT I HAVE LEARNED BY 1003 00:34:59,048 --> 00:35:01,617 STARTING THIS, WHO WILL DO THE 1004 00:35:01,617 --> 00:35:04,720 HYSTERECTOMY, BETTER TO DO IT 1005 00:35:04,720 --> 00:35:06,422 ROBOTICALLY OR OPEN? 1006 00:35:06,422 --> 00:35:09,258 WE STARTED WITH LIMITED INVASIVE 1007 00:35:09,258 --> 00:35:10,592 PEOPLE AND THEN OUR ONCOLOGISTS 1008 00:35:10,592 --> 00:35:12,294 COMPLAIN THEY WANT TO GET THE 1009 00:35:12,294 --> 00:35:14,797 EXPERIENCE WITH DOING THIS. 1010 00:35:14,797 --> 00:35:16,899 SO, NOW, WE DECIDED TO LET OUR 1011 00:35:16,899 --> 00:35:19,134 ON-CALLS TO IT. 1012 00:35:19,134 --> 00:35:21,737 BUT I THINK THERE IS A BIG PLACE 1013 00:35:21,737 --> 00:35:22,671 FOR MINIMALLY INVASIVE SURGEON 1014 00:35:22,671 --> 00:35:23,872 THERE. 1015 00:35:23,872 --> 00:35:25,607 ARE THE BEST PEOPLE WHEN IT 1016 00:35:25,607 --> 00:35:27,042 COMES TO DOING THE PROCEDURE. 1017 00:35:27,042 --> 00:35:30,245 AND OF COURSE, SOME OF THE 1018 00:35:30,245 --> 00:35:33,816 PATIENTS WITH A PLACENTA, YOU GO 1019 00:35:33,816 --> 00:35:35,717 IN THERE WITH THE HYSTERECTOMY 1020 00:35:35,717 --> 00:35:36,185 TO MOVE IT. 1021 00:35:36,185 --> 00:35:38,087 THESE ARE THE SOME OF THE THINGS 1022 00:35:38,087 --> 00:35:39,655 YOU'RE GOING TO GET AS YOU DO 1023 00:35:39,655 --> 00:35:46,095 MORE OF THESE CASES. 1024 00:35:46,095 --> 00:35:56,371 >> THANK YOU. 1025 00:36:00,943 --> 00:36:04,179 >> THANK YOU. 1026 00:36:04,179 --> 00:36:04,746 >> SORRY. 1027 00:36:04,746 --> 00:36:05,180 YEAH. 1028 00:36:05,180 --> 00:36:05,347 NO. 1029 00:36:05,347 --> 00:36:05,514 NO. 1030 00:36:05,514 --> 00:36:07,015 FROM GROUP ONE. 1031 00:36:07,015 --> 00:36:08,350 SORRY, WORLD GOING BACKWARDS. 1032 00:36:08,350 --> 00:36:11,553 VERY IMPORTANT. 1033 00:36:11,553 --> 00:36:11,820 THANK YOU. 1034 00:36:11,820 --> 00:36:14,223 GLOW AS WE STEP BACKWARDS, WE 1035 00:36:14,223 --> 00:36:17,526 HAVE BEEN FOCUS ON WHAT TO DO 1036 00:36:17,526 --> 00:36:18,026 WITH THE DIAGNOSIS. 1037 00:36:18,026 --> 00:36:19,828 WE WERE REALLY CHARGED WITH 1038 00:36:19,828 --> 00:36:21,663 THINKING ABOUT UNDERSTANDING THE 1039 00:36:21,663 --> 00:36:26,468 EPI, THE SCREENING AND THE 1040 00:36:26,468 --> 00:36:27,669 DIAGNOSIS. 1041 00:36:27,669 --> 00:36:30,572 WE WROTE IT IN NOTE FORMAT. 1042 00:36:30,572 --> 00:36:31,840 THIS IS THE ITERATIVE 1043 00:36:31,840 --> 00:36:32,641 DISCUSSION. 1044 00:36:32,641 --> 00:36:33,809 SO ANYWAY TO ENLARGE THAT? 1045 00:36:33,809 --> 00:36:34,343 I CAN'T CONTROL IT. 1046 00:36:34,343 --> 00:36:35,911 AT THE BOTTOM RIGHT THERE. 1047 00:36:35,911 --> 00:36:36,979 I CAN'T -- OH. 1048 00:36:36,979 --> 00:36:39,214 I CAN'T REALLY CONTROL THE 1049 00:36:39,214 --> 00:36:41,750 SCREEN. 1050 00:36:41,750 --> 00:36:42,551 OKAY. 1051 00:36:42,551 --> 00:36:46,255 SO CAN YOU KEEP INCREASING IT? 1052 00:36:46,255 --> 00:36:50,225 I'M TALKING TO SOMEONE 1053 00:36:50,225 --> 00:36:51,160 VIRTUALLY. 1054 00:36:51,160 --> 00:36:53,529 THANK YOU! 1055 00:36:53,529 --> 00:36:53,729 GREAT. 1056 00:36:53,729 --> 00:36:56,231 SO, THE INSPIRATION FOR THIS IS 1057 00:36:56,231 --> 00:36:57,332 WE'RE CLEARLY MISSING TOO MANY 1058 00:36:57,332 --> 00:36:59,768 CASES TO EVEN START HAVING THE 1059 00:36:59,768 --> 00:37:05,340 CONSERVATIONS OF WHAT TO DO. 1060 00:37:05,340 --> 00:37:07,743 SO WE IDENTIFIED OVER ALL THREE 1061 00:37:07,743 --> 00:37:09,077 FAIRLY LARGE AND BROAD, DON'T 1062 00:37:09,077 --> 00:37:13,115 FOCUS ON THE LANGUAGE, MOSTLY A 1063 00:37:13,115 --> 00:37:13,415 DISCUSSION. 1064 00:37:13,415 --> 00:37:15,017 KNOWLEDGE GAP ONE, WHAT IS 1065 00:37:15,017 --> 00:37:16,285 ACCRETA, IT COMES UP IN 1066 00:37:16,285 --> 00:37:17,719 DIFFERENT FLAVORS AND 1067 00:37:17,719 --> 00:37:18,020 DISCUSSION. 1068 00:37:18,020 --> 00:37:19,121 WE TALK ABOUT IS THE GOLD 1069 00:37:19,121 --> 00:37:20,455 STANDARD HISTOLOGY. 1070 00:37:20,455 --> 00:37:23,325 I THINK THAT WE DON'T KNOW. 1071 00:37:23,325 --> 00:37:26,361 AND WE HOPE THAT AS WE PUBLISH 1072 00:37:26,361 --> 00:37:27,162 AND CREATE PAPERS WE ARE VERY 1073 00:37:27,162 --> 00:37:30,732 CLEAR OF HOW WE'RE DEFINING 1074 00:37:30,732 --> 00:37:34,203 ACCRETA IN AS MANY, MANY 1075 00:37:34,203 --> 00:37:34,703 CLINICAL AND DEMOGRAPHIC 1076 00:37:34,703 --> 00:37:36,071 PARAMETERS AS POSSIBLE. 1077 00:37:36,071 --> 00:37:38,674 AND THEN THE SECOND KNOWLEDGE 1078 00:37:38,674 --> 00:37:40,609 GAP WAS RELATED TO SCREENING. 1079 00:37:40,609 --> 00:37:42,477 SO WE ACTUALLY BELIEVE THAT 1080 00:37:42,477 --> 00:37:44,479 THERE SHOULD BE UNIVERSAL 1081 00:37:44,479 --> 00:37:44,980 SCREENING. 1082 00:37:44,980 --> 00:37:46,715 WHEN WE SAY UNIVERSAL SCREENING 1083 00:37:46,715 --> 00:37:50,385 THAT IT MEANS CLINICAL RISK 1084 00:37:50,385 --> 00:37:50,619 FACTORS. 1085 00:37:50,619 --> 00:37:51,787 THAT INCLUDES YOUR CESAREAN, 1086 00:37:51,787 --> 00:37:52,354 YOUR INSTRUMENTITATION. 1087 00:37:52,354 --> 00:37:55,157 THAT IS PART OF OUR SCREENING. 1088 00:37:55,157 --> 00:37:57,960 WE FOLLOW THAT WITH ULTRASOUND. 1089 00:37:57,960 --> 00:37:59,728 AND THEN WE MOVE FORWARD FROM 1090 00:37:59,728 --> 00:37:59,928 THERE. 1091 00:37:59,928 --> 00:38:01,997 THE THIRD KNOWLEDGE GAP IS 1092 00:38:01,997 --> 00:38:04,166 CLEARLY, WE ARE MISSING THE HUGE 1093 00:38:04,166 --> 00:38:06,101 POPULATION AND WE NEED TO DO A 1094 00:38:06,101 --> 00:38:10,339 BETTER JOB FROM LEARNING FROM 1095 00:38:10,339 --> 00:38:10,806 THE UNDIAGNOSED CASES. 1096 00:38:10,806 --> 00:38:13,242 SO KIND OF FOCUS ON THE THREE 1097 00:38:13,242 --> 00:38:14,443 KNOWLEDGE GAP, THE DEFINITION, 1098 00:38:14,443 --> 00:38:16,578 THE SCREENING PULLROOMTERS AND 1099 00:38:16,578 --> 00:38:17,946 LEARNING FROM THE UNDIAGNOSED 1100 00:38:17,946 --> 00:38:19,047 CASES WHICH IS REALLY THE BLACK 1101 00:38:19,047 --> 00:38:19,781 BOX AND WE'RE PROBABLY GOING TO 1102 00:38:19,781 --> 00:38:21,717 GET A LOT OF DATA. 1103 00:38:21,717 --> 00:38:26,521 SO WITH THE EMMY, WE HAVE SUCH A 1104 00:38:26,521 --> 00:38:27,189 DIVERSE AND WIDE SPECTRUM FOR 1105 00:38:27,189 --> 00:38:28,023 THE PREVALENCE. 1106 00:38:28,023 --> 00:38:30,192 SO WE KIND OF HAVE IT IN A 1107 00:38:30,192 --> 00:38:30,959 QUESTION FORMAT. 1108 00:38:30,959 --> 00:38:32,995 SO WE HOPE THAT THOSE OF US WITH 1109 00:38:32,995 --> 00:38:35,631 WHO ARE DOING RESEARCH, AND 1110 00:38:35,631 --> 00:38:36,965 THOSE REPORTING ARE REALLY 1111 00:38:36,965 --> 00:38:37,532 THOUGHTFUL ABOUT THIS. 1112 00:38:37,532 --> 00:38:39,101 WE CAN USE EACH OTHER'S 1113 00:38:39,101 --> 00:38:39,568 RESEARCH. 1114 00:38:39,568 --> 00:38:42,170 FOR EXAMPLE, YOU KNOW, GROUPS 1115 00:38:42,170 --> 00:38:44,273 THAT PUBLISH ON CONSERVATIVE 1116 00:38:44,273 --> 00:38:45,874 MANAGEMENT DESCRIBE WHERE THE 1117 00:38:45,874 --> 00:38:48,677 PLACENTA IS, DESCRIBE THE 1118 00:38:48,677 --> 00:38:49,478 INSTRUMENTATION, THOSE THAT WERE 1119 00:38:49,478 --> 00:38:53,048 UNDIAGNOSED, WHO WAS THE ROOM? 1120 00:38:53,048 --> 00:38:54,816 WHO WASN'T IN THE ROOM? 1121 00:38:54,816 --> 00:38:57,219 WHEN WAS THE DIAGNOSIS MADE IF 1122 00:38:57,219 --> 00:38:58,754 AND REALLY, REALLY THE TIME OF 1123 00:38:58,754 --> 00:38:58,987 ACCRETA. 1124 00:38:58,987 --> 00:39:01,456 HOWEVER WE WANT TO DEFINE IT, AS 1125 00:39:01,456 --> 00:39:02,391 MUCH INFORMATION AS POSSIBLE. 1126 00:39:02,391 --> 00:39:04,226 BECAUSE AT THE END OUR GOAL IS 1127 00:39:04,226 --> 00:39:05,560 WHAT ARE THE DRIVERS OF 1128 00:39:05,560 --> 00:39:06,962 MORBIDITY. 1129 00:39:06,962 --> 00:39:09,464 AND ON THAT NOTE WITH MORBIDITY, 1130 00:39:09,464 --> 00:39:12,634 IT'S, YOU KNOW, WE OBSESS ABOUT 1131 00:39:12,634 --> 00:39:16,171 THE CDC'S 21 DEFINITIONS, BUT BY 1132 00:39:16,171 --> 00:39:19,107 DEFAULT, HYSTERECTOMY AND BLOOD 1133 00:39:19,107 --> 00:39:20,742 TRANSFUSION ARE ALL ACCRETAS 1134 00:39:20,742 --> 00:39:24,479 HAVE -- TO SOME DEGREE, SO FOCUS 1135 00:39:24,479 --> 00:39:27,149 ON PAS SPECIFIC SMM. 1136 00:39:27,149 --> 00:39:28,150 BUT MORBIDITY, SOMETHING 1137 00:39:28,150 --> 00:39:29,685 SPECIFIC TO OUR POPULATION. 1138 00:39:29,685 --> 00:39:32,287 BECAUSE WE THINK THAT THIS WILL 1139 00:39:32,287 --> 00:39:35,657 REALLY OWN THE EPIDEMIOLOGIC 1140 00:39:35,657 --> 00:39:35,957 PERSPECTIVE. 1141 00:39:35,957 --> 00:39:37,025 THAT KIND OF THE PIECE ON 1142 00:39:37,025 --> 00:39:37,326 DEFINITIONS. 1143 00:39:37,326 --> 00:39:39,027 THE CAME UP OVER AND OVER. 1144 00:39:39,027 --> 00:39:40,629 I KNOW THEY MADE IT VERY CLEAR, 1145 00:39:40,629 --> 00:39:42,197 TODAY WE'RE NOT CREATING 1146 00:39:42,197 --> 00:39:45,200 DEFINITIONS FOR PAS AND ACCRETA, 1147 00:39:45,200 --> 00:39:48,670 BUT ARE WE DOING A CLINICAL 1148 00:39:48,670 --> 00:39:50,305 DIAGNOSES, AND ULTRASOUND 1149 00:39:50,305 --> 00:39:51,106 DIAGNOSIS AND HISTOLOGICAL 1150 00:39:51,106 --> 00:39:51,373 DIAGNOSES. 1151 00:39:51,373 --> 00:39:54,276 IF WE'RE DOING THE RESEARCH, BE 1152 00:39:54,276 --> 00:39:56,912 VERY CLEAR AND HOW IT IS 1153 00:39:56,912 --> 00:39:57,145 DEFINED. 1154 00:39:57,145 --> 00:39:58,146 DO YOU MIND GOING DOWN TO 1155 00:39:58,146 --> 00:39:59,614 KNOWLEDGE GAP TWO. 1156 00:39:59,614 --> 00:40:00,315 FOCUSED ON SCREENING. 1157 00:40:00,315 --> 00:40:02,417 OUR GOAL, WE DON'T WANT TO BE 1158 00:40:02,417 --> 00:40:03,852 MISSING ACCRETAS, WE ARE CLEARLY 1159 00:40:03,852 --> 00:40:06,788 MISSING TOO MANY. 1160 00:40:06,788 --> 00:40:08,890 START WITH UNIVERSAL, CLINICAL 1161 00:40:08,890 --> 00:40:09,758 SCREENING OF ALL COMERS. 1162 00:40:09,758 --> 00:40:11,393 AND THEN TARGET. 1163 00:40:11,393 --> 00:40:14,796 SO WE'RE GOING TO MAKE IT, WE 1164 00:40:14,796 --> 00:40:19,067 IDEALLY WANT, IF YOU GET A EARLY 1165 00:40:19,067 --> 00:40:19,901 ULTRASOUND, SOMEWHERE BETWEEN 1166 00:40:19,901 --> 00:40:23,672 SIX AND NINE WEEKS, IT IS IN THE 1167 00:40:23,672 --> 00:40:24,940 LOWER UTERUS SEGMENT, SEND TO, 1168 00:40:24,940 --> 00:40:26,575 WHAT DO WE CALL IT? 1169 00:40:26,575 --> 00:40:28,076 A HIGHER LEVEL OF CARE. 1170 00:40:28,076 --> 00:40:29,378 WE STRUGGLED A LOT WOULD DO YOU 1171 00:40:29,378 --> 00:40:33,949 SEND IT TO A CENTER THAT IS FOR 1172 00:40:33,949 --> 00:40:34,783 ACCRETA DIAGNOSES, MFM, BUT WE 1173 00:40:34,783 --> 00:40:38,920 DECIDED A HIGHER LEVEL OF CARE 1174 00:40:38,920 --> 00:40:39,454 WE FELT COMFORTABLE WITH. 1175 00:40:39,454 --> 00:40:42,090 IF YOU HAVE THAT LOWER SEGMENT 1176 00:40:42,090 --> 00:40:42,591 IMPLANTATION REFER OUT. 1177 00:40:42,591 --> 00:40:47,162 FOR THE REST OF THE POPULATION, 1178 00:40:47,162 --> 00:40:49,431 WHENEVER YOU HAVE ULTRASOUND 1179 00:40:49,431 --> 00:40:51,133 MARKERS THAT WE WILL MAKE VERY 1180 00:40:51,133 --> 00:40:51,967 CLEAR WHAT THEY ARE, THERE'S 1181 00:40:51,967 --> 00:40:54,102 BEEN SOME WHITE PAPERS ON THIS, 1182 00:40:54,102 --> 00:40:57,506 YOU NEED TO REFER TO A CENTER OF 1183 00:40:57,506 --> 00:40:58,407 EXCELLENCE. 1184 00:40:58,407 --> 00:41:00,642 GOING BACK ON THIS THEME, AND 1185 00:41:00,642 --> 00:41:05,614 SO, WE WANT TO CREATE A TANGIBLE 1186 00:41:05,614 --> 00:41:07,949 AND USABLE COMMUNITY LIKE PIECE 1187 00:41:07,949 --> 00:41:10,285 OF RISK FACTORS. 1188 00:41:10,285 --> 00:41:12,387 VERY SIMILAR, I THINK THE 1189 00:41:12,387 --> 00:41:13,054 EXAMPLE WAS THE ASPIRIN TABLE 1190 00:41:13,054 --> 00:41:15,490 THAT WE ALL LOVE AND HATE WITH 1191 00:41:15,490 --> 00:41:17,492 THE HIGH RISK CRITERIA, THE 1192 00:41:17,492 --> 00:41:19,194 MODERATE AND MIDDLE RISK 1193 00:41:19,194 --> 00:41:20,095 CRITERIA, AND THE LOW RISK 1194 00:41:20,095 --> 00:41:22,164 CRITERIA, THIS IS FOR REFERRAL 1195 00:41:22,164 --> 00:41:22,497 OUT. 1196 00:41:22,497 --> 00:41:23,865 WE'RE GOING TOKING GO THROUGH 1197 00:41:23,865 --> 00:41:26,201 THE LITERATURE AND CONTINUE TO 1198 00:41:26,201 --> 00:41:30,071 ADD THIS OF WHAT ARE YOUR 1199 00:41:30,071 --> 00:41:31,606 RELATIVE RISKS FOR ACCRETA? 1200 00:41:31,606 --> 00:41:34,376 BASED ON YOUR RISK FACTORS. 1201 00:41:34,376 --> 00:41:38,280 SO IF YOU'RE HIGH, THE C-SECTION 1202 00:41:38,280 --> 00:41:40,115 I HAD LOWER UTERINE SEGMENT YOU 1203 00:41:40,115 --> 00:41:40,715 BETTER REFER OUT. 1204 00:41:40,715 --> 00:41:43,518 AND A LOT ARE LOWER DOWN ON THE 1205 00:41:43,518 --> 00:41:45,220 LIST WE DON'T UNDERSTAND. 1206 00:41:45,220 --> 00:41:47,155 WE WANT A USABLE TABLE WITH THE 1207 00:41:47,155 --> 00:41:50,659 FOLKS IN THE COMMUNITY FOR THAT 1208 00:41:50,659 --> 00:41:52,527 REGARD. 1209 00:41:52,527 --> 00:41:53,662 AND CLEARLY WHAT PIECES, FOUR, 1210 00:41:53,662 --> 00:41:55,597 WE WANT TO CONTINUE, THIS IS, 1211 00:41:55,597 --> 00:41:57,232 WITH SCREENING. 1212 00:41:57,232 --> 00:41:58,867 WE WANT THE DATA FROM THESE 1213 00:41:58,867 --> 00:41:59,167 ULTRASOUNDS. 1214 00:41:59,167 --> 00:42:02,404 WE WANT TO BE ABLE TO MOVE IN 1215 00:42:02,404 --> 00:42:04,406 THE DIRECTION SOMEONE MENTIONED, 1216 00:42:04,406 --> 00:42:06,174 YOU KNOW, WE HAD MR SPECIALIST 1217 00:42:06,174 --> 00:42:09,077 IN OUR COMMUNITY. 1218 00:42:09,077 --> 00:42:10,045 AND SPECTROSOMY. 1219 00:42:10,045 --> 00:42:12,113 THE EASE OF MR IS TO ABILITY TO 1220 00:42:12,113 --> 00:42:15,150 REMOVE THE OPERATOR OF THE 1221 00:42:15,150 --> 00:42:15,784 EQUATION. 1222 00:42:15,784 --> 00:42:17,719 SO, WE CAN DO THIS WITH 1223 00:42:17,719 --> 00:42:18,687 ULTRASOUND WE CAN STANDARDIZED 1224 00:42:18,687 --> 00:42:22,591 THE CLIPS THAT WE WANT, THE 1225 00:42:22,591 --> 00:42:23,725 DEFINITIONS WE WANT, AND WE NEED 1226 00:42:23,725 --> 00:42:25,393 TO MAINTAIN THAT RICH RESOURCE, 1227 00:42:25,393 --> 00:42:26,428 WE CANNOT BE WORKING IN THE 1228 00:42:26,428 --> 00:42:26,628 SILOS. 1229 00:42:26,628 --> 00:42:28,830 WE WANT TO CREATE A STANDARDIZED 1230 00:42:28,830 --> 00:42:30,966 PROTOCOL THAT IS AVAILABLE FOR 1231 00:42:30,966 --> 00:42:33,568 PEOPLE AND THEN AREAS TO 1232 00:42:33,568 --> 00:42:34,669 MAINTAIN THAT. 1233 00:42:34,669 --> 00:42:36,872 SO THIS, DO YOU MIND GOING DOWN, 1234 00:42:36,872 --> 00:42:39,140 PLEASE, TO THE -- PERSON, 1235 00:42:39,140 --> 00:42:42,878 THAT'S, THANK YOU. 1236 00:42:42,878 --> 00:42:47,582 SO THESE ARE KIND OF LIKE OUR 1237 00:42:47,582 --> 00:42:49,551 LIST OF DESIRES IN -- THAT TOUCH 1238 00:42:49,551 --> 00:42:53,421 THE THEMES. 1239 00:42:53,421 --> 00:42:55,590 THE DATA CONSORTIUM, WHATEVER 1240 00:42:55,590 --> 00:42:58,760 THAT BECOMES, ALL ACCRETAS AS 1241 00:42:58,760 --> 00:43:00,662 SOME OF US HAVE WITH PAS 1242 00:43:00,662 --> 00:43:02,197 SQUARED, I UNDERSTAND, IT NEEDS 1243 00:43:02,197 --> 00:43:02,764 TO INCLUDE IMAGING. 1244 00:43:02,764 --> 00:43:05,267 IT NEEDS TO INCLUDE IMAGING. 1245 00:43:05,267 --> 00:43:08,036 AND THESE REGISTRY CAN BE LINKED 1246 00:43:08,036 --> 00:43:09,938 TO EMRs, BUT WHATEVER IT IS, 1247 00:43:09,938 --> 00:43:13,575 IT NEEDS TO BE LINKED HOW TO 1248 00:43:13,575 --> 00:43:16,745 DIAGNOSES WAS OR WAS NOT MADE. 1249 00:43:16,745 --> 00:43:21,583 AND THEN SOMETHING I THINK 1250 00:43:21,583 --> 00:43:25,620 MISSED WAS WE WANT REVIEW AND 1251 00:43:25,620 --> 00:43:26,221 RECOMMENDATION FOR THE STRONG 1252 00:43:26,221 --> 00:43:26,488 ACCRETAS. 1253 00:43:26,488 --> 00:43:31,159 ANY TIME A ACCRETA WAS DIAGNOSED 1254 00:43:31,159 --> 00:43:31,993 INTRAOPERATIVELY OR 1255 00:43:31,993 --> 00:43:33,194 POSTOPERATIVELY BASED ON 1256 00:43:33,194 --> 00:43:34,129 HISTOLOGY OR CLINICAL OUTCOMES 1257 00:43:34,129 --> 00:43:36,998 IT NEEDS TO BE REVIEWED. 1258 00:43:36,998 --> 00:43:38,133 WE DEBATED, INTERNALLY REVIEWED 1259 00:43:38,133 --> 00:43:41,570 OR NEED TO BE REVIEWED WITH 1260 00:43:41,570 --> 00:43:43,605 WHOEVER WE DESIGNATE, LIKE 1261 00:43:43,605 --> 00:43:44,306 MATERNAL MORTALITY IS REVIEWED, 1262 00:43:44,306 --> 00:43:45,907 EVERY SINGLE CASE, AND FROM THAT 1263 00:43:45,907 --> 00:43:48,510 WE LEARN WHAT ARE ADDITIONAL 1264 00:43:48,510 --> 00:43:50,545 RISK FACTORS BOTH CLINICALLY, BY 1265 00:43:50,545 --> 00:43:54,282 ULTRASOUND, AND THEN, ALONG THAT 1266 00:43:54,282 --> 00:43:55,884 MAINTAIN THAT AND CONTINUE TO 1267 00:43:55,884 --> 00:43:56,685 IMPROVE IT. 1268 00:43:56,685 --> 00:43:58,286 THE OTHER THINGS THAT I THINK WE 1269 00:43:58,286 --> 00:43:59,888 DON'T HAVE HIGHLIGHTED HERE, BUT 1270 00:43:59,888 --> 00:44:01,323 IT IS PART OF SCREAMING AND 1271 00:44:01,323 --> 00:44:05,226 DIAGNOSIS, I KNOW IT IS TOUCHED 1272 00:44:05,226 --> 00:44:06,461 IN GROUP FOUR, BUT WE WANT TO 1273 00:44:06,461 --> 00:44:10,332 CONTINUE TO BUILD ON FOLKS THAT 1274 00:44:10,332 --> 00:44:14,302 ARE DIAGNOSED PRENATALLY. 1275 00:44:14,302 --> 00:44:18,540 A WAY TO CONSOLIDATE S.O.A.P. 1276 00:44:18,540 --> 00:44:21,643 FOR BIOBANKS AND A HOME HOME 1277 00:44:21,643 --> 00:44:22,611 THAT WE CAN SHARE FROM. 1278 00:44:22,611 --> 00:44:24,212 WE ARE ALL DOING THE WORK AND 1279 00:44:24,212 --> 00:44:25,180 COLLECTING, THINGS SHOULD NOT BE 1280 00:44:25,180 --> 00:44:26,314 JUST WAITING FOR A PROJECT. 1281 00:44:26,314 --> 00:44:28,783 EVERYONE NEEDS TO KNOW WHAT 1282 00:44:28,783 --> 00:44:29,451 EVERYONE IS DOING, BUILD 1283 00:44:29,451 --> 00:44:31,152 TOGETHER IN AN OPEN SOURCE 1284 00:44:31,152 --> 00:44:31,386 FASHION. 1285 00:44:31,386 --> 00:44:35,724 THAT IS PART OF OUR FANTASY. 1286 00:44:35,724 --> 00:44:37,959 IT WILL BE CENTRALIZED IN SOME 1287 00:44:37,959 --> 00:44:39,227 PLACE, BUT EVERYBODY WILL BE 1288 00:44:39,227 --> 00:44:44,165 WORKING AND ABLE TO SHARE 1289 00:44:44,165 --> 00:44:45,166 ANYTHING ELSE I MISSED? 1290 00:44:45,166 --> 00:44:46,034 FROM URLIVING DOCUMENT. 1291 00:44:46,034 --> 00:44:48,103 >> I WANT TO HIGHLIGHT ONE 1292 00:44:48,103 --> 00:44:49,371 REALLY IMPORTANT THING WE TALKED 1293 00:44:49,371 --> 00:44:54,576 ABOUT THAT CENTERS OF CARE ARE, 1294 00:44:54,576 --> 00:44:56,311 CENTERS OF EXCELLENCE ARE 1295 00:44:56,311 --> 00:44:57,278 STRATIFIED BASED ON DELIVERY NOT 1296 00:44:57,278 --> 00:44:58,747 DIAGNOSIS. 1297 00:44:58,747 --> 00:45:01,016 I THINK IS A RESPONSIBLE FOR 1298 00:45:01,016 --> 00:45:04,686 CENTERS OF CARE TO ENHANCE THAT 1299 00:45:04,686 --> 00:45:06,321 PORTION AND REFERRAL OUT TO 1300 00:45:06,321 --> 00:45:07,455 THEIR COMMUNITY, THESE ARE THE 1301 00:45:07,455 --> 00:45:09,691 PEOPLE WE WANT TO SEE. 1302 00:45:09,691 --> 00:45:13,662 SO I THINK, CENTERS OF 1303 00:45:13,662 --> 00:45:16,331 EXCELLENCE SHOULD EXPAND SIMPLY 1304 00:45:16,331 --> 00:45:17,332 BEYOND DELIVERY TO INCLUDE 1305 00:45:17,332 --> 00:45:18,233 UPSTREAM STAGES, THAT IS A 1306 00:45:18,233 --> 00:45:23,938 REALLY IMPORTANT PIECE OF WHAT 1307 00:45:23,938 --> 00:45:27,409 WE DISCUSSED. 1308 00:45:27,409 --> 00:45:27,909 >> YES. 1309 00:45:27,909 --> 00:45:29,678 >> I HAVE A PLEA. 1310 00:45:29,678 --> 00:45:30,211 I MENTIONED IT YESTERDAY. 1311 00:45:30,211 --> 00:45:33,782 WE NEED TO BE CAREFUL WHEN USING 1312 00:45:33,782 --> 00:45:37,819 DIAGNOSIS AND SCREENING. 1313 00:45:37,819 --> 00:45:40,021 IN MY OPINION, DIAGNOSES IS AT 1314 00:45:40,021 --> 00:45:40,655 SURGERY, AFTER SURGERY, AT 1315 00:45:40,655 --> 00:45:43,558 SURGERY, WE CANNOT TALK ABOUT 1316 00:45:43,558 --> 00:45:44,159 PRENATAL DIAGNOSIS. 1317 00:45:44,159 --> 00:45:45,860 THERE IS NOTE PRENATAL DIAGNOSES 1318 00:45:45,860 --> 00:45:48,463 IN THIS AREA. 1319 00:45:48,463 --> 00:45:49,230 IT IS PRENATAL SCREENING. 1320 00:45:49,230 --> 00:45:50,899 THE REASON I SAY THAT, BECAUSE 1321 00:45:50,899 --> 00:45:53,535 I'M AFRAID THAT PEOPLE HAVE 1322 00:45:53,535 --> 00:45:54,803 CONFUSED THE SCREENING WITH THE 1323 00:45:54,803 --> 00:45:56,905 DIAGNOSIS WHEN THEY ARE SAYING 1324 00:45:56,905 --> 00:45:59,074 THAT WE NEED BETTER ULTRASOUND, 1325 00:45:59,074 --> 00:46:00,709 WE NEED BETTER TECHNIQUES. 1326 00:46:00,709 --> 00:46:03,845 ACTUALLY, THE TECHNIQUES WE HAVE 1327 00:46:03,845 --> 00:46:06,614 ARE OUT STANDING FOR A SCREENING 1328 00:46:06,614 --> 00:46:07,148 TEST. 1329 00:46:07,148 --> 00:46:10,885 I'M AFRAID IF WE START PUSHING 1330 00:46:10,885 --> 00:46:12,087 THE SCREENING TEST, ULTRASOUND, 1331 00:46:12,087 --> 00:46:17,492 OR WHATEVER IT IS, TO INCREASE 1332 00:46:17,492 --> 00:46:18,460 SENSITIVITY, THE, BY DEFINITION 1333 00:46:18,460 --> 00:46:20,228 THE SPECIFICITY IS GOING TO GO 1334 00:46:20,228 --> 00:46:20,862 DOWN. 1335 00:46:20,862 --> 00:46:23,264 WHICH MEANS WE ARE GOING TRADE 1336 00:46:23,264 --> 00:46:25,066 THE FALSE-POSITIVE WITH THE 1337 00:46:25,066 --> 00:46:29,204 FALSE-NEGATIVE OR VICE-VERSA. 1338 00:46:29,204 --> 00:46:33,441 WE NEED TO ACCEPT WE HAVE AN 1339 00:46:33,441 --> 00:46:35,276 OUTSTANDING SCREENING TEST, I 1340 00:46:35,276 --> 00:46:36,978 BELIEVE ULTRASOUND, AND OTHER 1341 00:46:36,978 --> 00:46:37,612 PEOPLE MRI. 1342 00:46:37,612 --> 00:46:40,815 BUT MRI IS IN A SERIES WITH 1343 00:46:40,815 --> 00:46:44,252 ULTRASOUND, NO ONE DOES MRI 1344 00:46:44,252 --> 00:46:44,853 PRIMARILY, WHETHER YOU ADD THE 1345 00:46:44,853 --> 00:46:47,055 MRI OR NOT, THAT IS A DIFFERENT 1346 00:46:47,055 --> 00:46:47,856 STORY. 1347 00:46:47,856 --> 00:46:50,859 WE HAVE AN OUTSTANDING SCREENING 1348 00:46:50,859 --> 00:46:53,695 TEST, WE WILL HAVE A TRADE-OFF 1349 00:46:53,695 --> 00:46:54,763 BETWEEN SENSITIVITY AND 1350 00:46:54,763 --> 00:46:56,164 SPECIFICITY, AND MOVE ON BEYOND 1351 00:46:56,164 --> 00:46:57,398 THAT, GETTING THE PEOPLE THE 1352 00:46:57,398 --> 00:46:59,033 RIGHT ULTRASOUND RATHER THAN 1353 00:46:59,033 --> 00:47:01,736 KEEP FOCUSING ON THE ULTRASOUND. 1354 00:47:01,736 --> 00:47:04,339 >> CAN YOU MAKE A CLARIFICATION. 1355 00:47:04,339 --> 00:47:06,875 >> I THINK WE DO AGREE WITH 1356 00:47:06,875 --> 00:47:08,109 THAT, BUT ALSO IN OUR 1357 00:47:08,109 --> 00:47:09,477 DISCUSSIONS CENTERED ON THE FACT 1358 00:47:09,477 --> 00:47:12,614 THAT SO MANY WOMEN ARE NOT BEING 1359 00:47:12,614 --> 00:47:13,982 DIAGNOSED UNTIL THEY ARE AT 1360 00:47:13,982 --> 00:47:14,249 DELIVERY. 1361 00:47:14,249 --> 00:47:17,852 I THINK, WE CAN DO BETTER IN 1362 00:47:17,852 --> 00:47:18,553 THAT REGARD. 1363 00:47:18,553 --> 00:47:20,255 >> BECAUSE THEY ARE NOT GETTING 1364 00:47:20,255 --> 00:47:21,422 THE RIGHT ULTRASOUND. 1365 00:47:21,422 --> 00:47:21,923 >> WELL, THAT IS KEY. 1366 00:47:21,923 --> 00:47:23,858 THEY NEED TO GET THE RIGHT 1367 00:47:23,858 --> 00:47:24,159 ULTRASOUND. 1368 00:47:24,159 --> 00:47:27,362 >> NOW, IF YOU WANT TO IMPROVE 1369 00:47:27,362 --> 00:47:29,164 THE SCREENING BY MARKERS, OTHER 1370 00:47:29,164 --> 00:47:29,798 THINGS, THAT'S FINE. 1371 00:47:29,798 --> 00:47:32,500 THAT NEEDS TO BE STUDIED. 1372 00:47:32,500 --> 00:47:35,003 BUT RIGHT NOW, FOR, AS FAR AS 1373 00:47:35,003 --> 00:47:35,837 ULTRASOUND, THEY NEED TO GET THE 1374 00:47:35,837 --> 00:47:36,905 RIGHT ULTRASOUND. 1375 00:47:36,905 --> 00:47:37,939 >> CORRECT, TO GO BACK ON WHAT 1376 00:47:37,939 --> 00:47:41,376 YOU SAID, WE AGREE WITH THAT. 1377 00:47:41,376 --> 00:47:45,513 THERE ARE GOOD ULTRASOUND 1378 00:47:45,513 --> 00:47:45,747 MARKERS. 1379 00:47:45,747 --> 00:47:47,215 WE DO KNOW THIS VERY WELL, BUT 1380 00:47:47,215 --> 00:47:48,917 WOMEN ARE NOT GETTING THOSE. 1381 00:47:48,917 --> 00:47:50,652 >> I WANT TO COMMENT, SIMILAR TO 1382 00:47:50,652 --> 00:47:51,019 GEORGE'S POINT. 1383 00:47:51,019 --> 00:47:55,223 IT IS A MAJOR UNDERTAKING TO 1384 00:47:55,223 --> 00:47:56,191 IMPLEMENT A POPULATION-BASED 1385 00:47:56,191 --> 00:47:56,991 SCREENING PROTOCOL. 1386 00:47:56,991 --> 00:47:59,527 SO CERTAINLY, YOU KNOW, THE 1387 00:47:59,527 --> 00:48:00,128 PERFORMANCE CHARACTERISTICS OF 1388 00:48:00,128 --> 00:48:01,262 ULTRASOUND ARE ONE THING, BUT 1389 00:48:01,262 --> 00:48:03,164 YOU'RE GOING TO HAVE TO SCREEN A 1390 00:48:03,164 --> 00:48:03,798 LOT OF PEOPLE IF YOU'RE LOOKING 1391 00:48:03,798 --> 00:48:07,535 AT ANYONE WHO HAD A PRIOR 1392 00:48:07,535 --> 00:48:09,704 C-SECTION AND A PRIOR 1393 00:48:09,704 --> 00:48:10,839 UTERINE-TYPE INTERVENTION. 1394 00:48:10,839 --> 00:48:11,673 NUMBER ONE THAT COST-EFFECTIVE? 1395 00:48:11,673 --> 00:48:13,107 NUMBER TWO, THE PERFORMANCE OF 1396 00:48:13,107 --> 00:48:13,842 YOUR SCREENING TEST. 1397 00:48:13,842 --> 00:48:16,044 BUT THEN WHAT DO YOU DO WITH THE 1398 00:48:16,044 --> 00:48:16,277 RESULTS? 1399 00:48:16,277 --> 00:48:19,147 CAN YOU UTILIZE THAT DATA TO 1400 00:48:19,147 --> 00:48:19,848 ACTUALLY IMPROVE OUTCOMES? 1401 00:48:19,848 --> 00:48:22,150 SO AGAIN, I THINK IT IS 1402 00:48:22,150 --> 00:48:24,319 CERTAINLY A LETTABLE GOAL, 1403 00:48:24,319 --> 00:48:27,121 THAT'S WHERE WE NEED TO BE. 1404 00:48:27,121 --> 00:48:28,256 BUT BEFORE WE MAKE 1405 00:48:28,256 --> 00:48:28,690 RECOMMENDATIONS FOR 1406 00:48:28,690 --> 00:48:29,390 POPULATION-BASED SCREENING THERE 1407 00:48:29,390 --> 00:48:31,159 IS A LOT OF WORK THAT NEEDS TO 1408 00:48:31,159 --> 00:48:31,726 BE DONE. 1409 00:48:31,726 --> 00:48:33,228 >> SO WHAT WE'RE TALKING ABOUT, 1410 00:48:33,228 --> 00:48:35,163 WE ARE DEFINITELY TALKING ABOUT, 1411 00:48:35,163 --> 00:48:37,899 WE ALL AGREE THIS IS A SCREENING 1412 00:48:37,899 --> 00:48:38,233 TEST. 1413 00:48:38,233 --> 00:48:39,167 CLINICAL RISK FACTORS AND 1414 00:48:39,167 --> 00:48:40,001 ULTRASOUND ARE SCREENING. 1415 00:48:40,001 --> 00:48:41,302 WE WERE PRETTY BLACK AND WHITE 1416 00:48:41,302 --> 00:48:43,171 ABOUT OUR GROUP ABOUT THAT. 1417 00:48:43,171 --> 00:48:46,074 THE THING WE WERE UNSURE ABILITY 1418 00:48:46,074 --> 00:48:49,244 IS THE DIAGNOSIS. 1419 00:48:49,244 --> 00:48:49,944 INTEROPERATIVELY OR 1420 00:48:49,944 --> 00:48:50,778 HISTOLOGICALLY, WE DON'T KNOW, 1421 00:48:50,778 --> 00:48:52,647 THIS IS NOT THE SPACE TO DISCUSS 1422 00:48:52,647 --> 00:48:52,847 THAT. 1423 00:48:52,847 --> 00:48:54,449 BUT IF WE'RE DOING THE WORK, WE 1424 00:48:54,449 --> 00:48:56,217 NEED TO BE CLEAR HOW WE'RE 1425 00:48:56,217 --> 00:48:59,587 DEFINING IT. 1426 00:48:59,587 --> 00:48:59,921 KAREN IS NEXT. 1427 00:48:59,921 --> 00:49:02,857 >> ONE OF THE THINGS THAT CAME 1428 00:49:02,857 --> 00:49:04,692 UP IN OUR GROUP THAT OVERLAPS 1429 00:49:04,692 --> 00:49:06,761 WHAT YOU'RE SAYING, TOO, EXACTLY 1430 00:49:06,761 --> 00:49:07,428 WHAT YOU'RE SAYING, GET PEOPLE 1431 00:49:07,428 --> 00:49:09,430 TO THE RIGHT SCREENING AND 1432 00:49:09,430 --> 00:49:11,132 TREATMENT, ONE OF THOSE THINGS. 1433 00:49:11,132 --> 00:49:13,067 ONE OF THE BIG DRIVERS AND 1434 00:49:13,067 --> 00:49:15,436 BARRIERS IS ALSO THE FINANCIAL 1435 00:49:15,436 --> 00:49:16,404 INCENTIVE TO INSTITUTIONS TO 1436 00:49:16,404 --> 00:49:17,105 ACTUALLY REFER OUT. 1437 00:49:17,105 --> 00:49:19,908 THERE ARE A LOT OF HOSPITAL 1438 00:49:19,908 --> 00:49:21,943 SYSTEMS THAT WANT TO HOLD INTO 1439 00:49:21,943 --> 00:49:24,045 THEIR PATIENTS FOR THE VERY 1440 00:49:24,045 --> 00:49:25,446 LAST-MINUTE TO GREEN THERE 1441 00:49:25,446 --> 00:49:25,680 FUNDING. 1442 00:49:25,680 --> 00:49:27,949 HOW CAN WE AS A PUBLIC HEALTH 1443 00:49:27,949 --> 00:49:28,650 SYSTEMS VIEW ACTUALLY GET PEOPLE 1444 00:49:28,650 --> 00:49:30,852 TO DO THE RIGHT THING? 1445 00:49:30,852 --> 00:49:35,156 I THINK WE DO NEED RESEARCH ON 1446 00:49:35,156 --> 00:49:36,457 THAT. 1447 00:49:36,457 --> 00:49:36,724 >> BOB? 1448 00:49:36,724 --> 00:49:39,294 >> JUST A COUPLE MORE COMMENTS. 1449 00:49:39,294 --> 00:49:43,331 AND HOW DO I THINK THIS IS SO 1450 00:49:43,331 --> 00:49:45,900 IMPORTANT TO REMEM FUICIZE WHAT 1451 00:49:45,900 --> 00:49:46,601 GEORGE SAID, THIS CAME UP IN OUR 1452 00:49:46,601 --> 00:49:47,702 GROUP AS WELL. 1453 00:49:47,702 --> 00:49:51,205 IT IS REALLY TRICKY TALKING 1454 00:49:51,205 --> 00:49:55,610 ABOUT THE FIRST TRIMESTER 1455 00:49:55,610 --> 00:49:56,678 ULTRASOUND, BECAUSE DANNY 1456 00:49:56,678 --> 00:49:59,147 POINTED THIS OUT, WHAT IF YOU'RE 1457 00:49:59,147 --> 00:50:02,817 WRONG, YOU THINK IT IS A 1458 00:50:02,817 --> 00:50:05,954 C-SECTION ECTOPIC AND IT IS NOT, 1459 00:50:05,954 --> 00:50:06,821 AND SOMEONE TERMINATES THEIR 1460 00:50:06,821 --> 00:50:07,121 PREGNANCY. 1461 00:50:07,121 --> 00:50:10,658 IT IS SUPER IMPORTANT TO 1462 00:50:10,658 --> 00:50:11,225 ACKNOWLEDGE THE IMPERFECTION 1463 00:50:11,225 --> 00:50:12,093 THERE. 1464 00:50:12,093 --> 00:50:15,096 TO MAKE THE UNEQUIV I IT IS A 1465 00:50:15,096 --> 00:50:16,731 SCREENING TEST RATTER THEN A 1466 00:50:16,731 --> 00:50:17,498 DIAGNOSTIC TEST. 1467 00:50:17,498 --> 00:50:20,268 THE CONSEQUENCES ARE HUGE. 1468 00:50:20,268 --> 00:50:22,203 BUT ESPECIALLY HUGE IF WE'RE 1469 00:50:22,203 --> 00:50:24,072 WRONG ON A CYSTOSCOPY SCARRING 1470 00:50:24,072 --> 00:50:24,272 TOPIC. 1471 00:50:24,272 --> 00:50:26,307 AND SECOND, IT IS IDEAL IF 1472 00:50:26,307 --> 00:50:28,209 EVERYBODY GOT REFERRED, BUT FOR 1473 00:50:28,209 --> 00:50:31,646 THE EARLY ONES, FOR THE 1474 00:50:31,646 --> 00:50:33,514 C-SECTION SCAR ECTOPIC, A LOT OF 1475 00:50:33,514 --> 00:50:35,883 TIMES THOSE WILL BEHAVE LIKE 1476 00:50:35,883 --> 00:50:36,351 MISCARRIAGES. 1477 00:50:36,351 --> 00:50:38,686 IT IS IMPOSSIBLE TO REFER EVERY 1478 00:50:38,686 --> 00:50:39,988 PATIENT WITH A MISCARRIAGE TO A 1479 00:50:39,988 --> 00:50:41,255 TERTIARY CARE CENTER. 1480 00:50:41,255 --> 00:50:45,827 SO WHATEVER WE DO IN ADDITION TO 1481 00:50:45,827 --> 00:50:47,362 ENCOURAGING REFERRAL, THERE 1482 00:50:47,362 --> 00:50:50,331 NEEDS TO BE EDUCATION OF 1483 00:50:50,331 --> 00:50:50,965 EVERYBODY DOING ULTRASOUNDS IN 1484 00:50:50,965 --> 00:50:52,233 THE WORLD WHO DOES EARLY 1485 00:50:52,233 --> 00:50:55,470 ULTRASOUNDS TO BE BETTER AT 1486 00:50:55,470 --> 00:50:57,972 DISTINGUISHING BETWEEN A FAILED 1487 00:50:57,972 --> 00:51:02,643 ENTRY OR PREGNANCY AND A 1488 00:51:02,643 --> 00:51:03,878 C-SECTION SCARED ECTOPIC. 1489 00:51:03,878 --> 00:51:06,981 NOT SAYING WE SHOULDN'T REFER 1490 00:51:06,981 --> 00:51:09,150 PATIENTS AT HIGH-RISK, BUT 1491 00:51:09,150 --> 00:51:10,018 EDUCATE PEOPLE BETTER AT THE 1492 00:51:10,018 --> 00:51:12,553 FRONT LINES. 1493 00:51:12,553 --> 00:51:14,789 >> I HAVE TO MAKE TWO COMMENTS. 1494 00:51:14,789 --> 00:51:17,291 I KEEP HEARING THAT MOST WOMEN 1495 00:51:17,291 --> 00:51:18,259 ARE UNDIAGNOSED. 1496 00:51:18,259 --> 00:51:19,427 DO WE HAVE DATA? 1497 00:51:19,427 --> 00:51:20,795 >> I THINK WE HEARD IT IN THE 1498 00:51:20,795 --> 00:51:22,530 FIRST SINCE. 1499 00:51:22,530 --> 00:51:23,865 >> BUT I DIDN'T SEE ANY DATA. 1500 00:51:23,865 --> 00:51:26,167 THE MAIN REASON, I HAVE BEEN IN 1501 00:51:26,167 --> 00:51:28,836 THE BUSINESS FOR 250 ACCRETAS. 1502 00:51:28,836 --> 00:51:34,208 AROUND THE -- I SEE THIS -- 1503 00:51:34,208 --> 00:51:34,475 DIAGNOSIS. 1504 00:51:34,475 --> 00:51:35,343 THEY ARE REFERRED. 1505 00:51:35,343 --> 00:51:37,278 UNLOSS I SEE COMPLETE ACCRETA. 1506 00:51:37,278 --> 00:51:39,247 AND THE SECOND POINT, MY 1507 00:51:39,247 --> 00:51:40,415 CONCERN, ANY TIME YOU START 1508 00:51:40,415 --> 00:51:43,684 DOING SCREENING, THERE ARE SO 1509 00:51:43,684 --> 00:51:46,988 MANY SEQUENCES FOR THIS. 1510 00:51:46,988 --> 00:51:49,290 THIS IS THE DANGER ABOUT IT. 1511 00:51:49,290 --> 00:51:51,225 SCREENING WILL ALWAYS LEAD TO 1512 00:51:51,225 --> 00:51:54,395 MORE INTERVENTION AND MORE 1513 00:51:54,395 --> 00:51:55,163 FALSE-POSITIVES. 1514 00:51:55,163 --> 00:51:56,898 AND SAYING WE HAVE TO DO -- WE 1515 00:51:56,898 --> 00:51:58,633 HAVE TO DO SO MANY THINGS, 1516 00:51:58,633 --> 00:52:02,870 BECAUSE SO MANY WOMEN ARE GOING 1517 00:52:02,870 --> 00:52:03,237 TO BE DIAGNOSED. 1518 00:52:03,237 --> 00:52:04,839 SO WE HAVE TO BE VERY CAREFUL. 1519 00:52:04,839 --> 00:52:07,809 I ALWAYS LIKE TO SEE DATA BEFORE 1520 00:52:07,809 --> 00:52:08,943 I SEE IT. 1521 00:52:08,943 --> 00:52:12,146 SOMEBODY SAID MOST CASES ARE 1522 00:52:12,146 --> 00:52:12,447 UNDIAGNOSED. 1523 00:52:12,447 --> 00:52:15,416 I HAVE NOT SEEN ANY DATA THAT 1524 00:52:15,416 --> 00:52:16,017 THIS IS TRUE. 1525 00:52:16,017 --> 00:52:20,621 ARE YOU TALKING ABOUT A FULL 1526 00:52:20,621 --> 00:52:22,256 ACCRETA INSTEAD OF TWO 1527 00:52:22,256 --> 00:52:22,557 MILLIMETERS? 1528 00:52:22,557 --> 00:52:26,294 >> I THINK WE SAW DATA. 1529 00:52:26,294 --> 00:52:28,129 >> WHERE. 1530 00:52:28,129 --> 00:52:30,465 >> SO THE REFERENCES I PRESENTED 1531 00:52:30,465 --> 00:52:31,232 YESTERDAY WERE 2016 AND '17. 1532 00:52:31,232 --> 00:52:32,767 YOU ARE CORRECT, THEY ARE NOT 1533 00:52:32,767 --> 00:52:33,568 FIVE YEARS. 1534 00:52:33,568 --> 00:52:36,704 BUT YOU HAVE TO LOOK FOR IT. 1535 00:52:36,704 --> 00:52:39,474 THIS IS, I ENCOURAGE YOU IN YOUR 1536 00:52:39,474 --> 00:52:40,374 OWN INSTITUTION, LOOK THAT 1537 00:52:40,374 --> 00:52:41,442 PATHOLOGY DATABASE. 1538 00:52:41,442 --> 00:52:43,377 I THINK WE ALL THINK WE'RE DOING 1539 00:52:43,377 --> 00:52:44,011 A GREAT JOB. 1540 00:52:44,011 --> 00:52:46,447 WE'RE DOING A GREAT JOB. 1541 00:52:46,447 --> 00:52:48,182 WE SEE THE CASES WHY DIAGNOSE 1542 00:52:48,182 --> 00:52:49,050 THOSE, WE ARE RIGHT. 1543 00:52:49,050 --> 00:52:51,319 YOU DON'T SEE WHAT HAPPENS AT 1544 00:52:51,319 --> 00:52:57,825 3:00 IN THE MORNING I HAD A 1545 00:52:57,825 --> 00:53:01,062 PATIENT THAT BLEED CAN WE DID A 1546 00:53:01,062 --> 00:53:01,395 HYSTERECTOMY. 1547 00:53:01,395 --> 00:53:02,597 I FOUND THREE REFERENCES, A LOT 1548 00:53:02,597 --> 00:53:03,831 OF PEOPLE DON'T UTILIZE THAT. 1549 00:53:03,831 --> 00:53:05,933 >> I THINK ALSO WHEN YOUR 1550 00:53:05,933 --> 00:53:07,468 REFERRAL CENTER, THE NUMBER OF 1551 00:53:07,468 --> 00:53:10,938 IDENTIFIED AND REFERRED PATIENTS 1552 00:53:10,938 --> 00:53:14,275 STARTS TO OUTWEIGH THE 1553 00:53:14,275 --> 00:53:15,343 UNDIAGNOSED ONES AND THEN YOU GO 1554 00:53:15,343 --> 00:53:16,544 OUT IN THE COMMUNITY AND EXACTLY 1555 00:53:16,544 --> 00:53:18,412 THE OPPOSITE. 1556 00:53:18,412 --> 00:53:20,414 YOU HAVE TO CONSIDER AT AN 1557 00:53:20,414 --> 00:53:21,449 ENTIRE POPULATION LEVEL, AND NOT 1558 00:53:21,449 --> 00:53:22,483 JUST A TERTIARY CENTER. 1559 00:53:22,483 --> 00:53:23,751 >> IF I MAY, THIS IS WHAT WE 1560 00:53:23,751 --> 00:53:24,986 IDENTIFIED IN OUR GROUP. 1561 00:53:24,986 --> 00:53:27,255 IT IS REALLY HARD TO GET DATA 1562 00:53:27,255 --> 00:53:28,890 FROM COMMUNITY FACILITIES UNLESS 1563 00:53:28,890 --> 00:53:31,626 YOU HAVE A MANDATORY REPORTING 1564 00:53:31,626 --> 00:53:32,360 SYSTEM. 1565 00:53:32,360 --> 00:53:33,194 JUST TO SHIFT THE DISCUSSION 1566 00:53:33,194 --> 00:53:34,595 JUST A LITTLE BIT BRIEFLY, I 1567 00:53:34,595 --> 00:53:37,165 WOULD REALLY CONSIDER, I THINK 1568 00:53:37,165 --> 00:53:40,868 THE DATABASE AND LOOKING AT THE 1569 00:53:40,868 --> 00:53:42,136 IMAGING, THE REPOSITORY IS 1570 00:53:42,136 --> 00:53:45,173 GREAT, BUT LET'S ALSO LEVERAGE 1571 00:53:45,173 --> 00:53:46,607 TECHNOLOGY, WITH 1572 00:53:46,607 --> 00:53:47,141 TELECOMSALITATION TO HELP. 1573 00:53:47,141 --> 00:53:48,576 CAN WE CROSS THE STATE LINES IF 1574 00:53:48,576 --> 00:53:49,510 SOMEBODY IS IN A PLACE WHERE 1575 00:53:49,510 --> 00:53:52,580 THEY DON'T HAVE AN EXPERT CENTER 1576 00:53:52,580 --> 00:53:55,449 FOR SCREENING, BUT MAYBE I CAN 1577 00:53:55,449 --> 00:53:57,118 REVIEW THE STANDARDIZED IMAGE 1578 00:53:57,118 --> 00:54:03,457 ACQUISITION AND GIVE AN OPINION. 1579 00:54:03,457 --> 00:54:04,559 >> RIGHT. 1580 00:54:04,559 --> 00:54:04,825 GO AHEAD. 1581 00:54:04,825 --> 00:54:05,359 GEORGE. 1582 00:54:05,359 --> 00:54:07,895 >> I HAVE THE SAME EXPERIENCE AS 1583 00:54:07,895 --> 00:54:11,566 DOCTOR IN THE UNDIAGNOSED CASES. 1584 00:54:11,566 --> 00:54:13,634 WE RARELY SEE THEM, NOT ONLY WE 1585 00:54:13,634 --> 00:54:14,835 DON'T SEE THEM, BUT WE GET, I'M 1586 00:54:14,835 --> 00:54:17,171 SURE MANY OF YOU GET CASES TO 1587 00:54:17,171 --> 00:54:19,173 REVIEW, MEDICAL LEGALLY, I DON'T 1588 00:54:19,173 --> 00:54:19,674 SEE THEM. 1589 00:54:19,674 --> 00:54:22,910 SO AGAIN, IT IS NOT A REFERENCE, 1590 00:54:22,910 --> 00:54:24,645 MEDICAL LEGALLY, BUT -- I MEAN, 1591 00:54:24,645 --> 00:54:26,380 WE SHOULD HAVE SEEN THEM IF THEY 1592 00:54:26,380 --> 00:54:29,717 ARE REALLY 50% OF THE CASES ARE 1593 00:54:29,717 --> 00:54:31,652 UNDIAGNOSED AS WE HEAR. 1594 00:54:31,652 --> 00:54:34,522 WE SHOULD SEE 50 CASES A YEAR AT 1595 00:54:34,522 --> 00:54:35,823 PLACES WHERE YOU HAVE HUNDREDS 1596 00:54:35,823 --> 00:54:36,591 OF ACCRETAS. 1597 00:54:36,591 --> 00:54:39,994 WE DON'T SEE THAT. 1598 00:54:39,994 --> 00:54:41,395 SO WHAT MAYBE WE DON'T AGREE ON 1599 00:54:41,395 --> 00:54:41,596 THAT. 1600 00:54:41,596 --> 00:54:44,699 BUT THAT MEANS THIS IS AN 1601 00:54:44,699 --> 00:54:47,068 IMPORTANT AREA THAT WE NEED TO 1602 00:54:47,068 --> 00:54:47,401 STUDY. 1603 00:54:47,401 --> 00:54:49,971 WE NEED DATA, ACCURATE DATA ON 1604 00:54:49,971 --> 00:54:50,371 THAT. 1605 00:54:50,371 --> 00:54:53,641 NOT SOMETHING FROM A DISCHARGE 1606 00:54:53,641 --> 00:54:54,508 SUMMARY. 1607 00:54:54,508 --> 00:54:55,876 EVERY PATIENT WHO BLEEDS IN A 1608 00:54:55,876 --> 00:54:58,145 HOSPITAL WILL HAVE ACCRETA ON 1609 00:54:58,145 --> 00:54:59,180 THEIR DISCHARGE SUMMARILY 1610 00:54:59,180 --> 00:55:00,448 BECAUSE THAT HELPS THEM CODE 1611 00:55:00,448 --> 00:55:02,183 BETTER AND MAKE SURE THAT 1612 00:55:02,183 --> 00:55:07,922 THEY'RE NOT GOING TO BE BLAMED 1613 00:55:07,922 --> 00:55:09,423 FOR SOMETHING. 1614 00:55:09,423 --> 00:55:10,258 >> IF WE DO THIS STUDY, WHAT IS 1615 00:55:10,258 --> 00:55:11,959 THE DEFINITION OF ACCRETA. 1616 00:55:11,959 --> 00:55:14,929 SO WE CAN DO IN THIS ROOM AND 1617 00:55:14,929 --> 00:55:17,064 SEE IF WE HAVE A PROBLEM. 1618 00:55:17,064 --> 00:55:18,833 SO GO WITH PATHOLOGY AND SEE IF 1619 00:55:18,833 --> 00:55:20,601 THEY HAVE ACCRETA. 1620 00:55:20,601 --> 00:55:26,140 >> NO, WE DEVELOP THE PROTOCOL, 1621 00:55:26,140 --> 00:55:27,174 WITH OBGYN ONCOLOGIST, THEY 1622 00:55:27,174 --> 00:55:28,709 DESCRIBE ANYTHING IN THE 1623 00:55:28,709 --> 00:55:29,110 OPERATIVE REPORT. 1624 00:55:29,110 --> 00:55:32,179 THIS IS HOW WE COMPARE OUR 1625 00:55:32,179 --> 00:55:33,514 RESULTS WITH ULTRASOUND AND MRI. 1626 00:55:33,514 --> 00:55:35,916 WHAT DID YOUR SURGEON THAT DID 1627 00:55:35,916 --> 00:55:38,719 THE PROCEDURE AND THEN DETAILS. 1628 00:55:38,719 --> 00:55:40,021 WHAT THEY FOUND, WHEN THEY 1629 00:55:40,021 --> 00:55:41,522 STARTED THE DISSECTION, WHAT IS 1630 00:55:41,522 --> 00:55:44,592 THE AREA. 1631 00:55:44,592 --> 00:55:49,363 THIS IS THE MOST CONCRETE WAY TO 1632 00:55:49,363 --> 00:55:49,897 ESTABLISH, NOT PATHOLOGY, 1633 00:55:49,897 --> 00:55:51,565 BECAUSE THERE ARE MANY THINGS 1634 00:55:51,565 --> 00:55:54,935 THAT HAPPENED DURING THE 1635 00:55:54,935 --> 00:55:55,469 SURGERY. 1636 00:55:55,469 --> 00:55:56,804 >> BOB? 1637 00:55:56,804 --> 00:55:57,071 >> YEAH. 1638 00:55:57,071 --> 00:55:59,640 I MEAN, THIS IS -- THIS IS WHY 1639 00:55:59,640 --> 00:56:00,775 THIS CONFERENCE IS HAPPENING. 1640 00:56:00,775 --> 00:56:04,111 SO I THINK IF YOU REALLY WANTED 1641 00:56:04,111 --> 00:56:05,313 TO GET APPROXIMATELY UPSTREAM 1642 00:56:05,313 --> 00:56:08,149 FOR KNOWLEDGE GAPS YOU COULD 1643 00:56:08,149 --> 00:56:12,453 START WITH WE NEED A 1644 00:56:12,453 --> 00:56:13,554 REPRODUCIBLE OBJECTIVE 1645 00:56:13,554 --> 00:56:15,423 DEFINITION OF ACCRETA THAT IS 1646 00:56:15,423 --> 00:56:15,956 AGREED UPON UNIVERSALLY. 1647 00:56:15,956 --> 00:56:17,391 WE DON'T HAVE THAT. 1648 00:56:17,391 --> 00:56:19,060 AND I DON'T THINK WE CAN GET 1649 00:56:19,060 --> 00:56:20,995 THREE PEOPLE IN THIS ROOM TO 1650 00:56:20,995 --> 00:56:21,829 AGREE ON THAT. 1651 00:56:21,829 --> 00:56:23,397 WE TRIED TO HAMMER IT OUT OVER 1652 00:56:23,397 --> 00:56:24,999 TWO DAYS. 1653 00:56:24,999 --> 00:56:27,535 SO, I WOULD PUT THAT AS BEING A 1654 00:56:27,535 --> 00:56:28,135 REALLY IMPORTANT KNOWLEDGE GAP 1655 00:56:28,135 --> 00:56:29,970 TO FILL IN BEFORE WE CAN EVEN 1656 00:56:29,970 --> 00:56:35,576 TAKE ANY OF THE NEXT STEPS. 1657 00:56:35,576 --> 00:56:38,913 >> I ALSO WANT TO ADD TO THAT, 1658 00:56:38,913 --> 00:56:43,184 SO, DOCTOR? 1659 00:56:43,184 --> 00:56:47,421 >> I HAVE -- COMMENTS AND 1660 00:56:47,421 --> 00:56:49,390 QUESTION FROM -- CRITICAL 1661 00:56:49,390 --> 00:56:50,324 GYNECOLOGY POINT OF VIEW. 1662 00:56:50,324 --> 00:56:52,526 ONE IS THE PATIENT REFERRED TO 1663 00:56:52,526 --> 00:56:55,029 AS THE VERY LAST MOMENT, LET'S 1664 00:56:55,029 --> 00:56:57,865 SAY 32 WEEKS, 33 WEEKS AND THE 1665 00:56:57,865 --> 00:57:02,336 CHANCE OF A CASE -- AND MAKE A 1666 00:57:02,336 --> 00:57:05,539 HUGE -- NUMBER TWO IS -- 1667 00:57:05,539 --> 00:57:10,211 DIAGNOSTIC -- AS THEY SAY, 1668 00:57:10,211 --> 00:57:12,380 ACCRETA ON THE -- C-SECTION, 1669 00:57:12,380 --> 00:57:15,316 PLACENTA SEPARATE AND THEN WE 1670 00:57:15,316 --> 00:57:22,089 ARE LOSING -- BECAUSE WE MADE -- 1671 00:57:22,089 --> 00:57:25,760 ACCRETA CASE IN THE MORNING. 1672 00:57:25,760 --> 00:57:31,332 SO WE LOSE THE C-SECTION AND 1673 00:57:31,332 --> 00:57:32,333 HYSTERECTOMY, WE ARE LOSING OUR 1674 00:57:32,333 --> 00:57:32,600 DAY. 1675 00:57:32,600 --> 00:57:36,103 SO THIS IS VERY IMPORTANT. 1676 00:57:36,103 --> 00:57:36,904 I THINK. 1677 00:57:36,904 --> 00:57:39,039 >> I JUST WANT TO ADD, JUST A 1678 00:57:39,039 --> 00:57:39,407 POINT FOR DATA. 1679 00:57:39,407 --> 00:57:41,709 SO I THINK THAT 50% NUMBER IS 1680 00:57:41,709 --> 00:57:42,710 NOT TOO FAR OFF. 1681 00:57:42,710 --> 00:57:45,312 MAYBE IT IS NOT 50, BUT I THINK 1682 00:57:45,312 --> 00:57:47,615 IT IS HIGH. 1683 00:57:47,615 --> 00:57:50,151 THE MOST RECENT DATA FROM THE 1684 00:57:50,151 --> 00:57:51,719 NATIONAL INPATIENT STANDARD. 1685 00:57:51,719 --> 00:57:57,858 AND 40% OF IT ACCRETA, WE USE IT 1686 00:57:57,858 --> 00:57:58,559 FOR MANY OTHER DISEASE 1687 00:57:58,559 --> 00:58:01,796 PROCESSES, 47% AFTER 37 WEEKS, 1688 00:58:01,796 --> 00:58:05,666 AND 27% AFTER 37 WEEKS AND 14% 1689 00:58:05,666 --> 00:58:07,334 OF PROACCRETAS. 1690 00:58:07,334 --> 00:58:10,404 THOSE AFTER 37 WEEKS ARE 1691 00:58:10,404 --> 00:58:11,405 MISDIAGNOSED. 1692 00:58:11,405 --> 00:58:14,608 WE CAN DISAGREE THERE. 1693 00:58:14,608 --> 00:58:15,109 OR VERY LATE DIAGNOSIS. 1694 00:58:15,109 --> 00:58:17,511 SO I THINK THAT NUMBER THAT WAS 1695 00:58:17,511 --> 00:58:19,046 SHARED WITH US YESTERDAY ISN'T 1696 00:58:19,046 --> 00:58:20,448 THAT FAR-OFF, MAYBE THIS IS NOT 1697 00:58:20,448 --> 00:58:23,951 THE BEST DATA TO EXTRAPOLATE IT 1698 00:58:23,951 --> 00:58:24,151 FROM. 1699 00:58:24,151 --> 00:58:26,454 THAT IS, TOO, THAT YOU SHARED, 1700 00:58:26,454 --> 00:58:31,759 BUT I THINK IN OUR CENTERS, 1701 00:58:31,759 --> 00:58:33,093 YEAH. 1702 00:58:33,093 --> 00:58:34,795 IT IS PROBABLY LESS THAN 5%, 1703 00:58:34,795 --> 00:58:36,897 10%, BUT THAT IS NOT WHERE MOST 1704 00:58:36,897 --> 00:58:37,731 PEOPLE ARE GETTING IT. 1705 00:58:37,731 --> 00:58:40,434 THAT'S WHERE WE NEED TO FOCUS 1706 00:58:40,434 --> 00:58:40,701 THIS WORK. 1707 00:58:40,701 --> 00:58:43,170 >> JUST TO BUILD ON THAT, 1708 00:58:43,170 --> 00:58:44,438 THOUGH. 1709 00:58:44,438 --> 00:58:47,475 TWO OF THESE STUDIES, ONE IN MY 1710 00:58:47,475 --> 00:58:51,178 OWN INSTITUTION AT STANFORD, 1711 00:58:51,178 --> 00:58:51,612 50%. 1712 00:58:51,612 --> 00:58:53,747 WE DIDN'T DO ALL ULTRASOUND 1713 00:58:53,747 --> 00:58:55,182 SOMETIMES THEY COME IN FROM THE 1714 00:58:55,182 --> 00:59:00,454 COMMUNITY AND DELIVER. 1715 00:59:00,454 --> 00:59:04,792 BUT INPATIENT THAT DELIVES AND 1716 00:59:04,792 --> 00:59:05,493 KEEPS BLEEDING. 1717 00:59:05,493 --> 00:59:07,695 YOU OVER SEW THE PLACENTA AND 1718 00:59:07,695 --> 00:59:09,463 YOU MOVE TO HYSTERECTOMY. 1719 00:59:09,463 --> 00:59:11,432 IF PEOPLE LOOKED IN THEIR 1720 00:59:11,432 --> 00:59:12,933 PATHOLOGY DATABASES THEY MIGHT 1721 00:59:12,933 --> 00:59:15,002 BE SURPRISED, A LOT OF CASES 1722 00:59:15,002 --> 00:59:18,906 YOU'RE THINK IT WAS ATTONE, BUT 1723 00:59:18,906 --> 00:59:19,773 THEY FOUND ACCRETA THERE. 1724 00:59:19,773 --> 00:59:21,108 >> SO KNOWLEDGE GAP ONE THAT WE 1725 00:59:21,108 --> 00:59:24,979 HAD SEEMS LIKE TOP OF THE LIST 1726 00:59:24,979 --> 00:59:27,781 TO UNDERSTAND OUR DENOMINATOR OF 1727 00:59:27,781 --> 00:59:28,916 WHATEVER PERCENT THAT IS, IN 1728 00:59:28,916 --> 00:59:31,285 YOUR CASE FROM ZERO TO 50% SEEMS 1729 00:59:31,285 --> 00:59:34,688 LIKE THE RANGE, BUT IF WE DON'T 1730 00:59:34,688 --> 00:59:35,289 KNOW THE DENOMINATOR WE CAN'T 1731 00:59:35,289 --> 00:59:35,789 DEFINE THAT. 1732 00:59:35,789 --> 00:59:39,126 WHEN WE HAVE THE DEFINITION, THE 1733 00:59:39,126 --> 00:59:43,163 FOCUS ON SCREENING, WE CAN MAKE 1734 00:59:43,163 --> 00:59:44,031 RECOMMENDATIONS INCLUDING 1735 00:59:44,031 --> 00:59:45,065 EDUCATION AND THEN OUR PIE IN 1736 00:59:45,065 --> 00:59:46,700 THE SKY GOALS. 1737 00:59:46,700 --> 00:59:47,167 RIGHT? 1738 00:59:47,167 --> 00:59:52,706 DO WE FEEL OKAY? 1739 00:59:52,706 --> 00:59:53,607 THERE. 1740 00:59:53,607 --> 00:59:56,544 >> I JUST HAD A COMMENT ABOUT 1741 00:59:56,544 --> 00:59:57,545 THE DEFINITION OF ACCRETA. 1742 00:59:57,545 --> 01:00:01,849 THAT IS A REALLY IMPORTANT 1743 01:00:01,849 --> 01:00:02,049 THING. 1744 01:00:02,049 --> 01:00:12,593 WE THINK OF PATHOLOGY AS A GOLD 1745 01:01:56,397 --> 01:01:58,966 [ LOST AUDIO ] 1746 01:01:58,966 --> 01:02:01,468 >> MORBIDITY AND AN AFFECT ON 1747 01:02:01,468 --> 01:02:02,569 THE PATIENT, AND PATIENT 1748 01:02:02,569 --> 01:02:05,005 EXPERIENCE STANDPOINT, THAT IS 1749 01:02:05,005 --> 01:02:06,974 FOR PLACENTA ACCRETA SPECTRUM 1750 01:02:06,974 --> 01:02:09,443 >> I DO WANT TO LIKE, DISCLOSER 1751 01:02:09,443 --> 01:02:11,378 THERE IS NO PATHOLOGIST HERE. 1752 01:02:11,378 --> 01:02:14,648 SO WE ARE SPEAKING ON BEHALF OF 1753 01:02:14,648 --> 01:02:16,150 PATHOLOGY AS A SUBSPECIALTY, BUT 1754 01:02:16,150 --> 01:02:23,624 TO POINT THAT OUT. 1755 01:02:23,624 --> 01:02:24,358 >> OKAY. 1756 01:02:24,358 --> 01:02:29,630 >> OKAY. 1757 01:02:29,630 --> 01:02:36,403 WORKING GROUP FOUR. 1758 01:02:36,403 --> 01:02:37,438 >> HELLO AGAIN. 1759 01:02:37,438 --> 01:02:40,207 I WAS VERY HAPPY TO WORK WITH MY 1760 01:02:40,207 --> 01:02:41,642 POWER GROUP THIS MORNING. 1761 01:02:41,642 --> 01:02:43,844 VERY HAPPY TO WRAP UP THE DAY 1762 01:02:43,844 --> 01:02:44,878 ONCE AGAIN. 1763 01:02:44,878 --> 01:02:47,181 AND HOPEFULLY, WE HAVE SLIDES TO 1764 01:02:47,181 --> 01:02:48,582 TALK ABOUT. 1765 01:02:48,582 --> 01:02:50,617 AS A REMINDER, GROUP FOUR WAS A 1766 01:02:50,617 --> 01:02:54,021 LITTLE BIT OF A MIX OF TOPICS, 1767 01:02:54,021 --> 01:02:54,822 BUT HONESTLY THE DISCUSSIONS 1768 01:02:54,822 --> 01:02:57,524 WENT TOGETHER VERY WELL. 1769 01:02:57,524 --> 01:03:01,095 SO WE BROKE OUR -- OUR SLIDES 1770 01:03:01,095 --> 01:03:04,465 DOWN BASED ON OUR THREE TOPICS. 1771 01:03:04,465 --> 01:03:06,233 JUST A SECOND, IF I CAN MOVE 1772 01:03:06,233 --> 01:03:08,702 THEM. 1773 01:03:08,702 --> 01:03:10,971 LIKE THAT MAYBE. 1774 01:03:10,971 --> 01:03:12,506 OKAY. 1775 01:03:12,506 --> 01:03:14,007 SO, OUR THREE AREAS, FIRST WAS 1776 01:03:14,007 --> 01:03:16,210 BIOMARKERS CAN DIAGNOSIS. 1777 01:03:16,210 --> 01:03:19,513 AND FOR EACH OF THESE AREAS WE 1778 01:03:19,513 --> 01:03:20,814 BRAINSTORMED ON KNOWLEDGE GAPS. 1779 01:03:20,814 --> 01:03:23,550 WE PUT IN A SECTION ON KIND OF 1780 01:03:23,550 --> 01:03:24,384 GENERAL PRACTICE RECOMMENDATIONS 1781 01:03:24,384 --> 01:03:28,322 THAT WE THE WE COULD MAKE NOW. 1782 01:03:28,322 --> 01:03:28,722 AND THEN RESEARCH 1783 01:03:28,722 --> 01:03:30,457 RECOMMENDATIONS AND WHAT WE ARE 1784 01:03:30,457 --> 01:03:31,725 MISSING AND WHAT WE NEED IN 1785 01:03:31,725 --> 01:03:34,628 ORDER TO PURSUE THESE RESEARCH 1786 01:03:34,628 --> 01:03:34,828 GOALS. 1787 01:03:34,828 --> 01:03:38,298 SO FOR BIOMARKERS THE KNOWLEDGE 1788 01:03:38,298 --> 01:03:40,134 GAPS WERE WHAT BIOSPECIMENS 1789 01:03:40,134 --> 01:03:42,136 SHOULD BE COLLECTED, YOU KNOW, 1790 01:03:42,136 --> 01:03:45,572 AS AN EXAMPLE, SHOULD WE BE 1791 01:03:45,572 --> 01:03:46,673 FOCUS ON SERUM, URINE, ALL OF 1792 01:03:46,673 --> 01:03:51,345 THESE TO FIND THE PERFECT 1793 01:03:51,345 --> 01:03:51,945 SPECIMEN, WHAT PLATFORM IS THE 1794 01:03:51,945 --> 01:03:53,947 BEST TO USE IN TERMS OF STANDARD 1795 01:03:53,947 --> 01:03:56,583 PROCEDURES FOR COLLECTING AS 1796 01:03:56,583 --> 01:04:01,755 WELL AS ANALYZING AND WHAT 1797 01:04:01,755 --> 01:04:02,222 MODALITY TO USE. 1798 01:04:02,222 --> 01:04:05,025 WHAT POINT OF GESTATION IS 1799 01:04:05,025 --> 01:04:09,229 OPTIMAL FOR THE BIOMARKER, THE 1800 01:04:09,229 --> 01:04:10,664 BIOMARKER PREDICT DISEASE 1801 01:04:10,664 --> 01:04:12,299 SEVERITY, AND SPECIFIC MORBIDITY 1802 01:04:12,299 --> 01:04:13,834 AND OUTCOMES, AND CAN BIOMARKERS 1803 01:04:13,834 --> 01:04:16,003 HELP TO TAILOR TREATMENT. 1804 01:04:16,003 --> 01:04:17,371 I'M SORRY, I KEEP RUNNING THE 1805 01:04:17,371 --> 01:04:18,071 SCREEN HERE. 1806 01:04:18,071 --> 01:04:19,773 WE DIDN'T HAVE A PRACTICE 1807 01:04:19,773 --> 01:04:21,375 RECOMMENDATION RIGHT NOW WITH 1808 01:04:21,375 --> 01:04:22,442 REGARD TO BIOMARKER, BECAUSE WE 1809 01:04:22,442 --> 01:04:24,545 HAVE NOT VALIDATED A SINGLE 1810 01:04:24,545 --> 01:04:25,813 BIOMARKER, THAT WILL BE COMING 1811 01:04:25,813 --> 01:04:27,781 IN THE FUTURE. 1812 01:04:27,781 --> 01:04:29,183 FOR RESEARCH RECOMMENDATIONS, 1813 01:04:29,183 --> 01:04:30,717 OUR STATEMENT WAS FOR PATIENTS 1814 01:04:30,717 --> 01:04:34,121 WHO ARE AT RISK FOR PAS AND 1815 01:04:34,121 --> 01:04:38,025 THOSE WITH SUSPECTED PAS -- I'M 1816 01:04:38,025 --> 01:04:38,625 SORRY, THIS IS IN THE WRONG 1817 01:04:38,625 --> 01:04:42,763 PLACE, THIS IS OUR PRACTICE 1818 01:04:42,763 --> 01:04:43,130 RECOMMENDATION. 1819 01:04:43,130 --> 01:04:44,898 SO PATIENTS AT RISK FOR PAS OR 1820 01:04:44,898 --> 01:04:47,201 SUSPECTED WITH PAS, CAN HAVE AN 1821 01:04:47,201 --> 01:04:48,402 OPPORTUNITY TO PARTICIPATE IN 1822 01:04:48,402 --> 01:04:50,604 TRANSLATIONAL RESEARCH, I THINK 1823 01:04:50,604 --> 01:04:51,405 THAT MESSAGE SHOULD GO OUT WHO 1824 01:04:51,405 --> 01:04:53,574 TAKE CARE OF THE PATIENTS. 1825 01:04:53,574 --> 01:04:59,179 BUT WE DON'T HAVE A PRACTICE 1826 01:04:59,179 --> 01:05:01,448 GUIDELINE TO USE THESE. 1827 01:05:01,448 --> 01:05:02,382 AND VALIDATE A WIDE BIOMARKER 1828 01:05:02,382 --> 01:05:05,519 FOR PAS. 1829 01:05:05,519 --> 01:05:08,856 BOTH IN TERMS OF YES/NO OUTCOME 1830 01:05:08,856 --> 01:05:10,490 AND TO PREDICT MORBIDITY. 1831 01:05:10,490 --> 01:05:12,926 AND THE NEXT STEP AFTER THAT 1832 01:05:12,926 --> 01:05:14,061 INCORPORATE THE BIOMARKER TEST 1833 01:05:14,061 --> 01:05:16,797 INTO A MORE GLOBAL PREDICTION 1834 01:05:16,797 --> 01:05:18,098 MODEL WHICH ALSO INCLUDES 1835 01:05:18,098 --> 01:05:21,001 CLINICAL RISK FACTORS AND 1836 01:05:21,001 --> 01:05:21,301 ULTRASOUND. 1837 01:05:21,301 --> 01:05:24,504 THE MAJOR OBSTACLES IN THE AREA, 1838 01:05:24,504 --> 01:05:25,939 CLEARLY TO US, THE BIGGEST ONE 1839 01:05:25,939 --> 01:05:27,975 IS FUNDING AND RESOURCES. 1840 01:05:27,975 --> 01:05:29,977 THIS IS A VERY EXTENSIVE 1841 01:05:29,977 --> 01:05:31,211 UNDERTAKING, WE ARE GETTING INTO 1842 01:05:31,211 --> 01:05:32,880 THE VALIDATION STAGE, WE NEED A 1843 01:05:32,880 --> 01:05:34,014 LOT OF PATIENTS. 1844 01:05:34,014 --> 01:05:36,650 YOU NEED TO START COLLECTING THE 1845 01:05:36,650 --> 01:05:36,884 SAMPLES. 1846 01:05:36,884 --> 01:05:38,619 NOT JUST ON PATIENTS WITH 1847 01:05:38,619 --> 01:05:40,754 SUSPECTED PAS GOING INTO A PAS 1848 01:05:40,754 --> 01:05:41,955 CENTER. 1849 01:05:41,955 --> 01:05:43,957 BUT ON PREGNANT PATIENTS, A 1850 01:05:43,957 --> 01:05:44,491 BROADER GROUP OF PREGNANT 1851 01:05:44,491 --> 01:05:46,460 PATIENTS WITH RISK FACTORS YOU 1852 01:05:46,460 --> 01:05:53,934 WILL TRY TO APPLY THIS TEST TO. 1853 01:05:53,934 --> 01:05:55,135 WE DON'T HAVE STANDARD 1854 01:05:55,135 --> 01:05:56,236 PROCEDURES RIGHT NOW. 1855 01:05:56,236 --> 01:05:57,604 A LARGE NUMBER OF PATIENTS ARE 1856 01:05:57,604 --> 01:05:58,005 NEEDED. 1857 01:05:58,005 --> 01:05:59,606 AND JUST THE DIFFICULTY OF 1858 01:05:59,606 --> 01:06:00,674 CONDUCTING A MULTICENTER STUDY 1859 01:06:00,674 --> 01:06:03,877 LIKE THIS AND KEEPING THINGS 1860 01:06:03,877 --> 01:06:04,211 STANDARDIZED. 1861 01:06:04,211 --> 01:06:06,546 THE KEY METHODOLOGIES THAT ARE 1862 01:06:06,546 --> 01:06:07,748 NEEDED HERE TO DO PERSPECTIVE 1863 01:06:07,748 --> 01:06:08,815 RESEARCH AND OBVIOUSLY HAVE THE 1864 01:06:08,815 --> 01:06:12,653 VOLUME TO DO IT AS A MULTICENTER 1865 01:06:12,653 --> 01:06:13,186 STUDY. 1866 01:06:13,186 --> 01:06:15,689 THE NEXT AREA WAS RISK FACTORS 1867 01:06:15,689 --> 01:06:16,356 AND PREVENTION. 1868 01:06:16,356 --> 01:06:19,059 AND WE HAD A LOT OF KNOWLEDGE 1869 01:06:19,059 --> 01:06:20,360 GAPS HERE. 1870 01:06:20,360 --> 01:06:23,230 THE FIRST IS JUST WHAT IS THE 1871 01:06:23,230 --> 01:06:24,531 OPTIMAL C-SECTION DELIVERY RATE 1872 01:06:24,531 --> 01:06:25,999 FOR GOOD MATERNAL AND FETAL 1873 01:06:25,999 --> 01:06:27,434 OUTCOMES. 1874 01:06:27,434 --> 01:06:29,136 THAT IS A BIG QUESTION THAT GOES 1875 01:06:29,136 --> 01:06:29,670 BEYOND PAS. 1876 01:06:29,670 --> 01:06:30,871 SOME PEOPLE IN VARIOUS WAYS 1877 01:06:30,871 --> 01:06:35,375 TRIED TO ADDRESS THIS, BUT WHAT 1878 01:06:35,375 --> 01:06:36,143 WE'RE SAYING THIS SPECIFIC 1879 01:06:36,143 --> 01:06:38,178 QUESTION NEEDS TO BE ADDRESSED 1880 01:06:38,178 --> 01:06:40,113 WITH PAS AND NOT JUST IMMEDIATE, 1881 01:06:40,113 --> 01:06:42,282 LIKE FUTURE PAS AND NOT JUST 1882 01:06:42,282 --> 01:06:44,851 IMMEDIATE OUTCOMES IN MIND. 1883 01:06:44,851 --> 01:06:47,254 DOES C-SECTION TECHNIQUE 1884 01:06:47,254 --> 01:06:48,188 CONTRIBUTE TO THE INCREASES RATE 1885 01:06:48,188 --> 01:06:48,422 OF PAS. 1886 01:06:48,422 --> 01:06:52,426 IF SO, WHAT IS THE OPTIMAL 1887 01:06:52,426 --> 01:06:53,760 C-SECTION TECHNIQUES WITH 1888 01:06:53,760 --> 01:06:55,062 SHORT-TERM OUTCOMES AND LONGER 1889 01:06:55,062 --> 01:06:56,496 TERM OUTCOMES, AND THINKING 1890 01:06:56,496 --> 01:06:57,831 ABOUT FUTURE PAS. 1891 01:06:57,831 --> 01:07:02,035 AND SOMETHING WE CAN DO BEYOND 1892 01:07:02,035 --> 01:07:03,036 JUST STANDARD C-SECTION CAN HELP 1893 01:07:03,036 --> 01:07:05,038 WITH WOUND HEALING AT THE TIME 1894 01:07:05,038 --> 01:07:09,176 OF C-SECTION TO IMPROVE FUTURE 1895 01:07:09,176 --> 01:07:09,443 OUTCOMES. 1896 01:07:09,443 --> 01:07:11,311 AND THE OPTIMAL PREGNANCY 1897 01:07:11,311 --> 01:07:14,915 INTERVAL, AND THE OPTIMAL WAY TO 1898 01:07:14,915 --> 01:07:15,782 DIAGNOSE PREGNANCY. 1899 01:07:15,782 --> 01:07:17,985 THE OPTIMAL TREATMENT FOR 1900 01:07:17,985 --> 01:07:19,419 C-SECTION PREGNANCY WITH REGARD 1901 01:07:19,419 --> 01:07:23,824 TO SHORT AND LONG-TERM OUTCOMES. 1902 01:07:23,824 --> 01:07:26,360 WHAT ARE THE SPECIFICS OF 1903 01:07:26,360 --> 01:07:27,461 TECHNIQUE THAT CONTRIBUTE TO 1904 01:07:27,461 --> 01:07:30,297 PAS, THIS IS A SMALLER 1905 01:07:30,297 --> 01:07:31,431 POPULATION, THEN EVERYBODY WITH 1906 01:07:31,431 --> 01:07:33,667 A C-SECTION. 1907 01:07:33,667 --> 01:07:35,969 BUT IT MIGHT BE LOW-HANGING 1908 01:07:35,969 --> 01:07:38,839 FRUIT TO HAVE SOMETHING 1909 01:07:38,839 --> 01:07:40,974 MODIFIABLE TO REDUCE THE RISK. 1910 01:07:40,974 --> 01:07:42,609 DOES NONC-SECTION TECHNIQUE 1911 01:07:42,609 --> 01:07:45,078 CONTRIGUTE AND THE CONSEQUENCES 1912 01:07:45,078 --> 01:07:47,714 OF JUST INCIDENTALLY FOUND 1913 01:07:47,714 --> 01:07:48,081 C-SECTION SCAR. 1914 01:07:48,081 --> 01:07:52,886 SO AFTER A LOT OF WORK WE 1915 01:07:52,886 --> 01:07:55,222 NARROWED DOWN RESEARCH 1916 01:07:55,222 --> 01:07:56,623 RECOMMENDATIONS. 1917 01:07:56,623 --> 01:07:57,824 AVOIDING UNNECESSARY C-SECTION 1918 01:07:57,824 --> 01:07:59,626 DELIVERY AND UTERINE SURGERY. 1919 01:07:59,626 --> 01:08:01,161 PROMOTING EARLY DIAGNOSES AND 1920 01:08:01,161 --> 01:08:03,964 TREATMENT FOR C-SECTION SCAR 1921 01:08:03,964 --> 01:08:04,765 PREGNANCY. 1922 01:08:04,765 --> 01:08:05,999 PATIENTS WITH C-SECTION SCAR 1923 01:08:05,999 --> 01:08:07,534 PREGNANCY WHO CONTINUE TO 1924 01:08:07,534 --> 01:08:09,903 PREGNANCY, SHOULD BE REFERRED TO 1925 01:08:09,903 --> 01:08:10,704 PAS CENTERS. 1926 01:08:10,704 --> 01:08:14,674 AND PAS NEEDS TO BE INCORPORATED 1927 01:08:14,674 --> 01:08:15,208 COUNSELING PATIENTS ON ANY 1928 01:08:15,208 --> 01:08:15,475 PROCEDURE. 1929 01:08:15,475 --> 01:08:17,477 IT SOUNDS KIND OF OBVIOUS BUT 1930 01:08:17,477 --> 01:08:21,248 DISCUSSES RIGHT NOW, THIS IS ON 1931 01:08:21,248 --> 01:08:24,518 THE GENECOLOGY AND REPRODUCTIVE 1932 01:08:24,518 --> 01:08:27,020 WORLD, WHEN CONVERSATIONS ARE 1933 01:08:27,020 --> 01:08:28,255 SOME, SHOULD WE DO THIS, THE 1934 01:08:28,255 --> 01:08:29,456 CONCERNS ABOUT FUTURE PREGNANCY 1935 01:08:29,456 --> 01:08:30,557 RISK ARE PROBABLY NOT 1936 01:08:30,557 --> 01:08:32,859 INCORPORATED IN THE COUNSELING, 1937 01:08:32,859 --> 01:08:33,994 BUT THEY SHOULD BE. 1938 01:08:33,994 --> 01:08:35,962 FOR RESEARCH RECOMMENDATIONS AND 1939 01:08:35,962 --> 01:08:38,832 PRIORITIES, WHAT IS THE OPTIMAL 1940 01:08:38,832 --> 01:08:42,502 C-SECTION DELIVERY RATE FOR GOOD 1941 01:08:42,502 --> 01:08:46,873 MATERNAL FETAL OUTCOMES. 1942 01:08:46,873 --> 01:08:48,108 CAN C-SECTION BE IMPROVED, THE 1943 01:08:48,108 --> 01:08:49,076 CONCRETE THINGS WE CAN CHANGE 1944 01:08:49,076 --> 01:08:50,043 ABOUT C-SECTION. 1945 01:08:50,043 --> 01:08:52,279 THE OPTIMAL METHOD FOR DIAGNOSES 1946 01:08:52,279 --> 01:08:54,481 AND TREATING A C-SECTION SCAR 1947 01:08:54,481 --> 01:08:56,817 PREGNANCY, AND VALUE FOR 1948 01:08:56,817 --> 01:08:59,553 SCREENING AND TREATING NICHES. 1949 01:08:59,553 --> 01:09:00,120 OBSTACLES RIGHT NOW, LIKE WE 1950 01:09:00,120 --> 01:09:00,787 TALKED ABOUT YESTERDAY, IT IS 1951 01:09:00,787 --> 01:09:02,823 VERY HARD TO GO BACK AND GET 1952 01:09:02,823 --> 01:09:05,725 DETAILS OF PRIOR SURGERY WHEN WE 1953 01:09:05,725 --> 01:09:06,426 ARE SEEING THE PATIENT AT THE 1954 01:09:06,426 --> 01:09:07,027 TIME OF THEIR PAS. 1955 01:09:07,027 --> 01:09:11,164 SO IT WOULD BE IMPORTANT TO DO 1956 01:09:11,164 --> 01:09:13,600 ANY STUDIES LIKE THIS THAT WOULD 1957 01:09:13,600 --> 01:09:16,503 COULD CONDUCT PROSPECK POSITIVE 1958 01:09:16,503 --> 01:09:17,971 AND LONGITUDINAL RESEARCH AND 1959 01:09:17,971 --> 01:09:21,141 LINK FACTORS TO THEIR FUTURE PAS 1960 01:09:21,141 --> 01:09:21,341 RISK. 1961 01:09:21,341 --> 01:09:22,375 OUR LAST TOPIC AND VERY 1962 01:09:22,375 --> 01:09:24,711 IMPORTANT WAS ON PATIENT 1963 01:09:24,711 --> 01:09:27,214 EXPERIENCE AND LONG-TERM HEALTH. 1964 01:09:27,214 --> 01:09:28,748 KNOWLEDGE GAPS INCLUDED, YOU 1965 01:09:28,748 --> 01:09:29,616 KNOW, WHAT INTERVENTIONS WE 1966 01:09:29,616 --> 01:09:31,418 SHOULD BE DOING TO IMPROVE THE 1967 01:09:31,418 --> 01:09:33,954 MENTAL AND PHYSICAL OUTCOMES FOR 1968 01:09:33,954 --> 01:09:35,188 PATIENTS WHO HAVE PAS. 1969 01:09:35,188 --> 01:09:35,989 AND THIS IS BOTH IN THE 1970 01:09:35,989 --> 01:09:38,558 SHORT-TERM AS WELL AS IN THE 1971 01:09:38,558 --> 01:09:39,159 LONG-TERM. 1972 01:09:39,159 --> 01:09:41,194 WHAT ARE THE BARRIERS TO 1973 01:09:41,194 --> 01:09:43,530 IMPLEMENTING THESE 1974 01:09:43,530 --> 01:09:45,165 INTERVENTIONS, WHAT SHOULD 1975 01:09:45,165 --> 01:09:45,866 PATIENTS EXCEPT FOR THEIR 1976 01:09:45,866 --> 01:09:47,067 LONG-TERM HEALTH FAR INTO THE 1977 01:09:47,067 --> 01:09:48,668 FUTURE AFTER THEY HAVE GONE INTO 1978 01:09:48,668 --> 01:09:51,338 THE SURGERIES AND LONG-TERM 1979 01:09:51,338 --> 01:09:52,639 PSYCHOLOGICAL IMPACTS. 1980 01:09:52,639 --> 01:09:55,442 OUR RECOMMENDATIONS NOW ARE THAT 1981 01:09:55,442 --> 01:09:57,110 PARTIM MENTAL HEALTH SUPPORT 1982 01:09:57,110 --> 01:09:59,412 SHOULD BE AN ESSENTIAL PART OF 1983 01:09:59,412 --> 01:09:59,946 PAS CARE. 1984 01:09:59,946 --> 01:10:00,881 NOT HERE, EITHER IS A 1985 01:10:00,881 --> 01:10:04,050 RECOMMENDATION OR COULD BE A 1986 01:10:04,050 --> 01:10:05,252 RESEARCH QUESTION, HOW WE USE 1987 01:10:05,252 --> 01:10:08,688 DEDICATED PEOPLE WHO ARE PART OF 1988 01:10:08,688 --> 01:10:09,589 THE MULTIDISCIPLINARY TEAM AND 1989 01:10:09,589 --> 01:10:12,492 THERE SOLELY TO SUPPORT THE 1990 01:10:12,492 --> 01:10:12,926 PATIENT AND FAMILY. 1991 01:10:12,926 --> 01:10:14,561 WE NEED A LONG-TERM HEALTHCARE 1992 01:10:14,561 --> 01:10:18,098 MODEL TO BE DEVELOPED AND 1993 01:10:18,098 --> 01:10:21,101 DISSEMINATED IN PAS CENTERS 1994 01:10:21,101 --> 01:10:24,871 AND -- YOU KNOW, IT SHOULD BE BE 1995 01:10:24,871 --> 01:10:29,276 PART OF WHAT IS BUILT INTO PAS 1996 01:10:29,276 --> 01:10:31,044 CARE AND POSTPARTUM CARE. 1997 01:10:31,044 --> 01:10:31,978 RESEARCH RECOMMENDATIONS ARE TO 1998 01:10:31,978 --> 01:10:34,414 LOOK AT WHAT ARE EFFECTIVE KAYS 1999 01:10:34,414 --> 01:10:35,649 TO IMPROVE THE SHORT-TERM AND 2000 01:10:35,649 --> 01:10:38,785 LONG-TERM MENTAL HEALTH. 2001 01:10:38,785 --> 01:10:39,386 AND MANY THINGS CAN FALL UNDER 2002 01:10:39,386 --> 01:10:41,655 THIS, WE CAN MAKE A PAGE LONG 2003 01:10:41,655 --> 01:10:43,557 BULLET LIST IN TERMS OF THE 2004 01:10:43,557 --> 01:10:45,091 FACTORS WE CAN STUDY. 2005 01:10:45,091 --> 01:10:46,960 THE PRACTICE BARRIERS TO 2006 01:10:46,960 --> 01:10:47,727 PROVIDING MENTAL HEALTH AND 2007 01:10:47,727 --> 01:10:48,395 EDUCATIONAL SERVICES. 2008 01:10:48,395 --> 01:10:51,164 AND WHAT ARE THE LONG-TERM 2009 01:10:51,164 --> 01:10:51,565 PHYSICAL OUTCOMES. 2010 01:10:51,565 --> 01:10:53,667 AND WE'RE TALKING ABOUT THE 2011 01:10:53,667 --> 01:10:55,402 PRACTICE BARRIERS, YOU KNOW, I 2012 01:10:55,402 --> 01:10:57,204 THINK THERE IS IMPORTANT TO TALK 2013 01:10:57,204 --> 01:10:58,071 TO PAS PROVIDERS. 2014 01:10:58,071 --> 01:11:00,507 LIKE JUST FOR US TO UNDERSTAND 2015 01:11:00,507 --> 01:11:03,310 WHAT IS HOLDING PEOPLE BACK FROM 2016 01:11:03,310 --> 01:11:04,444 INTEGRATING THIS KIND OF CARE 2017 01:11:04,444 --> 01:11:06,446 INTO THEIR PAS SERVICE AND 2018 01:11:06,446 --> 01:11:07,814 MULTIDISCIPLINARY TEAM RIGHT NOW 2019 01:11:07,814 --> 01:11:11,952 TO DO SOMETHING TO IMPROVE THAT. 2020 01:11:11,952 --> 01:11:13,520 OBSTACLES THE MOST OBVIOUS ONE 2021 01:11:13,520 --> 01:11:17,757 IS, A GENERAL LACK OF MENTAL 2022 01:11:17,757 --> 01:11:19,626 HEALTHCARE SERVICES IN THE 2023 01:11:19,626 --> 01:11:21,127 UNITED STATES FOR EVERYBODY. 2024 01:11:21,127 --> 01:11:21,494 INCLUDING THIS. 2025 01:11:21,494 --> 01:11:23,330 I THINK TALKING ABOUT THE 2026 01:11:23,330 --> 01:11:27,167 PATIENTS AND PAS CARE, HAVING 2027 01:11:27,167 --> 01:11:28,602 PAS INFORMED SERVICES IS REALLY 2028 01:11:28,602 --> 01:11:28,868 IMPORTANT. 2029 01:11:28,868 --> 01:11:31,037 SO YOU KNOW, I THINK WE NEED TO 2030 01:11:31,037 --> 01:11:35,709 DO A BETTER JOB WITH MENTAL 2031 01:11:35,709 --> 01:11:36,109 HEALTHCARE PERIOD. 2032 01:11:36,109 --> 01:11:37,744 AND THEN HONING ON THIS AREA IS 2033 01:11:37,744 --> 01:11:39,379 A CHALLENGE. 2034 01:11:39,379 --> 01:11:41,448 AND THEN THE KEY METHODOLOGIES 2035 01:11:41,448 --> 01:11:44,317 HERE, ONE TO USE STANDARD 2036 01:11:44,317 --> 01:11:45,185 METRICS SO DEFINE AN 2037 01:11:45,185 --> 01:11:46,253 INTERVENTION AND MEASURE AN 2038 01:11:46,253 --> 01:11:48,288 OUTCOME, IF WE CAN MEASURE IT 2039 01:11:48,288 --> 01:11:50,624 THE SAME WAY, USING THE SAME 2040 01:11:50,624 --> 01:11:52,692 TOOLS AND TIME POINTS. 2041 01:11:52,692 --> 01:11:53,393 AND VERY IMPORTANT TO, AS WE DO 2042 01:11:53,393 --> 01:11:55,495 RESEARCH, TO USE A DIVERSE GROUP 2043 01:11:55,495 --> 01:11:58,531 OF PATIENTS TO MAKE SURE LIKE 2044 01:11:58,531 --> 01:12:00,800 WE'RE INCORPORATING AS MANY 2045 01:12:00,800 --> 01:12:01,334 DIFFERENT PERSPECTIVES AND 2046 01:12:01,334 --> 01:12:01,868 EXPERIENCES AS POSSIBLE. 2047 01:12:01,868 --> 01:12:03,470 WE KNOW FROM TAKING CARE OF THE 2048 01:12:03,470 --> 01:12:06,506 PATIENTS, TWO PEOPLE CAN HAVE A 2049 01:12:06,506 --> 01:12:08,241 SIMILAR CLINICAL EXPERIENCE AND 2050 01:12:08,241 --> 01:12:09,009 HAVE VERY DIFFERENT PERSPECTIVES 2051 01:12:09,009 --> 01:12:11,511 ABOUT IT OR EMOTIONAL RESPONSES 2052 01:12:11,511 --> 01:12:15,015 TO IT LATER ON. 2053 01:12:15,015 --> 01:12:17,017 AND THAT WAS OUR TOPIC. 2054 01:12:17,017 --> 01:12:23,556 ANY QUESTIONS? 2055 01:12:23,556 --> 01:12:24,624 >> THANKS. 2056 01:12:24,624 --> 01:12:24,924 >> DOCTOR? 2057 01:12:24,924 --> 01:12:28,194 >> WE CAN START BY SAYING 2058 01:12:28,194 --> 01:12:30,397 THIS -- THE PATIENT SHOULD BE 2059 01:12:30,397 --> 01:12:32,899 REFERRED TO A PAS CENTER. 2060 01:12:32,899 --> 01:12:33,867 WHAT DEFINES A PAS CENTER. 2061 01:12:33,867 --> 01:12:35,669 WHO IS GOING TO ENFORCE THIS? 2062 01:12:35,669 --> 01:12:36,970 WHERE IN THE UNITED STATES? 2063 01:12:36,970 --> 01:12:38,705 YOU HAVE TO ENFORCE IT. 2064 01:12:38,705 --> 01:12:40,206 >> YEAH, ABSOLUTELY. 2065 01:12:40,206 --> 01:12:44,411 NO, THAT'S COME UP OVER AND OVER 2066 01:12:44,411 --> 01:12:46,579 SINCE 2015 WHEN THE STANDARDIZED 2067 01:12:46,579 --> 01:12:47,080 PAPER CAME OUT. 2068 01:12:47,080 --> 01:12:49,549 THAT'S SOMETHING, AGAIN WE'RE 2069 01:12:49,549 --> 01:12:52,285 GOING TO TALK ABOUT STANDARD 2070 01:12:52,285 --> 01:12:52,886 METRICS I THINK ANY TIME WE'RE 2071 01:12:52,886 --> 01:12:54,087 DOING RESEARCH ON THIS AND WE'RE 2072 01:12:54,087 --> 01:12:55,088 TALKING ABOUT BUILDING CARE 2073 01:12:55,088 --> 01:12:56,589 MODELS FOR PATIENTS I THINK WE 2074 01:12:56,589 --> 01:13:02,829 HAVE TO TALK ABOUT WHAT 2075 01:13:02,829 --> 01:13:03,430 ENVIRONMENT ARE WE DISCUSSING? 2076 01:13:03,430 --> 01:13:04,764 AT A CENTER FOR WHATEVER, YOU 2077 01:13:04,764 --> 01:13:06,199 KNOW, THAT CENTER SAYS THAT IT 2078 01:13:06,199 --> 01:13:08,835 IS AND I THINK WE HAVE TO TALK 2079 01:13:08,835 --> 01:13:11,004 IN GENERAL WHAT IS AN ACCRETA 2080 01:13:11,004 --> 01:13:11,237 CENTER? 2081 01:13:11,237 --> 01:13:13,907 OR ARE PEOPLE TAKING CARE OF THE 2082 01:13:13,907 --> 01:13:18,044 PATIENTS IN THE COMMUNITY, 2083 01:13:18,044 --> 01:13:18,611 ESPECIALLY WITH UNDIAGNOSED 2084 01:13:18,611 --> 01:13:22,182 ONES, HOW WHO DO GET THE SAME 2085 01:13:22,182 --> 01:13:24,351 KIND RESOURCES TO THOSE PATIENTS 2086 01:13:24,351 --> 01:13:26,486 NOT NECESSARILY IN A HIGH VOLUME 2087 01:13:26,486 --> 01:13:27,287 CENTER. 2088 01:13:27,287 --> 01:13:29,389 >> YOU AND I HAD THIS 2089 01:13:29,389 --> 01:13:30,290 CONVERSATION MANY TIMES. 2090 01:13:30,290 --> 01:13:31,958 JUST TO HAVE CONTEXT THIS WITH 2091 01:13:31,958 --> 01:13:32,158 THAT. 2092 01:13:32,158 --> 01:13:34,527 I THINK USING THE TERM CENTER OF 2093 01:13:34,527 --> 01:13:35,628 EXCELLENCE IS A DISSERVICE. 2094 01:13:35,628 --> 01:13:38,398 BECAUSE I THINK IT PUTS SOME OF 2095 01:13:38,398 --> 01:13:41,668 AEROCOLLEAGUES IN A VERY 2096 01:13:41,668 --> 01:13:42,235 VULNERABLE POSITION, STUCK 2097 01:13:42,235 --> 01:13:44,437 TAKING CARE OF THE PATIENTS IN 2098 01:13:44,437 --> 01:13:45,538 THE MIDDLE OF THE NIGHT THERE. 2099 01:13:45,538 --> 01:13:47,407 WAS A PUSH BY A PRIVATE 2100 01:13:47,407 --> 01:13:48,041 ORGANIZATION YEARS AGO THAT CAME 2101 01:13:48,041 --> 01:13:50,877 TO MANY OF US AND SAID WE WANT 2102 01:13:50,877 --> 01:13:53,146 YOU TO START ENDURING THIS 2103 01:13:53,146 --> 01:13:53,380 PROGRAM. 2104 01:13:53,380 --> 01:13:55,382 -- AND COLLECTIVELY, WE SAID 2105 01:13:55,382 --> 01:13:57,917 THAT'S PROBABLY NOT THE RIGHT 2106 01:13:57,917 --> 01:14:00,487 THING AND FOCUS MORE ON VOLUME 2107 01:14:00,487 --> 01:14:02,222 AND OUTCOMES THEN THE TITLE 2108 01:14:02,222 --> 01:14:03,523 ITSELF. 2109 01:14:03,523 --> 01:14:05,425 SO I HOPE THAT THIS LANGUAGE 2110 01:14:05,425 --> 01:14:06,860 DIDN'T IMPLY THAT WE WERE GOING 2111 01:14:06,860 --> 01:14:07,727 THERE. 2112 01:14:07,727 --> 01:14:08,595 I DON'T THINK THE DID. 2113 01:14:08,595 --> 01:14:11,564 >> WELL, I THINK IT IS IMPORTANT 2114 01:14:11,564 --> 01:14:13,800 TO THINK ABOUT -- I THINK THE 2115 01:14:13,800 --> 01:14:17,103 EASY PART IS, IF YOU ARE CALLING 2116 01:14:17,103 --> 01:14:18,071 YOURSELF AN ACCRETA CENTER, I 2117 01:14:18,071 --> 01:14:20,140 WON'T SAY CENTER OF EXCELLENCE, 2118 01:14:20,140 --> 01:14:22,342 AND SOMEONE PROVIDING ACCRETA 2119 01:14:22,342 --> 01:14:23,877 CARE, YOUR TAKING REFERRALS AND 2120 01:14:23,877 --> 01:14:24,944 VOLUNTARILY MANAGING THE 2121 01:14:24,944 --> 01:14:26,746 PATIENTS, THESE ARE PIECES THAT 2122 01:14:26,746 --> 01:14:28,081 NEED TO BE INCORPORATED INTO 2123 01:14:28,081 --> 01:14:29,482 THAT PRACTICE. 2124 01:14:29,482 --> 01:14:32,352 IT IS ALSO VERY IMPORTANT, MAYBE 2125 01:14:32,352 --> 01:14:33,319 EVEN MORE IMPORTANT THAN THE 2126 01:14:33,319 --> 01:14:35,922 PATIENTS WHO DIDN'T MAKE IT IN 2127 01:14:35,922 --> 01:14:41,227 TO A DEDICATED CENTER WHO HAD AN 2128 01:14:41,227 --> 01:14:42,028 UNDIAGNOSED ACCRETA OR DELIVERED 2129 01:14:42,028 --> 01:14:42,929 OUT IN THE COMMUNITY GET ACCESS 2130 01:14:42,929 --> 01:14:44,731 TO RESOURCES AND A DIFFERENT WAY 2131 01:14:44,731 --> 01:14:47,300 OF GETTING THE RESOURCES TO 2132 01:14:47,300 --> 01:14:47,667 THOSE PATIENTS. 2133 01:14:47,667 --> 01:14:49,302 DOCTOR? 2134 01:14:49,302 --> 01:14:49,569 >> YES. 2135 01:14:49,569 --> 01:14:50,670 I APPRECIATE THE SENTIMENT AND 2136 01:14:50,670 --> 01:14:53,139 THE HOPE THAT WE HAVE CENTERS IN 2137 01:14:53,139 --> 01:14:54,874 THE U.S. 2138 01:14:54,874 --> 01:14:57,610 WE HAVE EXPERIENCE IN TEXAS, WE 2139 01:14:57,610 --> 01:15:01,214 MENTIONED IT DURING OUR MEETING, 2140 01:15:01,214 --> 01:15:02,148 SUBGROUP MEETING. 2141 01:15:02,148 --> 01:15:05,952 NOW IT IS A MANDATE IN TEXAS TO 2142 01:15:05,952 --> 01:15:07,954 DESIGNATE CENTERS AS ACCRETA 2143 01:15:07,954 --> 01:15:10,890 CENTERS WITHIN THE LEVEL FOUR 2144 01:15:10,890 --> 01:15:11,157 MATERNAL. 2145 01:15:11,157 --> 01:15:12,225 AND I DOUBT THIS IS GOING TO 2146 01:15:12,225 --> 01:15:15,161 MAKE A BIG DIFFERENCE BECAUSE IT 2147 01:15:15,161 --> 01:15:16,129 CANNOT BE IMPLEMENTED. 2148 01:15:16,129 --> 01:15:18,998 IT CANNOT BE ENDORSED. 2149 01:15:18,998 --> 01:15:21,935 BUT ANYWAY, IF WE ARE GOING TO 2150 01:15:21,935 --> 01:15:23,670 PROMOTE THE IDEA OF CENTERS, I 2151 01:15:23,670 --> 01:15:27,540 THINK WE NED TO ATTACH TO IT 2152 01:15:27,540 --> 01:15:30,276 SOME ADDITIONAL REQUIREMENTS 2153 01:15:30,276 --> 01:15:33,880 THAT WILL ENFORCE, MAKE IT MORE 2154 01:15:33,880 --> 01:15:35,982 ENFORCEABLE, BUT ALSO MAKE THE 2155 01:15:35,982 --> 01:15:36,816 MORE BENEFICIAL. 2156 01:15:36,816 --> 01:15:37,684 FOR EXAMPLE, ARE THESE CENTERS 2157 01:15:37,684 --> 01:15:40,053 GOING TO TAKE CARE OF PATIENTS 2158 01:15:40,053 --> 01:15:43,890 NO MATTER THEIR INSURANCE 2159 01:15:43,890 --> 01:15:44,123 STATUS? 2160 01:15:44,123 --> 01:15:45,859 THEIR PAYER STATUS? 2161 01:15:45,859 --> 01:15:48,962 POSSIBLY, AFTER SIX WEEKS 2162 01:15:48,962 --> 01:15:49,262 POSTPARTUM? 2163 01:15:49,262 --> 01:15:52,932 ARE THESE CENTERS GOING TO -- 2164 01:15:52,932 --> 01:15:55,768 SUPER, NOT SUPERVISE, BUT IMPACT 2165 01:15:55,768 --> 01:15:57,570 THE CARE IN THE REGION IN ORDER 2166 01:15:57,570 --> 01:16:00,507 TO MAKE SURE THAT THESE PATIENTS 2167 01:16:00,507 --> 01:16:02,008 ARE EARLY SCREENED OR SENT TO 2168 01:16:02,008 --> 01:16:04,944 THEM, HOW, HOW IS THAT GOING TO 2169 01:16:04,944 --> 01:16:05,645 WORK OUT? 2170 01:16:05,645 --> 01:16:07,981 SO, I -- IF WE'RE GOING TO SAY 2171 01:16:07,981 --> 01:16:10,383 CENTERS, IT'S NOT ENOUGH TO JUST 2172 01:16:10,383 --> 01:16:12,252 MENTION THE WORD CENTER, IT 2173 01:16:12,252 --> 01:16:13,553 REQUIRES A WHOLE BIG PROGRAM 2174 01:16:13,553 --> 01:16:18,124 THAT GOES WITH IT. 2175 01:16:18,124 --> 01:16:20,059 >> GEORGE, I WANT TO HUG YOU FOR 2176 01:16:20,059 --> 01:16:20,393 SAYING THAT. 2177 01:16:20,393 --> 01:16:22,829 BECAUSE I THINK THAT IS REALLY 2178 01:16:22,829 --> 01:16:23,363 IMPORTANT. 2179 01:16:23,363 --> 01:16:26,799 IN THIS AREA OF SYSTEMNESS, WE 2180 01:16:26,799 --> 01:16:28,701 OFTEN KNOW WHO OUR REFERS ARE 2181 01:16:28,701 --> 01:16:30,270 GOING TO BE. 2182 01:16:30,270 --> 01:16:32,272 WE HAVE DEDICATED COMMUNITY. 2183 01:16:32,272 --> 01:16:33,439 AND THE POINT ABOUT TELEHEALTH, 2184 01:16:33,439 --> 01:16:35,842 IN DESERTS WHERE WE DO NOT HAVE 2185 01:16:35,842 --> 01:16:36,709 OPPORTUNITIES FOR PATIENTS TO 2186 01:16:36,709 --> 01:16:38,611 DRIVE MANY HOURS TO COME 2187 01:16:38,611 --> 01:16:39,612 RELIABLE FOR THE ULTRASOUNDS 2188 01:16:39,612 --> 01:16:40,880 THAT THEY NEED, WE CAN HELP. 2189 01:16:40,880 --> 01:16:42,448 WE HAVE RESOURCES TO BE ABLE TO 2190 01:16:42,448 --> 01:16:44,384 BACK GIVE TO THE COMMUNITY, BUT 2191 01:16:44,384 --> 01:16:45,685 WE NEED, WE NEED THAT. 2192 01:16:45,685 --> 01:16:45,885 RIGHT? 2193 01:16:45,885 --> 01:16:49,222 WE NEED THAT TO BE VALUED AND BE 2194 01:16:49,222 --> 01:16:51,724 SOMETHING THAT IS -- KIND OF A 2195 01:16:51,724 --> 01:16:54,694 WIDER CATCHMENT THEN JUST THE 2196 01:16:54,694 --> 01:16:59,165 IMPLICATION ABOUT DELIVERY 2197 01:16:59,165 --> 01:17:02,235 LOCATION. 2198 01:17:02,235 --> 01:17:03,036 >> THIS IS -- YEAH? 2199 01:17:03,036 --> 01:17:05,705 >> MAY I? 2200 01:17:05,705 --> 01:17:06,272 >> YES. 2201 01:17:06,272 --> 01:17:07,774 >> SO, THIS IS NICHD WE WANT TO 2202 01:17:07,774 --> 01:17:08,641 TALK ABOUT RESEARCH AND 2203 01:17:08,641 --> 01:17:13,846 WHATEVER, I JUST WANT TO PUT A 2204 01:17:13,846 --> 01:17:15,415 PLUG IN THERE FOR COMPENSATION. 2205 01:17:15,415 --> 01:17:17,150 I THINK WE CAN TALK ABOUT THIS 2206 01:17:17,150 --> 01:17:20,620 TOPIC FOREVER AND ALL OF THESE 2207 01:17:20,620 --> 01:17:22,522 GRANDIOSE IDEAS, BUT UNLESS 2208 01:17:22,522 --> 01:17:23,189 THESE CASES ARE IDENTIFIED AS 2209 01:17:23,189 --> 01:17:26,392 DIFFERENT THAN JUST A DELIVERY, 2210 01:17:26,392 --> 01:17:27,994 I DON'T THINK WE'RE GOING TO 2211 01:17:27,994 --> 01:17:29,963 MAKE A BIG IMPACT HERE. 2212 01:17:29,963 --> 01:17:31,631 I KNOW THIS IS NICHD. 2213 01:17:31,631 --> 01:17:36,436 THIS IS NOT IN THE -- IN THE -- 2214 01:17:36,436 --> 01:17:38,571 AT PLAY HERE, BUT JUST WANTED TO 2215 01:17:38,571 --> 01:17:39,205 PUT THIS PLUG. 2216 01:17:39,205 --> 01:17:40,907 >> ONE OPTION FOR THE 2217 01:17:40,907 --> 01:17:44,110 PROCEEDINGS OF THIS COMMITTEE 2218 01:17:44,110 --> 01:17:46,112 WOULD BE TO TRY TO GIVE AS MANY 2219 01:17:46,112 --> 01:17:46,813 RECOMMENDATIONS AND TALK ABOUT 2220 01:17:46,813 --> 01:17:48,748 POLICY AND KEY RESEARCH GAPS 2221 01:17:48,748 --> 01:17:50,583 INTO A SINGLE DOCUMENT. 2222 01:17:50,583 --> 01:17:52,151 ONE OPTION, THOUGH, MIGHT BE 2223 01:17:52,151 --> 01:17:53,486 THAT WE DECIDE AT AN 2224 01:17:53,486 --> 01:17:56,990 INTERDISCIPLINARY GROUP TO HAVE 2225 01:17:56,990 --> 01:17:59,225 A SPECIFIC POLICY STATEMENT OR 2226 01:17:59,225 --> 01:17:59,592 REPORT DOCUMENT. 2227 01:17:59,592 --> 01:18:00,727 MAYBE WITH OR WITHOUT NICHD TO 2228 01:18:00,727 --> 01:18:02,662 SAY THESE ARE THE KEY BARRIERS 2229 01:18:02,662 --> 01:18:04,631 THAT ARE KEEPING FOLKS FROM 2230 01:18:04,631 --> 01:18:08,601 GETTING CARE THAT THEY NEED. 2231 01:18:08,601 --> 01:18:11,537 AND THEN, SO WE SHOULD TALK IN 2232 01:18:11,537 --> 01:18:13,706 THE COMING MONTHS ABOUT WHAT 2233 01:18:13,706 --> 01:18:15,141 THIS WHITE PAPER BECOMES AND IF 2234 01:18:15,141 --> 01:18:17,310 A SECOND PAPER ON POLICY IS 2235 01:18:17,310 --> 01:18:19,112 REALLY VALUABLE, I THINK IT 2236 01:18:19,112 --> 01:18:20,680 WOULD BE. 2237 01:18:20,680 --> 01:18:21,781 THE OTHER THING WITH, I WANT -- 2238 01:18:21,781 --> 01:18:24,517 US TO KEEP IN MIND A LITTLE BIT 2239 01:18:24,517 --> 01:18:27,320 ABOUT REFERRAL AND MAYBE THIS IS 2240 01:18:27,320 --> 01:18:28,554 THAT UNIQUE TO UTAH IN THE 2241 01:18:28,554 --> 01:18:30,657 MIDDLE OF NOWHERE. 2242 01:18:30,657 --> 01:18:33,493 BUT THERE IS A HUGE PATIENT AND 2243 01:18:33,493 --> 01:18:36,629 FAMILY BURDEN FOR TRAVEL. 2244 01:18:36,629 --> 01:18:37,864 AND I DON'T THINK THAT SHOULD 2245 01:18:37,864 --> 01:18:41,968 STOP FOLKS FROM COMING FROM THE 2246 01:18:41,968 --> 01:18:43,736 MIDDLE OF EASTERN MONTANA TO GET 2247 01:18:43,736 --> 01:18:44,671 CARE IF THEY ARE ACCRETA. 2248 01:18:44,671 --> 01:18:47,540 BUT I THINK ABOUT ALL OF OUR 2249 01:18:47,540 --> 01:18:50,076 DECISIONS WHO GETS SCREENED, HOW 2250 01:18:50,076 --> 01:18:51,244 THEY ARE SCREENED, WHERE THEY 2251 01:18:51,244 --> 01:18:53,379 GET SEEN, WHAT IS THE STANDARD, 2252 01:18:53,379 --> 01:18:55,982 DOES RESULT IN PATIENTS BEING 2253 01:18:55,982 --> 01:18:57,483 SEPARATED FROM THEIR FAMILIES, 2254 01:18:57,483 --> 01:18:58,718 LOSING TIME OF THEIR JOBS, 2255 01:18:58,718 --> 01:19:00,653 SPENDING AN INCREDIBLE AMOUNT OF 2256 01:19:00,653 --> 01:19:02,789 MONEY TO TRAVEL TO ALL OF OUR 2257 01:19:02,789 --> 01:19:03,356 CENTERS. 2258 01:19:03,356 --> 01:19:06,693 SO I DON'T US TO KEEP THAT IN 2259 01:19:06,693 --> 01:19:09,462 OUR HEADS AS ANOTHER PATIENT 2260 01:19:09,462 --> 01:19:10,730 EXPERIENCE COMPONENT WE CANNOT 2261 01:19:10,730 --> 01:19:14,000 LOSE TRACK OF. 2262 01:19:14,000 --> 01:19:15,568 THANKS FOR THE PRIVILEGE. 2263 01:19:15,568 --> 01:19:16,869 STEPPING ON MY SOAPBOX. 2264 01:19:16,869 --> 01:19:19,572 >> I THINK ANY, AT THE END OF, 2265 01:19:19,572 --> 01:19:21,441 ESSENTIALLY, YEARS AND WE DO 2266 01:19:21,441 --> 01:19:22,575 TRIALS AND EVERYTHING, THIS 2267 01:19:22,575 --> 01:19:26,245 MENTAL COMPONENT AND THE IMPACT 2268 01:19:26,245 --> 01:19:28,648 ON OUT PATIENT NEEDS TO BE 2269 01:19:28,648 --> 01:19:30,016 EVALUATED IN ANY TRIAL, THIS IS 2270 01:19:30,016 --> 01:19:30,750 IMPERATIVE. 2271 01:19:30,750 --> 01:19:32,218 AND THE SECOND THING, DID YOU 2272 01:19:32,218 --> 01:19:35,588 THINK ABOUT FORMING A STUDY. 2273 01:19:35,588 --> 01:19:38,191 WE KNOW THAT, YOU KNOW, THE C 2274 01:19:38,191 --> 01:19:41,461 SCAR PREGNANCIES, ONE OF THE 2275 01:19:41,461 --> 01:19:43,129 MAJOR RISK FACTORS FOR 2276 01:19:43,129 --> 01:19:44,030 EVENTUALLY DEVELOPING ACCRETA. 2277 01:19:44,030 --> 01:19:48,968 BUT ALSO AN IMPORTANT FOR STINTS 2278 01:19:48,968 --> 01:19:50,737 TO BE ABSTAINED EARLY THERE IS A 2279 01:19:50,737 --> 01:19:53,439 LOT OF THE MANAGEMENT OF THE 2280 01:19:53,439 --> 01:19:54,507 CASES ARE VARIED. 2281 01:19:54,507 --> 01:19:54,707 RIGHT? 2282 01:19:54,707 --> 01:19:56,342 SOME DO JUST INJUNCTIONS, SOME 2283 01:19:56,342 --> 01:19:58,411 EVEN PROPOSE, OKAY, BECAUSE OF 2284 01:19:58,411 --> 01:20:01,681 THE RISK OF ACCRETA FOR NEXT 2285 01:20:01,681 --> 01:20:05,017 TIME, TAKE YOUR TOWEL, CLOSE THE 2286 01:20:05,017 --> 01:20:06,519 REALLY WELL, AND SEE, SO DID YOU 2287 01:20:06,519 --> 01:20:08,788 DISCUSS THE MODALITIES AND THE 2288 01:20:08,788 --> 01:20:11,491 EVALUATION, OPPORTUNITY TO HAVE 2289 01:20:11,491 --> 01:20:11,758 SPECIMENS? 2290 01:20:11,758 --> 01:20:12,024 >> YEAH. 2291 01:20:12,024 --> 01:20:14,727 WE, WE -- IT DEFINITELY CAME UP. 2292 01:20:14,727 --> 01:20:16,062 WE DIDN'T, SAME KIND OF THINK WE 2293 01:20:16,062 --> 01:20:18,331 COULD NOT MAKE LONG LISTS OF ALL 2294 01:20:18,331 --> 01:20:20,299 OF THE ELEMENTS THAT GO INTO THE 2295 01:20:20,299 --> 01:20:20,967 RESEARCH QUESTIONS, BUT THIS 2296 01:20:20,967 --> 01:20:25,605 IDEA OF WHAT IS THE BEST WAY TO 2297 01:20:25,605 --> 01:20:29,375 TREAT A C-SECTION SCAR 2298 01:20:29,375 --> 01:20:33,312 IMPLANTATION MAY BE DEPENDENT ON 2299 01:20:33,312 --> 01:20:34,981 THE WEEKS GESTATION OF THE 2300 01:20:34,981 --> 01:20:35,214 PATIENT. 2301 01:20:35,214 --> 01:20:39,685 BUT THE NEEDS TO INCORPORATE 2302 01:20:39,685 --> 01:20:40,953 FINDINGS AND TREATMENT MODALITY 2303 01:20:40,953 --> 01:20:42,755 IN TERMS OF TREATMENT OUTCOMES. 2304 01:20:42,755 --> 01:20:44,891 AND THEME FOR THE PREVENTION, WE 2305 01:20:44,891 --> 01:20:47,393 HAVE TO BE ABLE TO LINK 2306 01:20:47,393 --> 01:20:48,594 PREGNANCIES, AND THAT IS NOT 2307 01:20:48,594 --> 01:20:50,496 ALWAYS EASY TO DO. 2308 01:20:50,496 --> 01:20:52,665 ESPECIALLY WITH THE MORE 2309 01:20:52,665 --> 01:20:54,033 COMPLICATED PREGNANCIES, 2310 01:20:54,033 --> 01:20:55,601 PATIENTS MAY BE DELIVERING IN 2311 01:20:55,601 --> 01:20:56,702 TWO DIFFERENT LOCATIONS OR MANY 2312 01:20:56,702 --> 01:20:59,438 LOCATIONS IN THE U.S., TO GET 2313 01:20:59,438 --> 01:21:01,808 THE MEDICAL RECORDS AND GET THEM 2314 01:21:01,808 --> 01:21:03,709 TOGETHER AND THE DETAIL IS HARD. 2315 01:21:03,709 --> 01:21:07,380 FOR ALL OF THIS COME UP, WE NEED 2316 01:21:07,380 --> 01:21:09,816 TO SOMEHOW STANDARDIZED DATA 2317 01:21:09,816 --> 01:21:10,783 COLLECTION AND LONGITUDINALLY 2318 01:21:10,783 --> 01:21:13,186 FOLLOW THE PATIENTS IN ORDER TO 2319 01:21:13,186 --> 01:21:17,657 DO THIS CORRECTLY. 2320 01:21:17,657 --> 01:21:17,924 ALL RIGHT. 2321 01:21:17,924 --> 01:21:19,225 WELL, THANK YOU VERY MUCH. 2322 01:21:19,225 --> 01:21:29,502 >> THANK YOU. 2323 01:21:42,582 --> 01:21:43,149 >> WOW. 2324 01:21:43,149 --> 01:21:44,116 WHAT A WORKSHOP, HUH? 2325 01:21:44,116 --> 01:21:44,650 [ LAUGHTER ] 2326 01:21:44,650 --> 01:21:45,785 THANK YOU ALL SO MUCH FOR ALL OF 2327 01:21:45,785 --> 01:21:48,454 YOUR WORK IN THE GROUPING 2328 01:21:48,454 --> 01:21:48,688 GROUPS. 2329 01:21:48,688 --> 01:21:50,456 I THINK, BRETT SORT OF LEANED 2330 01:21:50,456 --> 01:21:52,024 OVER TO ME WITH PRESENTATIONS 2331 01:21:52,024 --> 01:21:54,427 AND SAID THIS FORMAT IS REALLY 2332 01:21:54,427 --> 01:21:54,627 GREAT. 2333 01:21:54,627 --> 01:21:59,131 WE ARE HAD ROBUST CONVERSATIONS. 2334 01:21:59,131 --> 01:22:00,800 SO MUCH PASSION IN TERMS OF THE 2335 01:22:00,800 --> 01:22:02,168 DIFFERENT GAPS IDENTIFIED. 2336 01:22:02,168 --> 01:22:04,170 WE ARE GRATEFUL FOR EVERYBODY'S 2337 01:22:04,170 --> 01:22:05,438 ENGAGEMENT WITH ALL OF THAT 2338 01:22:05,438 --> 01:22:05,638 WORK. 2339 01:22:05,638 --> 01:22:06,672 WE KNOW WHO WE ARE. 2340 01:22:06,672 --> 01:22:07,940 WE DON'T NEED THAT AGAIN. 2341 01:22:07,940 --> 01:22:09,141 JUST TO SORT OF REMIND 2342 01:22:09,141 --> 01:22:11,911 EVERYBODY, THE WAY THAT WE 2343 01:22:11,911 --> 01:22:13,446 PARSED THIS OUT AND OBVIOUSLY IT 2344 01:22:13,446 --> 01:22:16,382 IS A LITTLE ARBITRARY AND THE 2345 01:22:16,382 --> 01:22:19,485 WAY WE DID THAT TO THINK ABOUT 2346 01:22:19,485 --> 01:22:21,854 EMDODGE, SCREENING AND 2347 01:22:21,854 --> 01:22:23,089 DIAGNOSIS, AND STAINING 2348 01:22:23,089 --> 01:22:25,291 ANDMAGEMENT, AND OPERATIVE 2349 01:22:25,291 --> 01:22:26,025 MANAGEMENT, AND PATIENT-CENTERED 2350 01:22:26,025 --> 01:22:26,425 APPROACHES. 2351 01:22:26,425 --> 01:22:28,394 THIS IS OUR GOALS, THIS IS WHAT 2352 01:22:28,394 --> 01:22:31,530 WE HOPED TO DO DURING THE COURSE 2353 01:22:31,530 --> 01:22:33,366 OF THIS WORKSHOP, TO GENERATE 2354 01:22:33,366 --> 01:22:34,800 CONCRETE AND INSIGHTS, IDENTIFY 2355 01:22:34,800 --> 01:22:36,002 KNOWLEDGE GAPS WHICH I THINK WE 2356 01:22:36,002 --> 01:22:39,138 HAVE IDENTIFIED QUITE A FEW, 2357 01:22:39,138 --> 01:22:40,072 HIGHLIGHT RESEARCH OPPORTUNITIES 2358 01:22:40,072 --> 01:22:42,275 AND THEN ENHANCE OUR 2359 01:22:42,275 --> 01:22:43,075 UNDERSTANDING OF PATIENT NEEDS. 2360 01:22:43,075 --> 01:22:45,645 THIS IS A LITTLE BIT OF WHAT I 2361 01:22:45,645 --> 01:22:46,612 HEARD. 2362 01:22:46,612 --> 01:22:47,914 SO OF DISTILLED MOVING FORWARD. 2363 01:22:47,914 --> 01:22:50,283 I THINK ONE OF THE THINGS THAT 2364 01:22:50,283 --> 01:22:51,217 REALLY CAME OUT IN THE 2365 01:22:51,217 --> 01:22:53,786 DISCUSSION I HAD IS THAT THE 2366 01:22:53,786 --> 01:22:58,057 REASON THAT THERE WERE SORT OF 2367 01:22:58,057 --> 01:22:58,557 INDIVIDUAL ORGANIZATIONS 2368 01:22:58,557 --> 01:22:59,659 STAKEHOLDERS BROUGHT WAS SO THAT 2369 01:22:59,659 --> 01:23:02,128 WE COULD BRING THIS BACK TO OUR 2370 01:23:02,128 --> 01:23:02,795 CONSTITUENCIES, I DO THINK THERE 2371 01:23:02,795 --> 01:23:05,698 IS ROOM FOR US TO IMPROVE WHAT 2372 01:23:05,698 --> 01:23:07,333 WE MOVE UP STREAM. 2373 01:23:07,333 --> 01:23:10,136 BE IT DEVELOPMENT OF A CLINICAL 2374 01:23:10,136 --> 01:23:13,105 RISK STRATIFICATION TOOL, BE IT 2375 01:23:13,105 --> 01:23:14,874 STANDARDIZATION OF WHO RECOMMEND 2376 01:23:14,874 --> 01:23:16,475 HAVE EARLY ULTRASOUND AND WHO IS 2377 01:23:16,475 --> 01:23:19,879 REFERRED TO, AGAIN, WHO THE 2378 01:23:19,879 --> 01:23:21,147 REFERRAL GOES TO IS IMPORTANT, 2379 01:23:21,147 --> 01:23:24,050 BUT IT DOESN'T HAVE TO BE A 2380 01:23:24,050 --> 01:23:28,988 SINGULAR ENTITY. 2381 01:23:28,988 --> 01:23:30,389 SO FMM. 2382 01:23:30,389 --> 01:23:33,426 DO THEY HAVE TO BE THE KEEPER 2383 01:23:33,426 --> 01:23:38,931 FOR ACCRETA CAROL. CARE. 2384 01:23:38,931 --> 01:23:39,999 THERE ARE OPPORTUNITIES FOR US 2385 01:23:39,999 --> 01:23:43,336 TO BRING BACK TO OUR STAKEHOLDER 2386 01:23:43,336 --> 01:23:44,637 ORGANIZATIONS FOR US TO 2387 01:23:44,637 --> 01:23:45,838 STANDARDIZE THE THINGS WE THINK 2388 01:23:45,838 --> 01:23:46,806 ARE IMPORTANT. 2389 01:23:46,806 --> 01:23:48,774 SO I DO THINK WE CAN THINK ABOUT 2390 01:23:48,774 --> 01:23:50,576 THAT MORE AS WE BRING THAT BACK. 2391 01:23:50,576 --> 01:23:52,645 WE ARE ALSO ALL MEMBERS OF THE 2392 01:23:52,645 --> 01:23:55,214 DIFFERENT ORGANIZATIONS, SO 2393 01:23:55,214 --> 01:23:57,750 THINKING THROUGH IN OUR 2394 01:23:57,750 --> 01:23:59,151 ORGANIZATIONAL LEADERSHIP WHO 2395 01:23:59,151 --> 01:24:00,386 ARE OUR RIGHT POLICYMAKERS AND 2396 01:24:00,386 --> 01:24:02,254 DOCUMENT WRITERS ARE IMPORTANT 2397 01:24:02,254 --> 01:24:08,894 TO SORT OF BE OUR -- FUTURE 2398 01:24:08,894 --> 01:24:09,128 POLICY. 2399 01:24:09,128 --> 01:24:09,729 IDENTIFICATION OF KNOWLEDGE 2400 01:24:09,729 --> 01:24:12,531 GAPS, I THINK THERE WERE MANY. 2401 01:24:12,531 --> 01:24:13,866 I THINK WE HEARD THE DEFINITIONS 2402 01:24:13,866 --> 01:24:15,067 LOUD AND CLEAR. 2403 01:24:15,067 --> 01:24:17,203 SOMETHING THAT WE NEED TO SORT 2404 01:24:17,203 --> 01:24:19,905 OF STRATIFY AND DO A BETTER JOB 2405 01:24:19,905 --> 01:24:22,975 OF BEING REALLY CLEAR ABOUT. 2406 01:24:22,975 --> 01:24:24,977 OUTCOMES INCLUDING SEVERE 2407 01:24:24,977 --> 01:24:26,078 MATERNAL MORBIDITY. 2408 01:24:26,078 --> 01:24:26,345 DIAGNOSIS. 2409 01:24:26,345 --> 01:24:29,448 I WILL, AGAIN, SORT OF 2410 01:24:29,448 --> 01:24:30,249 DIFFERENTIATE SCREENING AND 2411 01:24:30,249 --> 01:24:31,083 DIAGNOSES. 2412 01:24:31,083 --> 01:24:33,019 I THINK THAT IS A REALLY 2413 01:24:33,019 --> 01:24:33,386 EXCELLENT POINT. 2414 01:24:33,386 --> 01:24:35,121 BUT I THINK STAGING IS SOMETHING 2415 01:24:35,121 --> 01:24:36,655 THAT REALLY CAME OUT LOUD AND 2416 01:24:36,655 --> 01:24:37,857 CLEAR HERE. 2417 01:24:37,857 --> 01:24:39,291 HOW DO WE APPROPRIATE USE OUR 2418 01:24:39,291 --> 01:24:41,694 SCREENING TOOLS IN ORDER TO GET 2419 01:24:41,694 --> 01:24:43,062 THE PATIENTS THE RIGHT CARE IN 2420 01:24:43,062 --> 01:24:45,598 THE PLACE THEY NEED. 2421 01:24:45,598 --> 01:24:46,966 TECHNIQUE, I THOUGHT GROUP THREE 2422 01:24:46,966 --> 01:24:47,500 WAS REALLY CLEAR, THIS IS 2423 01:24:47,500 --> 01:24:51,137 SOMETHING THAT IS NOT A 2424 01:24:51,137 --> 01:24:53,272 ONE-SIZE-FITS-ALL, AS HAS BECOME 2425 01:24:53,272 --> 01:24:53,572 MOSTLY TRUE. 2426 01:24:53,572 --> 01:24:55,307 WHERE CAN WE DO A BETTER JOB OF 2427 01:24:55,307 --> 01:24:57,443 PROVIDING PATIENTS WITH A MENU 2428 01:24:57,443 --> 01:24:58,744 ABOUT TECHNIQUE. 2429 01:24:58,744 --> 01:24:59,311 AND LONGER TERM OUTCOMES. 2430 01:24:59,311 --> 01:25:00,513 AND THEN THE RESPONSIBILITY BACK 2431 01:25:00,513 --> 01:25:01,380 TO OUR COMMUNITY IS REALLY 2432 01:25:01,380 --> 01:25:01,781 IMPORTANT. 2433 01:25:01,781 --> 01:25:04,583 I THINK THAT IS WHERE -- PEOPLE 2434 01:25:04,583 --> 01:25:06,085 NEED OUR HELP. 2435 01:25:06,085 --> 01:25:08,320 I THINK OUR REFERRERS ARE 2436 01:25:08,320 --> 01:25:08,721 NEEDING OUR HELP. 2437 01:25:08,721 --> 01:25:09,789 WE ARE HEARING THAT AND NEED TO 2438 01:25:09,789 --> 01:25:11,924 DO A BETTER JOB OF GETTING THAT 2439 01:25:11,924 --> 01:25:14,093 BACK OUT TO THEM. 2440 01:25:14,093 --> 01:25:15,294 RESEARCH OPPORTUNITIES, MANY. 2441 01:25:15,294 --> 01:25:18,297 WE HEARD THE CALL FOR BOTH 2442 01:25:18,297 --> 01:25:20,132 ULTRASOUND AND OUTCOMES 2443 01:25:20,132 --> 01:25:22,668 REGISTRY, INCLUDING THINKING 2444 01:25:22,668 --> 01:25:23,536 THROUGH UNANTICIPATED OUTCOMES. 2445 01:25:23,536 --> 01:25:25,704 STAGING, TO DO THAT IN A WAY 2446 01:25:25,704 --> 01:25:28,374 THAT IS BETTER THAN WHAT WE'RE 2447 01:25:28,374 --> 01:25:28,941 DOING RIGHT NOW. 2448 01:25:28,941 --> 01:25:30,576 IN ADDITION TO ULTRASOUND THE 2449 01:25:30,576 --> 01:25:33,212 USE OF BIOMARKERS THAT CAN 2450 01:25:33,212 --> 01:25:35,448 STRATIFY PATIENTS, USE OF MRI. 2451 01:25:35,448 --> 01:25:39,151 I THINK I HEARD, I THINK THE 2452 01:25:39,151 --> 01:25:42,621 OLDER PARADIGM OF, YOU KNOW, MRI 2453 01:25:42,621 --> 01:25:44,690 IS USEFUL FOR RULING IN A 2454 01:25:44,690 --> 01:25:44,957 ACCRETA. 2455 01:25:44,957 --> 01:25:47,560 WE KNOW, WE CAN DIAGNOSE A 2456 01:25:47,560 --> 01:25:49,328 PROACCRETA, WE DON'T NEED A MRI 2457 01:25:49,328 --> 01:25:50,696 FOR THAT, BUT OR THINGS WE CAN 2458 01:25:50,696 --> 01:25:51,730 DO. 2459 01:25:51,730 --> 01:25:54,166 AND THE OTHER THING OF USING A 2460 01:25:54,166 --> 01:25:56,969 REFERRAL, CAN WE USE MRI THERE. 2461 01:25:56,969 --> 01:26:00,039 THERE IS A PRIME THERE. 2462 01:26:00,039 --> 01:26:01,440 AND THE MANAGEMENT, THINKING 2463 01:26:01,440 --> 01:26:05,311 THROUGH WHAT TIMES OF SURGICAL 2464 01:26:05,311 --> 01:26:07,646 MANAGEMENT VERSUS CONSERVATIVE 2465 01:26:07,646 --> 01:26:08,714 MANAGEMENT, AND THEN AMAZING 2466 01:26:08,714 --> 01:26:10,349 OPPORTUNITIES FOR PREVENTION. 2467 01:26:10,349 --> 01:26:12,485 I THINK THAT, I'M REALLY PROUD 2468 01:26:12,485 --> 01:26:13,252 THIS MEETING TALKED ABOUT 2469 01:26:13,252 --> 01:26:15,988 PATIENT NEEDS AND SUPPORT, AND 2470 01:26:15,988 --> 01:26:17,356 SHARED DECISIONMAKING TOOLS. 2471 01:26:17,356 --> 01:26:18,924 THE CALL HERE TO THINK THROUGH 2472 01:26:18,924 --> 01:26:21,393 THE IMPACT ON OUR PATIENTS. 2473 01:26:21,393 --> 01:26:22,595 AND THAT DIDN'T ONLY COME 2474 01:26:22,595 --> 01:26:25,231 THROUGH IN TERMS OF THINKING 2475 01:26:25,231 --> 01:26:26,599 THROUGH MANAGEMENT OUTCOMES AND 2476 01:26:26,599 --> 01:26:27,900 SHARED DECISIONMAKING AND ALSO 2477 01:26:27,900 --> 01:26:29,568 LONGER TERM OUTCOMES AND MENTAL 2478 01:26:29,568 --> 01:26:30,369 HEALTH SUPPORT. 2479 01:26:30,369 --> 01:26:33,205 I THINK THESE, TO ME, AS SORT OF 2480 01:26:33,205 --> 01:26:34,573 SITTING THERE IN THAT BIT OF THE 2481 01:26:34,573 --> 01:26:36,742 ROOM SEEMED LIKE -- WE DID A 2482 01:26:36,742 --> 01:26:39,278 GOOD JOB, I THINK WITH 2483 01:26:39,278 --> 01:26:41,147 IDENTIFYING KEY GOALS. 2484 01:26:41,147 --> 01:26:42,648 DO YOU HAVE ADDITIONAL, WHAT DID 2485 01:26:42,648 --> 01:26:43,616 I MISS. 2486 01:26:43,616 --> 01:26:45,651 >> NOTHING, I CANNOT ADD 2487 01:26:45,651 --> 01:26:46,552 ANYTHING TO THAT. 2488 01:26:46,552 --> 01:26:48,087 >> AND IF OTHER PEOPLE DO HAVE 2489 01:26:48,087 --> 01:26:49,889 THINGS TO ADD TO THAT, PLEASE, I 2490 01:26:49,889 --> 01:26:51,891 ALWAYS WANT TO BE AVAILABLE FOR 2491 01:26:51,891 --> 01:26:53,926 MORE CONVERSATION ABOUT THOSE 2492 01:26:53,926 --> 01:26:54,393 THINGS. 2493 01:26:54,393 --> 01:26:55,961 SO, WHAT HAPPENS NOW? 2494 01:26:55,961 --> 01:26:57,630 EACH OF THESE GROUPS, WORKING 2495 01:26:57,630 --> 01:26:59,999 GROUP REPORTS WILL BE DISTILLED 2496 01:26:59,999 --> 01:27:02,434 FURTHER INTO A ONE TO TWO PAGE 2497 01:27:02,434 --> 01:27:03,169 SUMMARY. 2498 01:27:03,169 --> 01:27:04,703 WE'RE HOPING THREE MONTHS 2499 01:27:04,703 --> 01:27:05,371 FOLLOWING THE WORKSHOP. 2500 01:27:05,371 --> 01:27:07,740 THIS MIGHT MEAN THAT THE HEAD OF 2501 01:27:07,740 --> 01:27:10,576 YOUR WORKING GROUP WILL WANT TO 2502 01:27:10,576 --> 01:27:13,579 RECLARIFY OR RECONVENE, WE ARE 2503 01:27:13,579 --> 01:27:15,814 HAPPY TO FACILITATE THAT AND 2504 01:27:15,814 --> 01:27:19,185 HAVE A ZOOM MEETING AND THINK 2505 01:27:19,185 --> 01:27:19,818 THROUGH DOES THIS DOCUMENT LIKE 2506 01:27:19,818 --> 01:27:21,220 WE WANT IT TO BE. 2507 01:27:21,220 --> 01:27:22,788 AND REFLECT THE CONVERSATION. 2508 01:27:22,788 --> 01:27:24,089 THERE IS A SCIENTIFIC WRITER 2509 01:27:24,089 --> 01:27:24,590 PART OF THIS PROCESS. 2510 01:27:24,590 --> 01:27:26,492 SO THERE WILL ALSO BE THE 2511 01:27:26,492 --> 01:27:29,929 SUMMARY OF THE WRITINGS OF THE 2512 01:27:29,929 --> 01:27:33,966 COUNTRY TENT OF -- CONTENT OF 2513 01:27:33,966 --> 01:27:34,700 THE WORKSHOP. 2514 01:27:34,700 --> 01:27:39,038 THAT IS AVAILABLE TO THE WORKING 2515 01:27:39,038 --> 01:27:41,207 GROUPS TO INCORPORATE INTO THE 2516 01:27:41,207 --> 01:27:41,707 SUMMARY. 2517 01:27:41,707 --> 01:27:44,076 WE ARE HOPING TO HAVE A WHITE 2518 01:27:44,076 --> 01:27:44,910 PAPER AVAILABLE FOR OUR 2519 01:27:44,910 --> 01:27:47,146 SOCIETIES TO BE ABLE TO TAKE 2520 01:27:47,146 --> 01:27:50,849 BACK WARDS AND BE ABLE TO 2521 01:27:50,849 --> 01:27:52,051 DEVELOP ONGOING RESEARCH 2522 01:27:52,051 --> 01:27:52,384 OPPORTUNITIES. 2523 01:27:52,384 --> 01:27:57,122 YEAH. 2524 01:27:57,122 --> 01:27:59,091 ANY QUESTIONS, CONCERNS, OR 2525 01:27:59,091 --> 01:27:59,525 COMMENTS ABOUT THAT? 2526 01:27:59,525 --> 01:28:01,060 AND WANT TO MAKE SURE EVERYBODY 2527 01:28:01,060 --> 01:28:02,261 FEELS PRETTY CLEAR. 2528 01:28:02,261 --> 01:28:03,762 SO IT IS A LOT TO THINK ABOUT 2529 01:28:03,762 --> 01:28:07,233 AND TO CHEW OFF, I REALLY WANT 2530 01:28:07,233 --> 01:28:08,834 TO APPRECIATE, AGAIN, SAY THANKS 2531 01:28:08,834 --> 01:28:11,036 FOR EVERYBODY FOR ENGAGING SO 2532 01:28:11,036 --> 01:28:12,605 INTENSELY. 2533 01:28:12,605 --> 01:28:15,874 >> YEAH, WE'RE, I MEAN, WE'RE 2534 01:28:15,874 --> 01:28:17,743 HELPFUL THE PROCEEDINGS OF THIS 2535 01:28:17,743 --> 01:28:18,744 MEETING WILL INSPIRE PEOPLE TO 2536 01:28:18,744 --> 01:28:21,180 DO THE RESEARCH AND MAKE THE 2537 01:28:21,180 --> 01:28:22,114 POLICY CHANGES THAT ARE NEEDED 2538 01:28:22,114 --> 01:28:23,549 TO MOVE OUR FIELD FORWARD. 2539 01:28:23,549 --> 01:28:26,185 IF YOU HAVE INNOVATIVE WAYS THAT 2540 01:28:26,185 --> 01:28:28,854 WE CAN DO THAT, BESIDES JUST 2541 01:28:28,854 --> 01:28:30,656 WRITING A WHITE PAPER, WE ARE 2542 01:28:30,656 --> 01:28:32,424 OPEN TO UP, AND OTHER PAPERS 2543 01:28:32,424 --> 01:28:36,295 LIKE THE PALSY PAPER THAT WILL 2544 01:28:36,295 --> 01:28:37,630 BE HELPFUL AS AN ADDITIONAL 2545 01:28:37,630 --> 01:28:39,999 PIECE TO THIS, LET US KNOW. 2546 01:28:39,999 --> 01:28:43,602 OPEN TO YOUR IDEAS. 2547 01:28:43,602 --> 01:28:50,109 AND SINCERELY, SINCERELY 2548 01:28:50,109 --> 01:28:53,145 APPRECIATE EVERYBODY'S 2549 01:28:53,145 --> 01:28:54,780 PRECIPITATION AND NICHD FOR 2550 01:28:54,780 --> 01:28:55,014 HOSTING. 2551 01:28:55,014 --> 01:28:58,017 >> AND GROUP THREE. 2552 01:28:58,017 --> 01:29:00,552 SO TWO DIFFERENT -- OR JUST ONE 2553 01:29:00,552 --> 01:29:04,256 BIG ONE AND COME BACK TOGETHER? 2554 01:29:04,256 --> 01:29:07,693 OTHERWISE-- MORE -- INTENSE 2555 01:29:07,693 --> 01:29:12,531 EFFORT. 2556 01:29:12,531 --> 01:29:12,798 >> YEAH. 2557 01:29:12,798 --> 01:29:14,800 COMMENTS ON THAT? 2558 01:29:14,800 --> 01:29:16,268 >> THERE IS OVERLAP BETWEEN WHAT 2559 01:29:16,268 --> 01:29:21,340 GROUP NUMBERS I WAS IN AND YOU 2560 01:29:21,340 --> 01:29:22,574 ARE IN, THE SPECIMEN TO COLLECT 2561 01:29:22,574 --> 01:29:25,344 AND THE GOAL OF THE SPECIMEN, I 2562 01:29:25,344 --> 01:29:27,479 THINK IT IS ONE REGISTRY, COME 2563 01:29:27,479 --> 01:29:29,214 UP WITH THE CONSENSUS ON WHAT 2564 01:29:29,214 --> 01:29:30,249 YOU CAN GET. 2565 01:29:30,249 --> 01:29:31,750 MY CURRENT APPROACH IS GET WHAT 2566 01:29:31,750 --> 01:29:33,419 YOU CAN GET. 2567 01:29:33,419 --> 01:29:34,620 I MEAN -- WE'LL USE IT. 2568 01:29:34,620 --> 01:29:38,157 BUT-- WE NEED TO BE A LITTLE BIT 2569 01:29:38,157 --> 01:29:38,724 MORE SYSTEMATIC. 2570 01:29:38,724 --> 01:29:38,991 >> YEAH. 2571 01:29:38,991 --> 01:29:41,026 I ALSO THINK, RIGHT NOW, I THINK 2572 01:29:41,026 --> 01:29:42,361 WE'RE GOING TO GO OUT AND THINK 2573 01:29:42,361 --> 01:29:43,796 ABOUT THAT AND TALK TO EACH 2574 01:29:43,796 --> 01:29:43,996 OTHER. 2575 01:29:43,996 --> 01:29:46,498 I THINK THROUGH WHAT MAKES THE 2576 01:29:46,498 --> 01:29:47,466 MOST SENSE. 2577 01:29:47,466 --> 01:29:49,368 SO I THINK -- 2578 01:29:49,368 --> 01:29:51,470 >> WE HAVE AN OPPORTUNITY, AS 2579 01:29:51,470 --> 01:29:52,671 NEEDED, TO GROUP, AGAIN, EITHER 2580 01:29:52,671 --> 01:29:55,607 WITH THE GROUP WHO SHARED THIS 2581 01:29:55,607 --> 01:29:57,543 WORKING GROUP SUMMARY WITH THE 2582 01:29:57,543 --> 01:29:58,911 VARIOUS GROUP, I MEAN, WE DON'T 2583 01:29:58,911 --> 01:30:01,447 WANT, THERE ARE OVERLAPPING. 2584 01:30:01,447 --> 01:30:03,248 IT IS CLEAR THERE WILL BE 2585 01:30:03,248 --> 01:30:04,116 OVERLAP. 2586 01:30:04,116 --> 01:30:06,552 WE ARE ALL TALKING ABOUT EARLY 2587 01:30:06,552 --> 01:30:08,887 DIAGNOSES IN A DIFFERENT WAY, WE 2588 01:30:08,887 --> 01:30:09,421 WERE TALKING ABOUT SIMILAR 2589 01:30:09,421 --> 01:30:12,291 THINGS THAT MIGHT BE 2590 01:30:12,291 --> 01:30:12,791 OVERLAPPING. 2591 01:30:12,791 --> 01:30:14,660 SO THAT IS ALSO ABOUT REGISTRY, 2592 01:30:14,660 --> 01:30:16,095 SO WE HAVE TO THINK HOW TO BRING 2593 01:30:16,095 --> 01:30:18,597 IT UP IN THE BEST WAY FOR ALL OF 2594 01:30:18,597 --> 01:30:19,298 US. 2595 01:30:19,298 --> 01:30:26,672 IT WILL NOT BE TWO OR THREE OR 2596 01:30:26,672 --> 01:30:27,106 ONE. 2597 01:30:27,106 --> 01:30:27,439 PROCEDURE. 2598 01:30:27,439 --> 01:30:30,809 >> LET ME THROW SOMETHING OUT TO 2599 01:30:30,809 --> 01:30:33,011 THE GROUP. 2600 01:30:33,011 --> 01:30:33,812 SO GREAT MEETING. 2601 01:30:33,812 --> 01:30:34,213 THANKS, EVERYONE. 2602 01:30:34,213 --> 01:30:36,882 AND WE WILL HAVE THIS WHITE 2603 01:30:36,882 --> 01:30:41,520 PAPER WHICH IS PRETTY MUCH YOU 2604 01:30:41,520 --> 01:30:47,326 KNOW, KNOWLEDGE GAPS, SOME BASIC 2605 01:30:47,326 --> 01:30:49,328 REPRESENT RECOMMENDATIONS AND 2606 01:30:49,328 --> 01:30:49,962 RESEARCH RECOMMENDATIONS IS 2607 01:30:49,962 --> 01:30:52,030 THERE A PLACE TO THROW A 2608 01:30:52,030 --> 01:30:52,498 PROTEASED DEFINITION. 2609 01:30:52,498 --> 01:30:54,566 IF YOU WERE TO CREATE A 2610 01:30:54,566 --> 01:30:56,001 DEFINITION, WHAT YOU WOULD DO IS 2611 01:30:56,001 --> 01:30:58,570 GET A BUNCH OF EXPERTS TOGETHER 2612 01:30:58,570 --> 01:31:00,272 AND HAVE A MEETING FOR TWO DAYS 2613 01:31:00,272 --> 01:31:04,176 AND HAMMER OUT A DEFINITION. 2614 01:31:04,176 --> 01:31:04,810 >> THE ORGANIZATION THAT YOUR 2615 01:31:04,810 --> 01:31:08,247 PRESIDENT OF IS WORKING ON THAT 2616 01:31:08,247 --> 01:31:10,082 RIGHT NOW. 2617 01:31:10,082 --> 01:31:12,084 [ LAUGHTER ] 2618 01:31:12,084 --> 01:31:12,551 YEAH. 2619 01:31:12,551 --> 01:31:13,752 YES. 2620 01:31:13,752 --> 01:31:14,019 >> SURE. 2621 01:31:14,019 --> 01:31:15,287 >> YOU WILL GET AN INVITATION. 2622 01:31:15,287 --> 01:31:17,289 >> THE JUST SEEMS LIKE A VERY 2623 01:31:17,289 --> 01:31:18,490 BASIC FIRST STEP. 2624 01:31:18,490 --> 01:31:20,025 IF YOU WANT TO HAVE A BIOMARKER, 2625 01:31:20,025 --> 01:31:23,429 YOU NEED TO HAVE A PHENOTYPE 2626 01:31:23,429 --> 01:31:24,696 THAT YOU'RE PREDICTING THAT 2627 01:31:24,696 --> 01:31:25,564 EVERYBODY AGREES ON. 2628 01:31:25,564 --> 01:31:28,100 IF YOU WANT TO ASSESS A 2629 01:31:28,100 --> 01:31:30,602 MANAGEMENT STRATEGY, YOU HAVE TO 2630 01:31:30,602 --> 01:31:31,904 HAVE A PHENOTYPE THAT EVERYBODY 2631 01:31:31,904 --> 01:31:32,905 AGREES OBJECT. 2632 01:31:32,905 --> 01:31:36,675 SO JUST SEEMS LIKE SUCH A 2633 01:31:36,675 --> 01:31:38,610 CRITICAL STEP THAT YOU CAN'T DO 2634 01:31:38,610 --> 01:31:39,478 ANYTHING ELSE UNTIL YOU HAVE 2635 01:31:39,478 --> 01:31:41,613 THAT PART DOWN. 2636 01:31:41,613 --> 01:31:43,849 AND IT'S COOL THAT DIFFERENT 2637 01:31:43,849 --> 01:31:45,083 ORGANIZATIONS ARE DOING THAT. 2638 01:31:45,083 --> 01:31:47,019 BUT YOU SORT OF NEED ONE 2639 01:31:47,019 --> 01:31:49,188 DEFINITION THAT EVERYBODY USES 2640 01:31:49,188 --> 01:31:50,155 FOR THIS TO ACTUALLY FUNCTION. 2641 01:31:50,155 --> 01:31:52,090 >> WE ARE. 2642 01:31:52,090 --> 01:31:55,227 LIKE AT LEAST -- PAS -- TO WORK 2643 01:31:55,227 --> 01:31:56,094 ON THIS. 2644 01:31:56,094 --> 01:31:57,496 >> THAT IS SOMETHING, I THINK IF 2645 01:31:57,496 --> 01:31:59,865 YOU ARE THE EXPERT. 2646 01:31:59,865 --> 01:32:02,601 SO IN THE GROUP OR WHEN YOU TALK 2647 01:32:02,601 --> 01:32:04,503 WITH EACH OTHER AND EXCHANGE 2648 01:32:04,503 --> 01:32:06,104 THESE DOCUMENT, THERE IS A NEED 2649 01:32:06,104 --> 01:32:06,972 OF THESE NEW DEFINITION, THEN 2650 01:32:06,972 --> 01:32:09,374 YOU AGREE WITH EACH OTHER, WITH 2651 01:32:09,374 --> 01:32:10,342 THE SOCIETY. 2652 01:32:10,342 --> 01:32:13,278 YOU ARE -- THE PAPER YOU'RE 2653 01:32:13,278 --> 01:32:16,448 WRITING DOESN'T REQUIRE OUR 2654 01:32:16,448 --> 01:32:17,716 PERMISSION. 2655 01:32:17,716 --> 01:32:20,352 THERE ARE SOME LIMITATIONS, LIKE 2656 01:32:20,352 --> 01:32:22,488 YOU CANNOT HAVE POLICY OR 2657 01:32:22,488 --> 01:32:23,422 CLINICAL RECOMMENDATION, THAT IS 2658 01:32:23,422 --> 01:32:25,724 NOT OUR GOAL, BUT I THINK THE 2659 01:32:25,724 --> 01:32:27,326 DEFINITION COULD BE UNDER THE 2660 01:32:27,326 --> 01:32:34,132 UMBRELLA FOR YOU TO RESEARCH BY 2661 01:32:34,132 --> 01:32:39,137 IMPROVING YOUR DEFINITION AND 2662 01:32:39,137 --> 01:32:40,939 STANDARD EQUATION. 2663 01:32:40,939 --> 01:32:47,045 >> PLEASE DO NOT HAVE ANOTHER 2664 01:32:47,045 --> 01:32:47,379 PREECLAMPSIA. 2665 01:32:47,379 --> 01:32:49,815 >> THAT MEANS BOB CANNOT BE ON 2666 01:32:49,815 --> 01:32:51,917 THE COMMITTEE. 2667 01:32:51,917 --> 01:32:53,719 >> FOLLOWING THAT DEFINITION, 2668 01:32:53,719 --> 01:32:55,387 ACCRETA, ACCRETA WITHOUT SEVERE 2669 01:32:55,387 --> 01:32:58,323 FEATURES, ACCRETA WITH SEVERE 2670 01:32:58,323 --> 01:32:58,590 FEATURES. 2671 01:32:58,590 --> 01:32:59,024 >> ABSOLUTELY NOT. 2672 01:32:59,024 --> 01:32:59,491 [ LAUGHTER ] 2673 01:32:59,491 --> 01:33:02,861 WHICH ONE IS SUPER IMPORTANT. 2674 01:33:02,861 --> 01:33:05,764 [ LAUGHTER ] 2675 01:33:05,764 --> 01:33:09,902 >> AND ADD SUPERIMPOSED 2676 01:33:09,902 --> 01:33:10,168 ACCRETAS. 2677 01:33:10,168 --> 01:33:14,506 >> THINK OF THE CHAT -- IN PART 2678 01:33:14,506 --> 01:33:16,408 OF THE GOAL. 2679 01:33:16,408 --> 01:33:18,610 WE CAN PROBABLY, WHENEVER WE GET 2680 01:33:18,610 --> 01:33:20,045 THIS DRAFT, WE CAN START TO 2681 01:33:20,045 --> 01:33:22,281 CIRCULATE SOME OF THE 2682 01:33:22,281 --> 01:33:23,448 DEFINITIONS AND TALK TOGETHER. 2683 01:33:23,448 --> 01:33:25,884 >> YEAH, I MEAN, I THINK, A CALL 2684 01:33:25,884 --> 01:33:29,254 FOR, THE ACTIVITY OF DEFINING 2685 01:33:29,254 --> 01:33:30,455 ACCRETA IS THE, IS WHAT'S GOING 2686 01:33:30,455 --> 01:33:31,657 TO BE IN THE WHITE PAPER. 2687 01:33:31,657 --> 01:33:33,959 AND THEN A SEPARATE PROCESS THAT 2688 01:33:33,959 --> 01:33:37,162 SOUNDS LIKE IS ALREADY UNDERWAY, 2689 01:33:37,162 --> 01:33:39,631 WHICH IS UNDERWAY. 2690 01:33:39,631 --> 01:33:40,232 >> YEAH. 2691 01:33:40,232 --> 01:33:41,900 REVIEW FOR PATHOLOGISTS INPUT 2692 01:33:41,900 --> 01:33:43,468 FOR THE DEFINITION? 2693 01:33:43,468 --> 01:33:43,735 >> YEAH. 2694 01:33:43,735 --> 01:33:46,772 BECAUSE WE DON'T HAVE A 2695 01:33:46,772 --> 01:33:48,941 PATHOLOGIST IN THIS WORKING 2696 01:33:48,941 --> 01:33:49,141 GROUP. 2697 01:33:49,141 --> 01:33:51,143 >> THERE IS, DANNY CAN SPEAK TO 2698 01:33:51,143 --> 01:33:51,743 THIS BETTER. 2699 01:33:51,743 --> 01:33:54,746 BUT PATHOLOGISTS ARE INVOLVED IN 2700 01:33:54,746 --> 01:33:55,847 YOUR DEFINITION. 2701 01:33:55,847 --> 01:33:56,915 >> YEAH THIS IS THE PERFECT 2702 01:33:56,915 --> 01:33:58,617 OPPORTUNITY TO PUT IN A PLUG. 2703 01:33:58,617 --> 01:34:02,154 WE WILL BE SENDING OUT EMAIL FOR 2704 01:34:02,154 --> 01:34:02,988 FOCUS GROUP PARTICIPATION. 2705 01:34:02,988 --> 01:34:04,523 REACHING OUT TO PAS EXPERTS AND 2706 01:34:04,523 --> 01:34:07,426 MANY OF YOU WILL BE RECEIVING 2707 01:34:07,426 --> 01:34:09,428 THE EMAILS SOON, AND ALSO 2708 01:34:09,428 --> 01:34:10,996 INCLUDE PATHOLOGISTS PART OF THE 2709 01:34:10,996 --> 01:34:13,231 WORKING GROUP AND TASK FORCE. 2710 01:34:13,231 --> 01:34:15,067 >> ( SPEAKER OFF MICROPHONE ). 2711 01:34:15,067 --> 01:34:17,302 >> YEAH, I WANTED TO ACKNOWLEDGE 2712 01:34:17,302 --> 01:34:19,705 THIS IS SOMETHING TO SHARE -- I 2713 01:34:19,705 --> 01:34:24,543 REALLY WANTED TO DO, IT WAS JUST 2714 01:34:24,543 --> 01:34:25,611 A LIMITATION WITH THE SECTION OF 2715 01:34:25,611 --> 01:34:27,045 PATHOLOGY, THERE WAS SO MUCH WE 2716 01:34:27,045 --> 01:34:28,880 COULD ACHIEVE AND TRY TO GET 2717 01:34:28,880 --> 01:34:31,283 DONE IN ONE DAY. 2718 01:34:31,283 --> 01:34:33,552 AND WE REALLY WANTED TO HAVE 2719 01:34:33,552 --> 01:34:36,521 THIS MOMENT OF DISCUSSION AND 2720 01:34:36,521 --> 01:34:39,157 NOT JUST HAVING A SERIES OF 2721 01:34:39,157 --> 01:34:40,759 PRESENTATION, BUT TO HAVE 2722 01:34:40,759 --> 01:34:41,526 ACTIONABLE ITEMS. 2723 01:34:41,526 --> 01:34:46,198 SO I'M SORRY THAT WE COULD NOT 2724 01:34:46,198 --> 01:34:46,732 GET THE PATHOLOGISTS. 2725 01:34:46,732 --> 01:34:53,171 >> I THINK WE'RE TO YOU. 2726 01:34:53,171 --> 01:35:03,415 [ LAUGHTER ] 2727 01:35:05,817 --> 01:35:08,387 >> OH, THE SAME LIGHTS. 2728 01:35:08,387 --> 01:35:11,923 [ LAUGHTER ] 2729 01:35:11,923 --> 01:35:14,059 MY PROMISE IS REALLY TWO 2730 01:35:14,059 --> 01:35:14,660 MINUTES. 2731 01:35:14,660 --> 01:35:17,329 I'M NOT GOING TO HOLD YOU BACK 2732 01:35:17,329 --> 01:35:20,399 FROM YOUR LUNCH OR FLIGHT OR 2733 01:35:20,399 --> 01:35:22,334 VISIT WASHINGTON, OR FIND COFFEE 2734 01:35:22,334 --> 01:35:32,544 SOMEWHERE. 2735 01:35:36,815 --> 01:35:37,315 IT'S FINE. 2736 01:35:37,315 --> 01:35:38,650 WELL, IT WAS JUST THE NAME OF 2737 01:35:38,650 --> 01:35:43,121 THE PANELISTS ON MY SLIDES. 2738 01:35:43,121 --> 01:35:47,125 SO I WANTED TO THANK EVERYONE OF 2739 01:35:47,125 --> 01:35:48,593 YOU, EVE AND EACH OF YOU, I 2740 01:35:48,593 --> 01:35:54,733 WANTED TO THANK THE SOCIETY. 2741 01:35:54,733 --> 01:35:56,301 [LISTING SOCIETY MEMBERS] FOR 2742 01:35:56,301 --> 01:35:58,003 SENDING AND SUPPORTING THE 2743 01:35:58,003 --> 01:36:00,539 WORKSHOP AND HAVING THEIR 2744 01:36:00,539 --> 01:36:03,308 REPRESENTATIVES HERE. 2745 01:36:03,308 --> 01:36:06,044 AND I REALLY ENCOURAGE TO WORK 2746 01:36:06,044 --> 01:36:07,412 WITH EACH OF YOU WITHIN YOUR 2747 01:36:07,412 --> 01:36:07,612 GROUP. 2748 01:36:07,612 --> 01:36:11,283 BECAUSE, YES, IT'S A PAPER, BUT 2749 01:36:11,283 --> 01:36:11,983 HOPEFULLY, THERE IS SOMETHING 2750 01:36:11,983 --> 01:36:16,088 THAT WILL COME OUT FROM THE 2751 01:36:16,088 --> 01:36:17,055 COMMUNITY, WHAT OUR COMMUNITY 2752 01:36:17,055 --> 01:36:20,092 CAN UNDERSTAND AND HAVE A BETTER 2753 01:36:20,092 --> 01:36:21,793 GUIDELINE OF WHAT YOU, AS THE 2754 01:36:21,793 --> 01:36:24,196 EXPERTS THINK WE SHOULD WORK AS 2755 01:36:24,196 --> 01:36:26,364 FAR AS THE SCREENING, 2756 01:36:26,364 --> 01:36:29,468 PREVENTION, DIAGNOSIS, AND 2757 01:36:29,468 --> 01:36:29,768 MANAGEMENT. 2758 01:36:29,768 --> 01:36:33,004 SO THE PRIOR SLIDES WERE ALL OF 2759 01:36:33,004 --> 01:36:33,305 YOUR NAMES. 2760 01:36:33,305 --> 01:36:33,638 [ LAUGHTER ] 2761 01:36:33,638 --> 01:36:35,240 BUT I THINK WE WENT OUT OF 2762 01:36:35,240 --> 01:36:36,742 ORDER. 2763 01:36:36,742 --> 01:36:38,810 BUT THAT IS FINE. 2764 01:36:38,810 --> 01:36:40,479 SO THIS IS JUST LIKE, TO THANK 2765 01:36:40,479 --> 01:36:42,547 ALL OF YOU. 2766 01:36:42,547 --> 01:36:47,119 AND DEFINITELY THOSE WHO CAME 2767 01:36:47,119 --> 01:36:48,053 FROM INTERNATIONAL FLIGHT FOR 2768 01:36:48,053 --> 01:36:51,156 48-HOUR TURNAROUND, THANK YOU SO 2769 01:36:51,156 --> 01:36:52,591 MUCH. 2770 01:36:52,591 --> 01:36:53,859 AND THE SOCIETY AND, AGAIN, 2771 01:36:53,859 --> 01:36:57,896 HERE, AND THANK YOU. 2772 01:36:57,896 --> 01:37:01,133 AND WE CONCLUDED OUR PLACENTA 2773 01:37:01,133 --> 01:37:02,300 ACCRETA SPECTRUM PRESENT AND 2774 01:37:02,300 --> 01:37:04,603 FUTURE, WE ARE LOOKING FOR THIS 2775 01:37:04,603 --> 01:37:05,303 DRAFT. 2776 01:37:05,303 --> 01:37:06,938 SEND YOUR QUESTIONS TO BRETT AND 2777 01:37:06,938 --> 01:37:08,240 KRISTINA, WHICH HAS BEEN 2778 01:37:08,240 --> 01:37:08,807 FABULOUS. 2779 01:37:08,807 --> 01:37:10,308 WORKING ON THIS WORKSHOP. 2780 01:37:10,308 --> 01:37:14,279 AND AGAIN, I HAD THE SUPPORT OF 2781 01:37:14,279 --> 01:37:15,147 NICHD. 2782 01:37:15,147 --> 01:37:18,416 DOCTOR IS WITH US UNTIL THE END. 2783 01:37:18,416 --> 01:37:22,087 HOPEFULLY, WE WILL SEE SOME MORE 2784 01:37:22,087 --> 01:37:23,688 COMMON MANAGEMENT, 2785 01:37:23,688 --> 01:37:25,323 STANDARDIZATION TO DEGREE, TO 2786 01:37:25,323 --> 01:37:27,325 REDUCE MORBIDITY AND MORTALITY 2787 01:37:27,325 --> 01:37:27,793 RELATED TO THIS TOPIC. 2788 01:37:27,793 --> 01:37:28,894 SO THANK YOU VERY MUCH FOR 2789 01:37:28,894 --> 01:37:30,195 JOINING US. 2790 01:37:30,195 --> 01:37:40,539 [ EVENT CONCLUDED ]