1 00:00:05,692 --> 00:00:06,559 GOOD MORNING, GOOD AFTERNOON, 2 00:00:06,559 --> 00:00:08,228 AND GOOD EVENING TO ALL OF YOU 3 00:00:08,228 --> 00:00:08,795 JOINING US FROM AROUND THE 4 00:00:08,795 --> 00:00:11,698 WORLD. 5 00:00:11,698 --> 00:00:15,134 WELCOME TO DAY 2 OF OUR 6 00:00:15,134 --> 00:00:17,170 WORKSHOP ON GLOBAL 7 00:00:17,170 --> 00:00:26,012 IMPLEMENTATION SCIENCES TO 8 00:00:26,012 --> 00:00:26,646 "GLOBAL IMPLEMENTATION SCIENCE 9 00:00:26,646 --> 00:00:27,280 APPROACHES TO IMPROVE MATERNAL 10 00:00:27,280 --> 00:00:27,880 HEART, LUNG, BLOOD, AND SLEEP 11 00:00:27,880 --> 00:00:35,054 HEALTH OUTCOMES- DAY 2" 12 00:00:35,054 --> 00:00:37,523 I'M VERONICA TONWE. 13 00:00:37,523 --> 00:00:40,860 I'M WITH THE CENTER FOR 14 00:00:40,860 --> 00:00:41,661 TRANSLATION RESEARCH AND 15 00:00:41,661 --> 00:00:42,362 IMPLEMENTATION. 16 00:00:42,362 --> 00:00:44,264 IT'S MY PLEASURE TO KICKOFF 17 00:00:44,264 --> 00:00:46,032 TODAY'S SESSION. 18 00:00:46,032 --> 00:00:49,202 YESTERDAY WAS A DAY FULL OF 19 00:00:49,202 --> 00:00:51,104 ENGAGING DISCUSSIONS AND 20 00:00:51,104 --> 00:00:52,071 INSIGHTFUL PRESENTATIONS. WE 21 00:00:52,071 --> 00:00:57,343 COVERED A BROAD RANGE OF TOPICS 22 00:00:57,343 --> 00:00:59,445 FROM CARDIOVASCULAR HEALTH, TO 23 00:00:59,445 --> 00:01:03,049 BLOOD DISORDERS AND DELVED INTO 24 00:01:03,049 --> 00:01:03,616 COMMUNITY IMPLEMENTATION 25 00:01:03,616 --> 00:01:05,118 PROGRAMS MAKING SIGNIFICANT 26 00:01:05,118 --> 00:01:06,219 STRIDES IN MATERNAL HEALTH. 27 00:01:06,219 --> 00:01:08,755 THE PARTICIPATION IN THE 28 00:01:08,755 --> 00:01:11,624 DYNAMIC EXCHANGE OF IDEAS WERE 29 00:01:11,624 --> 00:01:11,991 TRULY INSPIRING. 30 00:01:11,991 --> 00:01:13,459 BUT AS WE MOVE INTO TODAY WE 31 00:01:13,459 --> 00:01:16,262 CONTINUE OUR JOURNEY TO EXPLORE 32 00:01:16,262 --> 00:01:17,563 INNOVATIVE SOLUTIONS AND 33 00:01:17,563 --> 00:01:18,264 IMPLEMENTATION SCIENCE 34 00:01:18,264 --> 00:01:20,300 STRATEGIES THAT CAN ADDRESS 35 00:01:20,300 --> 00:01:21,801 MATERNAL HEALTH CRISIS BOTH IN 36 00:01:21,801 --> 00:01:25,104 THE U.S. AND GLOBALLY. 37 00:01:25,104 --> 00:01:26,239 OUR OBJECTIVES REMAIN FOCUSED 38 00:01:26,239 --> 00:01:28,474 TO EXPLORE THE MATERNAL HEALTH 39 00:01:28,474 --> 00:01:32,478 CRISIS IN THE CONTEXT OF HEALTH 40 00:01:32,478 --> 00:01:34,113 DISPARITIES AND HEART, LUNG, 41 00:01:34,113 --> 00:01:36,649 BLOOD AND SLEEP DISORDERS THAT 42 00:01:36,649 --> 00:01:39,052 AFFECT MATERNAL MORTALITY AND 43 00:01:39,052 --> 00:01:40,787 MORBIDITY. 44 00:01:40,787 --> 00:01:46,993 TO USE INFORMATION TO INFORM 45 00:01:46,993 --> 00:01:48,361 PRACTICES TO DISCUSS CHALLENGES 46 00:01:48,361 --> 00:01:50,663 AND OPPORTUNITIES FOR ADVANCE 47 00:01:50,663 --> 00:01:52,231 AND IMPLEMENTATION RESEARCH, 48 00:01:52,231 --> 00:01:54,867 TRAINING AND CAPACITY BUILDING 49 00:01:54,867 --> 00:01:56,969 AND MATERNAL HEALTH. 50 00:01:56,969 --> 00:01:58,671 TO EMPHASIZE THE IMPORTANCE OF 51 00:01:58,671 --> 00:02:00,873 COMMUNITY ENGAGEMENT IN THE 52 00:02:00,873 --> 00:02:02,809 MATERNAL HEALTH RESEARCH 53 00:02:02,809 --> 00:02:05,445 PROGRAMS AND SHARING OF 54 00:02:05,445 --> 00:02:07,013 INSIGHTS BETWEEN GLOBAL AND 55 00:02:07,013 --> 00:02:09,615 DOMESTIC SETTINGS TO FOSTER 56 00:02:09,615 --> 00:02:13,486 INNOVATIVE SOLUTIONS AND 57 00:02:13,486 --> 00:02:14,020 CO-LEARNING OPPORTUNITIES. 58 00:02:14,020 --> 00:02:17,590 IN ORDER TO MAINTAIN OUR GOAL 59 00:02:17,590 --> 00:02:20,493 OF CUTTING EDGE FINDING AND 60 00:02:20,493 --> 00:02:21,661 BEST PRACTICES, IDENTIFYING 61 00:02:21,661 --> 00:02:23,996 KNOWLEDGE GAPS AND CRITICAL 62 00:02:23,996 --> 00:02:25,832 UNMET NEEDS WHILE UNCOVERING 63 00:02:25,832 --> 00:02:28,968 OPPORTUNITIES FOR IMPROVING 64 00:02:28,968 --> 00:02:32,805 MATERNAL HEART, LUNG, BLOOD AND 65 00:02:32,805 --> 00:02:35,241 SLEEP OUTCOMES USING 66 00:02:35,241 --> 00:02:41,381 IMPLEMENTATION SIGNS BOTH 67 00:02:41,381 --> 00:02:44,984 DOMESTICALLY AND GLOBALLY. 68 00:02:44,984 --> 00:02:46,486 TODAY'S AGENDA PROMISES TO BE 69 00:02:46,486 --> 00:02:47,787 JUST AS ENRICHING. 70 00:02:47,787 --> 00:02:53,826 WE WILL START WITH KEYNOTE 71 00:02:53,826 --> 00:03:04,370 PRESENTATION FROM DR. MARY DIXON 72 00:03:07,407 --> 00:03:09,475 . 73 00:03:09,475 --> 00:03:11,444 THESE ARE TO ENCOURAGE 74 00:03:11,444 --> 00:03:12,345 COLLABORATION ACROSS 75 00:03:12,345 --> 00:03:13,579 DISCIPLINES AND BORDERS. BEFORE 76 00:03:13,579 --> 00:03:15,415 WE DIVE INTO OUR KEYNOTE, I 77 00:03:15,415 --> 00:03:17,550 WOULD LIKE TO REMIND YOU ALL TO 78 00:03:17,550 --> 00:03:18,951 STAY ENGAGED THROUGH THE Q&A 79 00:03:18,951 --> 00:03:21,020 BOX AND COMMENTS IN THE CHAT 80 00:03:21,020 --> 00:03:22,488 SECTION. 81 00:03:22,488 --> 00:03:24,390 OUR MODERATORS WILL BE ACTIVELY 82 00:03:24,390 --> 00:03:27,693 MODERATING THE CHAT AND THE QA 83 00:03:27,693 --> 00:03:29,028 AND WILL BRING YOUR COMMENTS 84 00:03:29,028 --> 00:03:32,231 AND QUESTIONS TO THE LIVE 85 00:03:32,231 --> 00:03:32,532 DISCUSSION. 86 00:03:32,532 --> 00:03:35,635 THANK YOU FOR YOUR CONTINUED 87 00:03:35,635 --> 00:03:38,838 PARTICIPATION TO IMPROVING 88 00:03:38,838 --> 00:03:39,372 MATERNAL HEALTH OUTCOMES. 89 00:03:39,372 --> 00:03:42,141 I WILL TURN IT OVER TO DR. MARY 90 00:03:42,141 --> 00:03:44,210 MASTERSON WHO WILL INTRODUCE 91 00:03:44,210 --> 00:03:46,546 OUR KEYNOTE SPEAKER. 92 00:03:46,546 --> 00:03:49,415 LET'S HAVE ANOTHER PRODUCTIVE 93 00:03:49,415 --> 00:03:49,816 AND INSPIRING DAY. 94 00:03:49,816 --> 00:03:54,253 OVER TO YOU, DR. MASTERSON. 95 00:03:54,253 --> 00:03:55,988 >> DR. MASTERSON: HELLO, IT'S 96 00:03:55,988 --> 00:03:58,691 MY PLEASURE TO INTRODUCE OUR 97 00:03:58,691 --> 00:04:09,168 KEYNOTE SPEAKER FOR DAY TWO. 98 00:04:10,937 --> 00:04:21,280 DR. KAREN WOODS. IN THE 99 00:04:25,384 --> 00:04:29,489 INTEREST OF TIME, I WILL NOT GO 100 00:04:29,489 --> 00:04:32,158 OVER HER BIO, PLEASE GO OVER 101 00:04:32,158 --> 00:04:32,658 THE DOCUMENT PRESENTED 102 00:04:32,658 --> 00:04:34,927 YESTERDAY. 103 00:04:34,927 --> 00:04:37,864 STRATEGIES WE CAN LEVERAGE TO 104 00:04:37,864 --> 00:04:39,465 SUPPORT HEALTHCARE IMPROVEMENT. 105 00:04:39,465 --> 00:04:41,601 WE WILL HOLD AN OPEN DISCUSSION 106 00:04:41,601 --> 00:04:43,870 AND BASED OFF THE ENGAGEMENT WE 107 00:04:43,870 --> 00:04:46,272 SAW YESTERDAY I LOOK FORWARD TO 108 00:04:46,272 --> 00:04:48,608 ADDRESSING YOUR QUESTIONS TO 109 00:04:48,608 --> 00:04:50,710 DR. DIXIT WOODS AND CHARGE US 110 00:04:50,710 --> 00:04:52,245 TO THINK CRITICALLY ABOUT 111 00:04:52,245 --> 00:04:54,080 STRATEGIES TO IMPROVE MATERNAL 112 00:04:54,080 --> 00:04:55,348 HEALTH OUTCOMES. 113 00:04:55,348 --> 00:04:59,652 WITH THAT, TAKE IT AWAY, DR. 114 00:04:59,652 --> 00:05:01,821 DIXIT WOODS. 115 00:05:01,821 --> 00:05:04,957 >> DR. WOODS: THANK YOU, DR. 116 00:05:04,957 --> 00:05:05,224 MASTERSON. 117 00:05:05,224 --> 00:05:08,995 I HOPE SOMEONE CAN SEE MY 118 00:05:08,995 --> 00:05:12,565 SLIDES OKAY. 119 00:05:12,565 --> 00:05:14,433 >> WE ARE STILL SEEING IT NOT 120 00:05:14,433 --> 00:05:21,574 IN PRESENTATION VIEW. 121 00:05:21,574 --> 00:05:24,877 >> GO TO WHERE IT SAYS DISPLAY 122 00:05:24,877 --> 00:05:29,849 SETTINGS AND TOGGLE LEFT. 123 00:05:29,849 --> 00:05:40,359 CLICK ON DISPLAY SETTINGS. AT 124 00:05:44,063 --> 00:05:46,699 THE TOP OF THE POWERPOINT. 125 00:05:46,699 --> 00:05:49,535 TOP MIDDLE. 126 00:05:49,535 --> 00:05:52,138 >> YEP, IT'S NOT THERE. 127 00:05:52,138 --> 00:05:53,973 >> LOOK AT YOUR SECOND MONITOR, 128 00:05:53,973 --> 00:05:55,541 IS IT ON THAT SCREEN? 129 00:05:55,541 --> 00:05:57,643 >> IT'S VERY LIKELY SHE IS 130 00:05:57,643 --> 00:05:58,377 SEEING THE PRESENTATION MODE 131 00:05:58,377 --> 00:06:00,479 AND WE ARE SEEING THE VIEWER. 132 00:06:00,479 --> 00:06:10,990 SO CAN I.T. HELP US WITH THAT. 133 00:06:57,336 --> 00:06:58,971 >> 134 00:06:58,971 --> 00:07:00,473 >> Mary Dixon-Woods: WE HAVE A 135 00:07:00,473 --> 00:07:02,708 PARTICULAR INTEREST IN 136 00:07:02,708 --> 00:07:03,075 MATERNITY CARE. 137 00:07:03,075 --> 00:07:04,243 ONE THING WE ARE TRYING TO DO 138 00:07:04,243 --> 00:07:05,678 IS BUILD A LEARNING HEALTH 139 00:07:05,678 --> 00:07:06,178 SYSTEM. 140 00:07:06,178 --> 00:07:08,714 WE THINK THAT HAS THREE 141 00:07:08,714 --> 00:07:10,549 COMPONENTS OR CAPABILITIES. 142 00:07:10,549 --> 00:07:11,851 FIRST TO CHARACTERIZE AND 143 00:07:11,851 --> 00:07:12,985 UNDERSTAND PROBLEMS. 144 00:07:12,985 --> 00:07:17,423 SECOND THE ABILITY TO DEVELOP A 145 00:07:17,423 --> 00:07:20,226 POSSIBLE SOLUTIONS AND TO 146 00:07:20,226 --> 00:07:20,559 EVALUATE THEM. 147 00:07:20,559 --> 00:07:21,193 SO THOSE THREE CAPABILITIES 148 00:07:21,193 --> 00:07:22,662 WILL GUIDE MUCH OF WHAT I 149 00:07:22,662 --> 00:07:24,263 PRESENT TO YOU TODAY, BECAUSE 150 00:07:24,263 --> 00:07:26,098 THEY ARE ALL HIGHLY RELEVANT TO 151 00:07:26,098 --> 00:07:27,199 IMPLEMENTATION. 152 00:07:27,199 --> 00:07:28,968 I THINK THE BUSINESS OF 153 00:07:28,968 --> 00:07:31,170 UNDERSTANDING THE PROBLEM IS A 154 00:07:31,170 --> 00:07:31,437 KEY STEP. 155 00:07:31,437 --> 00:07:33,439 BUT IT'S ONE THAT IS VERY OFTEN 156 00:07:33,439 --> 00:07:35,875 NEGLECTED AS WE RUSH TO 157 00:07:35,875 --> 00:07:36,142 SOLUTIONS. 158 00:07:36,142 --> 00:07:38,077 ONE OF OUR CHALLENGES IS THAT 159 00:07:38,077 --> 00:07:40,079 PROBLEMS, AS WE IMAGINE THEM, 160 00:07:40,079 --> 00:07:42,081 ARE NOT THE SAME AS PROBLEMS AS 161 00:07:42,081 --> 00:07:44,650 THEY REALLY ARE. 162 00:07:44,650 --> 00:07:46,585 THIS DELIGHTFUL CREATURE IS A 163 00:07:46,585 --> 00:07:49,255 CARVING IN A CHURCH ABOUT 30 164 00:07:49,255 --> 00:07:50,489 MILES FROM MY HOME. 165 00:07:50,489 --> 00:07:52,758 YOU MAY WISH TO PUT IN THE CHAT 166 00:07:52,758 --> 00:07:55,461 WHAT KIND OF ANIMAL YOU THINK 167 00:07:55,461 --> 00:07:56,962 THE MEDIEVAL ARTIST WAS TRYING 168 00:07:56,962 --> 00:07:58,764 TO DEPICT. 169 00:07:58,764 --> 00:08:00,966 WHAT I CAN PROBABLY GUARANTY IT 170 00:08:00,966 --> 00:08:02,501 WILL BE DIFFICULT TO GUESS THE 171 00:08:02,501 --> 00:08:05,171 MANL SHOWN HERE. 172 00:08:05,171 --> 00:08:06,739 ANIMAL SHOWN HERE. 173 00:08:06,739 --> 00:08:08,708 IT IS IN FACT ELEPHANT. 174 00:08:08,708 --> 00:08:10,509 THE ARTIST HAD NEVER SEEN ANEL 175 00:08:10,509 --> 00:08:13,212 HAVEN'T SO WHAT THEY DEPICT, IT 176 00:08:13,212 --> 00:08:14,647 LOOKS VERY UNLIKE WHAT WE KNOW 177 00:08:14,647 --> 00:08:16,248 TO BE REALITY FNLT 178 00:08:16,248 --> 00:08:18,284 WHEN WE DON'T REALLY UNDERSTAND 179 00:08:18,284 --> 00:08:20,486 THE PROBLEM WE IMAGINE 180 00:08:20,486 --> 00:08:23,489 SOMETHING WHAT IS NOT WHAT IT 181 00:08:23,489 --> 00:08:23,756 REALLY IS. 182 00:08:23,756 --> 00:08:26,692 THE REAL PROBLEM IS THE 183 00:08:26,692 --> 00:08:27,259 IMPROVEMENT ATTENTION GETS 184 00:08:27,259 --> 00:08:27,960 MISDIRECTED. 185 00:08:27,960 --> 00:08:29,729 THIS HAPPENS ALL THE TIME. 186 00:08:29,729 --> 00:08:32,198 ONE EXAMPLE IN MATERNITY 187 00:08:32,198 --> 00:08:36,001 CONTEXT IS CONCEPT OF 188 00:08:36,001 --> 00:08:37,503 ELECTRONIC FETAL MONITORING, A 189 00:08:37,503 --> 00:08:38,671 LONG HISTORY SHOWING ITS VERY 190 00:08:38,671 --> 00:08:41,006 DIFFICULT TO GET IT RIDE. 191 00:08:41,006 --> 00:08:42,274 AND FOCUSING EFFORT ON TRAINING 192 00:08:42,274 --> 00:08:49,415 PEOPLE BETTER AND HOW TO 193 00:08:49,415 --> 00:08:51,517 INTERPRET THE TRACINGS. IT 194 00:08:51,517 --> 00:08:53,219 HASN'T REALLY IMPROVED ANYTHING. 195 00:08:53,219 --> 00:08:55,421 WHEN YOU USE SOCIAL SCIENCE 196 00:08:55,421 --> 00:08:56,856 TECHNIQUES AND HUMAN PRAKTORS 197 00:08:56,856 --> 00:08:58,290 ANALYSIS, YOU GET TO A VERY 198 00:08:58,290 --> 00:08:59,592 DIFFERENT UNDERSTANDING OF THE 199 00:08:59,592 --> 00:09:02,328 PROBLEM, AND IT MEANS YOU CAN 200 00:09:02,328 --> 00:09:05,431 GUIDE YOUR IMPROVEMENT EFFORTS 201 00:09:05,431 --> 00:09:07,933 MUCH MORE EFFECTIVELY. 202 00:09:07,933 --> 00:09:17,176 THE GREAT DOCTOR, IT'S REALLY 203 00:09:17,176 --> 00:09:19,879 IMPORTANT TO RECOGNIZE HOW 204 00:09:19,879 --> 00:09:20,980 STRUCTURES AND PROCESSES 205 00:09:20,980 --> 00:09:21,947 CONTRIBUTE TO OUTCOMES. 206 00:09:21,947 --> 00:09:24,850 SOMETIMES WE SEE THE EMPHASIS 207 00:09:24,850 --> 00:09:25,918 GOING IN ONE DIRECTION RATHER 208 00:09:25,918 --> 00:09:27,953 THAN ANOTHER. 209 00:09:27,953 --> 00:09:28,888 IT'S ABSOLUTELY THE CASE 210 00:09:28,888 --> 00:09:30,556 STRUCTURE IS CRITICAL TO 211 00:09:30,556 --> 00:09:31,724 IMPROVING MATERNITY CARE. 212 00:09:31,724 --> 00:09:34,226 AND THAT'S GOING TO ABOUT 213 00:09:34,226 --> 00:09:35,194 THINGS LIKE FACILITIES, 214 00:09:35,194 --> 00:09:35,861 EQUIPMENT, PERSONNEL. 215 00:09:35,861 --> 00:09:37,263 WE ALL KNOW THIS. 216 00:09:37,263 --> 00:09:39,265 BUT THAT STUFF HAS TO BE RIGHT 217 00:09:39,265 --> 00:09:41,133 OR NOTHING IS RIGHT. 218 00:09:41,133 --> 00:09:43,235 BUT EQUALLY, IT IS TRUE THAT 219 00:09:43,235 --> 00:09:45,337 NOT ALL VARIABILITY CAN BE 220 00:09:45,337 --> 00:09:49,675 EXPLAINED BY VARIABILITY AND 221 00:09:49,675 --> 00:09:50,276 STRUCTURE. 222 00:09:50,276 --> 00:09:52,044 IF WE LOOK AT PROCESSES WE CAN 223 00:09:52,044 --> 00:09:53,712 SEE THESE HELP TO EXPLAIN MUCH 224 00:09:53,712 --> 00:09:56,882 OF THE VARIABILITY WE SEE AS 225 00:09:56,882 --> 00:09:57,750 WELL. 226 00:09:57,750 --> 00:09:59,518 THIS HAS BEEN DEMONSTRATED VERY 227 00:09:59,518 --> 00:10:01,420 EFFECTIVELY FOR EXAMPLE IN THE 228 00:10:01,420 --> 00:10:01,887 CONTEXT OF SURGERY. 229 00:10:01,887 --> 00:10:03,255 EVEN WHEN YOU HAVE 230 00:10:03,255 --> 00:10:04,356 ORGANIZATIONS AND UNIT THAT'S 231 00:10:04,356 --> 00:10:06,258 APPEAR TO BE VERY SIMILAR ON 232 00:10:06,258 --> 00:10:08,027 THE BASIS OF RESOURCES, 233 00:10:08,027 --> 00:10:08,861 ENVIRONMENTS AND POPULATIONS 234 00:10:08,861 --> 00:10:12,531 THEY MAY STILL HAVE VERY 235 00:10:12,531 --> 00:10:12,965 DIFFERENT OUTCOMES. 236 00:10:12,965 --> 00:10:13,799 THOSE DIFFERENCES IN OUTCOMES 237 00:10:13,799 --> 00:10:15,568 ARE NOT EXPLAINED BY 238 00:10:15,568 --> 00:10:18,771 DIFFERENCES IN COMPLICATIONS. 239 00:10:18,771 --> 00:10:21,140 RATES OF COMPLICATIONS TEND TO 240 00:10:21,140 --> 00:10:23,342 BE LARGELY SIMILAR BUT BY 241 00:10:23,342 --> 00:10:25,277 ABILITY TO RESCUE PATIENTS FROM 242 00:10:25,277 --> 00:10:25,611 COMPLICATIONS. 243 00:10:25,611 --> 00:10:27,513 SO THAT ABILITY TO RESCUE IS 244 00:10:27,513 --> 00:10:28,848 LINKED VERY SIGNIFICANTLY TO 245 00:10:28,848 --> 00:10:31,016 PROCESSES AND IN PARTICULAR TO 246 00:10:31,016 --> 00:10:31,784 THINGS LIKE TEAMWORK, 247 00:10:31,784 --> 00:10:32,852 COMMUNICATION AND CULTURE. 248 00:10:32,852 --> 00:10:34,687 IF WE ARE GOING TO GET 249 00:10:34,687 --> 00:10:37,823 HEALTHCARE RIGHT WE HAVE TO 250 00:10:37,823 --> 00:10:38,958 UNDERSTAND ORGANIZATIONAL AND 251 00:10:38,958 --> 00:10:39,658 INTERPERSONAL DYNAMICS. 252 00:10:39,658 --> 00:10:40,993 WE HAVE TO UNDERSTAND PROCESSES 253 00:10:40,993 --> 00:10:43,562 AND HOW ALL OF THIS WORKS 254 00:10:43,562 --> 00:10:49,468 TOGETHER JUST AS MUCH AS WE 255 00:10:49,468 --> 00:10:54,106 UNDERSTAND STRUCTURES. I THINK 256 00:10:54,106 --> 00:11:00,846 WE UNDER USE FORMAL MEASURES, 257 00:11:00,846 --> 00:11:02,047 HIGHLY STRUCTURED WAY OF 258 00:11:02,047 --> 00:11:05,084 GETTING TO THE ISSUES. THIS IS 259 00:11:05,084 --> 00:11:07,152 AN UNDER CITED STUDY, STUDYING 260 00:11:07,152 --> 00:11:08,687 WHAT NURSES WERE DOING AND 261 00:11:08,687 --> 00:11:10,489 SHOWED THEY ARE ESSENTIALLY, 262 00:11:10,489 --> 00:11:12,524 THEY LOS ABOUT 12% OF THEIR 263 00:11:12,524 --> 00:11:15,494 TIME TO WHAT ARE CALLED 264 00:11:15,494 --> 00:11:16,095 OPERATIONAL FAILURE AND 265 00:11:16,095 --> 00:11:17,329 INTERRUPTIONS BECAUSE THEY ARE 266 00:11:17,329 --> 00:11:18,697 CONSTANTLY HAVING TO WORK IN 267 00:11:18,697 --> 00:11:20,299 SYSTEM THAT'S ARE NOT OPTIMIZED 268 00:11:20,299 --> 00:11:22,368 FOR WORK THEY ARE TRYING TO DO. 269 00:11:22,368 --> 00:11:24,336 SO THEY SPEND A LOT OF TIME 270 00:11:24,336 --> 00:11:27,206 HUNTING FOR INFORMATION, GOING 271 00:11:27,206 --> 00:11:31,543 TO THE CUPBOARD TO FIND THE 272 00:11:31,543 --> 00:11:32,711 EQUIPMENT ISN'T THERE, OR CLEAN 273 00:11:32,711 --> 00:11:34,813 OR READY. 274 00:11:34,813 --> 00:11:38,217 WHEN WE COMPLETED THAT STUDY IN 275 00:11:38,217 --> 00:11:43,822 THE PRIMARY CARE CONTEXT IN THE 276 00:11:43,822 --> 00:11:46,358 U.K., THEY SPEND TIME DEALING 277 00:11:46,358 --> 00:11:48,527 WITH OPERATIONAL FAILURES AND 278 00:11:48,527 --> 00:11:49,895 INTERRUPTIONS. THESE ARE 279 00:11:49,895 --> 00:11:51,030 SYSTEMS NOT OPTIMIZED FOR THE 280 00:11:51,030 --> 00:11:55,100 WORK WE ARE ASKING PEOPLE TO DO. 281 00:11:55,100 --> 00:11:58,671 MOREOVER, WHAT PEOPLE ARE ASKED 282 00:11:58,671 --> 00:12:00,639 TO DO OFTEN EXCEEDS THE TIME 283 00:12:00,639 --> 00:12:02,508 THEY HAVE AVAILABLE. 284 00:12:02,508 --> 00:12:05,844 IT WOULD TAKE 27 HOURS A DAY 285 00:12:05,844 --> 00:12:08,280 FOR A PHYSICIAN TO DELIVER 286 00:12:08,280 --> 00:12:09,581 FULLY COMPLIANT GUIDELINE CARE. 287 00:12:09,581 --> 00:12:13,252 NO ONE HAS 27 HOURS A DAY. 288 00:12:13,252 --> 00:12:15,220 WE COULD ALL USE METHODS 289 00:12:15,220 --> 00:12:16,555 ADOPTED FROM OTHER INDUSTRIES 290 00:12:16,555 --> 00:12:17,790 TO ANALYZE WORK SYSTEMS. 291 00:12:17,790 --> 00:12:19,692 AND AGAIN, I THINK THIS IS 292 00:12:19,692 --> 00:12:21,093 SOMETHING THAT ISN'T DONE 293 00:12:21,093 --> 00:12:26,932 ENOUGH. 294 00:12:26,932 --> 00:12:28,567 KEN CATCHPOLE HAS DONE THIS 295 00:12:28,567 --> 00:12:30,436 WORK IN NORTH CAROLINA. 296 00:12:30,436 --> 00:12:32,604 HE LOOKS AT STERILE PROCESSING 297 00:12:32,604 --> 00:12:35,374 OF EQUIPMENT FOR SURGERY, THIS 298 00:12:35,374 --> 00:12:37,076 IS FRAUGHT WITH COMPLEXITY, AND 299 00:12:37,076 --> 00:12:38,877 HAS MULTIPLE POINTS OF 300 00:12:38,877 --> 00:12:39,244 VULNERABILITY. 301 00:12:39,244 --> 00:12:40,479 BUT UNLESS YOU UNDERSTAND THIS 302 00:12:40,479 --> 00:12:43,315 AND YOU MAP IT VERY 303 00:12:43,315 --> 00:12:44,783 SYSTEMATICALLY, IT'S VERY EASY 304 00:12:44,783 --> 00:12:48,287 TO MISDIRECT YOUR ATTENTION IN 305 00:12:48,287 --> 00:12:48,721 TERMS OF IMPROVING. 306 00:12:48,721 --> 00:12:50,656 I ALSO THINK WE FOCUS ON 307 00:12:50,656 --> 00:12:54,059 CLINICAL SYSTEMS, BUT TO THE 308 00:12:54,059 --> 00:12:55,961 EXCLUSION OF THE WIDER CONTEXT 309 00:12:55,961 --> 00:12:57,896 IN WHICH CARE IS PROVIDED. 310 00:12:57,896 --> 00:13:00,332 IN PARTICULAR, TEND TO UNDER 311 00:13:00,332 --> 00:13:01,533 VALUE COMPETENT MANAGEMENT, 312 00:13:01,533 --> 00:13:06,105 INCLUDING MANAGEMENT OF PEOPLE 313 00:13:06,105 --> 00:13:07,973 AND MANAGEMENT OF OPERATIONS 314 00:13:07,973 --> 00:13:09,641 AND FACILITIES. 315 00:13:09,641 --> 00:13:10,709 SO UNDERSTANDING THE PROBLEM IS 316 00:13:10,709 --> 00:13:11,343 ABSOLUTELY KEY. 317 00:13:11,343 --> 00:13:13,445 THEN WE HAVE TO GET TO WHAT ARE 318 00:13:13,445 --> 00:13:15,047 THE SOLUTIONS GOING TO BE. 319 00:13:15,047 --> 00:13:16,515 IT'S NOT LIKE THERE'S ANY 320 00:13:16,515 --> 00:13:18,283 SHORTAGE OF RECOMMENDATIONS FOR 321 00:13:18,283 --> 00:13:20,919 IMPROVING MATERNITY CARE. 322 00:13:20,919 --> 00:13:24,790 IN THE U.K. WE ESTIMATE IN ONE 323 00:13:24,790 --> 00:13:26,191 YEAR THERE WERE 1250 DIFFERENT 324 00:13:26,191 --> 00:13:28,193 RECOMMENDATIONS WHAT TO DO TO 325 00:13:28,193 --> 00:13:29,928 IMPROVE MATERNITY CARE. 326 00:13:29,928 --> 00:13:32,364 BUT WHAT WE LOOK IS EVIDENCE 327 00:13:32,364 --> 00:13:35,734 BASED FOR MANY RECOMMENDATIONS. 328 00:13:35,734 --> 00:13:36,568 PRIORITIZATION, COORDINATION, 329 00:13:36,568 --> 00:13:38,437 HIGH QUALITY DESIGN, TESTING 330 00:13:38,437 --> 00:13:40,305 AND EVALUATION AND CAPABILITY 331 00:13:40,305 --> 00:13:40,639 AND CAPACITY. 332 00:13:40,639 --> 00:13:42,441 SO I THINK YOU ARE THE SAME IN 333 00:13:42,441 --> 00:13:44,977 THE U.S. FROM MY VISITS TO SEE 334 00:13:44,977 --> 00:13:48,714 YOU. 335 00:13:48,714 --> 00:13:51,116 WE HAVE A PROBLEM WE CALL 336 00:13:51,116 --> 00:13:54,987 PRIORITY PICKETS, THERE ARE SO 337 00:13:54,987 --> 00:13:55,821 MANY PRIORITIES, INCENTIVES 338 00:13:55,821 --> 00:14:01,427 THAT HAVE TO BE MET THAT IT IS 339 00:14:01,427 --> 00:14:04,997 DIFFICULT FOR ORGANIZATIONS AND 340 00:14:04,997 --> 00:14:05,697 TEAMS TO IDENTIFY REALLY 341 00:14:05,697 --> 00:14:06,999 CLEARLY. 342 00:14:06,999 --> 00:14:08,967 THEIR OWN GOALS COULD BE 343 00:14:08,967 --> 00:14:13,439 DISPLACED BY THESE EXTERNALLY 344 00:14:13,439 --> 00:14:13,739 IMPOSED ONE. 345 00:14:13,739 --> 00:14:14,606 TOO OFTEN THE ANSWER SEEMS TO 346 00:14:14,606 --> 00:14:16,241 BE WE WILL JUST GROW MORE HANDS 347 00:14:16,241 --> 00:14:20,279 AND WE WILL BE OKAY, THAT'S NOT 348 00:14:20,279 --> 00:14:20,646 A GOOD SOLUTION. 349 00:14:20,646 --> 00:14:24,183 IF WE USE CO-DESIGN METHODS FOR 350 00:14:24,183 --> 00:14:25,684 EXAMPLE, CONSENSUS BUILDING 351 00:14:25,684 --> 00:14:27,619 THEN YOU CAN ACTUALLY HELP WITH 352 00:14:27,619 --> 00:14:30,155 THE PRIORITIZATION. 353 00:14:30,155 --> 00:14:33,225 DONE IN THE PAST TO GET THEM TO 354 00:14:33,225 --> 00:14:34,860 RANK WHAT WERE THEIR TOP 355 00:14:34,860 --> 00:14:36,462 PRIORITIES FOR IMPROVEMENT. 356 00:14:36,462 --> 00:14:37,930 ONCE YOU FIGURE OUT WHAT YOU 357 00:14:37,930 --> 00:14:41,166 NEED TO IMPROVE, THIS IS KIND 358 00:14:41,166 --> 00:14:44,336 OF BASIC AGAIN, BUT OFTEN GETS 359 00:14:44,336 --> 00:14:45,337 NEGLECTED, THE SOLUTIONS NEED 360 00:14:45,337 --> 00:14:47,739 TO BE GOOD ONES BUT WHAT WE SEE 361 00:14:47,739 --> 00:14:49,808 IS THEY ARE POOR QUALITY, NOT 362 00:14:49,808 --> 00:14:51,610 BASED IN EVIDENCE AND NOT 363 00:14:51,610 --> 00:14:53,979 INVOLVED PATIENTS OR STAFF, IN 364 00:14:53,979 --> 00:14:55,414 DESIGN, IMPLEMENTATION OR 365 00:14:55,414 --> 00:14:55,714 EVALUATION. 366 00:14:55,714 --> 00:14:56,415 AND THIS IS PARTICULARLY THE 367 00:14:56,415 --> 00:14:58,617 CASE WHEN YOU LOOK AT ROOT 368 00:14:58,617 --> 00:15:02,321 CAUSE ANALYSES AND THE 369 00:15:02,321 --> 00:15:04,623 RECOMMENDATIONS THAT ARISE FOR 370 00:15:04,623 --> 00:15:05,357 THOSE IMPROVEMENT AFTER 371 00:15:05,357 --> 00:15:07,426 INCIDENTS BUT IT'S TRUE FOR 372 00:15:07,426 --> 00:15:10,162 MANY APPARENT SOLUTIONS IN 373 00:15:10,162 --> 00:15:12,931 HEALTHCARE, MATERNITY CARE, 374 00:15:12,931 --> 00:15:13,298 MORE GENERALLY. 375 00:15:13,298 --> 00:15:14,466 WE ACTUALLY END UP WITH A 376 00:15:14,466 --> 00:15:15,834 TRIPLE THREAT IN TERMS OF 377 00:15:15,834 --> 00:15:17,269 SOLUTION GENERATION. 378 00:15:17,269 --> 00:15:19,671 WE END UP WITH PROBLEMS OF 379 00:15:19,671 --> 00:15:22,674 RESEARCH WASTE, DESIGN WASTE 380 00:15:22,674 --> 00:15:24,476 AND IMPLEMENTATION AND 381 00:15:24,476 --> 00:15:24,877 IMPROVEMENT WASTE. 382 00:15:24,877 --> 00:15:26,778 WE DO HAVE THE PROBLEM, THERE'S 383 00:15:26,778 --> 00:15:29,014 JUST TOO MUCH POOR QUALITY 384 00:15:29,014 --> 00:15:29,281 RESEARCH. 385 00:15:29,281 --> 00:15:30,849 IT'S NEVER GOING TO BE 386 00:15:30,849 --> 00:15:32,184 IMPLEMENTED AND IT ACTUALLY 387 00:15:32,184 --> 00:15:34,620 JUST DOESN'T DESERVE TO BE. 388 00:15:34,620 --> 00:15:37,122 SO THIS ARISES IN PART BECAUSE 389 00:15:37,122 --> 00:15:38,991 INTERVENTIONS AS IMAGINED ARE 390 00:15:38,991 --> 00:15:40,225 NOT REALLY INTERVENTIONS, AS 391 00:15:40,225 --> 00:15:42,995 THEY OPERATE IN PRACTICE. 392 00:15:42,995 --> 00:15:44,897 WE HAVE ANOTHER DELIGHTFUL 393 00:15:44,897 --> 00:15:46,131 MEDIEVAL ANIMAL HERE. 394 00:15:46,131 --> 00:15:47,733 AGAIN, YOU CAN PUT YOUR GUESSES 395 00:15:47,733 --> 00:15:50,903 INTO THE CHAT AS TO WHAT YOU 396 00:15:50,903 --> 00:15:51,603 DHI IT IS. 397 00:15:51,603 --> 00:15:53,138 -THINK IT IS. 398 00:15:53,138 --> 00:15:54,339 YOU MAY BE SURPRISED TO LEARN 399 00:15:54,339 --> 00:15:56,141 THIS IS A TIGER. 400 00:15:56,141 --> 00:15:58,143 BUT AGAIN, WHAT WE SEE IS 401 00:15:58,143 --> 00:16:00,612 THERE'S A HUGE GAP THAOEN WHAT 402 00:16:00,612 --> 00:16:02,114 HOW PEOPLE THINK SOMETHING WILL 403 00:16:02,114 --> 00:16:05,684 WORK AND HOW IT DOES IN REALITY. 404 00:16:05,684 --> 00:16:08,053 WE ARE IN HEALTHCARE CURRENTLY 405 00:16:08,053 --> 00:16:09,955 A WASH WITH CLINICAL PREDICTION 406 00:16:09,955 --> 00:16:12,224 MODELS CLAIMING TO DO ALL KINDS 407 00:16:12,224 --> 00:16:13,725 OF THINGS TO IDENTIFY THE 408 00:16:13,725 --> 00:16:16,495 PATIENT WHO IS GOING TO 409 00:16:16,495 --> 00:16:17,329 DETERIORATE OR DEVELOP A 410 00:16:17,329 --> 00:16:19,431 DISEASE AND WE ALSO HAVE 411 00:16:19,431 --> 00:16:21,500 GUIDANCE HOW TO IMPROVE THE 412 00:16:21,500 --> 00:16:22,301 REPORTING OF CLINICAL 413 00:16:22,301 --> 00:16:25,270 PREDICTION MODELS. 414 00:16:25,270 --> 00:16:29,241 BUT MUCH OF THE FIELD IS 415 00:16:29,241 --> 00:16:31,777 DOMINATED BY HYPE OR OVER 416 00:16:31,777 --> 00:16:34,947 OPTIMISM OR CLAIMS HOW WELL 417 00:16:34,947 --> 00:16:35,747 CLINICAL PREDICTION MODELS ARE 418 00:16:35,747 --> 00:16:38,150 GOING TO WORK. 419 00:16:38,150 --> 00:16:42,120 THE REPORT IS OFTEN VERY POOR. 420 00:16:42,120 --> 00:16:43,855 THERE ARE MULTIPLE PROBLEMS 421 00:16:43,855 --> 00:16:46,225 WITH STUDIES INCLUDING VERY 422 00:16:46,225 --> 00:16:47,593 SIGNIFICANT ISSUES WITH BIAS, 423 00:16:47,593 --> 00:16:49,328 WEAK DESIGNS AND STUDY CONDUCT, 424 00:16:49,328 --> 00:16:51,597 VERY HIGH RISK OF SCIENTIFIC 425 00:16:51,597 --> 00:16:56,001 BIAS AS WELL AS BIAS AGAINST 426 00:16:56,001 --> 00:16:57,035 PARTICULAR POPULATION GROUPS. 427 00:16:57,035 --> 00:17:00,205 SOMETHING SIMILAR AS THE UPGAR 428 00:17:00,205 --> 00:17:02,574 SCORE FOR EXAMPLE, 429 00:17:02,574 --> 00:17:03,609 SYSTEMATICALLY BIASED AGAINST 430 00:17:03,609 --> 00:17:04,910 BABIES WITH DARKER SKIN. 431 00:17:04,910 --> 00:17:06,445 WE ARE BECOMING MORE CONSCIOUS 432 00:17:06,445 --> 00:17:08,880 OF THIS, THANKS TO THE GREAT 433 00:17:08,880 --> 00:17:11,917 WORK THAT'S BEEN DONE IN THE 434 00:17:11,917 --> 00:17:13,752 U.S. RECOGNIZING THE EXTENT 435 00:17:13,752 --> 00:17:15,153 THESE AFFECT TECHNOLOGY AND 436 00:17:15,153 --> 00:17:18,523 ASSESSMENTSING. 437 00:17:18,523 --> 00:17:19,825 THEY ALSO AFFECT MODELS OF 438 00:17:19,825 --> 00:17:25,264 CARE, BASED ON THE ASSUMPTION 439 00:17:25,264 --> 00:17:27,399 THAT IT WILL WORK FOR EVERYONE 440 00:17:27,399 --> 00:17:30,302 BUT IT MACIS STEM MATICALLY EX 441 00:17:30,302 --> 00:17:33,338 KLAOUZ OR DISADVANTAGE OR BE 442 00:17:33,338 --> 00:17:35,274 BIASED AGAINST PARTICULAR 443 00:17:35,274 --> 00:17:35,674 POPULATION GROUPS. 444 00:17:35,674 --> 00:17:39,911 WHAT WE DO KNOW IS MANY OF THE 445 00:17:39,911 --> 00:17:41,446 CLINICAL PREDICTION MODELS ARE 446 00:17:41,446 --> 00:17:42,514 UNFIT FOR PURPOSE. 447 00:17:42,514 --> 00:17:44,816 IF WE LOOK AT COVID-19 THERE 448 00:17:44,816 --> 00:17:48,153 WERE OVER 600 PROGNOSTIC 449 00:17:48,153 --> 00:17:49,788 PREDICTION MODELS PUBLISHED IN 450 00:17:49,788 --> 00:17:57,629 THE BMJ BUT IT WAS ILL-INFORMED 451 00:17:57,629 --> 00:17:58,230 AND DISJOINTED. 452 00:17:58,230 --> 00:18:01,099 IF WE LOOK AT PSYCHIATRY WE SEE 453 00:18:01,099 --> 00:18:03,368 EXACTLY THE SAME PROBLEM. 454 00:18:03,368 --> 00:18:04,670 VERY POOR QUALITY TOOLS AND 455 00:18:04,670 --> 00:18:06,204 MOST OF THEM NEVER ACTUALLY 456 00:18:06,204 --> 00:18:09,107 APPEAR IN PRACTICE. 457 00:18:09,107 --> 00:18:12,311 SO VERY, VERY FEW IMPLEMENTING 458 00:18:12,311 --> 00:18:14,913 THESE MODELS RESULT IN ANY 459 00:18:14,913 --> 00:18:16,081 IMPROVEMENTS IN PATIENTS. 460 00:18:16,081 --> 00:18:17,382 WE HAVE AN ISSUE WITH THE 461 00:18:17,382 --> 00:18:20,018 RESEARCH NOT BEING GOOD ENOUGH 462 00:18:20,018 --> 00:18:20,652 ESSENTIALLY FOR IMPLEMENTATION 463 00:18:20,652 --> 00:18:23,021 BUT THEN WE HAVE AN 464 00:18:23,021 --> 00:18:24,189 UNDER-RECOGNIZED AND VERY 465 00:18:24,189 --> 00:18:25,624 IMPORTANT PROBLEM OF DESIGN 466 00:18:25,624 --> 00:18:25,824 WASTE. 467 00:18:25,824 --> 00:18:28,160 WHAT DO YOU NEED TO DO TO TURN 468 00:18:28,160 --> 00:18:30,095 A RESEARCH FINDING OR 469 00:18:30,095 --> 00:18:31,129 RECOMMENDATION INTO SOMETHING 470 00:18:31,129 --> 00:18:32,831 CLINICIANS CAN ACTUALLY WORK 471 00:18:32,831 --> 00:18:34,166 WITH AND THAT PATIENTS CAN 472 00:18:34,166 --> 00:18:35,701 BENEFIT FROM? 473 00:18:35,701 --> 00:18:38,036 I WOULD PUT IT TO YOU, IF WE 474 00:18:38,036 --> 00:18:40,672 DON'T DO THE DESIGN JOB AT 475 00:18:40,672 --> 00:18:42,474 SCALE AND WITH LARGE-SCALE 476 00:18:42,474 --> 00:18:44,176 COORDINATION YOU TEND TO GET A 477 00:18:44,176 --> 00:18:45,744 HUGE AMOUNT OF DESIGN WASTE. 478 00:18:45,744 --> 00:18:47,612 I SOMETIMES SAY THIS IS THE 479 00:18:47,612 --> 00:18:49,381 TOOTHBRUSH PROBLEM. 480 00:18:49,381 --> 00:18:50,782 EVERYONE HAS A TOOTHBRUSH BUT 481 00:18:50,782 --> 00:18:52,651 NO ONE WANTS TO USE ANYONE 482 00:18:52,651 --> 00:18:54,086 ELSES A. 483 00:18:54,086 --> 00:18:56,822 WE GET AN ENORMOUS AMOUNT OF 484 00:18:56,822 --> 00:18:58,924 WASTE WITH THE SPOKE SOLUTIONS 485 00:18:58,924 --> 00:19:00,926 FOR EVERY SINGLE SCENARIO. 486 00:19:00,926 --> 00:19:03,628 I CAN ILLUSTRATE THIS USING THE 487 00:19:03,628 --> 00:19:06,765 HISTORY OF APPROACHES TO 488 00:19:06,765 --> 00:19:09,134 PATIENT DETERIORATION, WHICH IS 489 00:19:09,134 --> 00:19:11,903 A VERY SENSIBLE IDEA, YOU 490 00:19:11,903 --> 00:19:13,372 MONITOR PATIENT'S VITAL SIGNS 491 00:19:13,372 --> 00:19:15,807 AND USE TRACK AND TRIGGER 492 00:19:15,807 --> 00:19:18,043 SYSTEMS TO IDENTIFY THE PATIENT 493 00:19:18,043 --> 00:19:20,112 GETTING INTO DIFFICULTY AND 494 00:19:20,112 --> 00:19:20,345 RESPOND. 495 00:19:20,345 --> 00:19:22,614 IF WE LOOK AT PEDIATRIC EARLY 496 00:19:22,614 --> 00:19:25,484 WARNING SCORES IN THE U.K., 497 00:19:25,484 --> 00:19:26,818 THERE ARE CURRENTLY DOZENS AND 498 00:19:26,818 --> 00:19:27,919 DOZENS OF THESE. 499 00:19:27,919 --> 00:19:30,555 BUT THIS REVIEW OF JUST SEVEN 500 00:19:30,555 --> 00:19:34,493 FOUND THEY ARE HUGELY VARIABLE 501 00:19:34,493 --> 00:19:40,599 AND USING DIFFERENT VARIABLES, 502 00:19:40,599 --> 00:19:41,099 THRESHOLDS, ESCALATION 503 00:19:41,099 --> 00:19:42,601 ALGORITHMS, THEY CAN'T ALL BE 504 00:19:42,601 --> 00:19:44,035 RIGHT AND COMPLICATE THE 505 00:19:44,035 --> 00:19:46,905 TRANSFER OF PATIENTS AND 506 00:19:46,905 --> 00:19:48,807 THERE'S MULTIPLE RISKS 507 00:19:48,807 --> 00:19:49,474 ASSOCIATED WITH STAFF TRAINING 508 00:19:49,474 --> 00:19:50,409 AND EXPERIENCE. 509 00:19:50,409 --> 00:19:53,612 IF WE GO BACK TO OBSTETRICS, 510 00:19:53,612 --> 00:19:55,213 AGAIN, ATTEMPTS TO DEVELOP 511 00:19:55,213 --> 00:19:57,916 EARLY WARNING SCORES, WE 512 00:19:57,916 --> 00:20:00,352 CURRENTLY HAVE 147 IN A COUNTRY 513 00:20:00,352 --> 00:20:04,890 THAT HAS BEEN 180 MATERNITY 514 00:20:04,890 --> 00:20:06,391 UNITS. DIFFERENT OBSTETRIC 515 00:20:06,391 --> 00:20:08,794 EARLY WARNING SCORES ACROSS 516 00:20:08,794 --> 00:20:09,027 ENGLAND. 517 00:20:09,027 --> 00:20:09,961 HUGE VARIATION IN WHAT IS 518 00:20:09,961 --> 00:20:12,030 CONSIDERED TO BE NORMAL. 519 00:20:12,030 --> 00:20:13,465 THE THRESHOLDS USED AND NATURE 520 00:20:13,465 --> 00:20:15,066 OF THE CLINICAL RESPONSE 521 00:20:15,066 --> 00:20:17,502 CLINICIANS ARE SUPPOSED TO TAKE. 522 00:20:17,502 --> 00:20:21,273 THINGS AS BASIC AS TEMPERATURE 523 00:20:21,273 --> 00:20:23,108 AND RESPIRATORY WEIGHT, HUGELY 524 00:20:23,108 --> 00:20:24,776 VARIABLE DEPENDING ON THE 525 00:20:24,776 --> 00:20:25,744 METHODS YOU LOOK AT. 526 00:20:25,744 --> 00:20:32,584 WHAT WE ARE DOING WHEN WE LEAVE 527 00:20:32,584 --> 00:20:35,220 THIS TYPE OF WORK TO INDIVIDUAL 528 00:20:35,220 --> 00:20:37,489 UNITS WE REINVENT THE WHEEL ALL 529 00:20:37,489 --> 00:20:37,756 THE TIME. 530 00:20:37,756 --> 00:20:40,692 AND WE END UP PRODUCING RISK 531 00:20:40,692 --> 00:20:42,260 AND POSSIBLE HARM. 532 00:20:42,260 --> 00:20:44,329 WHEN WE HAVE A GOOD SOLUTION WE 533 00:20:44,329 --> 00:20:45,931 AREN'T ALWAYS AS GOOD AS WE 534 00:20:45,931 --> 00:20:49,701 SHOULD BE ENSURING THAT IS 535 00:20:49,701 --> 00:20:51,102 IMPLEMENTED AND IMPLEMENTED 536 00:20:51,102 --> 00:20:51,403 EFFECTIVELY. 537 00:20:51,403 --> 00:20:54,506 THIS WAS A SERIES I EDIT FOR 538 00:20:54,506 --> 00:20:55,941 CAMBRIDGE UNIVERSITY PRESS 539 00:20:55,941 --> 00:20:57,075 ALONG WITH MY COLLEAGUES AT 540 00:20:57,075 --> 00:20:59,277 THIS INSTITUTE. 541 00:20:59,277 --> 00:21:01,413 IMPROVING QUALITY AND SAFETY IN 542 00:21:01,413 --> 00:21:01,780 HEALTHCARE. 543 00:21:01,780 --> 00:21:03,348 COMPLETELY OPEN ACCESS. 544 00:21:03,348 --> 00:21:07,185 THE AN OVERVIEW OF MAJOR 545 00:21:07,185 --> 00:21:08,887 APPROACHES TO IMPROVEMENT IN 546 00:21:08,887 --> 00:21:09,654 HEALTHCARE. 547 00:21:09,654 --> 00:21:12,624 WE BEGAN THIS SERIES BECAUSE OF 548 00:21:12,624 --> 00:21:13,892 THE RECOGNITION, A LOT OF WHAT 549 00:21:13,892 --> 00:21:17,529 WE DO IN THE NAME OF TRYING TO 550 00:21:17,529 --> 00:21:20,432 IMPROVE QUALITY AND SAFETY IN 551 00:21:20,432 --> 00:21:21,066 HEALTHCARE, IT E SEPTEMBERLY 552 00:21:21,066 --> 00:21:21,666 DOESN'T WORK. 553 00:21:21,666 --> 00:21:25,804 WE ARE LEFT WITH THE QUESTION, 554 00:21:25,804 --> 00:21:27,105 DOES QUALITY IMPROVEMENT 555 00:21:27,105 --> 00:21:27,772 IMPROVE QUALITY? 556 00:21:27,772 --> 00:21:28,807 THERE ARE MANY REASONS IT'S 557 00:21:28,807 --> 00:21:29,608 DIFFICULT TO ANSWER THIS 558 00:21:29,608 --> 00:21:29,975 QUESTION. 559 00:21:29,975 --> 00:21:33,478 BUT ONE OF THEM IS WE HAVE WAY 560 00:21:33,478 --> 00:21:39,484 TOO MANY POORLY SUPPORTED, 561 00:21:39,484 --> 00:21:41,653 POORLY DESIGNED LARGE-SCALE 562 00:21:41,653 --> 00:21:42,420 IMPROVEMENT DIRECTORS HANDED 563 00:21:42,420 --> 00:21:44,756 DOWN FROM ON HIGH AND DON'T 564 00:21:44,756 --> 00:21:48,460 HAVE A PATH THROUGH TO IMPACT 565 00:21:48,460 --> 00:21:48,860 INDIVIDUAL UNITS. 566 00:21:48,860 --> 00:21:52,097 WE CAN SEE IN ENGLAND WE HAD 567 00:21:52,097 --> 00:21:54,599 OVER 50 LARGE-SCALE IMPROVEMENT 568 00:21:54,599 --> 00:21:55,800 PROGRAMS TARGETING MATERNITY 569 00:21:55,800 --> 00:21:57,736 SINCE 2010, AND VERY FEW OF 570 00:21:57,736 --> 00:21:59,771 THOSE HAVE BEEN EVALUATED. 571 00:21:59,771 --> 00:22:01,973 ONLY 15 THAT WE COULD FIND. 572 00:22:01,973 --> 00:22:03,875 THERE ARE MAJOR PROBLEMS HOW 573 00:22:03,875 --> 00:22:05,844 THE PROGRAMS ARE DESCRIBED. 574 00:22:05,844 --> 00:22:08,847 OF THE 15 EVALUATED ONLY 8 575 00:22:08,847 --> 00:22:10,882 REPORTED AN EVIDENCE-BASE FOR 576 00:22:10,882 --> 00:22:14,819 THEIR INTERVENTIONS. ONLY 7 HAD 577 00:22:14,819 --> 00:22:16,621 PATIENT OR PUBLIC INVOLVEMENT, 578 00:22:16,621 --> 00:22:18,957 ONLY SIX USED THEORY FRAMEWORK. 579 00:22:18,957 --> 00:22:21,560 NOT ONE SET REDUCING INEQUALITY 580 00:22:21,560 --> 00:22:25,096 AS A GOAL, DESPITE OUR REALLY 581 00:22:25,096 --> 00:22:25,830 DISTRESSING INEQUITIES, 582 00:22:25,830 --> 00:22:30,802 PARTICULARLY IN RELATION TO 583 00:22:30,802 --> 00:22:33,104 ETHNICITY AND THE EVALUATIONS 584 00:22:33,104 --> 00:22:33,371 WERE WEAK. 585 00:22:33,371 --> 00:22:36,675 AS MUCH AS WE HAVE LARGE SCALE 586 00:22:36,675 --> 00:22:38,777 POORLY DESIGNED AND IMPLEMENTED 587 00:22:38,777 --> 00:22:42,681 EFFORTS WE HAVE POORLY 588 00:22:42,681 --> 00:22:43,715 SUPPORTED BOTTOM-UP 589 00:22:43,715 --> 00:22:45,116 IMPROVEMENT, IMPLEMENTATION 590 00:22:45,116 --> 00:22:46,384 EFFORTS. THAT'S INCENTIVIZED 591 00:22:46,384 --> 00:22:48,720 THROUGH VARIOUS MEANS BUT COULD 592 00:22:48,720 --> 00:22:50,789 LEAD TO WASTE AND SUB-OPTIMAL 593 00:22:50,789 --> 00:22:52,624 SOLUTIONS AND FAILURE TO LEARN 594 00:22:52,624 --> 00:22:53,725 FROM OTHER AREAS. WE HAVEN'T 595 00:22:53,725 --> 00:22:56,194 GOT THE STRUCTURE FOR 596 00:22:56,194 --> 00:22:56,828 IMPLEMENTATION AND IMPROVEMENT 597 00:22:56,828 --> 00:22:59,197 RIGHT YET. 598 00:22:59,197 --> 00:23:07,005 THIS PIECE FROM MY COLLEAGUE, 599 00:23:07,005 --> 00:23:07,772 LOCAL SURGICAL IMPROVEMENT 600 00:23:07,772 --> 00:23:09,007 TEAMS ARE TRYING TO DO 601 00:23:09,007 --> 00:23:12,377 IMPROVEMENT. 602 00:23:12,377 --> 00:23:14,045 WE HAVE TO GET BETTER FINDING 603 00:23:14,045 --> 00:23:15,146 SOLUTIONS THAT WORK. 604 00:23:15,146 --> 00:23:16,748 WHAT WE DO KNOW AND THIS HAS 605 00:23:16,748 --> 00:23:25,290 BEEN PUBLISHED IN THE CAMBRIDGE 606 00:23:25,290 --> 00:23:26,524 ELEMENT SERIES. 607 00:23:26,524 --> 00:23:29,728 WHEN YOU DO IT AT SCALE AND 608 00:23:29,728 --> 00:23:31,930 INCLUSIVELY AND USING 609 00:23:31,930 --> 00:23:32,564 COLLABORATION-BASED APPROACHES. 610 00:23:32,564 --> 00:23:37,235 WE LEARNED A LOT ABOUT THIS 611 00:23:37,235 --> 00:23:39,537 FROM THE SUCCESSFUL MICHIGAN 612 00:23:39,537 --> 00:23:41,606 COLLABORATIVES FUNDED BY BREW 613 00:23:41,606 --> 00:23:44,542 CROSS, BLUE STHAOELD THAT 614 00:23:44,542 --> 00:23:46,611 DEMONSTRATED QUITE REMARKABLE 615 00:23:46,611 --> 00:23:48,380 IMPROVEMENTS WHILE MANAGING TO 616 00:23:48,380 --> 00:23:49,581 CONTROL COSTS. WE REPORTED ON 617 00:23:49,581 --> 00:23:51,583 THIS JUST A FEW MONTHS AGO, 618 00:23:51,583 --> 00:23:53,618 WHAT WE THINK IS HAPPENING IN 619 00:23:53,618 --> 00:23:54,719 THOSE COLLABORATIVES THEY HAVE 620 00:23:54,719 --> 00:23:57,122 A VERY STRONG EMPHASIS ON 621 00:23:57,122 --> 00:24:00,191 POSITIVE DEVIANTS WHICH IS A 622 00:24:00,191 --> 00:24:02,494 TECHNIQUE, IN FACT FIRST USE IN 623 00:24:02,494 --> 00:24:03,795 DEVELOPMENT STUDIES WHERE IT'S 624 00:24:03,795 --> 00:24:05,030 OFTEN CLEAR THE LOCAL 625 00:24:05,030 --> 00:24:06,231 COMMUNITIES HAVE FOUND A 626 00:24:06,231 --> 00:24:07,432 SOLUTION AND THE CHALLENGES TO 627 00:24:07,432 --> 00:24:09,267 UNDERSTAND WHAT THEY ARE DOING 628 00:24:09,267 --> 00:24:11,202 AND THEN TO SPREAD IT. 629 00:24:11,202 --> 00:24:13,438 OTHER FEATURES OF HIGH QUALITY 630 00:24:13,438 --> 00:24:14,739 COLLABORATIVE IMPROVEMENT ARE 631 00:24:14,739 --> 00:24:17,375 REALLY HIGH QUALITY 632 00:24:17,375 --> 00:24:18,576 COORDINATION, HIGH-QUALITY 633 00:24:18,576 --> 00:24:20,912 MEASUREMENT, COMPARATIVE 634 00:24:20,912 --> 00:24:27,252 PERFORMANCE FEEDBACK. 635 00:24:27,252 --> 00:24:28,687 LEADERSHIP THAT SINGS WITH THE 636 00:24:28,687 --> 00:24:31,122 PEOPLE, SINGS THAT SONG. 637 00:24:31,122 --> 00:24:32,691 CREATING ACCOUNTABILITY FOR 638 00:24:32,691 --> 00:24:37,028 QUALITY WHILE RELIEVING E SITES 639 00:24:37,028 --> 00:24:39,130 FROM THE BURDENS *F PROGRAM 640 00:24:39,130 --> 00:24:40,365 PARTICIPATION. 641 00:24:40,365 --> 00:24:41,666 MOST OF ALL CO-DESIGN MEANS 642 00:24:41,666 --> 00:24:43,768 WORKING WITH THE PEOPLE WHO 643 00:24:43,768 --> 00:24:45,403 WORK IN SERVICES AND USE THEM. 644 00:24:45,403 --> 00:24:49,441 WHEN WE HAVE USED THESE 645 00:24:49,441 --> 00:24:53,445 CO-DESIGN TECHNIQUES AND ARE 646 00:24:53,445 --> 00:24:56,948 HIGHLY INCLUSIVE YOU CAN DO 647 00:24:56,948 --> 00:25:01,619 TREMENDOUS THINGS. 648 00:25:01,619 --> 00:25:04,189 THEORY IS SOMETHING THAT GETS 649 00:25:04,189 --> 00:25:05,623 PEOPLE VERY SPOOKED BUT IT'S 650 00:25:05,623 --> 00:25:08,426 VERY PRACTICAL AND THIS ARTICLE 651 00:25:08,426 --> 00:25:09,127 EXPLAINS JUST HOW PRACTICAL IT 652 00:25:09,127 --> 00:25:15,233 CAN BE. 653 00:25:15,233 --> 00:25:17,669 ESSENTIALLY YOU ARE TRYING TO 654 00:25:17,669 --> 00:25:18,770 IDENTIFY GOALS AND WHAT DO YOU 655 00:25:18,770 --> 00:25:21,172 NEED TO DO TO GET THERE. 656 00:25:21,172 --> 00:25:23,174 I WILL ILLUSTRATE HOW PRACTICAL 657 00:25:23,174 --> 00:25:24,909 IT COULD BE FROM MY OWN HOME 658 00:25:24,909 --> 00:25:28,079 WHERE WE HAVE A MAJOR ISSUE 659 00:25:28,079 --> 00:25:30,215 WITH SQUIRRELS AND THEY ARE 660 00:25:30,215 --> 00:25:32,484 DETERMINED TO USE OUR BIRD 661 00:25:32,484 --> 00:25:34,953 FEEDERS AS THEIR SOURCE OF FOOD. 662 00:25:34,953 --> 00:25:39,457 MY HUSBAND HAS BEEN IN A 663 00:25:39,457 --> 00:25:41,192 BATTLE WITH THE SQUIRRELS TO 664 00:25:41,192 --> 00:25:42,627 DISCOURAGE THEM FROM THIS 665 00:25:42,627 --> 00:25:44,896 PRACTICE, VERY LITTLE HAS 666 00:25:44,896 --> 00:25:45,597 WORKED. 667 00:25:45,597 --> 00:25:48,066 WHEN MY DAUGHTER WAS 5 AND JUST 668 00:25:48,066 --> 00:25:49,501 STARTED SCHOOL AND LEARNING TO 669 00:25:49,501 --> 00:25:51,136 READ AND IMPRESSED WITH RULES 670 00:25:51,136 --> 00:25:52,937 AND REGULATIONS SHE CAME UP 671 00:25:52,937 --> 00:25:54,672 WITH A PROPOSED SOLUTION, WHICH 672 00:25:54,672 --> 00:25:55,774 CONSISTS OF THIS SIGN. 673 00:25:55,774 --> 00:26:04,315 SHE FELT THAT WOULD BE THE 674 00:26:04,315 --> 00:26:05,550 ANSWER TO THE PROBLEMS WE WERE 675 00:26:05,550 --> 00:26:06,384 FACING. 676 00:26:06,384 --> 00:26:08,386 WE HAD A THEORY, A CLEAR GOAL 677 00:26:08,386 --> 00:26:09,988 AND RESOURCES BUT WHEN WE CAME 678 00:26:09,988 --> 00:26:12,056 TO EXAMINE THE ASSUMPTIONS THIS 679 00:26:12,056 --> 00:26:13,825 WAS BASED, FIRST THAT SQUIRRELS 680 00:26:13,825 --> 00:26:17,996 CAN READ, AND IF THEY DO, THEY 681 00:26:17,996 --> 00:26:19,364 WILL COMPLY, WE FOUND THEY WERE 682 00:26:19,364 --> 00:26:20,064 FLAWED. 683 00:26:20,064 --> 00:26:23,601 WE WERE ABLE TO SET ASIDE THAT 684 00:26:23,601 --> 00:26:25,870 THEORY AND MOVE ONTO MY 685 00:26:25,870 --> 00:26:27,205 HUSBAND'S SUGGESTION, MOVING 686 00:26:27,205 --> 00:26:28,540 ONTO A PLASTIC BOTTLE. 687 00:26:28,540 --> 00:26:31,142 WE HAD A CLEAR GOAL, WHICH WAS 688 00:26:31,142 --> 00:26:33,478 GOOD, WE HAD THE SOURCE 689 00:26:33,478 --> 00:26:34,445 REQUIRED, THREADING THE BOTTLE 690 00:26:34,445 --> 00:26:37,515 ON THE POLE SO THE SQUIRREL 691 00:26:37,515 --> 00:26:38,550 WOULD ENCOUNTER AS THEY CLIMB 692 00:26:38,550 --> 00:26:44,522 THE POLE AND THEY WOULD THEN BE 693 00:26:44,522 --> 00:26:45,824 DISCOURAGED OR INHIBITED FROM 694 00:26:45,824 --> 00:26:47,492 PROGRESSING FORWARD. 695 00:26:47,492 --> 00:26:49,394 THAT WAS THE ONE WE PUT INTO 696 00:26:49,394 --> 00:26:50,628 PRACTICE. 697 00:26:50,628 --> 00:26:51,696 THIS WAS IMPORTANT BECAUSE IF 698 00:26:51,696 --> 00:26:53,898 YOU DON'T HAVE A GOOD PROGRAM 699 00:26:53,898 --> 00:26:55,500 THEORY FOR CHOOSING WHAT YOU 700 00:26:55,500 --> 00:26:57,936 WILL GO AHEAD WITH, THEN THE 701 00:26:57,936 --> 00:26:59,737 INTERVENTION MAY BE FLAWED, IT 702 00:26:59,737 --> 00:27:01,272 MAY NOT BE LINKED TO THE 703 00:27:01,272 --> 00:27:04,175 OUTCOMES YOU WANT, IT COULD BE 704 00:27:04,175 --> 00:27:08,246 VERY HARD TO DESCRIBE THE 705 00:27:08,246 --> 00:27:10,849 INTERVENTION ACCURATELY AND 706 00:27:10,849 --> 00:27:13,084 IT'S HARD TO REPLICATE THE 707 00:27:13,084 --> 00:27:13,651 INTERVENTION OR ACCUMULATE 708 00:27:13,651 --> 00:27:14,819 LEARNING. 709 00:27:14,819 --> 00:27:18,623 ALSO IMPORTANT HERE IS BUILDING 710 00:27:18,623 --> 00:27:20,792 ON THE LITERATURE. 711 00:27:20,792 --> 00:27:22,794 MY HUSBAND MADE THE TERRIBLE 712 00:27:22,794 --> 00:27:24,295 MISTAKE TELLING OUR NEIGHBOR 713 00:27:24,295 --> 00:27:25,597 THIS SOLUTION APPEARED TO HAVE 714 00:27:25,597 --> 00:27:28,833 WORKED. 715 00:27:28,833 --> 00:27:31,603 THE NEIGHBOR WAS UNFORTUNATELY 716 00:27:31,603 --> 00:27:34,172 THE EDITOR OF THE NEWSLETTER 717 00:27:34,172 --> 00:27:36,040 AND THIS ARTICLE APPEARED, MUCH 718 00:27:36,040 --> 00:27:39,010 TO MY HUSBAND'S GREAT 719 00:27:39,010 --> 00:27:40,478 EMBARRASSMENT. 720 00:27:40,478 --> 00:27:43,481 BUT UNFORTUNATELY HIS 721 00:27:43,481 --> 00:27:45,316 EMBARRASSMENT WAS NOT 722 00:27:45,316 --> 00:27:46,517 SUFFICIENTLY WELL DISSEMINATED 723 00:27:46,517 --> 00:27:48,953 AND A COLLEAGUE HAD THE SAME 724 00:27:48,953 --> 00:27:51,723 ISSUE WITH BIRDS THAT KEPT 725 00:27:51,723 --> 00:27:54,592 FLYING INTO A WINDOW AND ENDING 726 00:27:54,592 --> 00:27:56,561 UP INJURED AND THEIR SOLUTION 727 00:27:56,561 --> 00:27:59,898 WAS THIS ONE, WHICH WE FELT 728 00:27:59,898 --> 00:28:05,403 REPRODUCED SOME OF THE PROBLEMS 729 00:28:05,403 --> 00:28:07,739 MY DAUGHTER'S HAD. 730 00:28:07,739 --> 00:28:08,973 IF INTERPERSONAL AND 731 00:28:08,973 --> 00:28:11,109 ORGANIZATIONAL DYNAMICKS ARE 732 00:28:11,109 --> 00:28:12,610 KEY, WE DESIGN BAD SOLUTIONS. 733 00:28:12,610 --> 00:28:14,212 IF WE REMEMBER THERE'S 734 00:28:14,212 --> 00:28:15,947 LITERATURE HOW WE MAKE TEAMS 735 00:28:15,947 --> 00:28:19,684 WAORK, HOW WE DEVELOP CULTURES 736 00:28:19,684 --> 00:28:21,519 OF HIGH QUALITY CARE WE DO MUCH 737 00:28:21,519 --> 00:28:22,987 BETTER. 738 00:28:22,987 --> 00:28:24,389 WE KNOW FOR EXAMPLE, THERE'S 739 00:28:24,389 --> 00:28:25,723 GOOD EVIDENCE ON THIS. 740 00:28:25,723 --> 00:28:29,327 IF YOU TRAIN PEOPLE, FOR 741 00:28:29,327 --> 00:28:30,061 EXAMPLE, IN OBSTETRIC 742 00:28:30,061 --> 00:28:31,629 EMERGENCIES YOU CAN MASSIVELY 743 00:28:31,629 --> 00:28:32,664 IMPROVE OUTCOMES. 744 00:28:32,664 --> 00:28:35,333 WE CAN SHOW THE SAME EFFECT. 745 00:28:35,333 --> 00:28:38,369 THIS IS VERY WELL EVIDENCED IN 746 00:28:38,369 --> 00:28:39,537 SURGICAL MORTALITY AND WE KNOW 747 00:28:39,537 --> 00:28:43,508 THE COME -- COMPONENTS HOW 748 00:28:43,508 --> 00:28:44,309 YOU DO THAT. 749 00:28:44,309 --> 00:28:46,110 WE COULD HAVE A THEORY THAT 750 00:28:46,110 --> 00:28:47,812 TEAMWORK IS IMPORTANT TO 751 00:28:47,812 --> 00:28:49,314 MATERNITY OUTCOMES AND WE COULD 752 00:28:49,314 --> 00:28:50,548 SELECT THEN THE SOLUTIONS THAT 753 00:28:50,548 --> 00:28:52,583 ARE MOST LIKELY TO WORK AND WE 754 00:28:52,583 --> 00:28:54,018 CAN DO THAT USING THE 755 00:28:54,018 --> 00:28:55,520 LITERATURE TO GUIDE US. 756 00:28:55,520 --> 00:29:02,927 WE CAN ALSO BUILD ON EXAMPLES 757 00:29:02,927 --> 00:29:05,463 OF POSITIVE DEVIANTS, AND WE 758 00:29:05,463 --> 00:29:08,866 HAVE BEEN ABLE TO DO THAT USING 759 00:29:08,866 --> 00:29:11,402 CO-DESIGN METHODS SO WE CAN 760 00:29:11,402 --> 00:29:12,303 MATURE OUR UNDERSTANDING OF 761 00:29:12,303 --> 00:29:16,207 WHAT YOU NEED TO BE DOING. 762 00:29:16,207 --> 00:29:19,811 ADD TO USE HUMAN FACTORS AND 763 00:29:19,811 --> 00:29:21,079 ERGONOMIC PRINCIPLES WHICH 764 00:29:21,079 --> 00:29:23,581 AGAIN I THINK CONTINUE TO BE 765 00:29:23,581 --> 00:29:25,483 UNDER USE IN HEALTHCARE AND 766 00:29:25,483 --> 00:29:29,387 MATERNITY. 767 00:29:29,387 --> 00:29:29,988 RECOGNIZING FOR EXAMPLE, 768 00:29:29,988 --> 00:29:37,695 EFFECTS OF FATIGUE AND THEY ARE 769 00:29:37,695 --> 00:29:38,963 PHYSICALLY FACILITATING THE 770 00:29:38,963 --> 00:29:45,870 WORK CLINICIANS NEED TO DO. 771 00:29:45,870 --> 00:29:47,905 WE KNOW ANTENATAL CARE IS 772 00:29:47,905 --> 00:29:49,607 FUNDAMENTAL TO GOOD OUTCOME OF 773 00:29:49,607 --> 00:29:51,709 PREGNANCY. 774 00:29:51,709 --> 00:29:55,079 DURING THE PANDEMIC WITH THE 775 00:29:55,079 --> 00:29:56,948 SHIFT TO REMOTE ANTENATAL CARE 776 00:29:56,948 --> 00:29:58,983 THERE WERE MANY ISSUES RAISE BY 777 00:29:58,983 --> 00:29:59,183 THIS. 778 00:29:59,183 --> 00:30:03,988 WE WERE ABLE TO WORK WITH 779 00:30:03,988 --> 00:30:05,890 WOMEN, WITH HEALTHCARE 780 00:30:05,890 --> 00:30:06,924 PROFESSIONALS, WITH MANAGERS 781 00:30:06,924 --> 00:30:09,293 AND GET TO REALLY STRONG 782 00:30:09,293 --> 00:30:10,128 GEOGRAPHIC DIVERSITY SO WE 783 00:30:10,128 --> 00:30:13,231 COULD COME UP WITH A FRAMEWORK 784 00:30:13,231 --> 00:30:15,900 FOR WHAT GOOD WOULD LOOK LIKE 785 00:30:15,900 --> 00:30:17,668 THAT WAS CO-DESIGNED WITH THOSE 786 00:30:17,668 --> 00:30:18,669 PARTICIPANTS. 787 00:30:18,669 --> 00:30:21,305 WE COULD SAY CLEARLY THERE WERE 788 00:30:21,305 --> 00:30:22,740 SEVEN FEATURES, THEY WILL LOOK 789 00:30:22,740 --> 00:30:24,342 CLEAR TO YOU BUT WE CAN ALSO 790 00:30:24,342 --> 00:30:26,477 SAY WHAT THEY LOOK LIKE. 791 00:30:26,477 --> 00:30:28,179 THAT PAPER IS PUBLISHED AND 792 00:30:28,179 --> 00:30:32,150 AGAIN OPEN ACCESS AS WELL. 793 00:30:32,150 --> 00:30:33,651 WE CAN CO-DESIGN PROCESS 794 00:30:33,651 --> 00:30:34,218 IMPROVEMENTS WHICH IS VERY 795 00:30:34,218 --> 00:30:35,053 IMPORTANT. 796 00:30:35,053 --> 00:30:39,323 WE DO THIS USING A PLATFORM 797 00:30:39,323 --> 00:30:41,426 WE'VE DEVELOPED CALLED 798 00:30:41,426 --> 00:30:41,692 DISCOVERY. 799 00:30:41,692 --> 00:30:42,794 ONE EXAMPLE DURING THE PANDEMIC 800 00:30:42,794 --> 00:30:47,965 WAS WHEN THE NEED TO REDESIGN 801 00:30:47,965 --> 00:30:57,075 THE PROCESS FOR HANDLING 802 00:30:57,075 --> 00:30:58,910 POST-PARTEM HEMORRHAGE WHEN THE 803 00:30:58,910 --> 00:31:00,812 WOMAN WAS COVID POSITIVE. 804 00:31:00,812 --> 00:31:02,180 WE DID THIS BY SHOOTING A VERY 805 00:31:02,180 --> 00:31:06,250 SHORT VIDEO. 806 00:31:06,250 --> 00:31:07,952 WE GOT PEOPLE TO RECOMMEND HOW 807 00:31:07,952 --> 00:31:09,954 TO IMPROVE IT. 808 00:31:09,954 --> 00:31:11,856 THERE WERE LOTS OF 809 00:31:11,856 --> 00:31:13,291 RECOMMENDATIONS, WE WERE ABLE 810 00:31:13,291 --> 00:31:17,028 TO DISTILL THOSE, WHAT WE 811 00:31:17,028 --> 00:31:18,496 LOOKED LIKE 22 RECOMMENDATIONS 812 00:31:18,496 --> 00:31:22,934 AND RAN THAT THROUGH A ADELPHI 813 00:31:22,934 --> 00:31:25,036 PROCESS SO PEOPLE WERE RATING 814 00:31:25,036 --> 00:31:26,370 THEM AND BEING INVITED BACK 815 00:31:26,370 --> 00:31:28,606 AGAIN TO RATE IN LIGHT OF 816 00:31:28,606 --> 00:31:28,840 OTHERS. 817 00:31:28,840 --> 00:31:30,475 THAT LED US TO 16 SOLUTIONS, 818 00:31:30,475 --> 00:31:32,677 WHICH WE WERE ABLE TO USE TO 819 00:31:32,677 --> 00:31:34,612 INFORM A NEW PROCESS. 820 00:31:34,612 --> 00:31:37,014 WE RESHOT THE VIDEO AND THIS 821 00:31:37,014 --> 00:31:40,518 HAS BEEN AN INCREDIBLY POPULAR 822 00:31:40,518 --> 00:31:44,055 RESOURCE VIEWED BY OVER 130,000 823 00:31:44,055 --> 00:31:45,156 PEOPLE AND USE OUTSIDE OF 824 00:31:45,156 --> 00:31:46,424 MATERNITY. 825 00:31:46,424 --> 00:31:49,160 IT WAS ENDORSED BY ALL THE 826 00:31:49,160 --> 00:31:50,761 MAJOR PROFESSIONAL BODIES AND 827 00:31:50,761 --> 00:31:52,163 MOST IMPORTANTLY BY PATIENT 828 00:31:52,163 --> 00:31:53,498 SAFETY ADVOCATE. 829 00:31:53,498 --> 00:31:55,533 SO WE WERE ABLE TO DO ALL OF 830 00:31:55,533 --> 00:31:57,034 THAT IN SIX WEEKS. 831 00:31:57,034 --> 00:32:00,037 IT SHOWS YOU CAN BUILD IMPROVED 832 00:32:00,037 --> 00:32:01,038 PROCESSES AND SYSTEMS 833 00:32:01,038 --> 00:32:03,007 COLLABORATIVELY, YOU CAN ENGAGE 834 00:32:03,007 --> 00:32:07,211 DIVERSE AND DISTRIBUTED 835 00:32:07,211 --> 00:32:09,514 EXPERTISE AND DOO IT AT SCALE. 836 00:32:09,514 --> 00:32:10,214 WE PUBLISHED THE METHODOLOGY 837 00:32:10,214 --> 00:32:11,916 FOR THAT. 838 00:32:11,916 --> 00:32:13,384 THEN YOU CAN CO-DESIGN CHANGES 839 00:32:13,384 --> 00:32:15,186 IN DLIN CAL PRACTICE. 840 00:32:15,186 --> 00:32:18,122 THIS GOES BACK TO MY POINT 841 00:32:18,122 --> 00:32:18,890 TRANSLATING RESEARCH FINDINGS 842 00:32:18,890 --> 00:32:20,458 INTO SOMETHING THAT WILL 843 00:32:20,458 --> 00:32:21,959 ACTUALLY BENEFIT PATIENTS. 844 00:32:21,959 --> 00:32:25,696 WE KNOW FAILURE TO DETECT AND 845 00:32:25,696 --> 00:32:26,864 RESPOND TO FETAL DETERIORATION 846 00:32:26,864 --> 00:32:29,734 DURING LABOR IS ONE OF THE MOST 847 00:32:29,734 --> 00:32:30,868 SIGNIFICANT CONTRIBUTORS TO 848 00:32:30,868 --> 00:32:33,137 AVOIDABLE BRAIN INJURY DURING 849 00:32:33,137 --> 00:32:34,138 CHILD BIRTH. 850 00:32:34,138 --> 00:32:35,840 OBVIOUSLY HUGE IMPACT ON 851 00:32:35,840 --> 00:32:37,608 FAMILIES WHICH IS POTENTIALLY 852 00:32:37,608 --> 00:32:40,044 LIFE LONG. 853 00:32:40,044 --> 00:32:41,846 IN U.K. CLINICAL NEGLIGENCE 854 00:32:41,846 --> 00:32:44,182 ACCOUNTS FOR THIS INJURY, A 855 00:32:44,182 --> 00:32:46,751 SIGNIFICANT PROPORTION OF OUR 856 00:32:46,751 --> 00:32:48,519 NHS BUDGET AND HAS CONSEQUENCES 857 00:32:48,519 --> 00:32:50,588 FOR STAFF EXPERIENCES AS WELL. 858 00:32:50,588 --> 00:32:52,957 WHAT WE KNOW FROM BIOMEDICAL 859 00:32:52,957 --> 00:32:54,926 SCIENCE, THERE'S A RANGE OF 860 00:32:54,926 --> 00:32:56,961 CLINICAL RISK FACTORS YOU NEED 861 00:32:56,961 --> 00:32:59,931 TO BE MEASURING AND ALSO THESE 862 00:32:59,931 --> 00:33:03,100 ARE NOT NECESSARILY, THESE RISK 863 00:33:03,100 --> 00:33:06,103 FACTORS ARE NOT EQUITABLY 864 00:33:06,103 --> 00:33:14,111 DISTRIBUTED INCLUDING MACONIUM 865 00:33:14,111 --> 00:33:15,613 WHICH TENDS TO APPEAR EARLIER 866 00:33:15,613 --> 00:33:17,715 IN WOMEN WITH DARKER SKIN. 867 00:33:17,715 --> 00:33:20,184 BUT WE KNOW TRYING TO TRANSLATE 868 00:33:20,184 --> 00:33:22,820 WHAT HAPPENS WHEN YOU'VE GOT A 869 00:33:22,820 --> 00:33:23,688 MULTIPLE DIFFERENT RISK FACTORS 870 00:33:23,688 --> 00:33:27,124 YOU NEED TO BE MONITORING INTO 871 00:33:27,124 --> 00:33:28,993 SOMETHING CLINICIANS CAN USE 872 00:33:28,993 --> 00:33:30,995 TENDS TO BE IMPERILED BY WEAK 873 00:33:30,995 --> 00:33:32,697 WORK SYSTEM DESIGN. 874 00:33:32,697 --> 00:33:34,532 WE WORKED WITH CLINICIANS, WE 875 00:33:34,532 --> 00:33:35,866 WORKED ONLINE, OFFLINE, WE 876 00:33:35,866 --> 00:33:38,803 WORKED WITH WOMEN AND THEIR 877 00:33:38,803 --> 00:33:39,470 BIRTH PARTNERS, BIRTHING 878 00:33:39,470 --> 00:33:41,205 PEOPLE, SO WE COULD MAKE SURE 879 00:33:41,205 --> 00:33:44,375 THAT THESE MET THE NEEDS OF 880 00:33:44,375 --> 00:33:44,775 EVERYONE INVOLVED. 881 00:33:44,775 --> 00:33:47,245 WE WERE ABLE TO SHOW, FOR 882 00:33:47,245 --> 00:33:49,280 EXAMPLE, VERY EARLY ON, THE 883 00:33:49,280 --> 00:33:50,781 CLINICIANS REALLY WANTED THIS. 884 00:33:50,781 --> 00:33:53,417 AND THERE WAS HUGE SUPPORT FOR 885 00:33:53,417 --> 00:33:54,986 STANDARDIZING THE APPROACH AND 886 00:33:54,986 --> 00:33:58,522 FOR HAVING AN APPROACH THAT 887 00:33:58,522 --> 00:33:59,824 MONITORED MULTIPLE RISK 888 00:33:59,824 --> 00:34:03,194 FACTORS, NOT JUST FETAL HEART 889 00:34:03,194 --> 00:34:04,929 RATE AND WITH THE DEFINITIONS 890 00:34:04,929 --> 00:34:06,497 AND NEED FOR MORE CLARITY 891 00:34:06,497 --> 00:34:08,266 BEFORE WE CAN PROCEED TO THE 892 00:34:08,266 --> 00:34:08,466 TOOL. 893 00:34:08,466 --> 00:34:10,301 WE DID THAT BY CONSULTING WITH 894 00:34:10,301 --> 00:34:12,003 CLINICIANS ON WHAT THEY THOUGHT 895 00:34:12,003 --> 00:34:13,537 THE DEFINITIONS SHOULD INVOLVE. 896 00:34:13,537 --> 00:34:15,806 AND THAT MEANT WE GOT TO 897 00:34:15,806 --> 00:34:17,541 CLARITY AND PEOPLE ALSO FELT 898 00:34:17,541 --> 00:34:19,777 THEY HAD OWNERSHIP ON THAT. 899 00:34:19,777 --> 00:34:21,178 WE DEVELOPED TWO DIFFERENT 900 00:34:21,178 --> 00:34:26,417 VERSIONS OF THE CLINICAL TOOLS. 901 00:34:26,417 --> 00:34:28,452 AND WE RAN INTERVIEWS, THINK 902 00:34:28,452 --> 00:34:30,988 LOUD INTERVIEWS AS THEY ARE 903 00:34:30,988 --> 00:34:33,090 CALLED TO ASSESS HOW TO IMPROVE 904 00:34:33,090 --> 00:34:34,792 THEM AND THEN RAN SIMULATION 905 00:34:34,792 --> 00:34:36,460 TESTING TO SEE WHAT WOULD 906 00:34:36,460 --> 00:34:39,096 HAPPEN WHEN YOU PUT THESE INTO 907 00:34:39,096 --> 00:34:40,831 PRACTICE AND WOMEN AND BIRNLING 908 00:34:40,831 --> 00:34:47,004 PEOPLE WERE JUST AS INVOLVED AS 909 00:34:47,004 --> 00:34:48,205 CLINICIANS. WE ENGAGED DEEPLY 910 00:34:48,205 --> 00:34:50,207 WITH WOMEN AND BIRTH PARTNERS 911 00:34:50,207 --> 00:34:52,376 THROUGHOUT SO THEY COULD TELL 912 00:34:52,376 --> 00:34:54,278 US WHAT GOOD WOULD LOOK LIKE 913 00:34:54,278 --> 00:34:56,814 FOR THEM AS THESE TOOLS WERE 914 00:34:56,814 --> 00:34:59,550 DEPLOYED AND SO THERE WAS 915 00:34:59,550 --> 00:35:00,117 CLARITY ABOUT COMMUNICATION. 916 00:35:00,117 --> 00:35:03,854 SO THAT WAS EXTREMELY VALUABLE. 917 00:35:03,854 --> 00:35:09,694 WE HAVE PUBLISHED THAT WORK. 918 00:35:09,694 --> 00:35:12,330 HOW TO CODIFY THE CO-DESIGN 919 00:35:12,330 --> 00:35:13,864 PRINCIPLES YOU WOULD USE. 920 00:35:13,864 --> 00:35:16,867 IN TERMS OF EVALUATION, THE 921 00:35:16,867 --> 00:35:20,504 DRUGS DON'T ALWAYS WORK AND 922 00:35:20,504 --> 00:35:27,778 THERE'S NO REASON 923 00:35:27,778 --> 00:35:28,412 IMPLEMENTATION AND IMPROVEMENT 924 00:35:28,412 --> 00:35:32,283 SHOULD WORK ALL THE TIME AS 925 00:35:32,283 --> 00:35:32,483 WELL. 926 00:35:32,483 --> 00:35:35,152 WE CAN SEE THIS FROM EVALUATION 927 00:35:35,152 --> 00:35:38,923 OF THE COACHING BASED WHO IS 928 00:35:38,923 --> 00:35:41,258 SAFER CHILD BIRTH INTERVENTION 929 00:35:41,258 --> 00:35:44,562 IN INDIA AND EFFORT TO SCALE UP 930 00:35:44,562 --> 00:35:45,396 PREVIOUSLY SUCCESSFUL 931 00:35:45,396 --> 00:35:47,598 SIMULATION TRAINING PROGRAM IN 932 00:35:47,598 --> 00:35:47,865 SCOTLAND. 933 00:35:47,865 --> 00:35:48,899 THESE THINGS DON'T ALWAYS WORK 934 00:35:48,899 --> 00:35:51,035 AND WE HAVE TO EVALUATE THEM IN 935 00:35:51,035 --> 00:35:52,636 ORDER TO UNDERSTAND WHY. 936 00:35:52,636 --> 00:35:54,572 ONE OF THE REASONS IS THE 937 00:35:54,572 --> 00:35:57,208 STRUGGLING UNITS TEND TO HAVE 938 00:35:57,208 --> 00:35:59,276 VERY DISTINCTIVE NEEDS AND THEY 939 00:35:59,276 --> 00:36:00,945 AREN'T ALWAYS ADDRESSED IN 940 00:36:00,945 --> 00:36:02,113 TERMS OF IMPROVEMENT PROGRAM SO 941 00:36:02,113 --> 00:36:07,084 THEY ARE LEFT TO STRUGGLE. 942 00:36:07,084 --> 00:36:09,019 AREAS WHERE THINGS LIKE AS IF 943 00:36:09,019 --> 00:36:13,257 THEY SHOULD WORK BUT DON'T 944 00:36:13,257 --> 00:36:14,558 INCLUDE HOTSPOTTING, WOULD 945 00:36:14,558 --> 00:36:16,327 IDENTIFY PEOPLE WHO APPEAR TO 946 00:36:16,327 --> 00:36:18,329 HAVE RISK FACTORS SO YOU CAN 947 00:36:18,329 --> 00:36:21,165 INTERVENE AND PREVENT THEM FROM 948 00:36:21,165 --> 00:36:23,634 BEING READMITTED. 949 00:36:23,634 --> 00:36:25,603 NEW ENGLAND JOURNAL STUDY 950 00:36:25,603 --> 00:36:26,937 SHOWED THIS DOESN'T LEAD TO 951 00:36:26,937 --> 00:36:28,372 IMPROVEMENTS IN THE NUMBER OF 952 00:36:28,372 --> 00:36:30,474 PEOPLE READMITTED. 953 00:36:30,474 --> 00:36:33,077 WE SEE EXACTLY THE SAME THING 954 00:36:33,077 --> 00:36:35,613 IN U.K. CONTEXT. 955 00:36:35,613 --> 00:36:36,847 USING MEASURES TO PREVENT 956 00:36:36,847 --> 00:36:40,618 PEOPLE AT HIGH RISK OF MERM SY 957 00:36:40,618 --> 00:36:43,854 INPATIENT ADMISSION, DO NOT 958 00:36:43,854 --> 00:36:44,722 REDEUCING HEALTHCARE 959 00:36:44,722 --> 00:36:48,459 UTILIZATION AND DO INCREASE 960 00:36:48,459 --> 00:36:49,693 INPATIENT ADMISSIONS AND 961 00:36:49,693 --> 00:36:50,861 INCREASE PRIMARY CARE WORKLOAD 962 00:36:50,861 --> 00:36:53,731 AND EXACTLY THE SAME THING 963 00:36:53,731 --> 00:36:57,201 HAPPENED IN THE TRIAL OF 964 00:36:57,201 --> 00:36:57,902 PREDICTIVE RISKS, 965 00:36:57,902 --> 00:36:59,069 STRATIFICATION IN PRIMARY CARE. 966 00:36:59,069 --> 00:37:00,504 WHAT HAPPENS MAY NOT BE THE 967 00:37:00,504 --> 00:37:02,773 SAME AS WHAT IS INTENDED. 968 00:37:02,773 --> 00:37:04,175 THE KEY ACTIVITIES MAY INTO THE 969 00:37:04,175 --> 00:37:06,911 HAPPEN OR LOOK THE WAY YOU 970 00:37:06,911 --> 00:37:09,847 EXPECT THEM, MECHANISMS MAY NOT 971 00:37:09,847 --> 00:37:10,981 FUNCTION, THE EXTERNAL MAY 972 00:37:10,981 --> 00:37:13,784 MODIFY WHAT IS POSSIBLE AND 973 00:37:13,784 --> 00:37:15,319 PEOPLE IMPROVISE, INNOVATE AND 974 00:37:15,319 --> 00:37:22,893 ADAPT. 975 00:37:22,893 --> 00:37:24,528 THIS IS MY FINAL EXAMPLE OF AN 976 00:37:24,528 --> 00:37:27,498 ANIMAL. 977 00:37:27,498 --> 00:37:37,908 THAT WOULD BE A GIRAFFE. 978 00:37:44,615 --> 00:37:47,785 FOR EXAMPLE THERE WERE WAY TOO 979 00:37:47,785 --> 00:37:49,620 MANY TARGETS, THERE WAS NOT 980 00:37:49,620 --> 00:37:50,521 ENOUGH SUPPORT PROVIDED AND 981 00:37:50,521 --> 00:37:53,424 PEOPLE WERE NOT ABLE TO DELIVER 982 00:37:53,424 --> 00:37:56,260 THE INTERVENTION AS DESIGNED. 983 00:37:56,260 --> 00:37:57,895 SO, TO CONCLUDE, IF WE ARE 984 00:37:57,895 --> 00:37:59,997 GOING TO IMPROVE MATERNITY CARE 985 00:37:59,997 --> 00:38:02,032 WE NEED BASIC COMPONENTS OF A 986 00:38:02,032 --> 00:38:03,567 LEARNING SYSTEM IN PLACE. 987 00:38:03,567 --> 00:38:05,169 YOU NEED TO CHARACTERIZE AND 988 00:38:05,169 --> 00:38:09,507 UNDERSTAND PROBLEMS, POSSIBLE 989 00:38:09,507 --> 00:38:10,708 SOLUTIONS AND EVALUATE THAT'S 990 00:38:10,708 --> 00:38:12,610 WHERE IMPROVEMENT IN MATERNITY 991 00:38:12,610 --> 00:38:16,947 CARE LIES. THANK YOU VERY MUCH, 992 00:38:16,947 --> 00:38:27,291 I WILL STOP TALKING. 993 00:38:27,892 --> 00:38:32,129 >> VERONICA TONWE: THANK YOU, 994 00:38:32,129 --> 00:38:33,931 DR. DIXON-WOODS. WE ARE SEEING 995 00:38:33,931 --> 00:38:36,600 SOME CLAPS. 996 00:38:36,600 --> 00:38:38,068 FEEL FREE TO ENTER QUESTIONS IN 997 00:38:38,068 --> 00:38:38,936 THE CHAT. 998 00:38:38,936 --> 00:38:40,804 I WILL START WITH ONE QUESTION 999 00:38:40,804 --> 00:38:42,740 AND THEN I'M GOING TO MOVE TO 1000 00:38:42,740 --> 00:38:53,217 THE CHAT AND OPEN THE FLOOR. 1001 00:38:55,119 --> 00:38:58,856 WITH TOP-DOWN AND BOTTOM UP, 1002 00:38:58,856 --> 00:39:03,994 CAN TECHNOLOGY OR DIGITAL TOOLS 1003 00:39:03,994 --> 00:39:06,030 BE OPTIMIZED TO BRIDGE THE 1004 00:39:06,030 --> 00:39:08,532 EVIDENCE GAPS AND ENHANCE 1005 00:39:08,532 --> 00:39:09,900 QUALITY OF MATERNAL CARE. 1006 00:39:09,900 --> 00:39:16,040 YOU TALKED ABOUT THE CAMBRIDGE 1007 00:39:16,040 --> 00:39:17,508 ELEMENTS. 1008 00:39:17,508 --> 00:39:19,443 >> Mary Dixon-Woods: I THINK 1009 00:39:19,443 --> 00:39:20,744 YOU NEED MODELS FOR 1010 00:39:20,744 --> 00:39:22,980 COORDINATING THE ACTIVITY. 1011 00:39:22,980 --> 00:39:24,214 THE DISCOVERY PLATFORM 1012 00:39:24,214 --> 00:39:25,983 ESSENTIALLY TRIES TO DO 1013 00:39:25,983 --> 00:39:27,551 CO-DESIGN AT SCALEMENT WE THINK 1014 00:39:27,551 --> 00:39:30,020 THERE ARE THREE THINGS YOU NEED. 1015 00:39:30,020 --> 00:39:32,256 YOU NEED A PLATFORM WHERE YOU 1016 00:39:32,256 --> 00:39:33,457 CAN CONVENE AN ONLINE COMMUNITY 1017 00:39:33,457 --> 00:39:35,359 AND THAT CAN BE THE COMMUNITY 1018 00:39:35,359 --> 00:39:37,595 YOU NEED TO SOLVE THIS PROBLEM 1019 00:39:37,595 --> 00:39:39,330 WHICH WILL OFTEN BE CLINICIANS 1020 00:39:39,330 --> 00:39:41,565 AND PATIENTS. 1021 00:39:41,565 --> 00:39:42,800 YOU NEED HIGH-QUALITY DATA SO 1022 00:39:42,800 --> 00:39:44,735 YOU HAVE BASELINES AND YOU CAN 1023 00:39:44,735 --> 00:39:46,136 ASSESS THE EFFECTS OF 1024 00:39:46,136 --> 00:39:48,005 INTERVENTION AND YOU NEED 1025 00:39:48,005 --> 00:39:51,175 CO-DESIGN CAPABILITIES AND 1026 00:39:51,175 --> 00:39:52,176 THOSE CO-DESIGN CAPABILITIES 1027 00:39:52,176 --> 00:39:54,778 ARE GROUNDED IN HUMAN FACTORS 1028 00:39:54,778 --> 00:39:57,548 AND GROUNDED IN LISTENING TO 1029 00:39:57,548 --> 00:39:59,783 PEOPLE AND GROUNDED IN LEARNING 1030 00:39:59,783 --> 00:40:01,652 FROM THE LITERATURE AND FROM 1031 00:40:01,652 --> 00:40:06,457 POSITIVE DEFENCE -- DEVIANTS 1032 00:40:06,457 --> 00:40:09,193 TO DESIGN A SOLUTION AT SCALE. 1033 00:40:09,193 --> 00:40:11,662 YOU GET TO MUCH MORE SATISFYING 1034 00:40:11,662 --> 00:40:12,997 SOLUTIONS PEOPLE ARE MUCH 1035 00:40:12,997 --> 00:40:15,633 HAPPIER TO ACCEPT AND IMPLEMENT. 1036 00:40:15,633 --> 00:40:18,736 BECAUSE THEY HAD THEIR SAY AND 1037 00:40:18,736 --> 00:40:20,437 TOOK ON THE JOURNEY WITH YOU 1038 00:40:20,437 --> 00:40:22,573 AND YOU HAVE ALSO TAKEN INTO 1039 00:40:22,573 --> 00:40:23,707 ACCOUNT THEIR CONCERNS AND 1040 00:40:23,707 --> 00:40:24,074 CONSIDERATIONS. 1041 00:40:24,074 --> 00:40:26,877 >> Mary Masterson: THAT'S A 1042 00:40:26,877 --> 00:40:27,911 WONDERFUL ANSWER. 1043 00:40:27,911 --> 00:40:29,279 I LIKE THE FACT YOU SAID 1044 00:40:29,279 --> 00:40:30,381 JOURNEY. 1045 00:40:30,381 --> 00:40:35,619 HAVING THEM FROM ALL THE WAY TO 1046 00:40:35,619 --> 00:40:37,421 THE END. 1047 00:40:37,421 --> 00:40:38,889 MANY STRATEGIES YOU SPOKE 1048 00:40:38,889 --> 00:40:40,658 TOWARDS FOCUSING ON THE 1049 00:40:40,658 --> 00:40:43,260 CO-DESIGN ELEMENT, HOW ARE WE 1050 00:40:43,260 --> 00:40:45,062 GOING TO BE ASSESSING 1051 00:40:45,062 --> 00:40:45,429 SUSTAINABILITY. 1052 00:40:45,429 --> 00:40:47,598 I KNOW ONE OF THE TOPICS YOU 1053 00:40:47,598 --> 00:40:49,466 SPOKE TOWARDS HAPPENED DURING 1054 00:40:49,466 --> 00:40:52,169 COVID WHERE THERE WERE MANY 1055 00:40:52,169 --> 00:40:54,605 VIDEO MONTAGES BUT HOW DO WE 1056 00:40:54,605 --> 00:40:55,806 EVALUATE THOSE PROCESSES, AS 1057 00:40:55,806 --> 00:40:57,675 YOU WERE MENTIONING? 1058 00:40:57,675 --> 00:41:01,445 >> Mary Dixon-Woods: YEP, A 1059 00:41:01,445 --> 00:41:01,912 VERY CHALLENGING IDEA. 1060 00:41:01,912 --> 00:41:04,081 WE TALKED ABOUT A JOURNEY, I 1061 00:41:04,081 --> 00:41:05,683 THINK MANY OF THESE JOURNEYS 1062 00:41:05,683 --> 00:41:06,583 NEVER END. 1063 00:41:06,583 --> 00:41:10,487 THERE HAS BEEN A SENSE WHICH 1064 00:41:10,487 --> 00:41:12,790 IMPROVEMENT AND IMPLEMENTATION 1065 00:41:12,790 --> 00:41:14,158 IS TREATED AS EPISODIC, YOU DO 1066 00:41:14,158 --> 00:41:15,492 IT AND GET OUT, THAT'S NOT THE 1067 00:41:15,492 --> 00:41:16,727 WAY THINGS WORK. 1068 00:41:16,727 --> 00:41:19,797 IF YOU SEE EXAMPLES OF 1069 00:41:19,797 --> 00:41:20,264 LONG-TERM SUSTAINED 1070 00:41:20,264 --> 00:41:22,366 IMPROVEMENTS IT'S KEEPING THE 1071 00:41:22,366 --> 00:41:24,234 COMMUNITY ENGAGED, IT'S 1072 00:41:24,234 --> 00:41:24,768 COMMITTING TO CONTINUOUS 1073 00:41:24,768 --> 00:41:26,036 IMPROVEMENT. 1074 00:41:26,036 --> 00:41:27,104 NEVER STOPPING, ALWAYS THINKING 1075 00:41:27,104 --> 00:41:28,972 WE CAN DO BETTER HERE, WE CAN 1076 00:41:28,972 --> 00:41:30,007 LEARN MORE, THERE'S ALWAYS 1077 00:41:30,007 --> 00:41:31,175 GOING TO BE SOMEBODY WHO HAS AN 1078 00:41:31,175 --> 00:41:32,076 IDEA. 1079 00:41:32,076 --> 00:41:33,544 AND AGAIN, I THINK THE 1080 00:41:33,544 --> 00:41:35,245 INFRASTRUCTURE FOR THAT IS 1081 00:41:35,245 --> 00:41:35,479 LACKING. 1082 00:41:35,479 --> 00:41:37,581 I DON'T THINK THE WILL TO DO IT 1083 00:41:37,581 --> 00:41:39,016 IS LACKING BUT I THINK 1084 00:41:39,016 --> 00:41:40,451 UNDERSTANDING HOW WE BRING 1085 00:41:40,451 --> 00:41:41,618 PEOPLE TOGETHER AND KEEP THEM 1086 00:41:41,618 --> 00:41:45,656 WITH US OVER THE LONG TERM. 1087 00:41:45,656 --> 00:41:56,166 BECAUSE WE KNOW, AND YOU WITH 1088 00:42:01,939 --> 00:42:03,373 THINGS YOU ARE SPOTTING AND 1089 00:42:03,373 --> 00:42:07,978 START TO DEVIATE AND YOU HAVE 1090 00:42:07,978 --> 00:42:08,679 WAYS OF INTERVENING. 1091 00:42:08,679 --> 00:42:11,682 >> Mary Masterson: I SEE DR. 1092 00:42:11,682 --> 00:42:13,183 MENSA HAS A FEW QUESTIONS. 1093 00:42:13,183 --> 00:42:15,486 DO YOU WANT TO GO OFF MUTE AND 1094 00:42:15,486 --> 00:42:17,521 ASK YOUR QUESTIONS OR I CAN ASK 1095 00:42:17,521 --> 00:42:17,921 IT. 1096 00:42:17,921 --> 00:42:19,823 JUST LET ME KNOW. 1097 00:42:19,823 --> 00:42:22,126 >> PLEASE GO AHEAD. 1098 00:42:22,126 --> 00:42:23,761 >> Mary Masterson: OKAY. 1099 00:42:23,761 --> 00:42:26,296 >> THAT WAS A REALLY EXCELLENT 1100 00:42:26,296 --> 00:42:27,064 PRESENTATION, SO THANK YOU VERY 1101 00:42:27,064 --> 00:42:28,699 MUCH. 1102 00:42:28,699 --> 00:42:29,867 >> I WILL ASK HIS FIRST 1103 00:42:29,867 --> 00:42:35,939 QUESTION. 1104 00:42:35,939 --> 00:42:36,707 DR. MENSAH SAID 1105 00:42:36,707 --> 00:42:37,641 CONGRATULATIONS. ONE QUESTION 1106 00:42:37,641 --> 00:42:40,377 WE ARE FOCUSED ON AS AN ELEMENT 1107 00:42:40,377 --> 00:42:42,312 OF THIS WORKSHOP IN A WAY WHAT 1108 00:42:42,312 --> 00:42:44,114 ARE OPPORTUNITIES YOU SEE FOR 1109 00:42:44,114 --> 00:42:45,949 RESEARCH FUNDING IN AGENCIES 1110 00:42:45,949 --> 00:42:50,254 SUCH AS NIH CAN SUPPORT 1111 00:42:50,254 --> 00:42:52,022 RESEARCH THAT ACTUALLY IMPROVE 1112 00:42:52,022 --> 00:42:53,023 QUALITY CARE DELIVERY AND 1113 00:42:53,023 --> 00:42:55,125 DISEASE IN THE HEART, LUNG, 1114 00:42:55,125 --> 00:42:56,660 BLOOD AND SLEEP SYSTEMS. 1115 00:42:56,660 --> 00:42:57,895 YOU KIND OF TOUCHED ON IT BUT I 1116 00:42:57,895 --> 00:43:00,898 WOULD LOVE IF YOU COULD EXPAND 1117 00:43:00,898 --> 00:43:01,198 ON IT SOME. 1118 00:43:01,198 --> 00:43:02,199 >> Mary Dixon-Woods: THANK YOU. 1119 00:43:02,199 --> 00:43:03,834 I MEAN GETTING THIS KIND OF 1120 00:43:03,834 --> 00:43:06,136 FUNDING IS ALWAYS A CHALLENGE. 1121 00:43:06,136 --> 00:43:16,680 WE HAVE SIMILAR CHALLENGES HERE. 1122 00:43:17,648 --> 00:43:20,150 ONE IS BUDDYING UP WITH THE 1123 00:43:20,150 --> 00:43:21,218 CLINICAL RESEARCHER AND MAKING 1124 00:43:21,218 --> 00:43:23,420 IT CLEAR THE IMPACT OF THEIR 1125 00:43:23,420 --> 00:43:24,755 WORK WILL BE MUCH-MORE ENHANCED 1126 00:43:24,755 --> 00:43:29,560 IF YOU GET THE CO-DESIGN AND 1127 00:43:29,560 --> 00:43:32,095 IMPLEMENTATION STUFF UP FRONT. 1128 00:43:32,095 --> 00:43:33,730 MY CONCERN FOR EXAMPLE WITH THE 1129 00:43:33,730 --> 00:43:34,765 CLINICAL PREDICTION MODELS I 1130 00:43:34,765 --> 00:43:36,567 WAS TALKING ABOUT IS THE DATA 1131 00:43:36,567 --> 00:43:37,901 PEOPLE DEVELOPED THEM AND THEN 1132 00:43:37,901 --> 00:43:39,469 TURN AROUND AND SAY THAT IS 1133 00:43:39,469 --> 00:43:40,971 YOUR PROBLEM TO SORT OUT HOW 1134 00:43:40,971 --> 00:43:43,540 IT'S GOING TO BE IMPLEMENTED. 1135 00:43:43,540 --> 00:43:45,108 THAT IS THE WRONG WAY TO THINK 1136 00:43:45,108 --> 00:43:45,843 ABOUT IMPLEMENTATION. 1137 00:43:45,843 --> 00:43:48,145 YOU HAVE TO THINK OF 1138 00:43:48,145 --> 00:43:49,379 IMPLEMENTATION FROM THE GET-GO. 1139 00:43:49,379 --> 00:43:50,747 IT'S TOO LATE BY THE TIME YOU 1140 00:43:50,747 --> 00:43:52,049 HAVE A PRODUCT. 1141 00:43:52,049 --> 00:43:53,684 IT'S WAY TOO LATE. 1142 00:43:53,684 --> 00:43:54,651 YOU HAVEN'T LISTENED TO PEOPLE 1143 00:43:54,651 --> 00:43:55,452 OR THOUGHT ABOUT THE WORK 1144 00:43:55,452 --> 00:43:56,753 SYSTEMS. 1145 00:43:56,753 --> 00:44:00,390 THAT'S WHY ONLY 3%, DESPITE THE 1146 00:44:00,390 --> 00:44:01,959 THOUSANDS PUBLISHED EVERY YEAR 1147 00:44:01,959 --> 00:44:03,327 ACTUALLY GO INTO CLINICAL 1148 00:44:03,327 --> 00:44:03,927 PRACTICE. 1149 00:44:03,927 --> 00:44:05,596 SO THIS IS CRAZY STUFF AND I 1150 00:44:05,596 --> 00:44:07,865 THINK THE FUNDING AGENCIES ARE 1151 00:44:07,865 --> 00:44:08,765 INCREASINGLY SENSITIVE TO THE 1152 00:44:08,765 --> 00:44:10,267 FACT THEY ARE FUNDING STUFF 1153 00:44:10,267 --> 00:44:11,468 THAT NEVER MAKES A DIFFERENCE 1154 00:44:11,468 --> 00:44:13,036 TO A SINGLE PATIENT. 1155 00:44:13,036 --> 00:44:14,338 SO MAKING THOSE PARTNERSHIPS UP 1156 00:44:14,338 --> 00:44:15,739 FRONT IS REALLY KEY. 1157 00:44:15,739 --> 00:44:17,774 I THINK A SECOND THING THEN IS 1158 00:44:17,774 --> 00:44:19,176 PARTNERING WITH PEOPLE WHO ARE 1159 00:44:19,176 --> 00:44:20,644 DOING THE HARD WORK ON THE 1160 00:44:20,644 --> 00:44:23,513 GROUND OF TRYING TO DO QUALITY 1161 00:44:23,513 --> 00:44:24,381 IMPROVEMENT, DO IMPLEMENTATION 1162 00:44:24,381 --> 00:44:28,752 AND SO ON. 1163 00:44:28,752 --> 00:44:29,353 BUILDING EVALUATION PROGRAMS 1164 00:44:29,353 --> 00:44:30,721 AROUND THEM. 1165 00:44:30,721 --> 00:44:33,724 GETTING THE CO-DESIGN AND 1166 00:44:33,724 --> 00:44:35,459 IMPLEMENTATION WORK IN RIGHT AT 1167 00:44:35,459 --> 00:44:36,593 THE BEGINNING, BECAUSE AGAIN 1168 00:44:36,593 --> 00:44:37,961 THOSE PEOPLE WILL WASTE AN 1169 00:44:37,961 --> 00:44:40,197 AWFUL LOT OF TIME AND ENERGY 1170 00:44:40,197 --> 00:44:41,598 AND RESOURCE AND GOODWILL IF 1171 00:44:41,598 --> 00:44:43,267 THAT IS NOT DONE REALLY 1172 00:44:43,267 --> 00:44:46,970 CAREFULLY FROM THE BEGINNING. 1173 00:44:46,970 --> 00:44:49,139 YOU HAVE GOT ARC, THAT'S BEEN A 1174 00:44:49,139 --> 00:44:51,041 VERY VALUABLE AGENCY. 1175 00:44:51,041 --> 00:44:53,110 AGAIN, LINKING IT TO THEIR 1176 00:44:53,110 --> 00:44:54,578 PRIORITIES, PATIENT SAFETY AND 1177 00:44:54,578 --> 00:44:57,080 SO ON FEELS LIKE ONE OF THE 1178 00:44:57,080 --> 00:44:57,381 WAYS TO GO. 1179 00:44:57,381 --> 00:45:01,418 BUT IT IS A CHALLENGING AREA TO 1180 00:45:01,418 --> 00:45:11,628 GET FUNDING. 1181 00:45:15,732 --> 00:45:18,869 >> Mary Masterson: I LOVE 1182 00:45:18,869 --> 00:45:19,903 FOCUSING ON PARTNERSHIPS 1183 00:45:19,903 --> 00:45:21,238 BECAUSE YOUR DATA AND OTHERS 1184 00:45:21,238 --> 00:45:23,140 HAVE SHOWN WE HAVE AN OVER 1185 00:45:23,140 --> 00:45:24,908 ABUNDANCE OF THIS TYPE OF 1186 00:45:24,908 --> 00:45:25,976 INFORMATION BEING PUSHED OUT 1187 00:45:25,976 --> 00:45:28,312 BUT HOW MUCH IS ACTUALLY BEING 1188 00:45:28,312 --> 00:45:29,446 UTILIZED BY THE COMMUNITIES AND 1189 00:45:29,446 --> 00:45:31,014 THE PEOPLE WHO NEED IT. 1190 00:45:31,014 --> 00:45:34,551 I ESPECIALLY WANT TO FOCUS ON 1191 00:45:34,551 --> 00:45:36,053 ANOTHER ASPECT OF YOUR 1192 00:45:36,053 --> 00:45:41,491 PRESENTATION, THE IMPORTANCE OF 1193 00:45:41,491 --> 00:45:43,593 INTERPERSONAL, TEAMING EFFECTS. 1194 00:45:43,593 --> 00:45:46,296 HOW DO WE TAKE THAT INTO 1195 00:45:46,296 --> 00:45:48,632 CONSIDER, PARTICULARLY FROM THE 1196 00:45:48,632 --> 00:45:51,234 DATA SCIENCE, LOOKING AT ROUGH 1197 00:45:51,234 --> 00:45:57,674 NUMBERS WHERE THERE'S PERSONAL 1198 00:45:57,674 --> 00:46:01,278 COMPONENTS. I APPRECIATE YOUR 1199 00:46:01,278 --> 00:46:01,511 ANSWERS. 1200 00:46:01,511 --> 00:46:02,045 DR. MENSAH, DO YOU HAVE 1201 00:46:02,045 --> 00:46:04,748 ANYTHING TO ADD? 1202 00:46:04,748 --> 00:46:09,319 >> I THINK REQUIRING THE NEED 1203 00:46:09,319 --> 00:46:10,487 FOR THE PARTNERSHIPS INSTEAD OF 1204 00:46:10,487 --> 00:46:12,356 LEAVING IT AND LETTING OTHERS. 1205 00:46:12,356 --> 00:46:13,023 BUT THAT'S HELPFUL. 1206 00:46:13,023 --> 00:46:13,357 THANK YOU. 1207 00:46:13,357 --> 00:46:14,891 >> Mary Dixon-Woods: THANK YOU. 1208 00:46:14,891 --> 00:46:19,696 I'M SUCH A FAN OF YOURS, I'VE 1209 00:46:19,696 --> 00:46:21,131 BEEN A BIT AWE-STRUCK TO 1210 00:46:21,131 --> 00:46:22,933 FINALLY MEET YOU. 1211 00:46:22,933 --> 00:46:25,068 >> THRILLED TO BE HERE. 1212 00:46:25,068 --> 00:46:25,769 THANK YOU. 1213 00:46:25,769 --> 00:46:28,338 >> Mary Masterson: DR. MENSAH 1214 00:46:28,338 --> 00:46:30,207 IS AWESOME. 1215 00:46:30,207 --> 00:46:32,576 HIS SECOND QUESTION IS ABOUT 1216 00:46:32,576 --> 00:46:36,246 POSITIVE DEVIANTS, ARE THERE 1217 00:46:36,246 --> 00:46:38,181 EXAMPLES OF NEGATIVE DEVIANTS 1218 00:46:38,181 --> 00:46:40,217 IN MATERNAL HEALTH THAT COULD 1219 00:46:40,217 --> 00:46:44,488 IDEALLY SERVE AS A FOCUS FOR 1220 00:46:44,488 --> 00:46:45,055 DE-IMPLEMENTATION RESEARCH. 1221 00:46:45,055 --> 00:46:45,756 >> Mary Dixon-Woods: OKAY, WOW, 1222 00:46:45,756 --> 00:46:47,190 THIS IS A VERY SMART QUESTION, 1223 00:46:47,190 --> 00:46:49,326 ONE WE HAVE ACTUALLY BEEN 1224 00:46:49,326 --> 00:46:49,659 BATTLING WITH. 1225 00:46:49,659 --> 00:46:51,428 WE HAVE HAD A SERIES OF 1226 00:46:51,428 --> 00:46:53,663 MATERNITY DISASTERS IN THE U.K. 1227 00:46:53,663 --> 00:46:57,200 IN FACT OUR MATERNITY SYSTEM IS 1228 00:46:57,200 --> 00:46:58,535 CURRENTLY IN CRISIS BECAUSE WE 1229 00:46:58,535 --> 00:47:05,275 HAVE HAD SO MANY SCANDALS 1230 00:47:05,275 --> 00:47:09,713 INVOLVING ORGANIZATIONAL 1231 00:47:09,713 --> 00:47:11,648 DEGRADATION CAUSING TERRIBLE 1232 00:47:11,648 --> 00:47:12,049 HARM TO FAMILIES. 1233 00:47:12,049 --> 00:47:14,851 SO THERE'S BEEN AN AWFUL LOT OF 1234 00:47:14,851 --> 00:47:18,321 NEGATIVE DEVIANTS, WE HAVE HAD 1235 00:47:18,321 --> 00:47:19,423 LOTS OF GOVERNMENT INQUIRIES 1236 00:47:19,423 --> 00:47:21,825 REPORTS AND ALL THE REST OF IT, 1237 00:47:21,825 --> 00:47:24,161 ACTUALLY CONTINUING TO FOCUS ON 1238 00:47:24,161 --> 00:47:25,028 THE NEGATIVE DEVIANTS, NOT 1239 00:47:25,028 --> 00:47:26,263 MOVING THE DIAL. 1240 00:47:26,263 --> 00:47:28,298 IN FACT I THINK WE HAVE ALL THE 1241 00:47:28,298 --> 00:47:30,434 JUICE WE CAN GET FROM WHAT GOES 1242 00:47:30,434 --> 00:47:30,634 WRONG. 1243 00:47:30,634 --> 00:47:32,803 WHAT WE ARE TRYING TO FOCUS ON 1244 00:47:32,803 --> 00:47:35,772 IS WHAT YOU NEED TO DO RIGHT. 1245 00:47:35,772 --> 00:47:36,606 WE CO-DESIGNED THAT FRAMEWORK 1246 00:47:36,606 --> 00:47:38,508 THAT SAYS HERE IS WHAT GOOD 1247 00:47:38,508 --> 00:47:41,445 LOOKS LIKE AND OPERATING AT A 1248 00:47:41,445 --> 00:47:42,245 FAIRLY GENERAL LEVEL. 1249 00:47:42,245 --> 00:47:46,083 I THINK THE QUESTION OF 1250 00:47:46,083 --> 00:47:48,952 DE-IMPLEMENTATION IS ABSOLUTELY 1251 00:47:48,952 --> 00:47:49,219 CRITICAL. 1252 00:47:49,219 --> 00:47:51,721 IF WE HAVE 147 DIFFERENT 1253 00:47:51,721 --> 00:47:54,724 OBSTETRIC EARLY WARNING SCORES 1254 00:47:54,724 --> 00:47:56,393 WE HAVE TO DE-IMPLEMENT MOST OF 1255 00:47:56,393 --> 00:48:00,464 THOSE AND GET TO ONE THAT IS 1256 00:48:00,464 --> 00:48:01,431 EVIDENCE-BASED AND THAT 1257 00:48:01,431 --> 00:48:03,300 EVERYBODY ACCEPTS IS GOING TO 1258 00:48:03,300 --> 00:48:04,101 WORK. 1259 00:48:04,101 --> 00:48:06,403 MOST OF IT HAS GONE ON 1260 00:48:06,403 --> 00:48:07,571 LOW-VALUE CARE, THAT'S NOT WHAT 1261 00:48:07,571 --> 00:48:09,473 THIS IS, MORE ABOUT TOOLS, 1262 00:48:09,473 --> 00:48:11,241 PRACTICES, ET CETERA. 1263 00:48:11,241 --> 00:48:12,642 IT'S NOT LOW VALUE, IT'S JUST 1264 00:48:12,642 --> 00:48:14,177 THAT IT IS NOT RIGHT. 1265 00:48:14,177 --> 00:48:16,880 WE HAVE STUDIED A PROGRAM WHERE 1266 00:48:16,880 --> 00:48:17,981 THE GOVERNMENT ESSENTIALLY SAID 1267 00:48:17,981 --> 00:48:19,816 ON THIS DAY YOU GOT TO STOP 1268 00:48:19,816 --> 00:48:23,787 USING THAT THING AND START 1269 00:48:23,787 --> 00:48:24,154 USING THIS ONE. 1270 00:48:24,154 --> 00:48:25,489 THAT WAS A VERY, VERY MIXED 1271 00:48:25,489 --> 00:48:27,090 SUCCESS. 1272 00:48:27,090 --> 00:48:28,258 ANOTHER APPROACH WOULD BE TO 1273 00:48:28,258 --> 00:48:31,661 WARM PEOPLE UP TO THE IDEA AND 1274 00:48:31,661 --> 00:48:34,131 OVER TIME GIVE THEM STRATEGIES, 1275 00:48:34,131 --> 00:48:36,933 AND DESIGN AND ALL THAT THAT 1276 00:48:36,933 --> 00:48:38,235 THEY NEED AND CALL IT. 1277 00:48:38,235 --> 00:48:39,836 YOU HAVE TO PHASE THIS OUT BY 1278 00:48:39,836 --> 00:48:40,837 SUCH AND SUCH A DAY. 1279 00:48:40,837 --> 00:48:44,574 I WOULD LIKE TO SEE A LOT MORE 1280 00:48:44,574 --> 00:48:45,442 RESEARCH ON DEIMPLEMENTATION 1281 00:48:45,442 --> 00:48:49,045 AND THE OTHER SIDE OF THAT IS 1282 00:48:49,045 --> 00:48:49,412 IMPLEMENTATION. 1283 00:48:49,412 --> 00:48:50,814 WHICH I STILL FEEL JUST DOESN'T 1284 00:48:50,814 --> 00:48:55,085 GET THE ATTENTION IT NEEDS. 1285 00:48:55,085 --> 00:48:56,887 >> THANK YOU, APPRECIATE IT. 1286 00:48:56,887 --> 00:48:58,989 >> Mary Masterson: YEAH, NO, I 1287 00:48:58,989 --> 00:49:01,992 THINK THAT'S A PHENOMENAL 1288 00:49:01,992 --> 00:49:02,592 ANSWER, THE DE-IMPLEMENTATION 1289 00:49:02,592 --> 00:49:03,894 ASPECTS. 1290 00:49:03,894 --> 00:49:05,362 BELOW VALUE, THERE'S BEEN A LOT 1291 00:49:05,362 --> 00:49:06,830 MORE WORK BUT THIS IS SOMETHING 1292 00:49:06,830 --> 00:49:08,431 THAT IS NEW GROUND. 1293 00:49:08,431 --> 00:49:10,066 I'M VERY CURIOUS AND LOOK 1294 00:49:10,066 --> 00:49:12,302 FORWARD TO YOUR FUTURE WORK, 1295 00:49:12,302 --> 00:49:15,138 ESPECIALLY AS IT RELATES TO 1296 00:49:15,138 --> 00:49:16,806 THAT TEAMING ASPECT. 1297 00:49:16,806 --> 00:49:17,874 DE-IMPLEMENTING ON THAT SCALE 1298 00:49:17,874 --> 00:49:21,144 DOES REQUIRE A SIGNIFICANT 1299 00:49:21,144 --> 00:49:24,848 LEVEL OF COORDINATION. 1300 00:49:24,848 --> 00:49:27,050 I DID WANT TO GO BACK TO THE 1301 00:49:27,050 --> 00:49:27,884 CO-DESIGN PROCESS. 1302 00:49:27,884 --> 00:49:30,187 SO THERE'S A LOT OF ENGAGEMENT 1303 00:49:30,187 --> 00:49:33,957 WITH WOMEN AND THEIR PARTNERS 1304 00:49:33,957 --> 00:49:35,859 THROUGH MANY OF YOUR 1305 00:49:35,859 --> 00:49:36,693 INTERVENTIONS AND THE STUDIES 1306 00:49:36,693 --> 00:49:38,428 THAT YOU HAVE DONE. 1307 00:49:38,428 --> 00:49:40,897 COULD YOU TALK A BIT MORE ABOUT 1308 00:49:40,897 --> 00:49:42,532 HOW YOU ENGAGE WITH THE 1309 00:49:42,532 --> 00:49:45,235 COMMUNITY AND JUST BUILD THIS 1310 00:49:45,235 --> 00:49:47,370 RAPPORT AND TRUST? 1311 00:49:47,370 --> 00:49:48,605 BECAUSE IT'S A LONG-STANDING 1312 00:49:48,605 --> 00:49:49,639 JOURNEY AND RELATIONSHIP YOU 1313 00:49:49,639 --> 00:49:50,807 ARE MENTIONING. 1314 00:49:50,807 --> 00:49:53,543 I'M CURIOUS TO HEAR A BIT MORE 1315 00:49:53,543 --> 00:49:54,044 ABOUT THAT. 1316 00:49:54,044 --> 00:49:55,779 >> Mary Dixon-Woods: YEAH, I'M 1317 00:49:55,779 --> 00:49:57,447 REALLY HAPPY TO TALK ABOUT 1318 00:49:57,447 --> 00:49:58,615 THAT, BECAUSE IT'S ONE OF THE 1319 00:49:58,615 --> 00:50:00,417 THINGS WE ARE VERY, VERY HAPPY 1320 00:50:00,417 --> 00:50:02,085 TO DO, VERY COMMITTED TO DOING. 1321 00:50:02,085 --> 00:50:03,653 WE HAVE TO DO THAT IN MULTIPLE 1322 00:50:03,653 --> 00:50:04,955 WAYS. 1323 00:50:04,955 --> 00:50:07,657 SOME IS THE LARGE-SCALE 1324 00:50:07,657 --> 00:50:08,291 CONSULTATION. 1325 00:50:08,291 --> 00:50:10,827 YOU HAVE TO DO THAT BECAUSE 1326 00:50:10,827 --> 00:50:12,596 IT'S THE ONLY WAY PEOPLE WILL 1327 00:50:12,596 --> 00:50:15,765 EVER BE ABLE TO CONTRIBUTE, 1328 00:50:15,765 --> 00:50:17,200 DIGITAL CONTEXT BECAUSE THEY 1329 00:50:17,200 --> 00:50:18,868 CAN'T LEAVE THEIR KIDS OR GET 1330 00:50:18,868 --> 00:50:20,570 TIME OFF WORK TO BE IN A 1331 00:50:20,570 --> 00:50:22,138 MEETING SOMEWHERE. 1332 00:50:22,138 --> 00:50:24,140 WE PUT AN EXAMPLE OF SOMETHING, 1333 00:50:24,140 --> 00:50:25,575 A LITTLE VIDEO OR ANIMATION 1334 00:50:25,575 --> 00:50:26,643 ONLINE. 1335 00:50:26,643 --> 00:50:28,411 AND BASICALLY TELL US WHAT THEY 1336 00:50:28,411 --> 00:50:30,180 THOUGHT WAS GOOD ABOUT IT, AND 1337 00:50:30,180 --> 00:50:31,281 WHAT THEY THOUGHT WAS LESS GOOD 1338 00:50:31,281 --> 00:50:32,949 ABOUT IT. 1339 00:50:32,949 --> 00:50:36,152 WE WOULD TYPICALLY DO THAT 1340 00:50:36,152 --> 00:50:38,188 USING SOMETHING NOT PERFECT TO 1341 00:50:38,188 --> 00:50:39,556 ENGINEER SOME PROBLEM. 1342 00:50:39,556 --> 00:50:41,324 PEOPLE ARE GREAT SAYING THIS IS 1343 00:50:41,324 --> 00:50:42,525 WHAT REALLY NEEDS TO HAPPEN. 1344 00:50:42,525 --> 00:50:44,995 SO WE CAN USE THAT. 1345 00:50:44,995 --> 00:50:46,863 THEN WE USE REALLY DEEP 1346 00:50:46,863 --> 00:50:48,598 ENGAGEMENT WITH PEOPLE IN 1347 00:50:48,598 --> 00:50:50,500 PERSON OR IN ONLINE MEETINGS 1348 00:50:50,500 --> 00:50:53,637 AND WE SOURCE THOSE VERY 1349 00:50:53,637 --> 00:50:53,970 INTENTIONALLY. 1350 00:50:53,970 --> 00:51:04,481 WE FIND PEOPLE WHO ARE IN WHO 1351 00:51:06,850 --> 00:51:10,020 WOULD OTHERWISE BE UNHEARD. 1352 00:51:10,020 --> 00:51:13,089 GOING INTO PLACES THAT ARE 1353 00:51:13,089 --> 00:51:13,857 DISADVANTAGED BY USING 1354 00:51:13,857 --> 00:51:17,394 NETWORKS. SO WE BRING THEM. 1355 00:51:17,394 --> 00:51:19,629 IT'S JUST HARD TO OVER STATE 1356 00:51:19,629 --> 00:51:21,131 WHAT A DIFFERENCE THEY MADE IN 1357 00:51:21,131 --> 00:51:22,332 THAT PROJECT. 1358 00:51:22,332 --> 00:51:24,434 THERE WERE EIGHT DIFFERENT RISK 1359 00:51:24,434 --> 00:51:27,270 FACTORS INTO A SINGLE TOOL THAT 1360 00:51:27,270 --> 00:51:29,506 THE CLINICIANS WOULD USE DURING 1361 00:51:29,506 --> 00:51:32,208 THE LABOR. 1362 00:51:32,208 --> 00:51:36,046 AS I SAID, WE TESTED THAT IN 1363 00:51:36,046 --> 00:51:37,747 SIMULATIONS. AND WHEN THE WOMEN 1364 00:51:37,747 --> 00:51:39,215 AND BIRTHING AND PEOPLE AND 1365 00:51:39,215 --> 00:51:44,287 THEIR PARTNERS SAW THIS, THEY 1366 00:51:44,287 --> 00:51:50,193 SAID "BUT YOU'RE NOT ASKING US.. 1367 00:51:50,193 --> 00:51:53,129 WE HAVE NO SAY, THIS TOOL IS 1368 00:51:53,129 --> 00:51:55,432 JUST MEASURING CLINICAL 1369 00:51:55,432 --> 00:51:57,233 PARAMETERS AND WE ACCEPT THEY 1370 00:51:57,233 --> 00:51:57,567 ARE IMPORTANT. 1371 00:51:57,567 --> 00:51:59,669 ." 1372 00:51:59,669 --> 00:52:01,037 THEY INSISTED THERE WAS A 1373 00:52:01,037 --> 00:52:03,440 QUESTION ON THE TOOL WHICH WAS 1374 00:52:03,440 --> 00:52:13,883 JUST AS MUCH STATUS AS MY 1375 00:52:20,890 --> 00:52:21,224 MACONIUM OR BLOOD. 1376 00:52:21,224 --> 00:52:22,125 THEY WERE GENUINELY INVOLVED IN 1377 00:52:22,125 --> 00:52:23,893 THE DIALOGUE AND CONVERSATION. 1378 00:52:23,893 --> 00:52:25,962 YOU HAVE TO CHECK EVERY HOUR ON 1379 00:52:25,962 --> 00:52:28,598 THE WOMEN'S PERCEPTION OF THE 1380 00:52:28,598 --> 00:52:31,701 SITUATION WHAT THEY WANT DOING. 1381 00:52:31,701 --> 00:52:34,270 THAT IS AN EXAMPLE OF REAL 1382 00:52:34,270 --> 00:52:35,071 CO-DESIGNMENT WE WOULDN'T HAVE 1383 00:52:35,071 --> 00:52:37,040 COME UP WITH ANY OF THIS 1384 00:52:37,040 --> 00:52:39,109 WITHOUT REALLY WORKING WITH THE 1385 00:52:39,109 --> 00:52:39,843 CLINICIANS, WITH THE 1386 00:52:39,843 --> 00:52:41,144 COMMUNITIES, SO WE COULD 1387 00:52:41,144 --> 00:52:42,278 ACTUALLY GET TO SOMETHING THAT 1388 00:52:42,278 --> 00:52:44,280 WAS GOING TO WORK FOR EVERYONE. 1389 00:52:44,280 --> 00:52:45,815 >> Mary Masterson: THAT'S 1390 00:52:45,815 --> 00:52:48,318 AMAZING AND I REALLY LOVE THE 1391 00:52:48,318 --> 00:52:50,620 EMPHASIS ON THE SELF-EFFICACY 1392 00:52:50,620 --> 00:52:52,722 AND THERE'S A NEED TO JUST MAKE 1393 00:52:52,722 --> 00:52:55,825 YOUR VOICE HEARD AND I'M HAPPY 1394 00:52:55,825 --> 00:52:58,862 TO HEAR IT'S DEFINITELY AN 1395 00:52:58,862 --> 00:52:59,562 INTEGRAL COMPONENT OF YOUR 1396 00:52:59,562 --> 00:53:00,363 DESIGN. 1397 00:53:00,363 --> 00:53:02,465 I DO SEE ANOTHER QUESTION. 1398 00:53:02,465 --> 00:53:06,903 SO REGARDING CO-DESIGN, CAN YOU 1399 00:53:06,903 --> 00:53:11,307 ELABORATE ON RESOURCES NEEDED 1400 00:53:11,307 --> 00:53:13,176 INCLUDING TIMELINE AND IF 1401 00:53:13,176 --> 00:53:15,044 SHOULD OR COULD BE A PHASE TO 1402 00:53:15,044 --> 00:53:16,946 REFINE THE STRATEGY. 1403 00:53:16,946 --> 00:53:19,015 >> Mary Masterson: THAT IS AN 1404 00:53:19,015 --> 00:53:19,449 IMPORTANT QUESTION. 1405 00:53:19,449 --> 00:53:21,251 WHEN WE WERE DEVELOPING THAT 1406 00:53:21,251 --> 00:53:24,921 PRACTICE TOOL THAT WAS A 1407 00:53:24,921 --> 00:53:25,455 SIX-MONTH PROJECT, THAT 1408 00:53:25,455 --> 00:53:29,526 REQUIRED A LOT OF RESOURCE. 1409 00:53:29,526 --> 00:53:31,161 MY CHALLENGE TO ANYONE WHO SAYS 1410 00:53:31,161 --> 00:53:33,163 THIS IS EXPENSIVE, IT'S VERY 1411 00:53:33,163 --> 00:53:34,631 EXPENSIVE TO PUT THINGS INTO 1412 00:53:34,631 --> 00:53:36,032 PRACTICE THAT THEN DON'T WORK. 1413 00:53:36,032 --> 00:53:38,668 SO YOU END UP WASTING THE MONEY 1414 00:53:38,668 --> 00:53:40,670 LATER DOWN THE LINE OF WHEN 1415 00:53:40,670 --> 00:53:44,607 IT'S NOT PRODUCING THE IMPACT 1416 00:53:44,607 --> 00:53:48,645 AND BRINGING IT FORWARD SO YOU 1417 00:53:48,645 --> 00:53:49,512 DO THE CO-DESIGN WORKUP FRONT 1418 00:53:49,512 --> 00:53:52,615 IS THE KEY. 1419 00:53:52,615 --> 00:53:54,918 WHETHER WE CAN PERSUADE 1420 00:53:54,918 --> 00:53:57,554 FUNDERS, BUT WI NEEDED 1421 00:53:57,554 --> 00:53:59,255 COMMUNITY ENGAGEMENT, HUMAN 1422 00:53:59,255 --> 00:54:00,323 FACTORS PEOPLE, VISUAL 1423 00:54:00,323 --> 00:54:01,391 DESIGNERS, CLINICIANS AND WE 1424 00:54:01,391 --> 00:54:04,327 NEEDED A KIND OF INFRASTRUCTURE 1425 00:54:04,327 --> 00:54:07,330 FOR FOR ESSENTIALLY 1426 00:54:07,330 --> 00:54:08,264 COORDINATING ALL OF THE 1427 00:54:08,264 --> 00:54:09,666 ACTIVITIES. 1428 00:54:09,666 --> 00:54:12,936 WE STARTED WITH AN ADVISORY 1429 00:54:12,936 --> 00:54:15,104 GROUP AND PATIENT GROUPS. WE 1430 00:54:15,104 --> 00:54:16,105 MOVED THROUGH DIFFERENT 1431 00:54:16,105 --> 00:54:17,941 VERSIONS THE DESIGN, WE USE THE 1432 00:54:17,941 --> 00:54:20,176 HUMAN FACTORS PEOPLE TO TELL US 1433 00:54:20,176 --> 00:54:22,579 HOW WE WOULD LAY THEM OUT, WE 1434 00:54:22,579 --> 00:54:24,447 USE THOSE THINK ALOUD 1435 00:54:24,447 --> 00:54:26,816 INTERVIEWS SO WE SENT PEOPLE 1436 00:54:26,816 --> 00:54:27,750 CLINICAL SCENARIOS AND VERSION 1437 00:54:27,750 --> 00:54:29,552 OF THE TOOL AND SAW HOW THEY 1438 00:54:29,552 --> 00:54:32,856 GOT ON TRYING TO USE IT. 1439 00:54:32,856 --> 00:54:34,390 WE VIDEOED THE SIMULATIONS SO 1440 00:54:34,390 --> 00:54:37,260 WE COULD TEST IT, IT WAS SAFE 1441 00:54:37,260 --> 00:54:38,928 SO THE SIMULATIONS INVOLVED 1442 00:54:38,928 --> 00:54:40,763 SOME TEAMS BEING GIVEN THE 1443 00:54:40,763 --> 00:54:43,166 TOOL, AND SOME TEAMS DOING IT 1444 00:54:43,166 --> 00:54:44,100 USING THEIR STANDARD PRACTICE, 1445 00:54:44,100 --> 00:54:46,135 SO WE WERE ABLE TO IDENTIFY THE 1446 00:54:46,135 --> 00:54:47,737 TEAMS GIVEN THE TOOL WERE ABLE 1447 00:54:47,737 --> 00:54:50,773 TO FIND THE BABY ON TIME AND 1448 00:54:50,773 --> 00:54:53,243 TAKE SAFE ACTIONS SUBSEQUENTLY. 1449 00:54:53,243 --> 00:54:57,213 SO ALL OF THAT I FEEL WAS 1450 00:54:57,213 --> 00:54:57,814 RESOURCE INTENSIVE. 1451 00:54:57,814 --> 00:54:59,649 BUT IT CAN BE DONE AND YOU DO 1452 00:54:59,649 --> 00:55:01,251 GET TO A VERY GOOD PLACE 1453 00:55:01,251 --> 00:55:02,685 AFTERWARDS. 1454 00:55:02,685 --> 00:55:04,287 >> Mary Masterson: IT SOUNDS 1455 00:55:04,287 --> 00:55:05,588 AMAZING AND ALSO THE FACTOR OF 1456 00:55:05,588 --> 00:55:06,322 TIME. 1457 00:55:06,322 --> 00:55:07,824 HAVING APPROPRIATE OF TIME TO 1458 00:55:07,824 --> 00:55:12,328 DO THIS IS SOMETHING THAT YOU 1459 00:55:12,328 --> 00:55:13,897 HAVE TO HAVE IN THERE. 1460 00:55:13,897 --> 00:55:15,265 I DO HAVE ANOTHER QUESTION FROM 1461 00:55:15,265 --> 00:55:16,533 MY COLLEAGUE. 1462 00:55:16,533 --> 00:55:18,635 THEY HAD A QUESTION ABOUT 1463 00:55:18,635 --> 00:55:19,702 COORDINATION AND PRIORITIZATION. 1464 00:55:19,702 --> 00:55:21,971 >> Mary Dixon-Woods: OH YEAH. 1465 00:55:21,971 --> 00:55:27,110 >> Mary Masterson: 27 HOURS TO 1466 00:55:27,110 --> 00:55:29,546 COMPLETE GUIDELINE CARE. 1467 00:55:29,546 --> 00:55:33,182 WE HEARD YESTERDAY HOW BUNDLING 1468 00:55:33,182 --> 00:55:33,683 SERVICES AND SCREENING. 1469 00:55:33,683 --> 00:55:35,485 HOW CAN WE WORK WITHIN THE 1470 00:55:35,485 --> 00:55:38,755 SYSTEMS TO DO THIS COORDINATION 1471 00:55:38,755 --> 00:55:39,589 AND PRIORITIZATION EFFECTIVELY, 1472 00:55:39,589 --> 00:55:41,691 BASED ON NEEDS FOR STANDARD 1473 00:55:41,691 --> 00:55:45,361 CARE WHILE ALSO CONSIDERING 1474 00:55:45,361 --> 00:55:46,763 LOCAL CONTEXT? 1475 00:55:46,763 --> 00:55:48,598 >> Mary Dixon-Woods: THAT'S A 1476 00:55:48,598 --> 00:55:51,000 COMPLEX QUESTION, SO I WILL BE, 1477 00:55:51,000 --> 00:55:54,470 I'LL TRY TO BE SUCCINCT. 1478 00:55:54,470 --> 00:55:56,339 I THINK SOME OF THIS IS ABOUT 1479 00:55:56,339 --> 00:55:58,374 FIGURING OUT WHAT OUR 1480 00:55:58,374 --> 00:55:59,676 PRIORITIES ARE FOR IMPROVEMENT 1481 00:55:59,676 --> 00:56:01,511 AND WHAT OUR PRIORITIES ARE FOR 1482 00:56:01,511 --> 00:56:02,011 CARE. 1483 00:56:02,011 --> 00:56:05,114 AND SOME OF THIS GOES BACK TO 1484 00:56:05,114 --> 00:56:07,784 NOT DESIGNING A LOT OF THIS 1485 00:56:07,784 --> 00:56:09,218 INTERVENTION STUFF UP FRONT, SO 1486 00:56:09,218 --> 00:56:13,690 WE THEN END UP WITH SOMETHING 1487 00:56:13,690 --> 00:56:14,023 UNIMPLEMENTAL. 1488 00:56:14,023 --> 00:56:15,692 WE CREATE RISKS BECAUSE PEOPLE 1489 00:56:15,692 --> 00:56:18,261 HAVE TO ESSENTIALLY SKIMP. 1490 00:56:18,261 --> 00:56:21,197 THEY CAN'T DO IT IN A 1491 00:56:21,197 --> 00:56:22,699 GUIDELINE-COMPLIANT WAY. 1492 00:56:22,699 --> 00:56:26,302 THEY ARE USING TECHNIQUES OF 1493 00:56:26,302 --> 00:56:26,903 CO-DESIGN TO IDENTIFY 1494 00:56:26,903 --> 00:56:29,205 PRIORITIES AND SOME OF THIS IS 1495 00:56:29,205 --> 00:56:30,340 WORK SYSTEM DESIGN SO YOU ARE 1496 00:56:30,340 --> 00:56:32,575 DOING THIS IN THE MOST 1497 00:56:32,575 --> 00:56:32,909 EFFICIENT WAY. 1498 00:56:32,909 --> 00:56:34,277 I DON'T HAVE THE ANSWER TO THE 1499 00:56:34,277 --> 00:56:36,245 BIGGER PROBLEM HERE WHICH IS 1500 00:56:36,245 --> 00:56:37,580 HEALTHCARE STRUCTURES ARE OFTEN 1501 00:56:37,580 --> 00:56:40,516 ADVERSE OR HOSTILE TO DESIGNING 1502 00:56:40,516 --> 00:56:41,851 THE BEST POSSIBLE HEALTHCARE 1503 00:56:41,851 --> 00:56:43,052 PROCESSES. 1504 00:56:43,052 --> 00:56:45,288 >> Mary Masterson: NO, WE DON'T 1505 00:56:45,288 --> 00:56:47,256 EXPECT YOU TO HAVE ALL THE 1506 00:56:47,256 --> 00:56:47,490 ANSWERS. 1507 00:56:47,490 --> 00:56:50,693 THERE IS MORE TO THIS SESSION. 1508 00:56:50,693 --> 00:56:52,195 IT'S A FRIENDLY LOCATION. 1509 00:56:52,195 --> 00:56:54,297 I WILL ASK A QUESTION ABOUT 1510 00:56:54,297 --> 00:56:57,200 ETHICS, BECAUSE YOU DID SPEAK A 1511 00:56:57,200 --> 00:56:59,002 LOT ABOUT POTENTIAL BIAS THAT'S 1512 00:56:59,002 --> 00:57:00,803 COULD BE FACED, INDEPENDENT OF 1513 00:57:00,803 --> 00:57:03,339 STRUCTURAL, IT COULD BE 1514 00:57:03,339 --> 00:57:04,674 STRUCTURAL. 1515 00:57:04,674 --> 00:57:08,111 HOW CAN WE ENSURE QUALITY 1516 00:57:08,111 --> 00:57:09,479 IMPROVEMENT AND EVIDENCE-BASED 1517 00:57:09,479 --> 00:57:14,183 PRACTICES ARE EQUITABLE AND DO 1518 00:57:14,183 --> 00:57:16,786 NOT INADVERTENTLY WIDEN HEALTH 1519 00:57:16,786 --> 00:57:17,553 DISPARITIES AND MATERNAL HEALTH 1520 00:57:17,553 --> 00:57:17,887 OUTCOMES. 1521 00:57:17,887 --> 00:57:18,855 >> Mary Dixon-Woods: THIS IS SO 1522 00:57:18,855 --> 00:57:20,356 IMPORTANT. 1523 00:57:20,356 --> 00:57:21,724 I THINK QUALITY IMPROVEMENT HAS 1524 00:57:21,724 --> 00:57:23,059 NOT GIVEN ENOUGH ATTENTION TO 1525 00:57:23,059 --> 00:57:24,193 THIS ISSUE. 1526 00:57:24,193 --> 00:57:27,063 AND WE HAVE BEEN RUNNING 1527 00:57:27,063 --> 00:57:28,197 MATERNITY IMPROVEMENT PROGRAMS 1528 00:57:28,197 --> 00:57:30,433 HERE FOR 13 OR 14 YEARS WITHOUT 1529 00:57:30,433 --> 00:57:31,901 INCLUDING INEQUALITY AS A 1530 00:57:31,901 --> 00:57:32,168 PRIORITY. 1531 00:57:32,168 --> 00:57:36,806 I THINK WE HAVE TO BE 1532 00:57:36,806 --> 00:57:37,473 INCREDIBLY PURPOSEFUL, 1533 00:57:37,473 --> 00:57:40,977 INTENTIONAL, COMMITTED, AND 1534 00:57:40,977 --> 00:57:42,378 GUIDED BY INCLUSION, HIGHLY, 1535 00:57:42,378 --> 00:57:43,780 HIGHLY ATTENTIVE TO DIVERSITY 1536 00:57:43,780 --> 00:57:50,820 AND THINK ABOUT THIS AS 1537 00:57:50,820 --> 00:57:52,021 ABSOLUTELY IN ALL IMPROVEMENT 1538 00:57:52,021 --> 00:57:56,492 AND IMPLEMENTATION. 1539 00:57:56,492 --> 00:57:58,428 >> Mary Masterson: I CAN SEE WE 1540 00:57:58,428 --> 00:58:00,930 ARE AT THE TOP OF TIME. 1541 00:58:00,930 --> 00:58:03,766 NICE SEGUE COULD BE FORMALIZED 1542 00:58:03,766 --> 00:58:05,535 METHODS YOU ARE STRESSING, JUST 1543 00:58:05,535 --> 00:58:09,238 OVERLAYING THAT EQUITY LENS. 1544 00:58:09,238 --> 00:58:09,872 >> Mary Dixon-Woods: DEFINITELY. 1545 00:58:09,872 --> 00:58:11,774 >> Mary Masterson: I'M SURE 1546 00:58:11,774 --> 00:58:12,375 SOMETHING EVERYONE IS WORKING 1547 00:58:12,375 --> 00:58:13,776 TOWARDS. 1548 00:58:13,776 --> 00:58:17,413 IT'S BEEN A PLEASURE SPEAKING 1549 00:58:17,413 --> 00:58:20,450 WITH YOU DR. MARY DIXON-WOODS, 1550 00:58:20,450 --> 00:58:22,351 FROM ONE MARY TO ANOTHER. 1551 00:58:22,351 --> 00:58:23,486 IT'S BEEN WOND IRFULL SPEAKING 1552 00:58:23,486 --> 00:58:25,221 WITH YOU AND THANK YOU AGAIN 1553 00:58:25,221 --> 00:58:25,955 FOR PARTICIPATING IN OUR 1554 00:58:25,955 --> 00:58:26,222 WORKSHOP. 1555 00:58:26,222 --> 00:58:28,624 >> Mary Dixon-Woods: THANK YOU 1556 00:58:28,624 --> 00:58:29,625 FOR THAT ABSOLUTELY TERRIFIC 1557 00:58:29,625 --> 00:58:30,259 HOSTING AND THANK YOU FOR 1558 00:58:30,259 --> 00:58:31,260 HAVING ME. 1559 00:58:31,260 --> 00:58:34,964 I HOPE THE REST OF THE WORKSHOP 1560 00:58:34,964 --> 00:58:36,299 GOES REALLY WELL. 1561 00:58:36,299 --> 00:58:37,033 >> GREAT, EXCELLENT. 1562 00:58:37,033 --> 00:58:41,504 THANK YOU. 1563 00:58:41,504 --> 00:58:42,371 >> THANK YOU. 1564 00:58:42,371 --> 00:58:44,774 I THINK WE ARE MOVING INTO A 1565 00:58:44,774 --> 00:58:46,509 SHOOTER BREAK BEFORE WE HAVE 1566 00:58:46,509 --> 00:58:47,143 OUR SLEEP PANEL. 1567 00:58:47,143 --> 00:59:00,067 SO THANK YOU. 1568 00:59:00,067 --> 00:59:04,138 >> SLEEP IS A BIOLOGICAL 1569 00:59:04,138 --> 00:59:04,838 IMPERATIVE, ESSENTIAL FOR 1570 00:59:04,838 --> 00:59:05,319 MAINTAINING GOOD HEALTH. 1571 00:59:05,319 --> 00:59:08,689 DECADES OF RESEARCH SHOW SLEEP 1572 00:59:08,689 --> 00:59:11,124 DISRUPTION ELEVATES RISK FOR 1573 00:59:11,124 --> 00:59:13,026 OBESITY, DIABETES, STROKE, 1574 00:59:13,026 --> 00:59:15,362 HYPERTENSION AND PREGNANCY 1575 00:59:15,362 --> 00:59:15,696 COMPLICATIONS. 1576 00:59:15,696 --> 00:59:16,830 WHILE STUDIES THAT ELEVATE 1577 00:59:16,830 --> 00:59:18,799 STRATEGIES FOR PROMOTING AND 1578 00:59:18,799 --> 00:59:20,100 IMPLEMENTING SLEEP HEALTH HAVE 1579 00:59:20,100 --> 00:59:21,335 SHOWN GREAT PROMISE. 1580 00:59:21,335 --> 00:59:27,341 WE STILL HAVE FAR TO GO BOTH 1581 00:59:27,341 --> 00:59:28,842 DOMESTICALLY AND GLOBALLY. 1582 00:59:28,842 --> 00:59:32,412 GIVEN THE NASCENT STATE OF 1583 00:59:32,412 --> 00:59:34,414 IMPLEMENTATION RESEARCH IN 1584 00:59:34,414 --> 00:59:35,482 MATERNAL SLEEP HEALTH. 1585 00:59:35,482 --> 00:59:38,986 THIS SESSION WILL EXPLORE THE 1586 00:59:38,986 --> 00:59:40,754 INTERSECTIONALIVITY SLEEP 1587 00:59:40,754 --> 00:59:43,724 HEALTH AND MATERNAL HEALTH, FOR 1588 00:59:43,724 --> 00:59:44,725 EVIDENCE-BASED INTERVENTIONS 1589 00:59:44,725 --> 00:59:45,792 FOR IMPROVING MATERNAL HEALTH. 1590 00:59:45,792 --> 00:59:51,498 TODAY WE WILL HEAR FROM DR. 1591 00:59:51,498 --> 00:59:54,234 GHADA BOURJEILY, WHO WILL SLEEP 1592 00:59:54,234 --> 00:59:58,639 ON SLEEP DISORDERS AND SARA 1593 00:59:58,639 --> 01:00:02,009 ENGLAND HOW IT AFFECTS MATERNAL 1594 01:00:02,009 --> 01:00:04,144 AND FETAL HEALTH AND WE WILL 1595 01:00:04,144 --> 01:00:11,518 CLOSE WITH DR. SUZIE BERTISCH. 1596 01:00:11,518 --> 01:00:12,386 THEN WE WILL LEAD INTO 1597 01:00:12,386 --> 01:00:13,520 DISCUSSION AND Q&A. 1598 01:00:13,520 --> 01:00:15,322 SO PLEASE PUT YOUR QUESTIONS IN 1599 01:00:15,322 --> 01:00:15,722 THE Q&A BOX. 1600 01:00:15,722 --> 01:00:19,292 THANK YOU SO MUCH. 1601 01:00:19,292 --> 01:00:26,199 DR. BOURJEILY. 1602 01:00:26,199 --> 01:00:32,105 THANK YOU SO MUCH, SHILPY FOR 1603 01:00:32,105 --> 01:00:36,309 THE INTRODUCTION AND NHLBI AND 1604 01:00:36,309 --> 01:00:40,180 CITRICS FOR THE INVITE. 1605 01:00:40,180 --> 01:00:41,615 HERE ARE DISCLOSURES, THEY HAVE 1606 01:00:41,615 --> 01:00:46,053 NOTHING TO DO WITH WHAT I WILL 1607 01:00:46,053 --> 01:00:46,453 TALK ABOUT TODAY. 1608 01:00:46,453 --> 01:00:47,921 NEXT SLIDE. 1609 01:00:47,921 --> 01:00:52,659 TODAY I WILL TALK ABOUT 1610 01:00:52,659 --> 01:00:54,361 INTRODUCE QUALITY AND SLEEP 1611 01:00:54,361 --> 01:00:56,463 DURATION CHANGE PREGNANCY AND 1612 01:00:56,463 --> 01:00:57,764 HOW SLEEP DISTURB [APPLAUSE]S 1613 01:00:57,764 --> 01:00:59,266 ARE MORE COMMON IN THIS 1614 01:00:59,266 --> 01:01:02,335 POPULATION AND WE ARE GOING TO 1615 01:01:02,335 --> 01:01:03,537 DISCUSS SOME POTENTIAL 1616 01:01:03,537 --> 01:01:05,038 CHALLENGES TO THE 1617 01:01:05,038 --> 01:01:05,706 IMPLEMENTATION OF 1618 01:01:05,706 --> 01:01:06,473 INTERVENTIONS. OVER THE LAST 1619 01:01:06,473 --> 01:01:11,878 COUPLE DAYS WE HEARD WONDERFUL 1620 01:01:11,878 --> 01:01:13,413 INTERVENTIONS IN THE PREGNANT 1621 01:01:13,413 --> 01:01:14,881 POPULATION BUT UNFORTUNATELY WE 1622 01:01:14,881 --> 01:01:15,949 ARE NOT THERE YET IN TERMS OF 1623 01:01:15,949 --> 01:01:17,984 SLEEP. 1624 01:01:17,984 --> 01:01:20,921 BUT THIS IS AN OPPORTUNITY AS I 1625 01:01:20,921 --> 01:01:21,254 WILL PRESENT. 1626 01:01:21,254 --> 01:01:28,695 NEXT. 1627 01:01:28,695 --> 01:01:32,432 AS YOU CAN SEE AND HEAR THERE 1628 01:01:32,432 --> 01:01:35,469 ARE MANY CHANGES THAT HAPPENED 1629 01:01:35,469 --> 01:01:37,637 IN PREGNANT POPULATION, FROM 1630 01:01:37,637 --> 01:01:39,740 SCHEMES FROM SLEEP ARCHITECTURE 1631 01:01:39,740 --> 01:01:44,578 TO SLEEP DISTURBANCES. IN WOMEN 1632 01:01:44,578 --> 01:01:45,479 OF REPRODUCTIVE STAGE AFTER 1633 01:01:45,479 --> 01:01:47,447 SLEEP ON SET IS HIGHER RED 1634 01:01:47,447 --> 01:01:49,616 BLOOD CELLER EM SLEEP DECREASES 1635 01:01:49,616 --> 01:01:51,952 SOMETIMES IN LATER PREGNANCY. 1636 01:01:51,952 --> 01:01:53,854 TOTAL SLEEP TIME CHANGES AND 1637 01:01:53,854 --> 01:01:56,189 NUMBER OF NAPS INCREASES IN 1638 01:01:56,189 --> 01:01:57,858 PREGNANCY AND DISRUPTIONS 1639 01:01:57,858 --> 01:01:58,725 HAPPEN FOR MANY REASONS. 1640 01:01:58,725 --> 01:01:59,926 NEXT. 1641 01:01:59,926 --> 01:02:03,296 SO YOU CAN SEE IN THIS TABLE 1642 01:02:03,296 --> 01:02:06,299 HOW THERE ARE DISRUPTIONS THAT 1643 01:02:06,299 --> 01:02:11,671 HAPPEN IN EARLY PREGNANCY, LIKE 1644 01:02:11,671 --> 01:02:18,011 NOCTURIA, MUSCULAR DISCOMFORT 1645 01:02:18,011 --> 01:02:22,048 AND FETAL MOVEMENT AND UTERINE 1646 01:02:22,048 --> 01:02:22,616 CONTRACTIONS AND HEARTBURN. 1647 01:02:22,616 --> 01:02:24,417 SO SLEEP QUALITY AND DURATION 1648 01:02:24,417 --> 01:02:27,420 AND EFFICIENCY CHANGE IN 1649 01:02:27,420 --> 01:02:29,523 PREGNANCY, COMPARED TO 1650 01:02:29,523 --> 01:02:31,258 NON-PREGNANT WOMEN, PREGNANT 1651 01:02:31,258 --> 01:02:32,559 INDIVIDUALS ARE 2-3 TIMES MORE 1652 01:02:32,559 --> 01:02:35,462 LIKELY TO PRESENT WITH ABNORMAL 1653 01:02:35,462 --> 01:02:38,632 SLEEP DURATION, MORE LIKELY TO 1654 01:02:38,632 --> 01:02:39,666 HAVE EXCESSIVE DAYTIME 1655 01:02:39,666 --> 01:02:41,201 SLEEPINESS AND LOWER SLEEP 1656 01:02:41,201 --> 01:02:41,768 EFFICIENCY. 1657 01:02:41,768 --> 01:02:43,870 WE WILL HEAR ABOUT THIS LATER 1658 01:02:43,870 --> 01:02:46,339 BUT COMPARED TO PRIOR TO 1659 01:02:46,339 --> 01:02:48,175 PREGNANCY, SLEEP TIMING CHANGES 1660 01:02:48,175 --> 01:02:49,442 IN COURSE OF PREGNANCY AND 1661 01:02:49,442 --> 01:02:50,677 CHAINSINGS BACK. 1662 01:02:50,677 --> 01:02:53,313 AND POOR SLEEP QUALITY IMPACTS 1663 01:02:53,313 --> 01:02:54,748 ABOUT HALF OF ALL PREGNANCIS. 1664 01:02:54,748 --> 01:02:57,150 NEXT. 1665 01:02:57,150 --> 01:02:58,051 SLEEP DISORDERS ALSO INCREASE 1666 01:02:58,051 --> 01:02:58,385 IN PREGNANCY. 1667 01:02:58,385 --> 01:03:05,859 NEXT. 1668 01:03:05,859 --> 01:03:07,460 INSOMNIA, FOR INSTANCE MIGHT 1669 01:03:07,460 --> 01:03:12,799 IMPACT UP TO 50% BY LATE JESS 1670 01:03:12,799 --> 01:03:15,502 STATION, RESTLESS LEG SYNDROME. 1671 01:03:15,502 --> 01:03:16,937 AND SLEEP DISORDER BREATHING, 1672 01:03:16,937 --> 01:03:19,806 THE PREVALENCE IS SOMEWHERE 1673 01:03:19,806 --> 01:03:21,341 BETWEEN 4-9% IN LOWER RISK 1674 01:03:21,341 --> 01:03:23,210 POPULATIONS BUT WHEN WE START 1675 01:03:23,210 --> 01:03:26,313 TO LOOK AT COMPLICATED 1676 01:03:26,313 --> 01:03:26,913 PREGNANCIES, SLEEP DISORDER 1677 01:03:26,913 --> 01:03:29,182 BREATHING IS A VERY COMMON 1678 01:03:29,182 --> 01:03:30,650 DISORDER THAT MIGHT IMPACT 1679 01:03:30,650 --> 01:03:33,019 THESE PREGNANCIS. NEXT. 1680 01:03:33,019 --> 01:03:36,857 THERE ARE ALSO SOME RACIAL AND 1681 01:03:36,857 --> 01:03:38,291 ETHNIC DISPARITIES JUST LIKE 1682 01:03:38,291 --> 01:03:39,926 MANY OTHER ASPECTS OF DISORDERS 1683 01:03:39,926 --> 01:03:43,763 IN MEDICINE. 1684 01:03:43,763 --> 01:03:45,465 SLEEP DURATION AND DISTURBANCES 1685 01:03:45,465 --> 01:03:48,168 ARE ALSO IMPACTED DIFFERENTLY 1686 01:03:48,168 --> 01:03:50,403 BY DIFFERENT RACES AND 1687 01:03:50,403 --> 01:03:50,670 ETHNICITY. 1688 01:03:50,670 --> 01:03:54,241 YOU CAN SEE IN THE BLACK BARS 1689 01:03:54,241 --> 01:03:55,909 THAT REPRESENT BLACK WOMEN. 1690 01:03:55,909 --> 01:03:58,278 BLACK WOMEN SEEM TO REPORT MORE 1691 01:03:58,278 --> 01:03:59,813 SHORTER SLEEP. 1692 01:03:59,813 --> 01:04:02,315 THEY HAVE MORE TROUBLE FALLING 1693 01:04:02,315 --> 01:04:02,549 ASLEEP. 1694 01:04:02,549 --> 01:04:05,051 AND THEY HAVE MORE 1695 01:04:05,051 --> 01:04:05,518 NON-REFRESHING SLEEP. 1696 01:04:05,518 --> 01:04:07,087 THESE ARE DATA FROM THE 1697 01:04:07,087 --> 01:04:08,822 NATIONAL DATA HEALTH INTERVIEW 1698 01:04:08,822 --> 01:04:11,224 SURVEY THAT SURVEYED MORE THAN 1699 01:04:11,224 --> 01:04:11,524 2,000 WOMEN. 1700 01:04:11,524 --> 01:04:14,361 NEXT. 1701 01:04:14,361 --> 01:04:15,762 SLEEP DISORDERS AND 1702 01:04:15,762 --> 01:04:17,364 DISTURBANCES ARE ASSOCIATED 1703 01:04:17,364 --> 01:04:18,832 WITH ADVERSE OUTCOMES. 1704 01:04:18,832 --> 01:04:22,235 WE JUST HEARD FROM SHILPY 1705 01:04:22,235 --> 01:04:22,869 BRIEFLY ABOUT THIS. 1706 01:04:22,869 --> 01:04:25,305 NEXT. 1707 01:04:25,305 --> 01:04:27,574 MANY SLEEP DISORDERS HAVE BEEN 1708 01:04:27,574 --> 01:04:29,175 ASSOCIATED WITH VARIOUS 1709 01:04:29,175 --> 01:04:30,110 IMPORTANT PREGNANCY OUTCOMES. 1710 01:04:30,110 --> 01:04:33,446 WE AND OTHERS HAVE DEMONSTRATED 1711 01:04:33,446 --> 01:04:35,982 AN ASSOCIATION BETWEEN SLEEP 1712 01:04:35,982 --> 01:04:37,684 DISORDER BREATHING AND HYPER 1713 01:04:37,684 --> 01:04:40,954 TENSIVE DISORDERS OF PREGNANCY. 1714 01:04:40,954 --> 01:04:43,156 OTHER SLEEP DISORDERS LIKE 1715 01:04:43,156 --> 01:04:44,991 SHORT SLEEP DURATION HAS BEEN 1716 01:04:44,991 --> 01:04:47,027 ASSOCIATED WITH HIGHER BLOOD 1717 01:04:47,027 --> 01:04:49,062 PRESSURE NUMBERS, SLEEP 1718 01:04:49,062 --> 01:04:51,131 DISORDER BREATHING, LATER SLEEP 1719 01:04:51,131 --> 01:04:53,099 TIMING, EVEN EXPOSURE TO BLUE 1720 01:04:53,099 --> 01:04:59,005 LIGHT HAVE BEEN ASSOCIATED WITH 1721 01:04:59,005 --> 01:05:02,342 HIGHER -- WITH MORE IMPACTED 1722 01:05:02,342 --> 01:05:04,511 GLUCOSE METABOLISM AND HIGHER 1723 01:05:04,511 --> 01:05:06,913 RATES OF GESTATIONAL DIABETES. 1724 01:05:06,913 --> 01:05:09,316 SLEEP DISORDER BREATHING AND 1725 01:05:09,316 --> 01:05:10,684 INSOMNIA HAVE BEEN ASSOCIATED 1726 01:05:10,684 --> 01:05:16,456 WITH SEVERE MATERNAL MORBIDITY. 1727 01:05:16,456 --> 01:05:17,991 CARDIOVASCULAR IS ALSO IMPACTED 1728 01:05:17,991 --> 01:05:19,526 BY SLEEP DISORDER BREATHING AND 1729 01:05:19,526 --> 01:05:21,962 WE HAVE DEMONSTRATED EVEN IN 1730 01:05:21,962 --> 01:05:32,172 WOMEN THAT HAVE PREECLAMPSIA, 1731 01:05:32,172 --> 01:05:35,775 THEY HAVE HIGHER CARDIOVASCULAR 1732 01:05:35,775 --> 01:05:37,077 MORE BIDITY AND HEALTHCARE 1733 01:05:37,077 --> 01:05:38,878 UTILIZATION. 1734 01:05:38,878 --> 01:05:40,947 MANY HAVE BEEN ASSOCIATED WITH 1735 01:05:40,947 --> 01:05:43,316 DEPRESSIVE SYMPTOMS. 1736 01:05:43,316 --> 01:05:45,318 SHORT SLEEP DURATION AND SLEEP 1737 01:05:45,318 --> 01:05:46,653 DISORDER BREATHING HAVE BEEN 1738 01:05:46,653 --> 01:05:48,989 ASSOCIATED WITH HIGHER RATES OF 1739 01:05:48,989 --> 01:05:50,824 CAESARIAN DELIVERIES AND SLEEP 1740 01:05:50,824 --> 01:05:52,592 DISORDER BREATHING ASSOCIATED 1741 01:05:52,592 --> 01:05:55,495 WITH HIGHER RATE ICU ADMISSIONS 1742 01:05:55,495 --> 01:05:56,062 IN POPULATION-BASED STUDIES. 1743 01:05:56,062 --> 01:05:58,732 NEXT. 1744 01:05:58,732 --> 01:06:01,468 SO SLEEP SAY MODIFIABLE RISK 1745 01:06:01,468 --> 01:06:03,603 FACTOR, COMPARED TO OTHER RISK 1746 01:06:03,603 --> 01:06:10,377 FACTORS FOR DISORDERS SUCH AS 1747 01:06:10,377 --> 01:06:18,718 PREECLAMPSIA, FOR EXAMPLE. 1748 01:06:18,718 --> 01:06:22,188 WE CAN MODIFY SLEEP TO IMPROVE 1749 01:06:22,188 --> 01:06:22,622 PREGNANCY OUTCOMES. 1750 01:06:22,622 --> 01:06:24,457 NEXT. 1751 01:06:24,457 --> 01:06:26,059 THERE ARE SOME SLEEP 1752 01:06:26,059 --> 01:06:27,394 INTERVENTIONS THAT HAVE BEEN 1753 01:06:27,394 --> 01:06:28,661 TESTED IN PREGNANCY. 1754 01:06:28,661 --> 01:06:32,599 THIS IS A SYSTEMATIC REVIEW 1755 01:06:32,599 --> 01:06:34,567 THAT LOOKED AT 1756 01:06:34,567 --> 01:06:35,268 NON-PHARMACOLOGICAL 1757 01:06:35,268 --> 01:06:35,802 INTERVENTIONS, AIMED AT 1758 01:06:35,802 --> 01:06:37,037 IMPROVING SLEEP IN THE COURSE 1759 01:06:37,037 --> 01:06:37,370 OF PREGNANCY. 1760 01:06:37,370 --> 01:06:38,605 NEXT. 1761 01:06:38,605 --> 01:06:40,940 AND IT SHOWED THERE WERE 16 1762 01:06:40,940 --> 01:06:44,411 STUDIES, THAT WAS BACK IN 2020, 1763 01:06:44,411 --> 01:06:50,617 THERE HAVE BEEN A FEW MORE 1764 01:06:50,617 --> 01:06:50,817 SINCE. 1765 01:06:50,817 --> 01:06:55,889 SOME HAVE TO DO WITH COGNITIVE 1766 01:06:55,889 --> 01:07:01,227 BEHAVIORAL THERAPY AIM AT 1767 01:07:01,227 --> 01:07:03,430 INSOMNIA, VERY FEW ABOUT 1768 01:07:03,430 --> 01:07:05,098 PHARMACOTHERAPY, UNDERSTANDABLY. 1769 01:07:05,098 --> 01:07:07,133 AND THEN OTHER INTERVENTIONS 1770 01:07:07,133 --> 01:07:11,538 SUCH AS MINDFULNESS AND YOGA. 1771 01:07:11,538 --> 01:07:14,107 INTERVENTIONS AIMED AT 1772 01:07:14,107 --> 01:07:16,810 IMPROVING INSOMNIA HAVE SHOWN 1773 01:07:16,810 --> 01:07:18,111 IMPROVEMENT SCORES COMPARED TO 1774 01:07:18,111 --> 01:07:20,447 CONDROLL AND THEN QUICKER AND 1775 01:07:20,447 --> 01:07:23,249 MORE COMMON RESOLUTION OF 1776 01:07:23,249 --> 01:07:24,184 INSOMNIA. 1777 01:07:24,184 --> 01:07:24,918 FROM IMPLEMENTATION SCIENCE, 1778 01:07:24,918 --> 01:07:26,786 EVEN THOUGH WE DON'T HAVE A LOT 1779 01:07:26,786 --> 01:07:29,322 OF SCIENCE THERE YET, THERE 1780 01:07:29,322 --> 01:07:31,891 HAVE BEEN SOME SCALABLE 1781 01:07:31,891 --> 01:07:33,059 INTERVENTIONS THAT HARNESS 1782 01:07:33,059 --> 01:07:35,095 TECHNOLOGY, INCLUDING TEXT 1783 01:07:35,095 --> 01:07:35,929 MESSAGES OR TELEHEALTH 1784 01:07:35,929 --> 01:07:36,896 INTERVENTIONS THAT HAVE 1785 01:07:36,896 --> 01:07:42,435 HAPPENED IN CANADA AND IN 1786 01:07:42,435 --> 01:07:46,539 AUSTRALIA THAT HAVE SHOWN IN 1787 01:07:46,539 --> 01:07:49,943 SIGNIFICANT IMPROVEMENT IN 1788 01:07:49,943 --> 01:07:51,878 INSOMNIA SEVERITY AND PROVIDED 1789 01:07:51,878 --> 01:07:54,214 GLIMPSE INTO NOVEL WAY DLOEFRZ 1790 01:07:54,214 --> 01:07:56,716 SLEEP INTERVENTIONS. THIS IS A 1791 01:07:56,716 --> 01:08:01,621 META-ANALYSIS THAT PRESENTED AT 1792 01:08:01,621 --> 01:08:09,129 APSS LED BY BILL. 1793 01:08:09,129 --> 01:08:11,831 CPAP IS THE MAIN STAY TREATMENT 1794 01:08:11,831 --> 01:08:14,200 FOR SLEEP DISORDER BREATHING 1795 01:08:14,200 --> 01:08:15,902 AND FIRST LINE THERAPY. 1796 01:08:15,902 --> 01:08:17,804 AS LONG AS TWO DECADES AGO, 1797 01:08:17,804 --> 01:08:23,376 THERE HAVE BEEN SOME DATA THAT 1798 01:08:23,376 --> 01:08:29,516 RANDOMIZED PREGNANT WOMEN WITH 1799 01:08:29,516 --> 01:08:32,752 PREECLAMPSIA, FOR THE TREATMENT 1800 01:08:32,752 --> 01:08:34,854 OF CPAP THAT WOMEN WITH 1801 01:08:34,854 --> 01:08:38,858 PREECLAMPSIA HAD A LOT OF UPPER 1802 01:08:38,858 --> 01:08:40,760 AIRWAY OBSTRUCTION DURING SLEEP 1803 01:08:40,760 --> 01:08:41,961 AND THAT CPAP WAS GOING TO 1804 01:08:41,961 --> 01:08:44,764 IMPROVE THAT. 1805 01:08:44,764 --> 01:08:47,600 TWO DECADES LATER WE HAVE A 1806 01:08:47,600 --> 01:08:50,937 TRIAL THAT HAS RANDOMIZED ABOUT 1807 01:08:50,937 --> 01:08:56,643 170 OR SO PEOPLE WITH SLEEP 1808 01:08:56,643 --> 01:08:57,210 DISORDERED BREATHING DURING 1809 01:08:57,210 --> 01:09:02,782 PREGNANCY FOR THE DURATION OF 1810 01:09:02,782 --> 01:09:07,453 PREGNANCY, NOT JUST ONE NIGHT. 1811 01:09:07,453 --> 01:09:08,955 SYSTOLIC BLOOD PRESSURE WAS 1812 01:09:08,955 --> 01:09:11,224 ACTUALLY BETTER IN THE GROUP 1813 01:09:11,224 --> 01:09:13,393 THAT WAS RANDOMIZED. 1814 01:09:13,393 --> 01:09:14,928 THE TWO GROUPS WAS ACTUALLY 1815 01:09:14,928 --> 01:09:15,161 LARGER. 1816 01:09:15,161 --> 01:09:16,896 NEXT. 1817 01:09:16,896 --> 01:09:19,632 SO THIS SPEAKS ABOUT ADHERENCE, 1818 01:09:19,632 --> 01:09:20,066 OBVIOUSLY. 1819 01:09:20,066 --> 01:09:22,535 THAT'S WHY WE HAVE SUCH A BIG 1820 01:09:22,535 --> 01:09:24,537 DIFFERENCE BETWEEN PER PROTOCOL 1821 01:09:24,537 --> 01:09:27,807 AND INTENTION TO TREAT ANALYSES. 1822 01:09:27,807 --> 01:09:29,742 CPAP ADHERENCE IS A MAJOR ISSUE 1823 01:09:29,742 --> 01:09:32,078 IN THIS POPULATION AND THERE 1824 01:09:32,078 --> 01:09:33,980 ARE SOME RANDOMIZED STUDIES 1825 01:09:33,980 --> 01:09:35,348 THAT REPORTED AN ADHERENCE OF 1826 01:09:35,348 --> 01:09:36,082 ONLY 4%. 1827 01:09:36,082 --> 01:09:38,451 IN ALL OF THE STUDIES THAT HAVE 1828 01:09:38,451 --> 01:09:40,420 BEEN PUBLISHED TO DATE, NOT 1829 01:09:40,420 --> 01:09:42,555 THAT MANY, LESS THAN 50% OF 1830 01:09:42,555 --> 01:09:53,099 WOMEN ARE ADHERE ANT BASED ON 1831 01:09:57,503 --> 01:09:59,806 SE PIXER A BASED, SOME USE FOR 1832 01:09:59,806 --> 01:10:01,441 LESS THAN 30 MINUTES TO ABOUT 1833 01:10:01,441 --> 01:10:11,584 THREE AND A HALF HOURS. 1834 01:10:11,584 --> 01:10:14,687 CBT-I64%, 80% IN PERSON OR 1835 01:10:14,687 --> 01:10:19,392 TELEHEALTH AND 64% FOR DIGITAL 1836 01:10:19,392 --> 01:10:22,128 INTERVENTIONS. I SEE MINIMAL 1837 01:10:22,128 --> 01:10:24,364 SAFETY DATA ON MANY FIRST LINE 1838 01:10:24,364 --> 01:10:27,300 DRUGS THAT ARE USED TO TREAT. 1839 01:10:27,300 --> 01:10:28,401 THAT'S MAINLY BECAUSE PREGNANT 1840 01:10:28,401 --> 01:10:31,904 WOMEN SEEM TO BE SYSTEMATICALLY 1841 01:10:31,904 --> 01:10:33,640 EXCLUDED FROM MANY DRUG TRIALS. 1842 01:10:33,640 --> 01:10:36,442 THERE ARE ALSO SOME RACIAL 1843 01:10:36,442 --> 01:10:39,045 DISPARITIES THAT EXIST IN 1844 01:10:39,045 --> 01:10:41,748 TREATMENT UP TAKE OF SLEEP 1845 01:10:41,748 --> 01:10:43,916 INTERVENTIONS EVEN WHEN WE 1846 01:10:43,916 --> 01:10:46,085 STANDARDIZE ACCESS TO THESE 1847 01:10:46,085 --> 01:10:49,289 INTERVENTIONS THROUGH PROTOCOL 1848 01:10:49,289 --> 01:10:50,423 AND HAVE INDIVIDUAL 1849 01:10:50,423 --> 01:10:52,258 PARTICIPANTS ACCESS IT FOR FREE. 1850 01:10:52,258 --> 01:10:54,127 QUESTION STILL SEE IN RACIAL 1851 01:10:54,127 --> 01:10:55,194 DISPARITIES IN THIS. 1852 01:10:55,194 --> 01:10:56,996 NEXT. 1853 01:10:56,996 --> 01:11:00,233 SO FACTORS THAT INFLUENCE 1854 01:11:00,233 --> 01:11:01,968 TREATMENT OF SLEEP DISSERBANCES 1855 01:11:01,968 --> 01:11:03,336 IN PREGNANCY CAN BE DIFFERENT 1856 01:11:03,336 --> 01:11:04,871 LEVELS. 1857 01:11:04,871 --> 01:11:06,706 THERE ARE MULTIPLE LEVELS, 1858 01:11:06,706 --> 01:11:09,108 COULD BE SYSTEM LEVEL FACTORS 1859 01:11:09,108 --> 01:11:10,843 THAT ARE KEY WITH ACCESS TO 1860 01:11:10,843 --> 01:11:12,879 CARE AND APPROPRIATE CARE BEING 1861 01:11:12,879 --> 01:11:15,081 SIGNIFICANT ISSUES. IF WE THINK 1862 01:11:15,081 --> 01:11:16,215 ABOUT SCREENING POPULATIONS 1863 01:11:16,215 --> 01:11:17,984 2004 SLEEP DISORDERS AND THEN 1864 01:11:17,984 --> 01:11:19,419 OFFERING THEM APPROPRIATE 1865 01:11:19,419 --> 01:11:20,987 TESTING FOR SOME DISORDERS AND 1866 01:11:20,987 --> 01:11:23,089 THEN STARTING TREATMENT THAT IS 1867 01:11:23,089 --> 01:11:25,758 VERY CHALLENGES WHEN A 1868 01:11:25,758 --> 01:11:27,193 SIGNIFICANT PERCENTAGE OF 1869 01:11:27,193 --> 01:11:29,095 PREGNANT INDIVIDUALS EXPERIENCE 1870 01:11:29,095 --> 01:11:30,330 SLEEP DISTURBANCES AND 1871 01:11:30,330 --> 01:11:31,631 PREGNANCY IS LIMITED BY THIS 1872 01:11:31,631 --> 01:11:34,033 SHORT PERIOD OF TIME COMPARED 1873 01:11:34,033 --> 01:11:35,768 TO THE NON-PREGNANT POPULATION. 1874 01:11:35,768 --> 01:11:37,837 SO THE FACT DURATION BETWEEN 1875 01:11:37,837 --> 01:11:39,505 EXPOSURE TO SLEEP DISORDERS AND 1876 01:11:39,505 --> 01:11:41,341 OUTCOME OF PREGNANCY IS SO 1877 01:11:41,341 --> 01:11:43,376 CONTRACTED COMPARED TO THE 1878 01:11:43,376 --> 01:11:45,578 GENERAL POPULATION PLACES AN 1879 01:11:45,578 --> 01:11:47,046 ADDITIONAL BURDEN TO IMPLEMENT 1880 01:11:47,046 --> 01:11:47,714 INTERVENTIONS IN A TIMELY 1881 01:11:47,714 --> 01:11:49,615 MANNER. 1882 01:11:49,615 --> 01:11:51,451 FURTHER IN MANY PLACES IN U.S. 1883 01:11:51,451 --> 01:11:54,587 THERE IS A PAUSITY OF SLEEP 1884 01:11:54,587 --> 01:11:56,589 CLINICIANS BOTH MEDICAL 1885 01:11:56,589 --> 01:11:57,390 CONDITIONS AND BEHAVIORAL 1886 01:11:57,390 --> 01:12:00,059 CONDITIONS AND THAT ADDS TO THE 1887 01:12:00,059 --> 01:12:01,227 CHALLENGES OF IMPLEMENTING THE 1888 01:12:01,227 --> 01:12:02,428 MANAGEMENT OF SLEEP DISORDERS. 1889 01:12:02,428 --> 01:12:05,565 WE ALSO NEED TO RETHINK OUR 1890 01:12:05,565 --> 01:12:08,334 CARE DELIVERY METHODS AND THINK 1891 01:12:08,334 --> 01:12:09,936 MORE INNOVATIVELY ABOUT HOW TO 1892 01:12:09,936 --> 01:12:11,170 REACH POPULATIONS THAT ARE MOST 1893 01:12:11,170 --> 01:12:14,941 IN NEED AND NOT JUST LIMITING 1894 01:12:14,941 --> 01:12:16,843 TO PRENATAL PRACTICES. 1895 01:12:16,843 --> 01:12:18,444 AT THE INDIVIDUAL LEVEL WE 1896 01:12:18,444 --> 01:12:20,213 HEARD QUITE A BIT YESTERDAY 1897 01:12:20,213 --> 01:12:22,048 ABOUT THE IMPORTANCE OF 1898 01:12:22,048 --> 01:12:23,282 CONSIDERING SOCIAL DETERMINANTS 1899 01:12:23,282 --> 01:12:25,184 OF HEALTH INTO CARE BUT WE ALSO 1900 01:12:25,184 --> 01:12:27,754 NEED TO CONSIDER HOW GENDER AND 1901 01:12:27,754 --> 01:12:29,222 THE RESPONSIBILITIES THAT 1902 01:12:29,222 --> 01:12:31,457 GENDER ENTAILS PLAY A ROLE IN 1903 01:12:31,457 --> 01:12:34,927 SLEEP AND SLEEP CHALLENGES, AS 1904 01:12:34,927 --> 01:12:39,632 SLEEP MANAGEMENT HAS TO DO WITH 1905 01:12:39,632 --> 01:12:41,267 NIGHTTIME CHORES FOR INSTANCE 1906 01:12:41,267 --> 01:12:43,703 AND THE GENDER ROLE LEAVES THAT 1907 01:12:43,703 --> 01:12:45,238 TO THE PREGNANT OR THE MOTHER, 1908 01:12:45,238 --> 01:12:47,573 MOST OF THE TIME. 1909 01:12:47,573 --> 01:12:52,378 AND CAN COMPLICATE THINGS. 1910 01:12:52,378 --> 01:12:55,615 PREGNANCY ITSELF ALSO PRESENTS 1911 01:12:55,615 --> 01:12:57,517 A UNIQUE CHALLENGE, SLEEP 1912 01:12:57,517 --> 01:13:01,154 MANAGEMENT ISN'T OFTEN OFFERED 1913 01:13:01,154 --> 01:13:03,189 WITHIN PRENATAL CARE AND 1914 01:13:03,189 --> 01:13:04,457 OBSTETRIC PRACTICES ARE THE 1915 01:13:04,457 --> 01:13:07,593 NORM IN MOST PLACES. 1916 01:13:07,593 --> 01:13:09,862 AS PRENATAL CARE REQUIRES 1917 01:13:09,862 --> 01:13:11,564 FREQUENT VISIT IT'S CAN PRESENT 1918 01:13:11,564 --> 01:13:13,599 A CHALLENGE TO ADD ADDITIONAL 1919 01:13:13,599 --> 01:13:15,935 VISITS OUTSIDE OF THESE ROUTINE 1920 01:13:15,935 --> 01:13:17,603 PRENATAL ONES BUT IT CAN ALSO 1921 01:13:17,603 --> 01:13:20,239 PRESENT AN OPPORTUNITY GIVEN 1922 01:13:20,239 --> 01:13:24,710 THE FREQUENT CONTACT WITH A 1923 01:13:24,710 --> 01:13:25,845 HEALTHCARE PROVIDER. 1924 01:13:25,845 --> 01:13:28,815 SO WE CAN EMBED AND PRIORITIZE 1925 01:13:28,815 --> 01:13:30,450 SLEEP MESSAGING AROUND AND 1926 01:13:30,450 --> 01:13:32,218 WITHIN PRENATAL CARE AND BEING 1927 01:13:32,218 --> 01:13:34,287 CAREFUL ABOUT THE ASSUMING 1928 01:13:34,287 --> 01:13:35,188 NORMAL PREGNANCY PHYSIOLOGY IS 1929 01:13:35,188 --> 01:13:37,690 THE MAIN DRIVER FOR ALL THE 1930 01:13:37,690 --> 01:13:38,624 SLEEP SYMPTOMS THAT PREGNANT 1931 01:13:38,624 --> 01:13:40,193 WOMEN REPORT. 1932 01:13:40,193 --> 01:13:42,128 THEN FINALLY THERE ARE SOME 1933 01:13:42,128 --> 01:13:43,729 BARRIERS SURROUNDING TREATMENT 1934 01:13:43,729 --> 01:13:45,231 THAT THE SIMILAR GENERAL 1935 01:13:45,231 --> 01:13:46,065 POPULATION EXPERIENCES WHILE 1936 01:13:46,065 --> 01:13:47,433 OTHER IT'S SPECIFIC TO 1937 01:13:47,433 --> 01:13:48,167 PREGNANCY. 1938 01:13:48,167 --> 01:13:50,436 THE DEMANDS AND EXPECTATIONS 1939 01:13:50,436 --> 01:13:53,239 AROUND BEING PREGNANT THAT MAY 1940 01:13:53,239 --> 01:13:53,539 PLAY A ROLE. 1941 01:13:53,539 --> 01:13:55,208 THERE ARE ALSO SOME BARRIERS 1942 01:13:55,208 --> 01:13:58,511 THAT ARE COMMON TO PREGNANT AND 1943 01:13:58,511 --> 01:14:00,613 NON-PREGNANT INDIVIDUALS BUT 1944 01:14:00,613 --> 01:14:01,681 THOSE ARE EXACERBATED BY 1945 01:14:01,681 --> 01:14:01,948 PREGNANCY. 1946 01:14:01,948 --> 01:14:05,451 NEXT. 1947 01:14:05,451 --> 01:14:08,287 I PRESENT HERE DATA FROM A 1948 01:14:08,287 --> 01:14:10,156 QUALITATIVE STUDY THAT WE 1949 01:14:10,156 --> 01:14:13,125 RECENTLY COMPLETED THAT LOOKED 1950 01:14:13,125 --> 01:14:16,729 AT PREGNANT AND NON-PREGNANT 1951 01:14:16,729 --> 01:14:17,763 REPRODUCTIVE AGE INDIVIDUALS, 1952 01:14:17,763 --> 01:14:19,899 ASKING THEM ABOUT THEIR 1953 01:14:19,899 --> 01:14:22,134 EXPERIENCE WITH CPAP DURING 1954 01:14:22,134 --> 01:14:22,401 PREGNANCY. 1955 01:14:22,401 --> 01:14:23,703 THESE ARE INDIVIDUALS THAT WERE 1956 01:14:23,703 --> 01:14:26,239 DIAGNOSED IN THE COURSE OF 1957 01:14:26,239 --> 01:14:28,274 PREGNANCY OR DIAGNOSED WITHIN 1958 01:14:28,274 --> 01:14:30,743 4-8 WEEKS AND WE IDENTIFIED 1959 01:14:30,743 --> 01:14:33,479 SOME BARRIERS AND SOME 1960 01:14:33,479 --> 01:14:34,013 FACILITATORS TO TREATMENT. 1961 01:14:34,013 --> 01:14:36,549 SOME OF THEM WERE COMMON TO 1962 01:14:36,549 --> 01:14:38,017 PREGNANT AND NON-PREGNANT 1963 01:14:38,017 --> 01:14:40,286 INDIVIDUALS BUT SOME ARE 1964 01:14:40,286 --> 01:14:41,320 OBVIOUSLY SPECIFIC TO PREGNANCY 1965 01:14:41,320 --> 01:14:44,223 AND THEY HELP US CUSTOMIZE 1966 01:14:44,223 --> 01:14:47,260 TREATMENT INTERVENTIONS TO THIS 1967 01:14:47,260 --> 01:14:47,560 POPULATION. 1968 01:14:47,560 --> 01:14:50,296 SO, FOR INSTANCE, PREGNANCY AND 1969 01:14:50,296 --> 01:14:51,697 FETAL HEALTH WERE POSITIVE 1970 01:14:51,697 --> 01:14:53,533 MOTIVATORS FOR THE USE OF CPAP 1971 01:14:53,533 --> 01:14:56,135 IN PREGNANCY. 1972 01:14:56,135 --> 01:14:58,204 WOMEN THAT WERE PREGNANT 1973 01:14:58,204 --> 01:14:59,438 DEMONSTRATED SOME CONCERN FOR 1974 01:14:59,438 --> 01:15:00,806 THEIR OWN HEALTH AND THIS COULD 1975 01:15:00,806 --> 01:15:04,544 BE IN THE CONTEXT OF THIS 1976 01:15:04,544 --> 01:15:06,579 FREQUENT INTERACTION WITH THE 1977 01:15:06,579 --> 01:15:07,947 HEALTHCARE SYSTEM AND 1978 01:15:07,947 --> 01:15:09,916 HEALTHCARE PROVIDERS THAT MAKES 1979 01:15:09,916 --> 01:15:13,319 THEM MORE AWARE AND MORE 1980 01:15:13,319 --> 01:15:14,820 COGNIZANT OF THE IMPORTANCE OF 1981 01:15:14,820 --> 01:15:16,956 THEIR OWN HEALTH. 1982 01:15:16,956 --> 01:15:18,291 PARTNERS HAVE PLAYED A ROLE 1983 01:15:18,291 --> 01:15:22,228 BOTH AS FACILITATORS AND AS 1984 01:15:22,228 --> 01:15:23,629 BARRIERS IN DIFFERENT CONTEXTS. 1985 01:15:23,629 --> 01:15:25,731 THE TRUST IN THE PROVIDER SEEM 1986 01:15:25,731 --> 01:15:29,168 TO BE A FACILITATOR TOWARD THE 1987 01:15:29,168 --> 01:15:31,370 USE OF CPAP WHERE, WHEN A 1988 01:15:31,370 --> 01:15:34,340 PERSON SAID THEY TRUSTED THE 1989 01:15:34,340 --> 01:15:35,942 ADVICE THE PROVIDER HAS GIVEN 1990 01:15:35,942 --> 01:15:37,410 THEM, THEY WERE SAYING THEY 1991 01:15:37,410 --> 01:15:39,345 WERE MORE LIKELY TO USE THEIR 1992 01:15:39,345 --> 01:15:41,447 CPAP. 1993 01:15:41,447 --> 01:15:44,150 WHEREAS OTHERS THAT HAVE 1994 01:15:44,150 --> 01:15:45,151 RECEIVED SOME DIFFERENT 1995 01:15:45,151 --> 01:15:47,053 MESSAGES FROM THE HEALTHCARE 1996 01:15:47,053 --> 01:15:49,488 SYSTEM IN GENERAL SEEM TO BE 1997 01:15:49,488 --> 01:15:50,957 LESS LIKELY TO PRIORITIZE CPAP 1998 01:15:50,957 --> 01:15:53,426 USE. 1999 01:15:53,426 --> 01:15:54,927 CPAP COMPLEXITY SEEMS TO BE ONE 2000 01:15:54,927 --> 01:15:57,063 OF THE ISSUES, ESPECIALLY IN A 2001 01:15:57,063 --> 01:15:59,298 BUSY LIFE WHEN THERE ARE SO 2002 01:15:59,298 --> 01:16:01,300 MANY DEMANDS, FROM A MEDICAL 2003 01:16:01,300 --> 01:16:02,802 STANDPOINT TO FOLLOW-UP FOR 2004 01:16:02,802 --> 01:16:04,136 VISITS DURING PREGNANCY AND 2005 01:16:04,136 --> 01:16:07,073 PRIORITIZE CARE AS WELL. 2006 01:16:07,073 --> 01:16:09,075 COSTS CONCERNS WERE OBVIOUSLY A 2007 01:16:09,075 --> 01:16:16,849 BARRIER AS WELL TO THIS. 2008 01:16:16,849 --> 01:16:19,485 AND INTIMACY SEEMS TO COME UP 2009 01:16:19,485 --> 01:16:21,687 QUITE OFTEN AS WELL. 2010 01:16:21,687 --> 01:16:23,489 SO MANY GAPS REMAIN. 2011 01:16:23,489 --> 01:16:25,358 UNFORTUNATELY WE DON'T HAVE AS 2012 01:16:25,358 --> 01:16:27,259 MANY SOLUTIONS FOR IMPROVING 2013 01:16:27,259 --> 01:16:29,495 SLEEP IN THIS POPULATION. 2014 01:16:29,495 --> 01:16:31,097 BUT THIS PRESENTS A REALLY BIG 2015 01:16:31,097 --> 01:16:33,899 OPPORTUNITY FOR US TO DO SO. 2016 01:16:33,899 --> 01:16:36,869 WE NEED TO UNDERSTAND HOW AND 2017 01:16:36,869 --> 01:16:39,972 WHETHER SLEEP INTERVENTIONS 2018 01:16:39,972 --> 01:16:42,908 COULD AMELIORATE SHORT-TERM AND 2019 01:16:42,908 --> 01:16:44,777 LONG-TERM SLEEP MENTAL HEALTH 2020 01:16:44,777 --> 01:16:46,512 AND HEALTH OUTCOMES, NOT JUST 2021 01:16:46,512 --> 01:16:48,147 FOR THE PREGNANT INDIVIDUAL BUT 2022 01:16:48,147 --> 01:16:50,049 FOR THEIR FAMILIES AS WELL AND 2023 01:16:50,049 --> 01:16:51,417 THEIR RELATIONSHIP WITH THEIR 2024 01:16:51,417 --> 01:16:52,518 OWN CHILDREN. 2025 01:16:52,518 --> 01:16:55,254 WE NEED TO DEVELOP SOME 2026 01:16:55,254 --> 01:16:56,756 CUSTOMIZED AND CULTURALLY 2027 01:16:56,756 --> 01:16:57,690 APPROPRIATE INTERVENTIONS THAT 2028 01:16:57,690 --> 01:17:01,027 MEET THE NEEDS OF PARENTS AND 2029 01:17:01,027 --> 01:17:02,928 COUPLES AND YOUNG FAMILIES 2030 01:17:02,928 --> 01:17:05,564 WHILE REDUCING DISPARITIES AND 2031 01:17:05,564 --> 01:17:05,865 INEQUITIES. 2032 01:17:05,865 --> 01:17:07,366 SO WE NEED TO MAKE SURE WE ARE 2033 01:17:07,366 --> 01:17:08,834 ADDRESSING THE NEEDS OF ALL OF 2034 01:17:08,834 --> 01:17:12,638 THESE POPULATIONS AND 2035 01:17:12,638 --> 01:17:13,773 DISCUSSIONS AROUND COMMUNITY 2036 01:17:13,773 --> 01:17:17,376 ENGAGEMENT AND PARTNERING WITH 2037 01:17:17,376 --> 01:17:22,748 PEOPLE THAT ARE CLOSEST TO THE 2038 01:17:22,748 --> 01:17:23,849 PAIN AS MENTIONED YESTERDAY 2039 01:17:23,849 --> 01:17:25,518 WOULD LIKELY GIVE US THE 2040 01:17:25,518 --> 01:17:27,820 BIGGEST BANG FOR OUR BUCK IN 2041 01:17:27,820 --> 01:17:29,321 TERMS OF IDENTIFYING SOLUTIONS. 2042 01:17:29,321 --> 01:17:39,331 THEN WE ALSO NEED TO FOCUS 2043 01:17:39,331 --> 01:17:42,435 INTERVENTIONS IN THE POST 2044 01:17:42,435 --> 01:17:43,169 PARTUM PERIOD. 2045 01:17:43,169 --> 01:17:45,571 WE DON'T HAVE A LOT OF 2046 01:17:45,571 --> 01:17:47,273 INTERVENTIONS DURING THAT 2047 01:17:47,273 --> 01:17:48,240 PERIOD OF TIME. 2048 01:17:48,240 --> 01:17:50,876 NEXT, I WOULD LIKE TO END THIS 2049 01:17:50,876 --> 01:17:53,012 BY THANKING THE TEAM. 2050 01:17:53,012 --> 01:18:01,787 YOU WON'T MENTION EVERYONE AND N 2051 01:18:01,787 --> 01:18:04,190 HLBI AND NIH IN GENERAL FOR THE 2052 01:18:04,190 --> 01:18:05,725 INVITE AND FUNDING OUR RESEARCH. 2053 01:18:05,725 --> 01:18:10,830 AND NOW I WILL PASS THIS TO DR. 2054 01:18:10,830 --> 01:18:14,300 ENGLAND TO SPEAK ABOUT SLEEP 2055 01:18:14,300 --> 01:18:18,137 AND CIRCADIAN RHYTHMS AFFECTING 2056 01:18:18,137 --> 01:18:23,642 MATERNAL AND FETAL HEALTH. 2057 01:18:23,642 --> 01:18:26,278 >> SARA ENGLAND: THANK YOU. 2058 01:18:26,278 --> 01:18:28,781 WORK WE HAVE BEEN DOING THE 2059 01:18:28,781 --> 01:18:31,117 LAST 3-4 YEARS LOOKING AT SLEEP 2060 01:18:31,117 --> 01:18:34,086 AND CIRCADIAN RHYTHMS AS THEY 2061 01:18:34,086 --> 01:18:34,920 AFFECT MATERNAL AND FETAL 2062 01:18:34,920 --> 01:18:35,721 HEALTH. 2063 01:18:35,721 --> 01:18:38,057 NEXT SLIDE, PLEASE. 2064 01:18:38,057 --> 01:18:40,960 THE STUDY ACTUALLY STARTED 2065 01:18:40,960 --> 01:18:43,162 BECAUSE WE WERE VERY INTERESTED 2066 01:18:43,162 --> 01:18:47,032 IN RISK FACTORS LEADING TOO 2067 01:18:47,032 --> 01:18:57,576 PRE-TERM BIRTH, THIS IS REALLY 2068 01:19:03,816 --> 01:19:06,285 INTO THREE CATEGORIES, MODERATE 2069 01:19:06,285 --> 01:19:10,156 TO LATE PRETERM BIRTH, 32-37 2070 01:19:10,156 --> 01:19:10,356 WEEKS. 2071 01:19:10,356 --> 01:19:13,692 VERY EARLY IS 28-32 WEEKS AND 2072 01:19:13,692 --> 01:19:15,261 EXTREMELY EARLY PRETERM BIRTH, 2073 01:19:15,261 --> 01:19:17,897 BEFORE 28 WEEKS, WITH MORE 2074 01:19:17,897 --> 01:19:19,865 NIC-U'S BEING ABLE TO KEEP THE 2075 01:19:19,865 --> 01:19:21,700 BABIES ALIVE FROM ABOUT 21 TO 2076 01:19:21,700 --> 01:19:22,735 22 WEEKS. 2077 01:19:22,735 --> 01:19:24,370 AS YOU CAN IMAGINE THIS IS THE 2078 01:19:24,370 --> 01:19:26,272 NUMBER ONE CAUSE OF DEATH OF 2079 01:19:26,272 --> 01:19:28,207 BABIES IN THE UNITED STATES AND 2080 01:19:28,207 --> 01:19:30,176 ASSOCIATED WITH HIGH RATES OF 2081 01:19:30,176 --> 01:19:32,077 BOTH SHORT AND LONG-TERM HEALTH 2082 01:19:32,077 --> 01:19:33,846 COMPLICATIONS DUE TO THE UNDER 2083 01:19:33,846 --> 01:19:35,614 DEVELOPMENT OF THE KIDS. 2084 01:19:35,614 --> 01:19:38,851 SO RIGHT NOW THE RATE OF 2085 01:19:38,851 --> 01:19:40,252 PRE-TERM BIRTH IN THE UNITED 2086 01:19:40,252 --> 01:19:42,054 STATES IS APPROXIMATELY 10% BUT 2087 01:19:42,054 --> 01:19:44,390 THIS IS CONTINUING TO ACTUALLY 2088 01:19:44,390 --> 01:19:46,392 RISE AS THERE WAS A STAGNATING 2089 01:19:46,392 --> 01:19:49,128 TIME FOR A WHILE BUT STARTING 2090 01:19:49,128 --> 01:19:49,361 TO RISE. 2091 01:19:49,361 --> 01:19:53,232 THERE WAS REALLY A VERY HIGH 2092 01:19:53,232 --> 01:19:55,334 DEGREE OF HEALTH DISPARITIES IN 2093 01:19:55,334 --> 01:19:56,335 THE RATES OF PRE-TERM BIRTH. 2094 01:19:56,335 --> 01:20:03,008 NEXT. 2095 01:20:03,008 --> 01:20:05,177 THIS CAN BE HIGHLIGHTED IN AREA 2096 01:20:05,177 --> 01:20:07,513 IN WHICH OUR HOSPITAL SYSTEM IS 2097 01:20:07,513 --> 01:20:07,746 LOCATED. 2098 01:20:07,746 --> 01:20:10,649 SO IF YOU LOOK AT THE RATES OF 2099 01:20:10,649 --> 01:20:12,718 PRE-TERM BIRTH BY ZIP CODE IN 2100 01:20:12,718 --> 01:20:13,886 ST. LOUIS COUNTY, WHAT YOU CAN 2101 01:20:13,886 --> 01:20:15,721 SEE IS IN THE NORTH PART OF THE 2102 01:20:15,721 --> 01:20:17,823 COUNTY WITH A LOT OF SOCIAL 2103 01:20:17,823 --> 01:20:19,959 DISADVANTAGE, THE RATES ARE 2104 01:20:19,959 --> 01:20:21,594 ABOUT 15-25%. 2105 01:20:21,594 --> 01:20:23,662 HOWEVER, IF YOU GO ABOUT EIGHT 2106 01:20:23,662 --> 01:20:26,332 MILES SOUTH TO WHERE THE 2107 01:20:26,332 --> 01:20:27,733 HOSPITALS ARE LOCATED, THESE 2108 01:20:27,733 --> 01:20:29,568 RATES ARE MUCH LOWER. 2109 01:20:29,568 --> 01:20:31,070 SO BETWEEN JUST IN EIGHT MILES 2110 01:20:31,070 --> 01:20:34,073 YOU CAN SEE THE SUBSTANTIAL 2111 01:20:34,073 --> 01:20:38,611 DIFFERENCE SUGGESTING THAT THIS 2112 01:20:38,611 --> 01:20:41,413 IS POSSIBLY SOMETHING THAT WE 2113 01:20:41,413 --> 01:20:42,882 CAN ACTUALLY ADDRESS, IF WE 2114 01:20:42,882 --> 01:20:46,252 LOOK A LITTLE BIT DEEPER INTO 2115 01:20:46,252 --> 01:20:48,654 WHAT FACTORS ARE DRIVING THE 2116 01:20:48,654 --> 01:20:49,989 DISPARITIES BETWEEN THESE TWO 2117 01:20:49,989 --> 01:20:54,693 AREAS. NEXT SLIDE. 2118 01:20:54,693 --> 01:20:57,830 SO PRE-TERM BIRTH IS INCREDIBLY 2119 01:20:57,830 --> 01:20:58,063 COMPLEX. 2120 01:20:58,063 --> 01:20:59,331 THERE ARE MULTIPLE PATHWAYS 2121 01:20:59,331 --> 01:21:02,568 THAT LEAD TO PRE-TERM BIRTH. 2122 01:21:02,568 --> 01:21:04,169 INFLAMMATION AND INFECTION IS 2123 01:21:04,169 --> 01:21:06,906 ONE CLEAR PATHWAY AS WELL AS 2124 01:21:06,906 --> 01:21:09,041 MATERNAL AND FETAL STRESS, 2125 01:21:09,041 --> 01:21:10,442 ABNORMAL UTERINE DISTENTION. 2126 01:21:10,442 --> 01:21:12,778 BUT THERE ARE ALSO FACTORS THAT 2127 01:21:12,778 --> 01:21:15,014 INTERSECT WITH THESE PATHWAYS 2128 01:21:15,014 --> 01:21:16,582 INCLUDING GENETICS, IMMUNE 2129 01:21:16,582 --> 01:21:19,351 STATUS, MEDICAL CONDITIONS, 2130 01:21:19,351 --> 01:21:20,753 EXTERNAL ENVIRONMENT, PSYCHO 2131 01:21:20,753 --> 01:21:22,821 SOCIAL FACTORS BUT ALSO 2132 01:21:22,821 --> 01:21:23,422 BEHAVIORAL OUTCOMES WE ARE 2133 01:21:23,422 --> 01:21:25,591 INTERESTED IN. 2134 01:21:25,591 --> 01:21:29,261 ALSO, THESE OUTCOMES THAT COME 2135 01:21:29,261 --> 01:21:31,063 BETWEEN THESE INTERSECTION AND 2136 01:21:31,063 --> 01:21:33,299 FACTORS LEADINGING TO PRETERM 2137 01:21:33,299 --> 01:21:38,037 BIRTH COULD BE INTRA UTERINE, 2138 01:21:38,037 --> 01:21:39,772 GROWTH RESTRICTION, PRE-TERM 2139 01:21:39,772 --> 01:21:41,073 LABOR AND THEN DISPARITY WE ARE 2140 01:21:41,073 --> 01:21:42,841 SEING IN OUR AREA. 2141 01:21:42,841 --> 01:21:44,310 WE THOUGHT ARE THERE POLICIES 2142 01:21:44,310 --> 01:21:46,312 AND THINGS WE COULD INTERVENE 2143 01:21:46,312 --> 01:21:47,279 ON THAT WOULD IMPROVE THESE 2144 01:21:47,279 --> 01:21:48,280 RATES? 2145 01:21:48,280 --> 01:21:50,716 AND ARE THERE ANY ORIGIN 2146 01:21:50,716 --> 01:21:51,784 REGULATORS WE COULD CONSIDER 2147 01:21:51,784 --> 01:21:52,851 FOR INTERVENTION? 2148 01:21:52,851 --> 01:21:54,920 NEXT SLIDE. 2149 01:21:54,920 --> 01:21:57,890 SO, WE LOOK BACK AT THE 2150 01:21:57,890 --> 01:21:59,291 LITERATURE AND LOOKED AT 2151 01:21:59,291 --> 01:22:00,526 DELIVERIES. 2152 01:22:00,526 --> 01:22:04,563 THIS WAS COLLABORATION BETWEEN 2153 01:22:04,563 --> 01:22:11,904 ME AND ERIC HERZOG, FAY AND 2154 01:22:11,904 --> 01:22:13,672 EMILY YOUNGHEIM. 2155 01:22:13,672 --> 01:22:17,810 THIS WAS A STUDY DONE BY KAISER 2156 01:22:17,810 --> 01:22:19,611 AND HALBERG IN 1962 BEFORE 2157 01:22:19,611 --> 01:22:23,983 THERE WERE A LOT OF 2158 01:22:23,983 --> 01:22:26,485 INTERVENTIONS. LOOKING AT OVER 2159 01:22:26,485 --> 01:22:28,587 600,000 DELIVERIES THERE WERE 2160 01:22:28,587 --> 01:22:31,957 ACTUALLY A DAILY RHYTHM WHEN 2161 01:22:31,957 --> 01:22:35,394 BIRTHS OCCURRED, AROUND 2:00 2162 01:22:35,394 --> 01:22:36,929 A.M.-6:00 A.M., AND THIS 2163 01:22:36,929 --> 01:22:39,164 DECREASED IN THE P.M. HOURS 2164 01:22:39,164 --> 01:22:40,966 FROM 2:00 P.M. TO 6:00 P.M. 2165 01:22:40,966 --> 01:22:43,035 SO WE WERE INTERESTED IN THE 2166 01:22:43,035 --> 01:22:45,037 KIND OF DAILY RHYTHM WHICH 2167 01:22:45,037 --> 01:22:45,504 DELIVERIES OCCURRED. 2168 01:22:45,504 --> 01:22:47,106 NEXT SLIDE. 2169 01:22:47,106 --> 01:22:49,842 WE WERE INTERESTED IN CIRCADIAN 2170 01:22:49,842 --> 01:22:51,510 RHYTHMS WHICH IS A 24-HOUR 2171 01:22:51,510 --> 01:22:53,612 PERIOD THAT MOST OF OUR CELLS 2172 01:22:53,612 --> 01:22:56,382 UNDER GO. 2173 01:22:56,382 --> 01:22:58,650 THEY HELP REGULAR SLEEP/WAKE 2174 01:22:58,650 --> 01:22:59,485 CYCLES, HORMONE RELEASE, ET 2175 01:22:59,485 --> 01:22:59,785 CETERA. 2176 01:22:59,785 --> 01:23:01,520 THERE'S A TIME OF THE DAY OUR 2177 01:23:01,520 --> 01:23:03,522 BLOOD PRESSURE IS THE HIGHEST, 2178 01:23:03,522 --> 01:23:05,591 WE HAVE THE LOWEST BODY 2179 01:23:05,591 --> 01:23:06,925 TEMPERATURE, WHEN CORTISOL IS 2180 01:23:06,925 --> 01:23:09,228 RELEASED AND WE WERE REALLY 2181 01:23:09,228 --> 01:23:11,030 INTERESTED IN THE INTERSECTION 2182 01:23:11,030 --> 01:23:15,768 BETWEEN THESE DAILY RHYTHMS AND 2183 01:23:15,768 --> 01:23:18,137 ADVERSE REPRODUCTIVE OUTCOMES. 2184 01:23:18,137 --> 01:23:22,574 WE ALL HAVE A CROHN TYPE OR 2185 01:23:22,574 --> 01:23:23,842 PREFERENCE WHEN OUR SLEEP/WAKE 2186 01:23:23,842 --> 01:23:24,910 ACTIVITY OCCURS. 2187 01:23:24,910 --> 01:23:27,246 MANY OF US ARE EARLY BIRDS, 2188 01:23:27,246 --> 01:23:30,849 PREFER TO GET UP FROM 5:00-060 2189 01:23:30,849 --> 01:23:33,118 A.M. SO OUR SLEEP PRESSURE IS 2190 01:23:33,118 --> 01:23:34,153 ACTUALLY PRETTY HIGH IN THE 2191 01:23:34,153 --> 01:23:36,722 EARLY PART OF THE NIGHT VERSUS 2192 01:23:36,722 --> 01:23:39,425 THOSE NIGHT OWLS WHO LIKE TO GO 2193 01:23:39,425 --> 01:23:44,563 TO BED AT 1:00 TO 2:00 A.M. AND 2194 01:23:44,563 --> 01:23:46,598 THEN HAVING SLEEP PRESSURE MORE 2195 01:23:46,598 --> 01:23:49,468 TOWARDS THE EARLY MORNING HOURS. 2196 01:23:49,468 --> 01:23:51,737 THIS IS INFLUENCED BY NUMBER OF 2197 01:23:51,737 --> 01:23:52,571 FACTORS INCLUDING GENETICS, AGE 2198 01:23:52,571 --> 01:23:53,772 AND SEX. 2199 01:23:53,772 --> 01:23:56,175 SO WE WERE INTERESTED IN NOT 2200 01:23:56,175 --> 01:23:57,342 JUST WHEN YOU SLEEP BUT HOW YOU 2201 01:23:57,342 --> 01:24:01,146 SLEEP. 2202 01:24:01,146 --> 01:24:04,616 THERE IS MISALIGNMENT IN OUR 2203 01:24:04,616 --> 01:24:05,751 BIOLOGICAL RHYTHM JUST DUE TO 2204 01:24:05,751 --> 01:24:07,753 THE FACT MOST OF US HAVE TO GO 2205 01:24:07,753 --> 01:24:10,155 TO WORK AND BE SOMEWHERE IN A 2206 01:24:10,155 --> 01:24:12,624 CERTAIN TIME. 2207 01:24:12,624 --> 01:24:13,659 BUT THERE'S ENVIRONMENTAL 2208 01:24:13,659 --> 01:24:15,961 NAKTORS SUCH AS SHIFT WORK AND 2209 01:24:15,961 --> 01:24:17,029 CONSTANTLY CHANGING YOUR 2210 01:24:17,029 --> 01:24:18,864 SCHEDULE THAT ALSO PLAY INTO 2211 01:24:18,864 --> 01:24:19,064 THIS. 2212 01:24:19,064 --> 01:24:27,039 SO AS WE HAVE SPOKEN ABOUT 2213 01:24:27,039 --> 01:24:29,141 GYAYADA, WE WERE INTERESTED IN 2214 01:24:29,141 --> 01:24:31,577 LOOKING AT THIS IN PRE-TERNL 2215 01:24:31,577 --> 01:24:31,944 BIRTH. 2216 01:24:31,944 --> 01:24:34,279 NEXT SLIDE. 2217 01:24:34,279 --> 01:24:36,682 WHEN WE FIRST SET UP OUR STUDY 2218 01:24:36,682 --> 01:24:40,452 WE WANTED A PILOT COHORT TO SEE 2219 01:24:40,452 --> 01:24:41,487 IF CIRCADIAN RHYTHMS 2220 01:24:41,487 --> 01:24:43,122 CHAINSINGED WITH PREGNANCY. 2221 01:24:43,122 --> 01:24:49,161 WE LOOKED AT A COHORT OF 2222 01:24:49,161 --> 01:24:50,929 PREGNANCY PLANNERS. THEY WERE 2223 01:24:50,929 --> 01:24:53,565 NOT GETTING TREATMENT, HOWEVER, 2224 01:24:53,565 --> 01:24:55,434 THEY WERE BEING WATCHED. 2225 01:24:55,434 --> 01:24:58,504 WE GAVE THEM A HOST OF SLEEP 2226 01:24:58,504 --> 01:24:59,271 QUESTIONNAIRES, CROHN TYPE 2227 01:24:59,271 --> 01:25:01,206 QUESTIONNAIRES AS WELL AS 2228 01:25:01,206 --> 01:25:05,410 LIFESTYLE SURVEYS. WE ALSO HAD 2229 01:25:05,410 --> 01:25:07,079 AN ACTIVE WATCH CAMERON TECH 2230 01:25:07,079 --> 01:25:09,648 WHICH ALLOWED US TO GET DATA 2231 01:25:09,648 --> 01:25:12,384 DUE TO ITS BATTERY LIFE FOR AN 2232 01:25:12,384 --> 01:25:14,286 EXTENDED PERIOD OF TIME. 2233 01:25:14,286 --> 01:25:16,421 AGAIN, WE HAD THEM WEAR THE 2234 01:25:16,421 --> 01:25:18,290 WATCH FOR TWO WEEKS, WHEN THEY 2235 01:25:18,290 --> 01:25:19,858 WERE PLANNING THEIR PREGNANCY 2236 01:25:19,858 --> 01:25:21,660 BUT WEREN'T PREGNANT. 2237 01:25:21,660 --> 01:25:23,762 WE LOOKED AT THEM EACH 2238 01:25:23,762 --> 01:25:25,063 TRIMESTER. 2239 01:25:25,063 --> 01:25:27,533 AGAIN WE WERE TRYING TO SEE IF 2240 01:25:27,533 --> 01:25:28,700 CROHN TYPE CHANGED WITH 2241 01:25:28,700 --> 01:25:28,967 PREGNANCY. 2242 01:25:28,967 --> 01:25:30,636 NEXT SLIDE. 2243 01:25:30,636 --> 01:25:35,140 SO WHAT WE FOUND THIS IS AN 2244 01:25:35,140 --> 01:25:36,675 ACTIVITY GRAPH OF ONE OF OUR 2245 01:25:36,675 --> 01:25:38,010 PATIENTS. 2246 01:25:38,010 --> 01:25:42,648 WHAT YOU CAN SEE AT THE TOP IS 2247 01:25:42,648 --> 01:25:44,583 THAT SHE WORE THE WATCH FOR TWO 2248 01:25:44,583 --> 01:25:47,519 WEEKS WHEN SHE WAS NOT PREGNANT. 2249 01:25:47,519 --> 01:25:50,322 WHEN SHE GOT PREGNANT, SHE CAME 2250 01:25:50,322 --> 01:25:51,557 IN, THAT'S THE GAP IN LINE, THE 2251 01:25:51,557 --> 01:25:52,858 BREAK. 2252 01:25:52,858 --> 01:25:54,293 WE WATCHED HER ACTIVITY DURING 2253 01:25:54,293 --> 01:25:55,761 THE FIRST, SECOND AND THIRD 2254 01:25:55,761 --> 01:25:57,062 TRIMESTER. 2255 01:25:57,062 --> 01:25:59,298 THE BLACK TICKY LINES ARE 2256 01:25:59,298 --> 01:26:05,204 ACTUALLY HER ACTIVITY. 2257 01:26:05,204 --> 01:26:07,539 THE DARK BLACK LINE IS WHEN SHE 2258 01:26:07,539 --> 01:26:11,076 WENT TO BED, THE GREEN LINE IS 2259 01:26:11,076 --> 01:26:12,544 HER SLEEP PERIOD START TIME. 2260 01:26:12,544 --> 01:26:14,680 CAN SEE THE SLEEP PERIOD START 2261 01:26:14,680 --> 01:26:16,148 TIME ADVANCED IN THE FIRST 2262 01:26:16,148 --> 01:26:18,550 TRIMESTER WHEN SHE WAS PREGNANT. 2263 01:26:18,550 --> 01:26:20,652 WE TRIED TO GET MID SLEEP PHASE 2264 01:26:20,652 --> 01:26:23,355 BUT MOST OF OUR POPULATION 2265 01:26:23,355 --> 01:26:25,824 ACTUALLY HAD JOBS AND GOT UP AT 2266 01:26:25,824 --> 01:26:26,158 THE SAME TIME. 2267 01:26:26,158 --> 01:26:32,531 WE USE THIS AS A MEASURE OF 2268 01:26:32,531 --> 01:26:37,336 CHRONOTYPE. 2269 01:26:37,336 --> 01:26:39,504 START TIME WERE EARLIER IN THE 2270 01:26:39,504 --> 01:26:42,140 FIRST AND SECOND TRIMESTER. 2271 01:26:42,140 --> 01:26:43,542 MINIMAL CHANGE IN THE SLEEP 2272 01:26:43,542 --> 01:26:45,777 TIMES DUE TO THE FACT THAT MOST 2273 01:26:45,777 --> 01:26:49,114 OF THEM WERE WORKING. 2274 01:26:49,114 --> 01:26:51,416 IN IN THIS STUDY CHARACTERIZED 2275 01:26:51,416 --> 01:26:52,985 BY NOT ONLY EARLIER SLEEP 2276 01:26:52,985 --> 01:26:55,220 PERIOD START TIMES BUT LONGER 2277 01:26:55,220 --> 01:26:57,456 SLEEP DURATION AND POORER SLEEP 2278 01:26:57,456 --> 01:26:58,490 QUALITY THAN IN PRE-PREGNANCY. 2279 01:26:58,490 --> 01:26:59,825 NEXT SLIDE. 2280 01:26:59,825 --> 01:27:01,560 BUT WHEN WE LOOKED AT OUTCOMES 2281 01:27:01,560 --> 01:27:04,997 OF THE WOMEN, WHAT WE ALSO 2282 01:27:04,997 --> 01:27:08,000 FOUND WAS THAT THOSE THAT HAD 2283 01:27:08,000 --> 01:27:09,601 HIGH DEGREE OF VARIABILITY, IT 2284 01:27:09,601 --> 01:27:10,636 TOOK THEM LONGER TO GET 2285 01:27:10,636 --> 01:27:12,137 PREGNANT. 2286 01:27:12,137 --> 01:27:14,673 WHAT YOU CAN SEE HERE IS WE 2287 01:27:14,673 --> 01:27:17,075 TOOK THIS PILOT COHORT AND THEN 2288 01:27:17,075 --> 01:27:20,512 WE LOOKED AT THEIR DAY-TO-DAY 2289 01:27:20,512 --> 01:27:21,113 VARIABILITY AND SLEEP-PERIOD 2290 01:27:21,113 --> 01:27:25,083 START TIME. 2291 01:27:25,083 --> 01:27:35,627 SO THE FIRST QUARTILE ARE MOST 2292 01:27:40,899 --> 01:27:42,768 REGULAR CHANGED THEIR 2293 01:27:42,768 --> 01:27:44,736 DAY-TO-DAY BEDTIME. 2294 01:27:44,736 --> 01:27:47,005 THE FOURTH LEAST REGULAR AND 2295 01:27:47,005 --> 01:27:49,274 MOST OF THEM CHANGED THEIR 2296 01:27:49,274 --> 01:27:49,941 DAY-TO-DAY VARIABILITY BY ABOUT 2297 01:27:49,941 --> 01:27:52,978 TWO AND A HALF HOURS. LITTLE 2298 01:27:52,978 --> 01:27:55,447 OVER 60% OF THEM WERE PREGNANT. 2299 01:27:55,447 --> 01:28:00,786 OVER THOSE IN THE FOURTH 2300 01:28:00,786 --> 01:28:03,889 QUARTILE HAD A HIGH DEGREE OF 2301 01:28:03,889 --> 01:28:09,328 VARIABILITY ONLY ABOUT 10-12% 2302 01:28:09,328 --> 01:28:13,198 WERE PREGNANT AFTER SIX MONTHS. 2303 01:28:13,198 --> 01:28:15,867 AFTER ADJUSTING FOR AGE, BMI, 2304 01:28:15,867 --> 01:28:17,369 RACE, EDUCATION AND INCOME, ALL 2305 01:28:17,369 --> 01:28:18,170 THINGS ASSOCIATED WITH TIME TO 2306 01:28:18,170 --> 01:28:18,603 PREGNANCY. 2307 01:28:18,603 --> 01:28:24,276 NEXT SLIDE. 2308 01:28:24,276 --> 01:28:27,145 SO OUR STUDY WAS REALLY 2309 01:28:27,145 --> 01:28:29,448 INTERESTED IN PRE-TERM BIRTH. 2310 01:28:29,448 --> 01:28:35,387 AGAIN, WE LOOKED AT WHETHER 2311 01:28:35,387 --> 01:28:38,757 DISRUPTION OR CHRONO DISRUPTION 2312 01:28:38,757 --> 01:28:43,495 WAS ASSOCIATED WITH POOR 2313 01:28:43,495 --> 01:28:46,631 PERINATAL OUTCOMES. 2314 01:28:46,631 --> 01:28:48,633 WE RECRUITED ANY WOMEN WHO CAME 2315 01:28:48,633 --> 01:28:51,970 IN PRIOR TO 20 WEEKS WAS 2316 01:28:51,970 --> 01:28:54,005 ENROLLED, COULD BE ENROLLED IN 2317 01:28:54,005 --> 01:28:55,107 OUR STUDY. 2318 01:28:55,107 --> 01:28:56,908 BUT WE GOT MOST OF THE 2319 01:28:56,908 --> 01:28:58,643 PARTICIPANTS IN THE FIRST, 2320 01:28:58,643 --> 01:29:00,746 SECOND AND THIRD PRIME. 2321 01:29:00,746 --> 01:29:02,381 -- TRIMESTER. 2322 01:29:02,381 --> 01:29:03,849 NEXT SLIDE. 2323 01:29:03,849 --> 01:29:06,618 SO I JUST WANTED TO SAY THIS 2324 01:29:06,618 --> 01:29:09,287 WAS REALLY A VERY COMPREHENSIVE 2325 01:29:09,287 --> 01:29:12,858 STUDY BECAUSE NOT ONLY, IT 2326 01:29:12,858 --> 01:29:17,329 WASN'T SLEEP STUDY, IT WAS 2327 01:29:17,329 --> 01:29:27,506 REALLY STRESS SCALES, 2328 01:29:27,506 --> 01:29:32,744 CHRONOTYPE QUESTIONNAIRES. 2329 01:29:32,744 --> 01:29:34,279 RUSSELL SLAY KAISER PHYSICAL 2330 01:29:34,279 --> 01:29:35,247 ACTIVITY BUT ALSO INVOLVED IN 2331 01:29:35,247 --> 01:29:38,250 OTHER PARTS OF THE STUDIES 2332 01:29:38,250 --> 01:29:40,485 INCLUDING CERVICAL IMAGING, 2333 01:29:40,485 --> 01:29:43,121 UTERINE MRI AND BIOLOGICAL 2334 01:29:43,121 --> 01:29:44,923 SAMPLES AND TIME STAMPED FOR US 2335 01:29:44,923 --> 01:29:46,358 TO COMPLETE THE STUDY AND I 2336 01:29:46,358 --> 01:29:48,660 WANT TO THANK THE DIVISION OF 2337 01:29:48,660 --> 01:29:50,595 CLINICAL RESEARCH WHO RECRUITED 2338 01:29:50,595 --> 01:29:51,296 ALL OF THESE PARTICIPANTS. 2339 01:29:51,296 --> 01:29:53,398 NEXT SLIDE. 2340 01:29:53,398 --> 01:29:55,667 SO THE DEMOGRAPHICS OF OUR 2341 01:29:55,667 --> 01:29:57,502 STUDY WERE RESEMBLED IN OUR 2342 01:29:57,502 --> 01:29:58,470 POPULATION, I'M ONLY SHOWING 2343 01:29:58,470 --> 01:29:59,571 THOSE INCLUDED IN THE ANALYSIS 2344 01:29:59,571 --> 01:30:01,773 HERE. 2345 01:30:01,773 --> 01:30:03,542 OUR AVERAGE AGE WAS ABOUT 30, 2346 01:30:03,542 --> 01:30:05,010 MOST OF THEM WERE PRIVATE 2347 01:30:05,010 --> 01:30:07,112 INSURANCE BUT WE STILL HAD 2348 01:30:07,112 --> 01:30:08,847 ABOUT 25% ON MEDICAID. 2349 01:30:08,847 --> 01:30:11,049 ABOUT 50% OF THEM HAVE AN 2350 01:30:11,049 --> 01:30:13,485 INCOME OF $50,000 OR LESS AND 2351 01:30:13,485 --> 01:30:15,086 ABOUT 60% HAVE A HIGH SCHOOL 2352 01:30:15,086 --> 01:30:20,725 EDUCATION OR LESS. 2353 01:30:20,725 --> 01:30:22,461 NEXT SLIDE. 2354 01:30:22,461 --> 01:30:29,034 SO WHAT WE NOTICED IS WE LOOKED 2355 01:30:29,034 --> 01:30:29,468 AT CHRONOTYPE FIRST. 2356 01:30:29,468 --> 01:30:38,343 THOSE WHO HAVE A LATE 2357 01:30:38,343 --> 01:30:40,879 CHRONOTYPE, THOSE WHO GOT UP 2358 01:30:40,879 --> 01:30:45,450 LATER HAVE A SHORTER 2359 01:30:45,450 --> 01:30:47,018 GESTATIONAL LINKS. SO IF YOU 2360 01:30:47,018 --> 01:30:49,054 LOOK AT INNER DAILY SLEEP 2361 01:30:49,054 --> 01:30:51,957 VARIABILITY, OF SLEEP ON 2362 01:30:51,957 --> 01:30:53,291 SET/OFFSET MID TIME IN 2363 01:30:53,291 --> 01:30:54,993 DURATION, WHAT WE COULD SEE IS 2364 01:30:54,993 --> 01:30:56,828 THOSE WHO HAVE A LOW DAILY 2365 01:30:56,828 --> 01:30:58,530 VARIABILITY IN THE LATE 2366 01:30:58,530 --> 01:31:00,031 CHRONOTYPES WERE ACTUALLY WHO 2367 01:31:00,031 --> 01:31:03,602 HAVE A HIGH VARIABILITY IN THE 2368 01:31:03,602 --> 01:31:05,504 LATE CHRONOTYPES WERE MORE 2369 01:31:05,504 --> 01:31:06,638 SIGNIFICANTLY HAD A SHORTER 2370 01:31:06,638 --> 01:31:09,508 GESTATION AS YOU CAN SEE BY THE 2371 01:31:09,508 --> 01:31:09,774 RED LINES. 2372 01:31:09,774 --> 01:31:12,444 THIS WAS SEEN IN BOTH THE SLEEP 2373 01:31:12,444 --> 01:31:14,746 ON SET, SLEEP OFFSET, SLEEP MID 2374 01:31:14,746 --> 01:31:17,015 TIME AND SLEEP DURATION. 2375 01:31:17,015 --> 01:31:18,850 SO THIS WAS ASSOCIATED WITH 2376 01:31:18,850 --> 01:31:20,085 PRE-TERM BIRTH. 2377 01:31:20,085 --> 01:31:23,788 WHEN HE BROKE THE QUARTILES TO 2378 01:31:23,788 --> 01:31:25,457 THE FIRST VERSUS THE THIRD 2379 01:31:25,457 --> 01:31:27,292 QUARTILE, WE COULD SEE THE 2380 01:31:27,292 --> 01:31:29,561 RELATIVE RISK WAS A LITTLE OVER 2381 01:31:29,561 --> 01:31:29,728 TWO. 2382 01:31:29,728 --> 01:31:31,930 WHEN WE ADJUSTED FOR MATERNAL 2383 01:31:31,930 --> 01:31:36,401 AGE, INCOME, WE COO SEE THIS 2384 01:31:36,401 --> 01:31:38,803 WAS ABOUT 1.5 WITH STRONGER 2385 01:31:38,803 --> 01:31:40,338 FINDINGS FOR GESTATIONAL AGE 2386 01:31:40,338 --> 01:31:40,672 LESS THAN 34. 2387 01:31:40,672 --> 01:31:42,140 NEXT SLIDE. 2388 01:31:42,140 --> 01:31:43,441 WE ARE JUST TRYING TO FIGURE 2389 01:31:43,441 --> 01:31:47,379 OUT NOW WHAT IS ASSOCIATED WITH 2390 01:31:47,379 --> 01:31:47,746 PRE-TERM BIRTH. 2391 01:31:47,746 --> 01:31:50,215 WHEN WE LOOKED AT SLEEP 2392 01:31:50,215 --> 01:31:52,350 ACTIVITY, SLEEP FREQUENCY, THAT 2393 01:31:52,350 --> 01:31:55,554 THE RELATIVE RISK FOR HAVING A 2394 01:31:55,554 --> 01:31:59,524 PRE-TERM BIRTH BEFORE 28 WEEKS 2395 01:31:59,524 --> 01:32:00,759 WAS DEFINITELY HIGHER IN THOSE 2396 01:32:00,759 --> 01:32:02,627 WHO HAD ACTIVITY IN THE SLEEP 2397 01:32:02,627 --> 01:32:05,964 CYCLE, AS SHOWN BY THE DARKER 2398 01:32:05,964 --> 01:32:07,165 BARS, UNDER 28 WEEKS. 2399 01:32:07,165 --> 01:32:08,733 NEXT SLIDE. 2400 01:32:08,733 --> 01:32:12,470 WHEN WE LOOKED AT THE SLEEP 2401 01:32:12,470 --> 01:32:13,638 PARAMETERS ASSOCIATED WITH 2402 01:32:13,638 --> 01:32:16,541 THIS, IT WAS REALLY SLEEP 2403 01:32:16,541 --> 01:32:20,745 DURATION THAT THOSE WHO HAD THE 2404 01:32:20,745 --> 01:32:27,085 RELATIVE RISK FOR EARLY PRETERM 2405 01:32:27,085 --> 01:32:31,022 BIRTH OR EXTREMELY PRE-TERM 2406 01:32:31,022 --> 01:32:34,259 BIRTH WAS THOSE WHO HAD VERY 2407 01:32:34,259 --> 01:32:34,726 SHORT SLEEP DURATION. 2408 01:32:34,726 --> 01:32:35,994 BUT WHERE WE SAW THE BIGGEST 2409 01:32:35,994 --> 01:32:37,195 INDICATION -- NEXT SLIDE. 2410 01:32:37,195 --> 01:32:38,697 WAS JUST DUE TO THE VARIABILITY. 2411 01:32:38,697 --> 01:32:41,132 SO YOU WERE AT A MUCH HIGHER 2412 01:32:41,132 --> 01:32:43,468 RISK FOR AN EARLY PRE-TERM 2413 01:32:43,468 --> 01:32:45,870 BIRTH IF YOU HAVE A LOT OF 2414 01:32:45,870 --> 01:32:47,739 DAILY VARIABILITY IN YOUR SLEEP 2415 01:32:47,739 --> 01:32:53,144 SCHEDULES, WHETHER IT BE YOUR 2416 01:32:53,144 --> 01:32:55,614 SLEEP/START TIME, YOUR MIDPOINT 2417 01:32:55,614 --> 01:32:56,815 OR SLEEP DURATION. 2418 01:32:56,815 --> 01:32:58,183 NEXT SLIDE. 2419 01:32:58,183 --> 01:33:00,051 I JUST WANTED TO POINT OUT WE 2420 01:33:00,051 --> 01:33:02,554 NOTICED THIS ALSO BECAUSE OUR 2421 01:33:02,554 --> 01:33:04,556 WATCHES HAD A LIGHT MEET UR. 2422 01:33:04,556 --> 01:33:07,525 AND WHEN WE LOOKED AT THE TERM 2423 01:33:07,525 --> 01:33:15,333 PATIENTS AND LOOKED AT THE 2424 01:33:15,333 --> 01:33:17,636 MOTION COUNTER AND THERE WAS 2425 01:33:17,636 --> 01:33:19,571 IRREGULARITY IN THE PATTERN, 2426 01:33:19,571 --> 01:33:22,107 WHEN WE LOOK AT PRE-TERM BIRTH 2427 01:33:22,107 --> 01:33:23,742 PATTERNS THEY LOOK LIKE THEY 2428 01:33:23,742 --> 01:33:26,444 HAVE ABSOLUTELY NO KIND OF 2429 01:33:26,444 --> 01:33:27,979 REGULARITY AND THEIR LIGHT 2430 01:33:27,979 --> 01:33:29,881 EXPOSURE, WHICH ALSO IS SHOWN 2431 01:33:29,881 --> 01:33:37,288 IN THEIR ACTIVITY EXPOSURE. 2432 01:33:37,288 --> 01:33:39,190 WE ARE CONTINUING TO LOOK AT 2433 01:33:39,190 --> 01:33:40,792 THIS LIGHT DATA TO SEE WHAT 2434 01:33:40,792 --> 01:33:42,894 THIS TELLS US ABOUT THE PATIENT 2435 01:33:42,894 --> 01:33:44,562 POPULATION AND WHAT THEY ARE 2436 01:33:44,562 --> 01:33:46,464 SEEING AND THEIR ENVIRONMENTAL 2437 01:33:46,464 --> 01:33:48,500 EXPOSURES AND MAYBE SOME 2438 01:33:48,500 --> 01:33:49,868 BEHAVIORAL MODIFICATIONS WE CAN 2439 01:33:49,868 --> 01:33:50,068 MAKE. 2440 01:33:50,068 --> 01:33:53,838 NEXT SLIDE. 2441 01:33:53,838 --> 01:33:55,840 SO THIS IS JUST REPEATING WE 2442 01:33:55,840 --> 01:33:57,142 SAW AS THE REGULAR LIGHT 2443 01:33:57,142 --> 01:33:57,876 PATTERN. 2444 01:33:57,876 --> 01:34:01,946 WHAT WE CAN SEE IS THAT WE SAW 2445 01:34:01,946 --> 01:34:05,150 THIS IN ALL, IN MANY OF THE 2446 01:34:05,150 --> 01:34:06,818 PATIENTS, IF WE LOOK AT EXAMPLE 2447 01:34:06,818 --> 01:34:09,154 TO THE VERY RIGHT, THE REGULAR 2448 01:34:09,154 --> 01:34:13,058 PATIENTS ARE AT THE LOWER RED 2449 01:34:13,058 --> 01:34:14,959 BOX VERSUS THE IRREGULAR, WE 2450 01:34:14,959 --> 01:34:17,395 CAN SEE THE GESTATIONAL WEEKS 2451 01:34:17,395 --> 01:34:19,397 IS THOSE THAT ARE BEING BORN 2452 01:34:19,397 --> 01:34:21,466 VERY EARLY AND THOSE WHO ARE 2453 01:34:21,466 --> 01:34:23,468 ACTUALLY HAVING A PREGNANCY 2454 01:34:23,468 --> 01:34:25,670 LOSS HAVE VERY IRREGULAR LIGHT 2455 01:34:25,670 --> 01:34:26,271 SCHEDULES OR LIGHT EXPOSURE. 2456 01:34:26,271 --> 01:34:36,481 NEXT SLIDE. 2457 01:34:39,150 --> 01:34:41,119 WE NEED TO THINK 2458 01:34:41,119 --> 01:34:44,355 MECHANISTICALLY TO UNDERSTAND 2459 01:34:44,355 --> 01:34:46,491 STUDIES IN PATHWAYS, HOPEFULLY 2460 01:34:46,491 --> 01:34:48,159 WE CAN PROMOTE LIFESTYLE 2461 01:34:48,159 --> 01:34:50,228 CHANGES TO ALIGN OUR BIOLOGICAL 2462 01:34:50,228 --> 01:34:52,230 RHYTHMS TO OUR NORMAL 2463 01:34:52,230 --> 01:34:54,232 LIFESTYLES. AND WE HAVE TO 2464 01:34:54,232 --> 01:34:56,134 UNDERSTAND BETTER HOW SLEEP 2465 01:34:56,134 --> 01:34:59,204 DISPARITIES ARE ASSOCIATED WITH 2466 01:34:59,204 --> 01:34:59,771 DISPARITIES IN REPRODUCTIVE 2467 01:34:59,771 --> 01:35:00,038 OUTCOMES. 2468 01:35:00,038 --> 01:35:01,306 NEXT SLIDE. 2469 01:35:01,306 --> 01:35:02,307 THAT JUST HIGHLIGHTS WHAT I 2470 01:35:02,307 --> 01:35:02,941 JUST SAID. 2471 01:35:02,941 --> 01:35:04,375 AND NEXT SLIDE. 2472 01:35:04,375 --> 01:35:06,644 I WANT TO THANK EVERYBODY WHO 2473 01:35:06,644 --> 01:35:08,413 HELPED WITH THIS STUDY, 2474 01:35:08,413 --> 01:35:10,415 INCLUDING MY LAB AND MY 2475 01:35:10,415 --> 01:35:13,551 COLLABORATORS AND THE MARCH OF 2476 01:35:13,551 --> 01:35:15,687 DIMES AND NIH WHO HELPED FUND 2477 01:35:15,687 --> 01:35:17,322 THE STUDIES AND THE SLEEP 2478 01:35:17,322 --> 01:35:18,089 PARTICIPANTS. 2479 01:35:18,089 --> 01:35:20,992 THANK YOU VERY MUCH. 2480 01:35:20,992 --> 01:35:25,396 AND I THINK I WILL LEAVE IT TO 2481 01:35:25,396 --> 01:35:30,201 SUZIE BERTISCH. 2482 01:35:30,201 --> 01:35:32,303 >> THANK YOU FOR HAVING ME 2483 01:35:32,303 --> 01:35:33,605 SPEAK AT THIS CONFERENCE TODAY. 2484 01:35:33,605 --> 01:35:36,374 TODAY I WILL BE SPEAKING, 2485 01:35:36,374 --> 01:35:38,376 SORRY, MY SLIDES ARE GOING 2486 01:35:38,376 --> 01:35:46,551 AHEAD ON THEMSELVES. 2487 01:35:46,551 --> 01:35:49,487 TODAY I WILL BE SPEAKING ON 2488 01:35:49,487 --> 01:35:50,455 IMPLEMENTATION SCIENCE AND 2489 01:35:50,455 --> 01:35:52,457 APPROACHES AND KEY EXAMPLES IN 2490 01:35:52,457 --> 01:35:53,858 THE SLEEP LITERATURE, WRAP UP 2491 01:35:53,858 --> 01:35:55,160 WITH KEY POINTS TODAY AND I 2492 01:35:55,160 --> 01:35:59,330 THINK WE WILL GO INTO OUR 2493 01:35:59,330 --> 01:36:02,634 DISCUSSION. 2494 01:36:02,634 --> 01:36:04,235 NEXT SLIDE, PLEASE. 2495 01:36:04,235 --> 01:36:08,206 NEXT SLIDE, PLEASE. 2496 01:36:08,206 --> 01:36:11,943 AS WE TALKED ABOUT THIS 2497 01:36:11,943 --> 01:36:13,278 CONFERENCE, ON IMPLEMENTATION 2498 01:36:13,278 --> 01:36:13,511 SCIENCE. 2499 01:36:13,511 --> 01:36:14,078 WE ARE TRYING TO BETTER 2500 01:36:14,078 --> 01:36:15,980 UNDERSTAND HOW WE TAKE WHAT WE 2501 01:36:15,980 --> 01:36:17,615 KNOW AND THIS HELPS BE SPECIFIC 2502 01:36:17,615 --> 01:36:20,251 ABOUT SLEEP TO WHAT WE DO AND 2503 01:36:20,251 --> 01:36:21,386 IMPLEMENTATION SCIENCE IS 2504 01:36:21,386 --> 01:36:24,589 REALLY THINKING ABOUT GIVING 2505 01:36:24,589 --> 01:36:27,458 US THE TOOLS TO DO THIS 2506 01:36:27,458 --> 01:36:30,428 RESEARCH. 2507 01:36:30,428 --> 01:36:32,564 AS ELUDED TO IN THIS PANEL, 2508 01:36:32,564 --> 01:36:38,970 WORK IN THIS AREA BUT IT'S VERY 2509 01:36:38,970 --> 01:36:39,204 NASCENT. 2510 01:36:39,204 --> 01:36:40,772 THE GOOD NEWS IS WE HAVE 2511 01:36:40,772 --> 01:36:42,440 INTERVENTIONS THAT TREAT A LOT 2512 01:36:42,440 --> 01:36:44,175 OF THE SLEEP DISRUPTIONS AND 2513 01:36:44,175 --> 01:36:46,377 SLEEP DISORDERS WE HEARD ABOUT. 2514 01:36:46,377 --> 01:36:47,879 MAYBE NOT ALWAYS SPECIFICALLY 2515 01:36:47,879 --> 01:36:49,614 TAILORED FOR THE EXACT 2516 01:36:49,614 --> 01:36:50,782 POPULATION BUT REALLY ROBUST 2517 01:36:50,782 --> 01:36:53,785 TREATMENTS THAT SEEM TO WORK 2518 01:36:53,785 --> 01:36:55,320 ACROSS DIFFERENT SLEEP 2519 01:36:55,320 --> 01:36:56,821 DISORDERS OR JUST SLEEP HEALTH 2520 01:36:56,821 --> 01:36:57,856 MORE GENERALLY. 2521 01:36:57,856 --> 01:36:59,991 I THINK TAKING A VIEW OF A 2522 01:36:59,991 --> 01:37:01,593 SNAPSHOT WHERE WE ARE IN SLEEP 2523 01:37:01,593 --> 01:37:04,162 IN GENERAL AT THIS TIME IS 2524 01:37:04,162 --> 01:37:07,832 HELPFUL, HOPEFULLY, AND TO 2525 01:37:07,832 --> 01:37:08,800 GUIDE FUTURE IMPLEMENTATION 2526 01:37:08,800 --> 01:37:10,468 SCIENCE, THINKING ABOUT SLEEP 2527 01:37:10,468 --> 01:37:11,269 INTERVENTIONS AND HOW WE GET 2528 01:37:11,269 --> 01:37:12,871 THEM TO PEOPLE. 2529 01:37:12,871 --> 01:37:14,839 THE IRONY IS EVERYBODY SLEEPS 2530 01:37:14,839 --> 01:37:17,375 BUT OUR FIELD IS STILL REALLY 2531 01:37:17,375 --> 01:37:17,709 NEW. 2532 01:37:17,709 --> 01:37:19,677 NASCENT IN LEARNING ABOUT HOW 2533 01:37:19,677 --> 01:37:23,381 DO WE ACTUALLY BRING THESE 2534 01:37:23,381 --> 01:37:33,892 TOOLS TO PEOPLE A LOT AT THE 2535 01:37:35,927 --> 01:37:38,129 CONFERENCE TALKED ABOUT HEALTH 2536 01:37:38,129 --> 01:37:38,363 EQUITY. 2537 01:37:38,363 --> 01:37:40,632 IT'S IMPORTANT TO STATE HOW 2538 01:37:40,632 --> 01:37:42,300 IMPLEMENTATION SCIENCE AND 2539 01:37:42,300 --> 01:37:43,601 HEALTH EQUITY AND DISPARITIES 2540 01:37:43,601 --> 01:37:45,036 ALIGN. 2541 01:37:45,036 --> 01:37:48,806 HEALTH EQUITIES IS DEFINED 2542 01:37:48,806 --> 01:37:50,408 EVERYONE HAVING A FAIR AND JUST 2543 01:37:50,408 --> 01:37:51,509 OPPORTUNITY TO BE AS HEALTHY AS 2544 01:37:51,509 --> 01:37:52,410 POSSIBLE. 2545 01:37:52,410 --> 01:37:56,481 THIS IS WHERE THE FIELDS ALIGN, 2546 01:37:56,481 --> 01:37:58,583 IN ORDER TO HAVE EVERYONE BE AS 2547 01:37:58,583 --> 01:38:00,919 HEALTHY AS THEY CAN BE REQUIRES 2548 01:38:00,919 --> 01:38:03,621 MOVING OBSTACLES IN THEIR WAY. 2549 01:38:03,621 --> 01:38:06,257 BOTH IMPLEMENTATION SCIENCE 2550 01:38:06,257 --> 01:38:07,292 RESEARCH AND DISPARITIES 2551 01:38:07,292 --> 01:38:08,793 RESEARCHERS HAVE A COMMON GOAL 2552 01:38:08,793 --> 01:38:11,429 MAKING SURE PEOPLE HAVE, NO 2553 01:38:11,429 --> 01:38:12,730 MATTER THE BEST OPPORTUNITY TO 2554 01:38:12,730 --> 01:38:15,500 RECEIVE THE HIGHEST QUALITY OF 2555 01:38:15,500 --> 01:38:17,468 CARE, AS GENERATED BY THE 2556 01:38:17,468 --> 01:38:19,904 RESEARCH EVIDENCE. 2557 01:38:19,904 --> 01:38:21,806 THIS INCLUDES GETTING 2558 01:38:21,806 --> 01:38:24,776 HEALTHCARE ACROSS DIFFERENT 2559 01:38:24,776 --> 01:38:26,377 CONTEXTS. CLINICAL SETTINGS, 2560 01:38:26,377 --> 01:38:27,745 COMMUNITY, EVEN SCHOOL SETTINGS 2561 01:38:27,745 --> 01:38:28,780 HAVE BEEN DONE SOMEWHAT IN THE 2562 01:38:28,780 --> 01:38:30,014 FIELD OF SLEEP. 2563 01:38:30,014 --> 01:38:31,616 NEXT SLIDE, PLEASE. 2564 01:38:31,616 --> 01:38:38,356 SO THIS IS JUST ONE EXAMPLE 2565 01:38:38,356 --> 01:38:39,724 FROM THE SLEEP LITERATURE. 2566 01:38:39,724 --> 01:38:41,759 IN 2016 THE AMERICAN COLLEGE OF 2567 01:38:41,759 --> 01:38:44,162 PHYSICIANS CAME OUT WITH 2568 01:38:44,162 --> 01:38:46,130 MANAGEMENT GUIDELINE FOR 2569 01:38:46,130 --> 01:38:47,598 CHRONIC INSOMNIA DISORDER IN 2570 01:38:47,598 --> 01:38:50,435 ADULTS, THIS IS ALL ADULTS. 2571 01:38:50,435 --> 01:38:52,870 THEY RECOMMEND ALL PATIENTS 2572 01:38:52,870 --> 01:38:55,440 RECEIVE COGNITIVE BEHAVIORAL 2573 01:38:55,440 --> 01:38:56,474 THERAPY FOR INSOMNIA. 2574 01:38:56,474 --> 01:38:59,177 THIS IS THE SAME TREATMENT THAT 2575 01:38:59,177 --> 01:39:01,512 DR. BOURJEILY TALKED ABOUT IN 2576 01:39:01,512 --> 01:39:03,314 HER TALK, EFFECTIVE TREATMENT 2577 01:39:03,314 --> 01:39:04,382 FOR INSOMNIA. 2578 01:39:04,382 --> 01:39:06,084 THE PROBLEM THERE'S NO GUIDE 2579 01:39:06,084 --> 01:39:08,119 BOOK HOW WE GET THIS TO PEOPLE. 2580 01:39:08,119 --> 01:39:10,121 MY FRIENDS AND I JOKE, WE HAD 2581 01:39:10,121 --> 01:39:12,390 OUR BABIES AND WE WERE WAITING 2582 01:39:12,390 --> 01:39:14,559 FOR A GUIDE BOOK HOW TO RAISE 2583 01:39:14,559 --> 01:39:15,526 THESE TINY HUMANS AS BEST AS 2584 01:39:15,526 --> 01:39:16,894 POSSIBLE. 2585 01:39:16,894 --> 01:39:18,396 NINE YEARS LATER I'M STILL 2586 01:39:18,396 --> 01:39:20,498 WAITING FOR THAT TOOL BOOK. 2587 01:39:20,498 --> 01:39:21,733 IT HASN'T ARRIVED YET. 2588 01:39:21,733 --> 01:39:23,267 IT'S VERY HARD TO UNDERSTAND 2589 01:39:23,267 --> 01:39:25,103 HOW TO TAKE THESE ELOQUENT 2590 01:39:25,103 --> 01:39:27,338 GUIDELINES AND ACTUALLY MAKE 2591 01:39:27,338 --> 01:39:29,307 THEM IN PRACTICE. 2592 01:39:29,307 --> 01:39:34,412 WE KNOW THAT GUIDELINES OF THE 2593 01:39:34,412 --> 01:39:35,546 SAME INTERVENTIONS, THAT 2594 01:39:35,546 --> 01:39:37,015 CONTEXT REALLY MATTERS AND 2595 01:39:37,015 --> 01:39:39,951 WHERE AND HOW WE DELIVER 2596 01:39:39,951 --> 01:39:40,551 COGNITIVE BEHAVIORAL THERAPY 2597 01:39:40,551 --> 01:39:42,086 REALLY WORKS. 2598 01:39:42,086 --> 01:39:43,988 WE NEED TO STOP THINKING ABOUT 2599 01:39:43,988 --> 01:39:49,560 A ONE SIZE FITS ALL APPROACH AND 2600 01:39:49,560 --> 01:39:51,262 BETTER UNDERSTAND HOW WE GET 2601 01:39:51,262 --> 01:39:52,597 THE CONTEXT IN WHICH WE ARE 2602 01:39:52,597 --> 01:39:54,098 DELIVERING IT. 2603 01:39:54,098 --> 01:39:57,435 SO HOW DO WE THINK ABOUT 2604 01:39:57,435 --> 01:39:59,937 REMOVING BARRIERS, NEXT SLIDE, 2605 01:39:59,937 --> 01:40:01,105 FOR GETTING PREGNANT PEOPLE TO 2606 01:40:01,105 --> 01:40:03,374 SLEEP BETTER. 2607 01:40:03,374 --> 01:40:05,777 WHEN THINKING OF BARRIERS TO 2608 01:40:05,777 --> 01:40:07,011 IMPLEMENTATION -- NEXT SLIDE. 2609 01:40:07,011 --> 01:40:08,746 WE HAVE TO THINK ABOUT WHAT ARE 2610 01:40:08,746 --> 01:40:11,516 THE BARRIERS THAT IMPACT HOW 2611 01:40:11,516 --> 01:40:13,418 WELL THESE TREATMENTS WORK IN 2612 01:40:13,418 --> 01:40:14,085 THE REAL-WORLD SETTING GETTING 2613 01:40:14,085 --> 01:40:15,420 TO THEM. 2614 01:40:15,420 --> 01:40:16,354 IN ORDER FOR EFFECTIVE 2615 01:40:16,354 --> 01:40:17,488 TREATMENTS TO WORK, HOW THAT 2616 01:40:17,488 --> 01:40:19,757 WILL BE USED IN THE REAL WORLD, 2617 01:40:19,757 --> 01:40:22,560 WE THINK ABOUT ADOPTION, SO 2618 01:40:22,560 --> 01:40:24,162 PEOPLE USING INTERVENTION, HOW 2619 01:40:24,162 --> 01:40:25,963 WE WILL TRAIN HEALTHCARE 2620 01:40:25,963 --> 01:40:27,698 WORKERS AND SYSTEMS TO DELIVER 2621 01:40:27,698 --> 01:40:30,034 THE INTERVENTION, HOW TO 2622 01:40:30,034 --> 01:40:31,202 DELIVER IT WITH FIDELITY, 2623 01:40:31,202 --> 01:40:32,403 GIVING PEOPLE ACCESS TO 2624 01:40:32,403 --> 01:40:34,639 TREATMENTS AND ALSO MAKING THEM 2625 01:40:34,639 --> 01:40:34,939 SUSTAINABLE. 2626 01:40:34,939 --> 01:40:36,741 NEXT SLIDE, POLARIZE. 2627 01:40:36,741 --> 01:40:38,709 -PLEASE. 2628 01:40:38,709 --> 01:40:41,179 SPECIFICALLY IF WE THINK ABOUT 2629 01:40:41,179 --> 01:40:42,680 COGNITIVE BEHAVIORAL THERAPY 2630 01:40:42,680 --> 01:40:47,185 FOR INSOMNIA AND OUR WORK HAS 2631 01:40:47,185 --> 01:40:48,019 FOCUSED ON 2632 01:40:48,019 --> 01:40:48,553 ECONOMICALLY-MARGINALIZED 2633 01:40:48,553 --> 01:40:49,554 ADULTS, THINKING MORE OF THE 2634 01:40:49,554 --> 01:40:51,622 INDIVIDUAL LEVEL. 2635 01:40:51,622 --> 01:40:54,392 DR. BOURJEILY HAD A NICE SLIDE 2636 01:40:54,392 --> 01:40:56,494 LOOKING AT SYSTEMS, INDIVIDUAL 2637 01:40:56,494 --> 01:40:58,329 AND OTHER PREGNANCY-RELATED FACT 2638 01:40:58,329 --> 01:41:01,632 >>ERS AUTO SOME OF THE 2639 01:41:01,632 --> 01:41:02,567 IMPLEMENTATION ISSUES. SHE 2640 01:41:02,567 --> 01:41:04,435 MENTIONED WE TALK ABOUT 2641 01:41:04,435 --> 01:41:05,369 WORKFORCE SHORTAGES NOT ENOUGH 2642 01:41:05,369 --> 01:41:07,371 PEOPLE KNOW HOW TO DELIVER THE 2643 01:41:07,371 --> 01:41:09,407 THERAPIES, THE TIME IT TAKES TO 2644 01:41:09,407 --> 01:41:12,944 PARTICIPATE IN THE THERAPY, 2645 01:41:12,944 --> 01:41:15,480 COGNITIVE BEHAVIORAL THERAPY 2646 01:41:15,480 --> 01:41:17,315 INVOLVES SEEING PRACTITIONER 2647 01:41:17,315 --> 01:41:19,083 MULTI-IMTIMES FOR EVER THE 2648 01:41:19,083 --> 01:41:22,420 COURSE OF AN HOUR FOR 6-8 WEEKS 2649 01:41:22,420 --> 01:41:25,590 AND MOST OF CBTI IS NOT COVERED 2650 01:41:25,590 --> 01:41:27,525 BY INSURERS, THERE'S LIMITED 2651 01:41:27,525 --> 01:41:29,193 ACCESS TO SPECIALISTS WHO CAN 2652 01:41:29,193 --> 01:41:30,428 DELIVER IT, THERE'S 2653 01:41:30,428 --> 01:41:32,330 TRANSPORTATION BARRIERS, EVEN 2654 01:41:32,330 --> 01:41:34,866 THEIR DIGITAL DIVIDES, FACTORS 2655 01:41:34,866 --> 01:41:36,033 ASSOCIATED WITH STIGMA, 2656 01:41:36,033 --> 01:41:36,567 DISCRIMINATION, ACCESSING 2657 01:41:36,567 --> 01:41:39,537 THERAPY AND WE THINK ABOUT 2658 01:41:39,537 --> 01:41:39,804 LANGUAGE. 2659 01:41:39,804 --> 01:41:42,540 CBTI IS OFTEN ONLY AVAILABLE IN 2660 01:41:42,540 --> 01:41:44,275 ENGLISH AND GENERAL HEALTH 2661 01:41:44,275 --> 01:41:45,476 LITERACY CHALLENGES AND HOW DO 2662 01:41:45,476 --> 01:41:47,211 WE MAKE IT ACTUALLY USABLE FOR 2663 01:41:47,211 --> 01:41:49,380 PEOPLE TO NOT ONLY UNDERSTAND 2664 01:41:49,380 --> 01:41:51,682 THE INFORMATION BUT "E:60" 2665 01:41:51,682 --> 01:41:52,650 ESSENTIALLY MAKE THE BEHAVIORAL 2666 01:41:52,650 --> 01:41:53,784 CHANGE NECESSARY TO DO THAT. 2667 01:41:53,784 --> 01:41:55,486 NEXT SLIDE. 2668 01:41:55,486 --> 01:41:57,722 WHAT ARE SOME EXAMPLES IN 2669 01:41:57,722 --> 01:41:59,257 SLEEP, TRYING TO ADDRESS SOME 2670 01:41:59,257 --> 01:42:01,859 OF THESE FACTORS. THE NEXT FEW 2671 01:42:01,859 --> 01:42:04,962 EXAMPLES WE WILL FOCUS MORON 2672 01:42:04,962 --> 01:42:05,730 BEHAVIORAL SLEEP MEDICINE 2673 01:42:05,730 --> 01:42:08,099 TECHNIQUES AND THEN LATER IN 2674 01:42:08,099 --> 01:42:10,501 THE TALK ABOUT SLEEP APNEA 2675 01:42:10,501 --> 01:42:13,237 WHICH IS ALSO HIGHLY RELEVANT 2676 01:42:13,237 --> 01:42:14,572 TO THIS PATIENT POPULATION. 2677 01:42:14,572 --> 01:42:16,274 BECAUSE WE ARE A NASCENT FIELD 2678 01:42:16,274 --> 01:42:19,310 WE HE DON'T HAVE A LOT OF 2679 01:42:19,310 --> 01:42:20,778 IMPLEMENTATION STUDIES TO TALK 2680 01:42:20,778 --> 01:42:20,978 ABOUT. 2681 01:42:20,978 --> 01:42:23,781 BUT HOW WE CAN LEVERAGE 2682 01:42:23,781 --> 01:42:25,883 IMPLEMENTATION SCIENCE ACROSS 2683 01:42:25,883 --> 01:42:27,618 THE TRANSLATIONAL CONTINUUM. 2684 01:42:27,618 --> 01:42:29,820 NEXT SLIDE, PLEASE. 2685 01:42:29,820 --> 01:42:32,156 SO IN THINKING ABOUT EACH OF 2686 01:42:32,156 --> 01:42:33,658 THE STAGES I'LL PRESENT WE WILL 2687 01:42:33,658 --> 01:42:35,426 TALK ABOUT HOW THEY USE 2688 01:42:35,426 --> 01:42:38,596 DIFFERENT CORE ELEMENTS OF 2689 01:42:38,596 --> 01:42:40,264 IMPLEMENTATION SCIENCE, 2690 01:42:40,264 --> 01:42:40,965 DIFFERENT THEORIES, MODELS, 2691 01:42:40,965 --> 01:42:43,167 FRAMEWORKS, STAKE HARRIS 2692 01:42:43,167 --> 01:42:44,235 FIELDER COLLABORATOR 2693 01:42:44,235 --> 01:42:44,902 ENGAGEMENT, INTERVENTION 2694 01:42:44,902 --> 01:42:46,871 SELECTION EVALUATION TOOLS AND 2695 01:42:46,871 --> 01:42:47,605 IMPLEMENTATION STRATEGIES. 2696 01:42:47,605 --> 01:42:50,508 NEXT SLIDE, POLARIZE. 2697 01:42:50,508 --> 01:42:51,442 -- PLEASE. 2698 01:42:51,442 --> 01:42:57,715 I WOULD LIKE TO USE THE 2699 01:42:57,715 --> 01:42:59,517 LANE-FALL ET AL. BMC MEDICAL 2700 01:42:59,517 --> 01:43:05,890 RESEARCH. 2701 01:43:05,890 --> 01:43:07,291 ARE THERE PATHWAYS, THE FIRST 2702 01:43:07,291 --> 01:43:09,427 QUESTION IS DO WE HAVE AN 2703 01:43:09,427 --> 01:43:11,362 INTERVENTION THAT IS 2704 01:43:11,362 --> 01:43:11,662 EFFICACIOUS. 2705 01:43:11,662 --> 01:43:13,965 NEXT SLIDE, PLEASE. 2706 01:43:13,965 --> 01:43:19,537 SO HERE IS AN EXAMPLE OF HOW 2707 01:43:19,537 --> 01:43:20,771 BEHAVIORAL SLEEP MEDICINE 2708 01:43:20,771 --> 01:43:23,074 RESEARCHER ACTUALLY WORKING IN 2709 01:43:23,074 --> 01:43:25,376 HEALTHCARE DISPARITIES HAS USE 2710 01:43:25,376 --> 01:43:26,811 IMPLEMENTATION SCIENCE TO 2711 01:43:26,811 --> 01:43:29,513 IMPROVE SLEEP AGAIN, IT'S NOT 2712 01:43:29,513 --> 01:43:31,148 TAILORED FOR PREGNANT PATIENTS 2713 01:43:31,148 --> 01:43:33,217 BUT ACTUALLY FOR KIDS IN THE 2714 01:43:33,217 --> 01:43:33,451 CLINIC. 2715 01:43:33,451 --> 01:43:35,119 BUT I THINK IT'S IMPORTANT WORK 2716 01:43:35,119 --> 01:43:39,223 TO LOOK AT HOW WE CAN BE 2717 01:43:39,223 --> 01:43:41,525 THINKING ABOUT LONG-TERM 2718 01:43:41,525 --> 01:43:42,126 IMPLEMENTATION FACTORS. SO 2719 01:43:42,126 --> 01:43:44,195 WILLIAMSON WHEN SHE WAS AT 2720 01:43:44,195 --> 01:43:45,129 UNIVERSITY OF PENNSYLVANIA 2721 01:43:45,129 --> 01:43:49,200 WANTED TO DEVELOP, FOR THE 2722 01:43:49,200 --> 01:43:50,935 PEDIATRIC HEALTH POPULATION, SO 2723 01:43:50,935 --> 01:43:59,010 WHEN KIDS WERE BROUGHT INTO 2724 01:43:59,010 --> 01:44:02,580 PEDIATRICIANS FOR ROUTINE 2725 01:44:02,580 --> 01:44:10,354 CHILDHOOD CARE BEHAVIORAL SLEEP 2726 01:44:10,354 --> 01:44:11,756 STRATEGY, SHE THOUGHT ABOUT 2727 01:44:11,756 --> 01:44:14,091 WHAT CAN ACTUALLY THESE 2728 01:44:14,091 --> 01:44:15,793 PATIENTS IN THESE CONTEXTS DO, 2729 01:44:15,793 --> 01:44:19,563 AND HOW DO WE ACTUALLY 2730 01:44:19,563 --> 01:44:21,832 IMPLEMENT, HELP THEM NOT ONLY 2731 01:44:21,832 --> 01:44:23,234 IMPLEMENT IT PERSONALLY BUT HOW 2732 01:44:23,234 --> 01:44:24,902 ZO WE ACTUALLY HELP THE 2733 01:44:24,902 --> 01:44:26,337 PRAMEELA CARE PRACTICES WHERE 2734 01:44:26,337 --> 01:44:29,440 THEY WERE RECEIVING CARE TO 2735 01:44:29,440 --> 01:44:31,575 IMPLEMENT THIS BEHAVIORAL 2736 01:44:31,575 --> 01:44:31,909 INTERVENTION. 2737 01:44:31,909 --> 01:44:33,277 SHE REALLY USE IMPLEMENTATION 2738 01:44:33,277 --> 01:44:36,714 SCIENCE FRAMEWORKS TO HELP HER 2739 01:44:36,714 --> 01:44:37,815 KEEP THE FUTURE IMPLEMENTATION 2740 01:44:37,815 --> 01:44:40,985 OF IT IN MIND. 2741 01:44:40,985 --> 01:44:43,487 THROUGHOUT HER PROCESS ENGAGED 2742 01:44:43,487 --> 01:44:44,121 PRIMARY CARE DLINITIONS, 2743 01:44:44,121 --> 01:44:46,424 PARENTS, SHE HAD A NAMLY 2744 01:44:46,424 --> 01:44:48,859 ADVISORY BEARD TO DEVELOP THE 2745 01:44:48,859 --> 01:44:50,461 INTERVENTION AND ITERATIVE 2746 01:44:50,461 --> 01:44:51,662 CHANGES OF HER INTERVENTION. 2747 01:44:51,662 --> 01:44:52,897 NEXT SLIDE, PLEASE. 2748 01:44:52,897 --> 01:44:56,167 SHE IS MOVING DOWN THE PIPELINE 2749 01:44:56,167 --> 01:45:00,604 IN TERMS OF EARLY FEASIBILITY, 2750 01:45:00,604 --> 01:45:01,572 ADAPTATION STUDIES, RANDOMIZE 2751 01:45:01,572 --> 01:45:03,574 CONTROL STUDIES SO WHEN SHE IS 2752 01:45:03,574 --> 01:45:05,443 FURTHER DOWN THE TRANSLATIONAL 2753 01:45:05,443 --> 01:45:06,610 SPECTRUM THIS INTERVENTION IS 2754 01:45:06,610 --> 01:45:08,379 GOING TO BE EASIER TO IMPLEMENT. 2755 01:45:08,379 --> 01:45:09,814 NEXT SLIDE. 2756 01:45:09,814 --> 01:45:11,949 AS WE THINK OF TRANSLATIONAL 2757 01:45:11,949 --> 01:45:16,854 SPECTRUM WE ARE THINKING ABOUT 2758 01:45:16,854 --> 01:45:19,390 ETHIC STUDIES. 2759 01:45:19,390 --> 01:45:20,257 IMPLEMENTATION RESEARCH IS HOW 2760 01:45:20,257 --> 01:45:22,026 DO WE MAKE IT WORK. 2761 01:45:22,026 --> 01:45:24,628 THERE'S A FEW EXAMPLES IN SLEEP 2762 01:45:24,628 --> 01:45:25,663 LITERATURE ABOUT HYBRID DESIGNS. 2763 01:45:25,663 --> 01:45:27,565 NEXT SLIDE, PLEASE. 2764 01:45:27,565 --> 01:45:33,304 I WILL TALK BRIEFLY ABOUT 2765 01:45:33,304 --> 01:45:34,905 CURRENTLY-FUNDED NHLBI TRIAL, 2766 01:45:34,905 --> 01:45:38,175 HYBRID TYPE ONE EFFECTIVENESS 2767 01:45:38,175 --> 01:45:39,677 IMPLEMENTATION TRIAL EVALUATING 2768 01:45:39,677 --> 01:45:43,681 BEHAVIORAL TREATMENTS FOR 2769 01:45:43,681 --> 01:45:44,615 INSOMNIA AMONGST SOCIETIES 2770 01:45:44,615 --> 01:45:45,249 DISADVANTAGED ADULTS IN PRIMARY 2771 01:45:45,249 --> 01:45:47,685 CARE. 2772 01:45:47,685 --> 01:45:49,854 STELLA STUDY. 2773 01:45:49,854 --> 01:45:52,723 WE ARE COMPARING EFFECTIVENESS 2774 01:45:52,723 --> 01:45:56,127 OF THED NON-INFERIORITY OF 2775 01:45:56,127 --> 01:45:58,763 TELEHEALTH, IT'S A SHORTER 2776 01:45:58,763 --> 01:46:00,431 PROGRAM THAN CBTI THAT COULD BE 2777 01:46:00,431 --> 01:46:03,467 DELIVERED BY A RANGE OF 2778 01:46:03,467 --> 01:46:09,874 HEALTHCARE CLINICIANS TO MORE 2779 01:46:09,874 --> 01:46:11,242 TRADITIONAL TELEPHONE DELIVERED 2780 01:46:11,242 --> 01:46:13,444 CBTI, CHOICES ARE TELEPHONE TOO 2781 01:46:13,444 --> 01:46:18,716 IMPROVE ACCESS ON SHORT-TERM 2782 01:46:18,716 --> 01:46:20,618 INSOMNIA, TO SOCIO 2783 01:46:20,618 --> 01:46:22,019 DISADVANTAGED ADULTS WITH 2784 01:46:22,019 --> 01:46:23,320 INSOMNIA SPECIFICALLY IN THE 2785 01:46:23,320 --> 01:46:23,954 PRIMARY CARE SETTING. 2786 01:46:23,954 --> 01:46:28,159 NEXT SLIDE. 2787 01:46:28,159 --> 01:46:32,363 EVALUATE THE BARRIERS, IF WE 2788 01:46:32,363 --> 01:46:33,531 FIND BBTI IS NON-INFERIOR HOW 2789 01:46:33,531 --> 01:46:35,399 DO WE FIGURE OUT HOW TO 2790 01:46:35,399 --> 01:46:36,434 IMPLEMENT IT IN THE PRIMARY 2791 01:46:36,434 --> 01:46:38,502 CARE SETTING. 2792 01:46:38,502 --> 01:46:39,703 THAT SETTING WAS CHOSEN BECAUSE 2793 01:46:39,703 --> 01:46:45,676 THAT'S WHERE SOME OF THE 2794 01:46:45,676 --> 01:46:46,644 COMMUNITY HEALTH CENTERS, AND 2795 01:46:46,644 --> 01:46:48,479 PRIMARY CARE THERE'S A LOT OF 2796 01:46:48,479 --> 01:46:50,781 TRUST WITH OUR PATIENT 2797 01:46:50,781 --> 01:46:53,050 POPULATION WITH THEIR 2798 01:46:53,050 --> 01:46:55,953 PROVIDERS. WE'RE LEVERAGING 2799 01:46:55,953 --> 01:46:58,122 SOME IMPLEMENTATION SCIENCE 2800 01:46:58,122 --> 01:46:59,990 FRAMEWORKS USING STAKEHOLDER 2801 01:46:59,990 --> 01:47:02,193 AND COLLABORATIVE ENGAGEMENT TO 2802 01:47:02,193 --> 01:47:03,327 REALLY CONDUCT INTERVIEWS AND 2803 01:47:03,327 --> 01:47:05,262 SURVEYS TO BETTER UNDERSTAND 2804 01:47:05,262 --> 01:47:07,665 HOW WE CAN EMBED THESE 2805 01:47:07,665 --> 01:47:08,766 TREATMENTS IN CLINICAL SETTING. 2806 01:47:08,766 --> 01:47:09,900 NEXT SLIDE, PLEASE. 2807 01:47:09,900 --> 01:47:13,270 THIS IS JUST AN EXAMPLE HOW WE 2808 01:47:13,270 --> 01:47:16,440 MAPPED OUT THIS IMPLEMENTATION 2809 01:47:16,440 --> 01:47:18,075 ASSESSMENT FOR USE IN OUR 2810 01:47:18,075 --> 01:47:24,615 FRAMEWORKS. NEXT SLIDE, PLEASE. 2811 01:47:24,615 --> 01:47:26,383 HYBRID EFFECTIVENESS STUDY, 2812 01:47:26,383 --> 01:47:29,053 CBTI AND BBTI ARE EFFICACIOUS. 2813 01:47:29,053 --> 01:47:31,121 MOVING WITH THE SUBWAY MAP OF 2814 01:47:31,121 --> 01:47:32,890 IMPLEMENTATION AND GETTING INTO 2815 01:47:32,890 --> 01:47:34,425 IMPLEMENTATION RESEARCH WHICH 2816 01:47:34,425 --> 01:47:38,562 IS REALLY ULTIMATELY TESTING 2817 01:47:38,562 --> 01:47:39,096 IMPLEMENTATION STRATEGIES. 2818 01:47:39,096 --> 01:47:39,897 SOME EXAMPLES IN SLEEP, THE 2819 01:47:39,897 --> 01:47:41,232 FIRST THING REALLY IS TO 2820 01:47:41,232 --> 01:47:42,500 UNDERSTAND THE CONTEXT OF 2821 01:47:42,500 --> 01:47:43,367 HEALTHCARE DELIVERY. 2822 01:47:43,367 --> 01:47:47,538 NEXT SLIDE, PLEASE. 2823 01:47:47,538 --> 01:47:54,245 SO IN FRAMEWORKS PROPOSED MODEL 2824 01:47:54,245 --> 01:47:58,883 OF FACTORS LIKELY TO INFLUENCE 2825 01:47:58,883 --> 01:48:02,520 THE ADOPTION OF SUSTAINABILITY, 2826 01:48:02,520 --> 01:48:03,621 EVIDENCE-BASED PRACTICE, TO 2827 01:48:03,621 --> 01:48:05,189 IDENTIFY FACTORS TO HELP SELECT 2828 01:48:05,189 --> 01:48:06,457 THE RIGHT STRATEGY OR 2829 01:48:06,457 --> 01:48:09,059 STRATEGIES TO USE DURING THE 2830 01:48:09,059 --> 01:48:09,560 IMPLEMENTATION PROCESS. 2831 01:48:09,560 --> 01:48:12,897 NEXT SLIDE, PLEASE. 2832 01:48:12,897 --> 01:48:14,498 THESE STRATEGIES ARE SYSTEMIC 2833 01:48:14,498 --> 01:48:17,635 PROCESSES TO ADOPT AND 2834 01:48:17,635 --> 01:48:18,202 INTEGRATE EVIDENCE-BASED 2835 01:48:18,202 --> 01:48:19,303 INNOVATIONS IN USUAL CARE. 2836 01:48:19,303 --> 01:48:20,971 SO PUTTING THAT TOGETHER WE USE 2837 01:48:20,971 --> 01:48:22,573 THE FRAMEWORKS TO FIGURE OUT 2838 01:48:22,573 --> 01:48:24,475 WHAT -- NEXT SLIDE, PLEASE. 2839 01:48:24,475 --> 01:48:26,176 WE USE THE FRAMEWORKS TO 2840 01:48:26,176 --> 01:48:28,245 IDENTIFY THE FACTORS THAT WILL 2841 01:48:28,245 --> 01:48:32,349 HELP US CHOOSE THESE STRATEGIES 2842 01:48:32,349 --> 01:48:34,018 WHICH ARE REALLY HOW, YOU KNOW, 2843 01:48:34,018 --> 01:48:35,486 HOW TO GET PEOPLE TO DO THE 2844 01:48:35,486 --> 01:48:36,287 THING. 2845 01:48:36,287 --> 01:48:39,089 AND THERE'S DIFFERENT WAYS TO 2846 01:48:39,089 --> 01:48:39,690 CATEGORIZE AS MOST PROBABLY 2847 01:48:39,690 --> 01:48:42,793 KNOW. 2848 01:48:42,793 --> 01:48:43,627 PLANNING, EDUCATIONAL, 2849 01:48:43,627 --> 01:48:44,495 FINANCIAL, RESTRUCTURING, 2850 01:48:44,495 --> 01:48:46,297 QUALITY MANAGEMENT STRATEGIES 2851 01:48:46,297 --> 01:48:48,365 AND IDEALLY CHOOSING MORE THAN 2852 01:48:48,365 --> 01:48:49,800 ONE STRATEGY TO IDENTIFY THAT. 2853 01:48:49,800 --> 01:48:53,470 I THINK A NICE EXAMPLE OF THIS, 2854 01:48:53,470 --> 01:48:54,672 NEXT SLIDE, PLEASE. 2855 01:48:54,672 --> 01:48:58,275 IS IN THE SLEEP APNEA, WHICH IS 2856 01:48:58,275 --> 01:49:00,477 RELEVANT TO THIS POPULATION. 2857 01:49:00,477 --> 01:49:02,079 CURRENT GUIDELINES RECOMMEND 2858 01:49:02,079 --> 01:49:05,316 DIAGNOSE KNOWING AND TREATING 2859 01:49:05,316 --> 01:49:06,684 OSA IN PATIENTS WITH STROKE. 2860 01:49:06,684 --> 01:49:08,285 NEXT SLIDE, PLEASE. 2861 01:49:08,285 --> 01:49:10,321 LOOKING AT THE V.A. POPULATION, 2862 01:49:10,321 --> 01:49:11,922 EVEN WITH THE GUIDELINES THERE 2863 01:49:11,922 --> 01:49:15,326 WAS STILL A LOW RATE OF SLEEP 2864 01:49:15,326 --> 01:49:17,628 STUDY TESTING WITH PATIENTS 2865 01:49:17,628 --> 01:49:17,928 WITH STROKE. 2866 01:49:17,928 --> 01:49:20,931 THIS IS SIMILAR TO PATIENTS 2867 01:49:20,931 --> 01:49:22,900 WITH PREGNANCY AND THINK ABOUT 2868 01:49:22,900 --> 01:49:24,368 THE SHORTENED TIMEFRAME. 2869 01:49:24,368 --> 01:49:25,869 NEXT SLIDE, PLEASE. 2870 01:49:25,869 --> 01:49:30,407 THEY HAVE BEEN FUNDED TO DO A 2871 01:49:30,407 --> 01:49:32,943 STUDY, A RANDOMIZED STUDY, 2872 01:49:32,943 --> 01:49:35,279 CLUSTER DESIGN ACROSS VARIOUS 2873 01:49:35,279 --> 01:49:37,881 VA MEDICAL CENTERS TO EVALUATE 2874 01:49:37,881 --> 01:49:40,484 THE EFFECTIVENESS AND 2875 01:49:40,484 --> 01:49:41,719 SUSTAINABILITY OF DIFFERENT 2876 01:49:41,719 --> 01:49:42,720 IMPLEMENTATION STRATEGIES TO 2877 01:49:42,720 --> 01:49:43,621 IMPROVE DIAGNOSIS AND 2878 01:49:43,621 --> 01:49:45,189 MANAGEMENT OF SLEEP APNEA. 2879 01:49:45,189 --> 01:49:47,057 NEXT SLIDE, PLEASE. 2880 01:49:47,057 --> 01:49:52,796 THEY ARE USING THESE SYSTEMS 2881 01:49:52,796 --> 01:49:54,531 REDESIGNS, VIRTUAL 2882 01:49:54,531 --> 01:49:55,633 COLLABORATIVE DATA MONITORING 2883 01:49:55,633 --> 01:49:57,267 AND HOW TO GET PEOPLE TO DO 2884 01:49:57,267 --> 01:49:58,302 THIS THING. 2885 01:49:58,302 --> 01:50:01,038 THIS IS THE LIST OF STRATEGIES, 2886 01:50:01,038 --> 01:50:01,338 NEXT SLIDE. 2887 01:50:01,338 --> 01:50:05,309 THEY ARE LOOKING AT FACILITY 2888 01:50:05,309 --> 01:50:07,044 DIAGNOSTIC RATES FOR CURRENT 2889 01:50:07,044 --> 01:50:10,948 VASCULAR EVENTS, NEXT SLIDE. 2890 01:50:10,948 --> 01:50:11,649 TREATMENT RATES, 90 DAY 2891 01:50:11,649 --> 01:50:12,149 MORTALITY. 2892 01:50:12,149 --> 01:50:13,817 NEXT SLIDE. 2893 01:50:13,817 --> 01:50:22,459 THIS IS OTHER EXAMPLES. AND 2894 01:50:22,459 --> 01:50:23,360 JESSICA LEVINSON THAT'S 2895 01:50:23,360 --> 01:50:25,129 INTERVENTION DEVELOPMENT. 2896 01:50:25,129 --> 01:50:27,898 SHE WORKS IN BOTH SLEEP HEALTH 2897 01:50:27,898 --> 01:50:29,566 AND JUVENILE JUSTICE AND THEN 2898 01:50:29,566 --> 01:50:31,268 MOVING MUCH LATER DOWN THE 2899 01:50:31,268 --> 01:50:34,138 PIPELINE IN LATER STAGE MOST OF 2900 01:50:34,138 --> 01:50:36,240 THE WORK IN SLEEP, A LOT OF 2901 01:50:36,240 --> 01:50:37,508 FOCUS IN THE VA SETEDING. 2902 01:50:37,508 --> 01:50:38,842 NEXT SLIDE. 2903 01:50:38,842 --> 01:50:40,044 WHAT ARE FUTURE GAPS? 2904 01:50:40,044 --> 01:50:43,180 NEXT SLIDE, PLEASE. 2905 01:50:43,180 --> 01:50:45,783 NEXT SLIDE, PLEASE. 2906 01:50:45,783 --> 01:50:49,453 FIGURING OUT HOW TO USE, 2907 01:50:49,453 --> 01:50:50,654 LEVERAGE IMPLEMENTATION SCIENCE 2908 01:50:50,654 --> 01:50:52,856 CORE PRINCIPLES IN THE WORK TO 2909 01:50:52,856 --> 01:50:53,257 ANSWER QUESTIONS. 2910 01:50:53,257 --> 01:50:58,295 GO TO THE NEXT SLIDE, PLEASE. 2911 01:50:58,295 --> 01:50:59,463 DETERMINE WHERE SLEEP 2912 01:50:59,463 --> 01:51:01,799 INTERVENTION STUDIES FALL ALONG 2913 01:51:01,799 --> 01:51:04,001 THE CLINICAL TRANSLATIONAL 2914 01:51:04,001 --> 01:51:06,270 RESEARCH CONTINUUM AND DESCRIBE 2915 01:51:06,270 --> 01:51:07,471 HOW IMPLEMENTATION SCIENCE 2916 01:51:07,471 --> 01:51:10,240 FRAMEWORKS CAN ADDRESS CURRENT 2917 01:51:10,240 --> 01:51:12,543 RESEARCH TO PRACTICE GAPS, TO 2918 01:51:12,543 --> 01:51:13,844 IMPROVE MATERNAL HEALTH. 2919 01:51:13,844 --> 01:51:15,779 NEXT SLIDE, PLEASE. 2920 01:51:15,779 --> 01:51:17,414 IDENTIFY PRACTICAL STRATEGIES 2921 01:51:17,414 --> 01:51:19,083 TO BROADEN PERSPECTIVES AND 2922 01:51:19,083 --> 01:51:20,484 THAT INFORM SLEEP INTERVENTION 2923 01:51:20,484 --> 01:51:22,953 RESEARCH TO IMPROVE MATERNAL 2924 01:51:22,953 --> 01:51:23,187 HEALTH. 2925 01:51:23,187 --> 01:51:27,858 NEXT BULLET, PLEASE. 2926 01:51:27,858 --> 01:51:31,195 REFLECT HOW SLEEP INTERVENTION 2927 01:51:31,195 --> 01:51:34,331 PROTOCOLS AND PROGRAMS, IN THE 2928 01:51:34,331 --> 01:51:36,867 POST PARTUM PERIOD, HOW THEY 2929 01:51:36,867 --> 01:51:37,968 CAN DETERMINE SOCIAL 2930 01:51:37,968 --> 01:51:39,870 DETERMINANTS OF HEALTH AND 2931 01:51:39,870 --> 01:51:40,871 STRUCTURAL RACISM BECAUSE 2932 01:51:40,871 --> 01:51:42,172 THAT'S RELATED TO EVERYTHING WE 2933 01:51:42,172 --> 01:51:44,541 HAVE TALKED ABOUT TODAY. 2934 01:51:44,541 --> 01:51:45,843 SOME ADDITIONAL RESOURCES 2935 01:51:45,843 --> 01:51:46,710 THAT'S BEEN PUBLISHED. 2936 01:51:46,710 --> 01:51:48,178 NEXT SLIDE. 2937 01:51:48,178 --> 01:51:49,580 I THINK IT'S IMPORTANT TO KEEP 2938 01:51:49,580 --> 01:51:52,216 IN MIND, IF YOU DON'T KNOW 2939 01:51:52,216 --> 01:51:54,218 WHERE YOU ARE GOING, GO TO THE 2940 01:51:54,218 --> 01:51:55,452 NEXT SLIDE, I MENTIONED THESE 2941 01:51:55,452 --> 01:51:57,087 ALREADY. 2942 01:51:57,087 --> 01:51:59,590 YOU MIGHT WIND UP SOMEPLACE 2943 01:51:59,590 --> 01:52:03,427 ELSE. 2944 01:52:03,427 --> 01:52:04,595 THANK YOU. 2945 01:52:04,595 --> 01:52:06,296 I THINK IT'S IMPORTANT TO KEEP 2946 01:52:06,296 --> 01:52:13,437 IN MIND, EVEN THOUGH IN THIS 2947 01:52:13,437 --> 01:52:15,372 IS NASCENT AREA FOR DEVELOPING 2948 01:52:15,372 --> 01:52:20,744 SLEEP INTERVENTIONS FOR 2949 01:52:20,744 --> 01:52:22,679 MATERNAL HEALTH, IT'S IMPORTANT 2950 01:52:22,679 --> 01:52:26,650 TO THINK ABOUT WHERE YOU ARE IN 2951 01:52:26,650 --> 01:52:28,485 THE CONTINUUM OF HEALTH, EF A 2952 01:52:28,485 --> 01:52:31,021 CA SY STUDIES TO GET IN THE 2953 01:52:31,021 --> 01:52:33,090 PIPELINE SOONER HAD YOU NOT 2954 01:52:33,090 --> 01:52:35,492 CONSIDERED THE FRAMEWORK AND 2955 01:52:35,492 --> 01:52:36,226 TOOLS THAT IMPLEMENTATION 2956 01:52:36,226 --> 01:52:37,828 SCIENCE GIVES US. 2957 01:52:37,828 --> 01:52:38,629 THANKS SO MUCH. 2958 01:52:38,629 --> 01:52:39,530 I LOOK FORWARD TO THE 2959 01:52:39,530 --> 01:52:49,540 DISCUSSION. 2960 01:52:49,540 --> 01:52:51,975 >> SHILPY DIXIT: THANK YOU SO 2961 01:52:51,975 --> 01:52:53,677 MUCH, THAT WAS REALLY VALUABLE 2962 01:52:53,677 --> 01:52:55,913 INFORMATION AND I THINK 2963 01:52:55,913 --> 01:52:56,713 CONTEXTUALIZATIONS THE ROLE 2964 01:52:56,713 --> 01:52:59,082 THAT SLEEP HEALTH AND CIRCADIAN 2965 01:52:59,082 --> 01:53:01,485 HEALTH PLAYS, I KNOW I GLIEFPED 2966 01:53:01,485 --> 01:53:04,188 OUT THERE, BUT THEN THE ROLE 2967 01:53:04,188 --> 01:53:06,990 THAT SLEEP HEALTH AND CIRCADIAN 2968 01:53:06,990 --> 01:53:10,527 HEALTH PLAYS A GLOBAL MATERNAL 2969 01:53:10,527 --> 01:53:12,095 HEALTH BUT DOMESTICALLY AND 2970 01:53:12,095 --> 01:53:14,865 WAYS IN WHICH SLEEP HEALTH, 2971 01:53:14,865 --> 01:53:16,433 SLEEP IMPLEMENTATION HEALTH CAN 2972 01:53:16,433 --> 01:53:18,635 BE USED TO PROMOTE SLEEP HEALTH 2973 01:53:18,635 --> 01:53:19,903 AND MATERNAL HEALTH. 2974 01:53:19,903 --> 01:53:22,039 ONE THING I WANT TO TOUCH ON 2975 01:53:22,039 --> 01:53:23,340 BEFORE WE GET INTO ANY 2976 01:53:23,340 --> 01:53:25,475 QUESTIONS, ALL OF YOU TALKED 2977 01:53:25,475 --> 01:53:28,645 ABOUT SLEEP HEALTH DISPARITY OR 2978 01:53:28,645 --> 01:53:31,215 HEALTH DISPARITIES WITHIN THE 2979 01:53:31,215 --> 01:53:32,349 MATERNAL HEALTH POPULATION, 2980 01:53:32,349 --> 01:53:35,586 WITHIN THE SLEEP HEALTH 2981 01:53:35,586 --> 01:53:37,187 POPULATIONS OR SLEEP 2982 01:53:37,187 --> 01:53:37,888 DISPARITIES OR SLEEP DISORDERS 2983 01:53:37,888 --> 01:53:39,289 POPULATION. 2984 01:53:39,289 --> 01:53:41,525 I KNOW THAT SLEEP HEALTH 2985 01:53:41,525 --> 01:53:43,560 DISPARITIES IS A RESEARCH 2986 01:53:43,560 --> 01:53:44,228 PRIORITY ACROSS NONSINGER IH AS 2987 01:53:44,228 --> 01:53:46,196 WELL. 2988 01:53:46,196 --> 01:53:48,665 SLEEP HEALTH HAS BECOME A 2989 01:53:48,665 --> 01:53:50,000 HEALTH EQUITY ISSUE, WOULD LIKE 2990 01:53:50,000 --> 01:53:53,937 TO HIGHLIGHT ONE OF THE FINAL 2991 01:53:53,937 --> 01:53:55,172 POINTS THAT DR. ENGLAND SPOKE 2992 01:53:55,172 --> 01:54:00,510 ABOUT WITH REGARD TO HER DATA, 2993 01:54:00,510 --> 01:54:03,347 VARIABILITY IN SLEEP SCHEDULES 2994 01:54:03,347 --> 01:54:05,182 AND LIGHT EXPOSURE. 2995 01:54:05,182 --> 01:54:08,218 ROUGHLY 30% OF AMERICANS ARE 2996 01:54:08,218 --> 01:54:09,519 CONSIDERED SHIFT WORKERS. THOSE 2997 01:54:09,519 --> 01:54:12,522 SHIFT WORK IS MORE COMMON IN 2998 01:54:12,522 --> 01:54:14,458 RACIAL AND ETHNIC MINORITIES. 2999 01:54:14,458 --> 01:54:17,494 AS WE LOOK AT POLICIES AND 3000 01:54:17,494 --> 01:54:19,129 PRACTICES AROUND MATERNAL 3001 01:54:19,129 --> 01:54:22,833 HEALTH AND PROTECTIONS, IS THIS 3002 01:54:22,833 --> 01:54:26,904 SOMETHING THAT SHOULD BE 3003 01:54:26,904 --> 01:54:28,739 CONSIDERED AS ANOTHER 3004 01:54:28,739 --> 01:54:29,306 PROTECTION AROUND PREGNANCY. 3005 01:54:29,306 --> 01:54:30,941 I KNOW THIS IS MAYBE A LITTLE 3006 01:54:30,941 --> 01:54:34,444 TOO DEEP OR A LITTLE BEYOND 3007 01:54:34,444 --> 01:54:36,380 THE SCOPE OF THIS TALK. 3008 01:54:36,380 --> 01:54:39,449 BUT IT DID OCCUR TO ME THAT 3009 01:54:39,449 --> 01:54:40,417 DURING THIS CONVERSATION, IS 3010 01:54:40,417 --> 01:54:41,952 THIS A RISK? 3011 01:54:41,952 --> 01:54:47,357 IS SHIFT WORK BECOMING A RISK 3012 01:54:47,357 --> 01:54:52,663 FOR THIS POPULATION? 3013 01:54:52,663 --> 01:54:57,167 FOR PREGNANT PEOPLE? 3014 01:54:57,167 --> 01:55:05,475 >> SARA H ENGLAND: WE HAVE 3015 01:55:05,475 --> 01:55:08,211 TALKED A LOT ABOUT THIS IN OUR 3016 01:55:08,211 --> 01:55:09,913 GROUP, IS SHIFT WORK, THE 3017 01:55:09,913 --> 01:55:12,349 OUTCOMES ARE GOING TO BE WORSE. 3018 01:55:12,349 --> 01:55:15,585 LIKE FIRST, SECOND, THIRD 3019 01:55:15,585 --> 01:55:18,288 TRIMESTER. 3020 01:55:18,288 --> 01:55:19,089 WE HAVEN'T GOTTEN THERE. 3021 01:55:19,089 --> 01:55:20,457 MAYBE SOME OF THE OTHER 3022 01:55:20,457 --> 01:55:21,625 SPEAKERS WILL KNOW. 3023 01:55:21,625 --> 01:55:24,061 BUT AT LEAST IN OUR DATA, WE 3024 01:55:24,061 --> 01:55:26,964 HAVE NOT BEEN ABLE TO PULL THAT 3025 01:55:26,964 --> 01:55:27,130 OUT. 3026 01:55:27,130 --> 01:55:28,665 HOWEVER, THE ONE THING WE DID 3027 01:55:28,665 --> 01:55:30,267 FIND FROM OUR POPULATION WAS 3028 01:55:30,267 --> 01:55:32,169 THAT THE SLEEP HEALTH THEY WENT 3029 01:55:32,169 --> 01:55:35,005 INTO THEIR PREGNANCY WITH, IS 3030 01:55:35,005 --> 01:55:36,139 BASICALLY THEIR SLEEP HEALTH 3031 01:55:36,139 --> 01:55:37,808 DURING THEIR PREGNANCY. 3032 01:55:37,808 --> 01:55:44,614 FOR THOSE WHERE YOU GET THEM 3033 01:55:44,614 --> 01:55:45,882 PRECONCEPTUALLY, THEY DIDN'T 3034 01:55:45,882 --> 01:55:46,883 REALLY CHANGE THEIR HABITS, DO 3035 01:55:46,883 --> 01:55:50,988 WE NEED TO DO MORE 3036 01:55:50,988 --> 01:55:51,788 PRECONCEPTUAL COUNSELING OF 3037 01:55:51,788 --> 01:55:54,024 PEOPLE WHO ARE PLANNING THEIR 3038 01:55:54,024 --> 01:55:56,026 PREGNANCIES AND NOT JUST FOCUS 3039 01:55:56,026 --> 01:55:57,527 WHEN THEY ARE ALREADY PREGNANT. 3040 01:55:57,527 --> 01:56:01,365 THAT IS SOMETHING THAT WE HAVE 3041 01:56:01,365 --> 01:56:01,832 HAD DISCUSSIONS WITH. 3042 01:56:01,832 --> 01:56:02,799 BUT AGAIN, WE HAD A LOT OF 3043 01:56:02,799 --> 01:56:05,736 PEOPLE WHO COME IN WHO ARE 3044 01:56:05,736 --> 01:56:07,471 ALREADY PREGNANT AND WHAT ARE 3045 01:56:07,471 --> 01:56:09,306 YOU, AT THAT POINT, WHAT ARE 3046 01:56:09,306 --> 01:56:11,341 THE STRATEGIES THAT WE SHOULD 3047 01:56:11,341 --> 01:56:11,541 TAKE. 3048 01:56:11,541 --> 01:56:16,146 SO I WOULD LOVE TO HEAR THE 3049 01:56:16,146 --> 01:56:17,547 OTHER PANELISTS' OPINIONS ON 3050 01:56:17,547 --> 01:56:21,385 THAT. 3051 01:56:21,385 --> 01:56:23,954 >> GHADA BOURJEILY: IN OUR 3052 01:56:23,954 --> 01:56:25,188 STUDIES WE HAVE SHIFT WORK WHEN 3053 01:56:25,188 --> 01:56:29,393 WE ARE LOOKING FOR A SPECIFIC 3054 01:56:29,393 --> 01:56:31,194 DISORDER FOR THAT REASON, WE 3055 01:56:31,194 --> 01:56:39,369 THINK IT MAY ACTUALLY IMPACT OR 3056 01:56:39,369 --> 01:56:40,771 CONFOUND THE FINDINGS. I CAN'T 3057 01:56:40,771 --> 01:56:42,572 REMEMBER HOW MANY YEARS AGO BUT 3058 01:56:42,572 --> 01:56:45,909 AT LEAST A DECADE AGO I WOULD 3059 01:56:45,909 --> 01:56:48,578 SAY FEMALE RESIDENTS BEING 3060 01:56:48,578 --> 01:56:50,580 HIGHER RISK FOR COMPLICATIONS, 3061 01:56:50,580 --> 01:56:53,517 FEMALE RESIDENTS SO THEY ARE 3062 01:56:53,517 --> 01:56:55,385 MEDICAL RESIDENTS OR SURGICAL. 3063 01:56:55,385 --> 01:56:56,086 THEIR HOURS ARE CHANGING ALL 3064 01:56:56,086 --> 01:56:57,687 THE TIME AND THEY DON'T HAVE 3065 01:56:57,687 --> 01:56:58,889 TIME TO ADJUST TO THE SHIFT 3066 01:56:58,889 --> 01:57:02,025 WORK AT ALL AND THEY HAVE WORSE 3067 01:57:02,025 --> 01:57:05,028 OUTCOMES THAN, YOU KNOW, THE 3068 01:57:05,028 --> 01:57:05,729 NON-FEMALE RESIDENTS FOR 3069 01:57:05,729 --> 01:57:07,064 INSTANCE. 3070 01:57:07,064 --> 01:57:09,433 OR THE WIVES OF THE MALE 3071 01:57:09,433 --> 01:57:12,502 RESIDENTS I THINK IS WHAT THE 3072 01:57:12,502 --> 01:57:13,703 STUDIES LOOK AT. 3073 01:57:13,703 --> 01:57:15,405 BUT I DON'T THINK WE HAVE 3074 01:57:15,405 --> 01:57:16,840 SPECIFIC STUDY THAT'S HAVE 3075 01:57:16,840 --> 01:57:18,141 LOOKED AT SHIFT WORK, 3076 01:57:18,141 --> 01:57:19,876 SPECIFICALLY TO SEE WHAT IT IS. 3077 01:57:19,876 --> 01:57:22,345 BUT WE KNOW WHAT THE OUTCOMES 3078 01:57:22,345 --> 01:57:24,281 LOOK LIKE OUTSIDE OF PREGNANCY 3079 01:57:24,281 --> 01:57:27,784 IN TERMS OF CARDIOVASCULAR 3080 01:57:27,784 --> 01:57:28,952 HEALTH AND METABOLIC HEALTH, ET 3081 01:57:28,952 --> 01:57:30,954 CETERA, I ASSUME IT WOULD BE 3082 01:57:30,954 --> 01:57:32,722 SIMILAR IN THIS POPULATION BUT 3083 01:57:32,722 --> 01:57:40,797 WE CERTAINLY NEED TO STUDY THAT. 3084 01:57:40,797 --> 01:57:42,199 >> SHILPY DIXIT: I WANT TO 3085 01:57:42,199 --> 01:57:43,366 THANK YOU FOR TALKING ABOUT 3086 01:57:43,366 --> 01:57:44,234 BARRIERS. 3087 01:57:44,234 --> 01:57:45,936 THAT WAS GOING TO BE MY NUMBER 3088 01:57:45,936 --> 01:57:48,238 ONE, WHAT ARE THE BARRIERS? 3089 01:57:48,238 --> 01:57:49,673 THANK YOU FOR ADDRESSING THOSE. 3090 01:57:49,673 --> 01:57:54,611 ONE THING I WANT TO ASK ABOUT 3091 01:57:54,611 --> 01:57:56,813 IS CULTIVATING SOME 3092 01:57:56,813 --> 01:57:57,414 PARTNERSHIPS. IMPLEMENTATION 3093 01:57:57,414 --> 01:57:59,015 SCIENCE AND ESPECIALLY BECAUSE 3094 01:57:59,015 --> 01:58:01,418 WE WANT TO FOCUS ON 3095 01:58:01,418 --> 01:58:02,119 INTERSECTIONALITY HERE BECAUSE 3096 01:58:02,119 --> 01:58:04,221 SLEEP IS NOT ONLY A BEHAVIOR 3097 01:58:04,221 --> 01:58:06,456 BUT IT'S ALSO A BIOLOGY. 3098 01:58:06,456 --> 01:58:07,757 AND MATERNAL HEALTH IS ALSO 3099 01:58:07,757 --> 01:58:09,559 SOMETHING THAT TOUCHES SO MANY 3100 01:58:09,559 --> 01:58:11,928 OTHER ASPECTS OF THE MOTHER AND 3101 01:58:11,928 --> 01:58:13,096 ALSO THE FETUS, THE BABY, THE 3102 01:58:13,096 --> 01:58:15,765 LIFE. 3103 01:58:15,765 --> 01:58:22,906 AND SO WHEN TALKING ABOUT THE 3104 01:58:22,906 --> 01:58:24,608 BARRIERS AND DR. BOURJEILY WHEN 3105 01:58:24,608 --> 01:58:27,144 TALKING ABOUT THE BARRIERS AND 3106 01:58:27,144 --> 01:58:28,011 FACILITATORS, RELATIONSHIP WITH 3107 01:58:28,011 --> 01:58:31,381 THE CLINICIAN AND HOW IT COULD 3108 01:58:31,381 --> 01:58:34,551 BUILD TRUST OR DIMINISH TRUST, 3109 01:58:34,551 --> 01:58:36,753 THE RELATIONSHIP WITH THE 3110 01:58:36,753 --> 01:58:40,891 PARTNER AND HOW CAN BUILD TRUST 3111 01:58:40,891 --> 01:58:43,460 OR DIMINISH TRUST AND HOW THE 3112 01:58:43,460 --> 01:58:45,462 PREGNANT PERSON FEELS ABOUT HER 3113 01:58:45,462 --> 01:58:47,497 OWN HEALTH AND HER BABY'S 3114 01:58:47,497 --> 01:58:47,964 HEALTH. 3115 01:58:47,964 --> 01:58:51,368 WHEN YOU ARE THINKING ABOUT, OR 3116 01:58:51,368 --> 01:58:53,937 WHEN ANY OF YOU ARE THINKING 3117 01:58:53,937 --> 01:58:56,339 ABOUT HOW TO DESIGN AND 3118 01:58:56,339 --> 01:58:57,274 IMPLEMENT THESE INTERVENTIONS 3119 01:58:57,274 --> 01:58:59,276 HOW DO PARTNERSHIPS PLAY A ROLE 3120 01:58:59,276 --> 01:59:03,513 HERE, LIKE ACROSS THE SPECTRUM? 3121 01:59:03,513 --> 01:59:04,514 >> GHADA BOURJEILY: I CAN START 3122 01:59:04,514 --> 01:59:05,515 WITH THIS. 3123 01:59:05,515 --> 01:59:07,250 I THINK THE PARTNERSHIPS IN 3124 01:59:07,250 --> 01:59:09,586 THIS CONTEXT OF SLEEP DISORDERS 3125 01:59:09,586 --> 01:59:12,489 NEED TO ALSO START BY 3126 01:59:12,489 --> 01:59:13,857 INTERDISCIPLINARY TEAMS WORKING 3127 01:59:13,857 --> 01:59:14,124 TOGETHER. 3128 01:59:14,124 --> 01:59:16,760 SO HAVING A SLEEP PERSON THAT 3129 01:59:16,760 --> 01:59:18,562 DOESN'T SEE PREGNANT WOMEN ALL 3130 01:59:18,562 --> 01:59:19,796 THAT OFTEN DEVELOP SOMETHING 3131 01:59:19,796 --> 01:59:22,232 AND NOT UNDERSTAND HOW THE 3132 01:59:22,232 --> 01:59:24,267 PRENATAL CARE WORKS, OR WHAT 3133 01:59:24,267 --> 01:59:25,535 THOSE REQUIREMENTS ARE, IT 3134 01:59:25,535 --> 01:59:29,539 DOESN'T DO IT ANY JUSTICE OR 3135 01:59:29,539 --> 01:59:33,176 HAVING AN OBSTETRIC PERSON 3136 01:59:33,176 --> 01:59:34,411 DEVELOP THESE THINGS WITHOUT 3137 01:59:34,411 --> 01:59:36,012 KNOWING THE SLEEP WORLD AS 3138 01:59:36,012 --> 01:59:37,514 WELL, DOESN'T WORK AS WELL. 3139 01:59:37,514 --> 01:59:41,017 SO WE NEED TO WORK WITHIN TEAMS 3140 01:59:41,017 --> 01:59:43,553 AND THEN AS I WAS THINKING 3141 01:59:43,553 --> 01:59:45,455 ABOUT THIS, I'M SO HAPPY YOU 3142 01:59:45,455 --> 01:59:47,524 INVITED ME TO SPEAK HERE. 3143 01:59:47,524 --> 01:59:48,692 IT FORCED ME TO SPEAK ABOUT 3144 01:59:48,692 --> 01:59:50,327 WHAT THE OPPORTUNITIES ARE. 3145 01:59:50,327 --> 01:59:52,829 I THINK THERE ARE PLACES WHERE 3146 01:59:52,829 --> 01:59:55,599 THERE ARE INTEGRATED BEHAVIORAL 3147 01:59:55,599 --> 01:59:56,666 HEALTH PRACTICES WITHIN 3148 01:59:56,666 --> 01:59:57,867 OBSTETRIC CARE. 3149 01:59:57,867 --> 01:59:59,569 WHY CAN'T WE USE SOME OF THOSE 3150 01:59:59,569 --> 02:00:03,540 TO TRY TO EMBED SOME OF THE 3151 02:00:03,540 --> 02:00:05,942 SLEEP INTERVENTIONS WITHIN THE 3152 02:00:05,942 --> 02:00:07,310 PRENATAL PRACTICE, FOR INSTANCE. 3153 02:00:07,310 --> 02:00:09,846 WE CAN TRAIN SOME OF THE NURSES 3154 02:00:09,846 --> 02:00:12,315 ON DOING SLEEP HYGIENE. 3155 02:00:12,315 --> 02:00:14,351 I KNOW PRENATAL CARE, 3156 02:00:14,351 --> 02:00:16,319 ESPECIALLY IN THE INITIAL 3157 02:00:16,319 --> 02:00:18,955 VISITS, IT'S REALLY HEAVY ON 3158 02:00:18,955 --> 02:00:21,491 PREVENTION AND ON TESTING AND 3159 02:00:21,491 --> 02:00:22,826 SCREENING AND ADDING YET 3160 02:00:22,826 --> 02:00:25,528 ANOTHER THING, THIS IS WHAT I 3161 02:00:25,528 --> 02:00:26,796 HEAR FROM MY O.B. COLLEAGUES 3162 02:00:26,796 --> 02:00:28,064 ALL THE TIME. 3163 02:00:28,064 --> 02:00:29,266 THAT ADDING ONE MORE THING FOR 3164 02:00:29,266 --> 02:00:34,838 THE TEAM TO HAVE TO DO FOR 3165 02:00:34,838 --> 02:00:36,606 EVERY INITIAL O.B. VISIT SEEMS 3166 02:00:36,606 --> 02:00:38,275 TO BE A BURDEN. 3167 02:00:38,275 --> 02:00:39,643 OUR PARTNERS NEED TO START 3168 02:00:39,643 --> 02:00:41,177 THERE WITHIN THE MEDICAL SYSTEM. 3169 02:00:41,177 --> 02:00:43,913 BUT THEN THERE ARE MANY PEOPLE 3170 02:00:43,913 --> 02:00:46,216 WHO DON'T ACCESS PRENATAL CARE, 3171 02:00:46,216 --> 02:00:47,450 11 OR 13 WEEKS. 3172 02:00:47,450 --> 02:00:48,718 AND HOW DO WE ACCESS THOSE 3173 02:00:48,718 --> 02:00:51,788 PEOPLE? 3174 02:00:51,788 --> 02:00:55,592 THIS IS WHERE OUR PARTNERSHIPS 3175 02:00:55,592 --> 02:00:57,294 WITH COMMUNITIES NEED TO WORK. 3176 02:00:57,294 --> 02:01:00,196 THERE ARE PLENTY OF COMMUNITY 3177 02:01:00,196 --> 02:01:01,865 ORGANIZATIONS THAT PARTNER WITH 3178 02:01:01,865 --> 02:01:06,436 PATIENT AND ASSIST THEM IN YOU 3179 02:01:06,436 --> 02:01:07,837 KNOW, EITHER OBTAINING FOOD, 3180 02:01:07,837 --> 02:01:09,606 FOOD STAMPS OR GIVING THEM MORE 3181 02:01:09,606 --> 02:01:16,546 ACCESS TO FOOD, OR PROVIDING 3182 02:01:16,546 --> 02:01:17,580 EDUCATION ABOUT LACTATION DOWN 3183 02:01:17,580 --> 02:01:19,282 THE LINE. 3184 02:01:19,282 --> 02:01:22,018 THERE ARE PLENTY OF LOCAL 3185 02:01:22,018 --> 02:01:22,686 ORGANIZATIONS THE PROVIDERS 3186 02:01:22,686 --> 02:01:24,487 COULD WORK WITH TO BE ABLE TO 3187 02:01:24,487 --> 02:01:27,490 REACH PEOPLE WHERE THEY ARE. 3188 02:01:27,490 --> 02:01:29,259 ANOTHER THING THAT WE TALKED 3189 02:01:29,259 --> 02:01:32,128 ABOUT IS THAT SLEEP IS NOT A 3190 02:01:32,128 --> 02:01:35,632 PRIORITY IN PRENATAL CARE YET. 3191 02:01:35,632 --> 02:01:36,566 I THINK IT'S IMPORTANT IT 3192 02:01:36,566 --> 02:01:37,467 BECOMES THAT. 3193 02:01:37,467 --> 02:01:40,170 THAT'S WHERE WE NEED TO ACCESS 3194 02:01:40,170 --> 02:01:42,005 IT WITH COMMUNITIES AND TALK 3195 02:01:42,005 --> 02:01:43,707 ABOUT WHAT SARAH HAS SHOWN 3196 02:01:43,707 --> 02:01:44,741 EARLIER, TALK ABOUT THE 3197 02:01:44,741 --> 02:01:46,343 IMPORTANCE OF THIS LACK OF 3198 02:01:46,343 --> 02:01:47,644 VARIABILITY IN SLEEP AND GOING 3199 02:01:47,644 --> 02:01:49,579 TO BED AT THE SAME TIME AND 3200 02:01:49,579 --> 02:01:51,715 WAKING UP AT THE SAME TIME, AS 3201 02:01:51,715 --> 02:01:54,818 MUCH AS THEY CAN DO THAT. 3202 02:01:54,818 --> 02:01:56,353 THERE ARE SOME INTERVENTIONS I 3203 02:01:56,353 --> 02:01:59,489 THINK ARE PRETTY EASY AND WITH 3204 02:01:59,489 --> 02:02:00,724 PARTNERING, PRETTY EASY -- 3205 02:02:00,724 --> 02:02:04,627 DON'T QUOTE ME ON THAT. 3206 02:02:04,627 --> 02:02:06,229 [ CHUCKLES ] 3207 02:02:06,229 --> 02:02:07,864 IT WILL DEMONSTRATE ITSELF THE 3208 02:02:07,864 --> 02:02:10,200 HARDEST THING TO DO, BUT THERE 3209 02:02:10,200 --> 02:02:13,002 ARE MANY OPPORTUNITIES WE CAN 3210 02:02:13,002 --> 02:02:14,437 JUMP ON THESE INSTANCES BY 3211 02:02:14,437 --> 02:02:15,038 PARTNERING WITH THE RIGHT 3212 02:02:15,038 --> 02:02:21,378 PEOPLE. 3213 02:02:21,378 --> 02:02:22,846 >> SHILPY DIXIT: ABSOLUTELY. 3214 02:02:22,846 --> 02:02:24,247 THERE ARE A FEW QUESTIONS FROM 3215 02:02:24,247 --> 02:02:26,149 THE AUDIENCE, NUMBER ONE HAVE 3216 02:02:26,149 --> 02:02:29,419 ANY OF THESE STUDIES OR 3217 02:02:29,419 --> 02:02:31,821 INTERVENTIONS BEEN CONDUCTED IN 3218 02:02:31,821 --> 02:02:33,623 LMIC OR LOWER MIDDLE INCOME 3219 02:02:33,623 --> 02:02:41,631 COUNTRIES, DO YOU KNOW OF ANY? 3220 02:02:41,631 --> 02:02:43,433 >> GHADA BOURJEILY: CPAP 3221 02:02:43,433 --> 02:02:44,868 INTERVENTION. 3222 02:02:44,868 --> 02:02:46,169 IT'S NOT AN IMPLEMENTATION 3223 02:02:46,169 --> 02:02:48,304 THING, BUT IT'S TESTING THE 3224 02:02:48,304 --> 02:02:50,840 EFFICACY OF CPAP IN IMPROVING 3225 02:02:50,840 --> 02:02:52,208 BLOOD PRESSURE MARKERS, THIS 3226 02:02:52,208 --> 02:02:54,077 WAS DONE IN THAILAND. 3227 02:02:54,077 --> 02:02:57,380 THAT I SHOWED BEFORE. 3228 02:02:57,380 --> 02:03:00,617 THERE WAS ANOTHER LOOKED AT 3229 02:03:00,617 --> 02:03:01,751 GLUCOSE METABOLISM DONE IN 3230 02:03:01,751 --> 02:03:03,720 THAILAND AS WELL. 3231 02:03:03,720 --> 02:03:06,890 NOT MANY OTHERWISE, THE CBTI 3232 02:03:06,890 --> 02:03:09,192 INTERVENTIONS THAT SHOWED 3233 02:03:09,192 --> 02:03:10,693 COUPLE MINDFULNESS, DONE IN THE 3234 02:03:10,693 --> 02:03:14,230 WIFT EARN WORLD, CANADA, U.S., 3235 02:03:14,230 --> 02:03:21,237 AUSTRALIA, EUROPE, ET CETERA. 3236 02:03:21,237 --> 02:03:24,073 >> SHILPY DIXIT: WE HAVE ONE 3237 02:03:24,073 --> 02:03:25,542 FROM NHLBI. 3238 02:03:25,542 --> 02:03:30,480 THANK YOU FOR THE EXCELLENT 3239 02:03:30,480 --> 02:03:33,216 MRENTATION, DR. BERTISCH. 3240 02:03:33,216 --> 02:03:35,585 MENTIONED BARRIERS TO ADOPTION 3241 02:03:35,585 --> 02:03:36,219 AND SUSTAINABILITY FOR 3242 02:03:36,219 --> 02:03:37,654 INTERVENTIONS CAN YOU SPEAK A 3243 02:03:37,654 --> 02:03:39,088 LITTLE BIT MORE CULTURAL 3244 02:03:39,088 --> 02:03:39,789 APPROPRIATENESS OF IPT 3245 02:03:39,789 --> 02:03:43,092 CONVENIENT SHUNS AND HOW RISKS 3246 02:03:43,092 --> 02:03:45,662 AND PROTECTIVE FACTORS INHERENT 3247 02:03:45,662 --> 02:03:47,964 TO EACH UNIQUE COMMUNITY HELP 3248 02:03:47,964 --> 02:03:49,332 DETERMINE THE BEST 3249 02:03:49,332 --> 02:03:52,702 IMPLEMENTATION STRATEGIES FOR 3250 02:03:52,702 --> 02:03:53,670 SLEEP INTERVENTIONS. INDIGENOUS 3251 02:03:53,670 --> 02:03:55,338 COMMUNITIES MAY HAVE CULTURAL 3252 02:03:55,338 --> 02:03:58,308 VALUES AND BELIEFS. 3253 02:03:58,308 --> 02:03:59,909 >> YEAH, THAT'S A GREAT 3254 02:03:59,909 --> 02:04:01,211 QUESTION AND THOUGHT ABOUT 3255 02:04:01,211 --> 02:04:02,812 DOWNSTREAM FOR MY WORK AND 3256 02:04:02,812 --> 02:04:04,948 TALKED TO COLLEAGUES ABOUT IN 3257 02:04:04,948 --> 02:04:05,281 THE AREA TOO. 3258 02:04:05,281 --> 02:04:07,550 I WILL TAKE A STEP BACK. 3259 02:04:07,550 --> 02:04:09,285 I THINK WHAT'S PARTICULARLY 3260 02:04:09,285 --> 02:04:12,422 INTERESTING HEARING SOME 3261 02:04:12,422 --> 02:04:13,756 REFLECTIONS THAT GHADA HAD, 3262 02:04:13,756 --> 02:04:15,358 EVERYBODY SLEEPS. SLEEP IS A 3263 02:04:15,358 --> 02:04:17,360 BEHAVIOR BUT ALSO A BIOLOGY. 3264 02:04:17,360 --> 02:04:20,597 I THINK ONE ADVANTAGE OUR FIELD 3265 02:04:20,597 --> 02:04:22,999 HAS IS THAT CBTI, IN GENERAL, 3266 02:04:22,999 --> 02:04:27,003 WILL WORK FOR ANY HUMAN. 3267 02:04:27,003 --> 02:04:29,472 THE CATCH IS HOW TO GET PEOPLE 3268 02:04:29,472 --> 02:04:30,707 TO DO IT. 3269 02:04:30,707 --> 02:04:31,741 OBVIOUSLY IN DIFFERENT DISEASE 3270 02:04:31,741 --> 02:04:35,478 STATES THERE MAY BE SOME 3271 02:04:35,478 --> 02:04:36,479 TAILORING, WE WOULDN'T LIMIT 3272 02:04:36,479 --> 02:04:38,515 THE TIME IN BED AS MUCH. 3273 02:04:38,515 --> 02:04:40,016 BUT WE HAVE A VERY ROBUST 3274 02:04:40,016 --> 02:04:43,620 INTERVENTION. 3275 02:04:43,620 --> 02:04:45,788 I THINK 90% OF OUR PROBLEM NOW 3276 02:04:45,788 --> 02:04:48,758 IS THIS CONTEXT. 3277 02:04:48,758 --> 02:04:50,693 AND ISSUE OF CULTURE IS SO 3278 02:04:50,693 --> 02:04:52,395 EMBEDDED IN THE CONTEXT. 3279 02:04:52,395 --> 02:04:53,997 THESE INTERVENTIONS I THINK OF 3280 02:04:53,997 --> 02:04:55,632 THEM BOTH AS SYSTEMS CONTEXT 3281 02:04:55,632 --> 02:04:59,769 WHERE WE ARE DELIVERING IT. 3282 02:04:59,769 --> 02:05:04,240 BUT ALSO MOSTLY EVERYONE IS 3283 02:05:04,240 --> 02:05:05,475 BRINGING BEHAVIORAL 3284 02:05:05,475 --> 02:05:07,710 INTERVENTION, IRUC PAT IS 3285 02:05:07,710 --> 02:05:09,245 ACTUALLY A BEHAVIORAL 3286 02:05:09,245 --> 02:05:11,814 INTERVENTION AS MUCH AS 3287 02:05:11,814 --> 02:05:12,715 PHYSIOLOGICAL ONE BECAUSE YOU 3288 02:05:12,715 --> 02:05:15,552 NEED A CHANGE IN BEHAVIOR IN 3289 02:05:15,552 --> 02:05:17,387 ORDER FOR PEOPLE TO DO IT. 3290 02:05:17,387 --> 02:05:18,888 IT NEEDS TO ALIGN. 3291 02:05:18,888 --> 02:05:22,225 HOW EARLY DO WE NEED TO DO THE 3292 02:05:22,225 --> 02:05:23,426 STUDY, VERSUS, WHAT POINT DO WE 3293 02:05:23,426 --> 02:05:27,063 NEED TO DO THAT ADAPTATION. 3294 02:05:27,063 --> 02:05:28,431 OBVIOUSLY, COLLABORATION WITH 3295 02:05:28,431 --> 02:05:31,401 THE TARGET AND USERS ARE 3296 02:05:31,401 --> 02:05:31,935 ESSENTIAL THROUGHOUT THE 3297 02:05:31,935 --> 02:05:32,702 PROCESS. 3298 02:05:32,702 --> 02:05:36,239 BUT YOU KNOW, DO WE NEED TO 3299 02:05:36,239 --> 02:05:37,440 REDEVELOP CBTI SPECIFICALLY FOR 3300 02:05:37,440 --> 02:05:39,642 EACH CULTURE TO FIGURE OUT WHAT 3301 02:05:39,642 --> 02:05:41,878 COMPONENTS DO WE NEED TO ADD OR 3302 02:05:41,878 --> 02:05:45,214 SUBTRACT OR DO THAT ADAPTATION 3303 02:05:45,214 --> 02:05:46,482 MORE TOWARD ADAPTATION RESEARCH 3304 02:05:46,482 --> 02:05:49,552 AND FIGURE OUT WHICH 3305 02:05:49,552 --> 02:05:51,788 STRATEGIES, IT'S CONSTANTLY 3306 02:05:51,788 --> 02:05:53,957 THIS CHANGE IN FIDELITY AND 3307 02:05:53,957 --> 02:05:55,959 PROCESSING AN WHAT WILL BE THE 3308 02:05:55,959 --> 02:05:57,360 MOST EFFICIENT PROCESS. 3309 02:05:57,360 --> 02:06:00,763 SO THAT'S A QUESTION ACROSS 3310 02:06:00,763 --> 02:06:04,367 CULTURES YOU KNOW, SOME CLINICS 3311 02:06:04,367 --> 02:06:09,439 WHERE THEY HAVE SIESTAS AND 3312 02:06:09,439 --> 02:06:11,641 NAPS. IT'S A HUGE PROBLEM, NOT 3313 02:06:11,641 --> 02:06:13,276 A PROBLEM BUT SOMETHING WE NEED 3314 02:06:13,276 --> 02:06:15,845 TO LEVERAGE BECAUSE IT WILL 3315 02:06:15,845 --> 02:06:17,246 INFLUENCE ULTIMATELY HOW WELL 3316 02:06:17,246 --> 02:06:20,049 THE TREATMENTS WILL USE FOR ANY 3317 02:06:20,049 --> 02:06:22,585 GIVEN PERSON WITHIN BOTH 3318 02:06:22,585 --> 02:06:23,920 CULTURE AND CLINICAL CONTEXT. 3319 02:06:23,920 --> 02:06:25,688 I THINK THE STRAIN OUR FIELD 3320 02:06:25,688 --> 02:06:27,490 HAS WE ARE A LITTLE BIT WRAPPED 3321 02:06:27,490 --> 02:06:31,260 UP IN DOING ADAPTATIONS EARLY, 3322 02:06:31,260 --> 02:06:34,397 GREAT, CBTI WORKS FOR THIS, NOW 3323 02:06:34,397 --> 02:06:35,798 LET'S DO CBTI FOR THIS 3324 02:06:35,798 --> 02:06:36,866 POPULATION AND CHANGE IT FOR 3325 02:06:36,866 --> 02:06:38,167 THIS POPULATION. 3326 02:06:38,167 --> 02:06:41,638 ULTIMATELY IS STILL A LITTLE 3327 02:06:41,638 --> 02:06:42,872 BIT AN INCUBATOR APPROACH, THEY 3328 02:06:42,872 --> 02:06:45,074 ARE STILL DOING IT IN CLINICAL 3329 02:06:45,074 --> 02:06:46,109 TRIAL CONTEXT. 3330 02:06:46,109 --> 02:06:48,311 I THINK IT'S GETTING THE 3331 02:06:48,311 --> 02:06:49,245 COLLABORATORS AND STAKEHOLDERS 3332 02:06:49,245 --> 02:06:50,847 IN THE COMMUNITIES AND 3333 02:06:50,847 --> 02:06:52,582 PARTNERSHIPS ENGAGED EARLY ON. 3334 02:06:52,582 --> 02:06:54,484 THAT'S WHY I THINK DR. 3335 02:06:54,484 --> 02:06:56,119 WILLIAMSON'S WORK IS A 3336 02:06:56,119 --> 02:06:57,120 BEAUTIFUL EXAMPLE FOR ALL US TO 3337 02:06:57,120 --> 02:06:58,755 THINK ABOUT. 3338 02:06:58,755 --> 02:06:59,622 THAT'S WHAT SHE DID FROM DAY 3339 02:06:59,622 --> 02:07:00,456 ONE. 3340 02:07:00,456 --> 02:07:01,824 SHE WENT IN THERE AND THOUGHT 3341 02:07:01,824 --> 02:07:03,526 SHE WAS GOING TO DO SOMETHING 3342 02:07:03,526 --> 02:07:04,794 ELSE. 3343 02:07:04,794 --> 02:07:07,130 LIKE THERE ARE BEHAVIORAL SLEEP 3344 02:07:07,130 --> 02:07:09,365 INTERVENTIONS BUT WHEN SHE 3345 02:07:09,365 --> 02:07:12,502 STARTED TALKING TO THE PARENTS 3346 02:07:12,502 --> 02:07:15,204 AND DOCTORS IT WAS LIKE THIS IS 3347 02:07:15,204 --> 02:07:17,507 NEVER GOING TO WORK EARLY ON. 3348 02:07:17,507 --> 02:07:19,809 I KNOW I'M NOT REALLY ANSWERING 3349 02:07:19,809 --> 02:07:21,244 THE SPECIFIC QUESTION. 3350 02:07:21,244 --> 02:07:23,279 THAT'S THE WHOLE POINT IS 3351 02:07:23,279 --> 02:07:25,014 CONTEXT IS ALMOST EVERYTHING 3352 02:07:25,014 --> 02:07:27,216 AND FIGURING OUT THE PIECES TO 3353 02:07:27,216 --> 02:07:29,686 GET IT TO WORK IS THE TOOL, 3354 02:07:29,686 --> 02:07:30,253 AGAIN. 3355 02:07:30,253 --> 02:07:33,790 EVERYBODY SLEEPS. MOST PEOPLE 3356 02:07:33,790 --> 02:07:35,725 ACTUALLY HAD INTACT MECHANISMS 3357 02:07:35,725 --> 02:07:44,467 SO MOST PEOPLE THEIR CIRCADIAN 3358 02:07:44,467 --> 02:07:47,136 CONTROLLERS, YOU KNOW, THERE'S 3359 02:07:47,136 --> 02:07:49,038 PLACES THEY CAN HARNESS THE 3360 02:07:49,038 --> 02:07:50,640 TOOLS IN OUR OWN BRIN BAU WE 3361 02:07:50,640 --> 02:07:53,342 NEED TO CHANGE THE BEHAVIOR. 3362 02:07:53,342 --> 02:07:55,411 THERE'S CONSTRAINED SHIFT 3363 02:07:55,411 --> 02:07:56,312 WORKERS AS MENTIONED, HAVING 3364 02:07:56,312 --> 02:07:57,680 OPPORTUNITY FOR SLEEP IS A 3365 02:07:57,680 --> 02:07:59,348 WHOLE OTHER TYPE OF BARRIER. 3366 02:07:59,348 --> 02:08:01,184 I THINK IN SLEEP OURSELVES IS 3367 02:08:01,184 --> 02:08:03,686 TO START THINKING ABOUT THE 3368 02:08:03,686 --> 02:08:04,420 MULTI-LEVEL INTERVENTIONS 3369 02:08:04,420 --> 02:08:07,056 BECAUSE MOST OTHER FIELD IT'S 3370 02:08:07,056 --> 02:08:08,825 BEEN REALLY ISOLATED TO 3371 02:08:08,825 --> 02:08:10,693 INDIVIDUAL LEVEL AND BEING MORE 3372 02:08:10,693 --> 02:08:12,328 CREATIVE IN GENERAL THE SCIENCE 3373 02:08:12,328 --> 02:08:15,665 HOW TO DO THOSE MULTI-LEVEL 3374 02:08:15,665 --> 02:08:17,533 STUDIES. 3375 02:08:17,533 --> 02:08:19,035 >> SHILPY DIXIT: I THINK YOU 3376 02:08:19,035 --> 02:08:21,471 DID ANSWER THE QUESTION, IT'S A 3377 02:08:21,471 --> 02:08:22,105 VALUABLE CONSIDERATION, WHAT 3378 02:08:22,105 --> 02:08:24,240 POINT DO WE NEED TO BRING THAT 3379 02:08:24,240 --> 02:08:26,309 CONSIDERATION IN, I THINK IT 3380 02:08:26,309 --> 02:08:29,245 MIGHT BE DIFFERENT FOR EVERY 3381 02:08:29,245 --> 02:08:30,313 INTERVENTION, OR EVERY CRITICAL 3382 02:08:30,313 --> 02:08:31,013 QUESTION WE ARE TRYING TO 3383 02:08:31,013 --> 02:08:31,814 ANSWER. 3384 02:08:31,814 --> 02:08:34,016 SO I THINK WE ARE OUT OF TIME 3385 02:08:34,016 --> 02:08:37,086 AND RIGHT UP AGAINST LUNCH HERE. 3386 02:08:37,086 --> 02:08:38,955 BUT BEFORE WE CLOSE FOR LUNCH, 3387 02:08:38,955 --> 02:08:41,023 BEFORE WE BREAK FOR LUNCH, I DO 3388 02:08:41,023 --> 02:08:43,226 WANT TO LEAVE THE GROUP WITH 3389 02:08:43,226 --> 02:08:44,360 JUST ONE MORE CONSIDERATION, 3390 02:08:44,360 --> 02:08:47,430 AND ONE QUESTION FROM THE 3391 02:08:47,430 --> 02:08:47,764 AUDIENCE. 3392 02:08:47,764 --> 02:08:49,365 JUST SOMETHING TO THINK ABOUT 3393 02:08:49,365 --> 02:08:55,838 WHILE YOU EAT. 3394 02:08:55,838 --> 02:08:56,939 WONDERING WHAT THE PRESENTERS' 3395 02:08:56,939 --> 02:08:59,375 THOUGHTS ARE ON HOW YOU MIGHT 3396 02:08:59,375 --> 02:09:04,046 EVEN GO ABOUT ASSESSING THIS IN 3397 02:09:04,046 --> 02:09:05,314 LOW-AND-MIDDLE INCOME COUNTRIES 3398 02:09:05,314 --> 02:09:06,616 GIVEN THAT CLINICAL RESOURCES 3399 02:09:06,616 --> 02:09:07,717 ARE ALREADY SO LIMITED. 3400 02:09:07,717 --> 02:09:10,286 I KNOW WE HAVE A DISCUSSION AT 3401 02:09:10,286 --> 02:09:11,554 THE END OF THIS WAORK SHOP 3402 02:09:11,554 --> 02:09:13,823 TODAY. 3403 02:09:13,823 --> 02:09:14,624 BUT THAT IS DEFINITELY 3404 02:09:14,624 --> 02:09:16,225 SOMETHING I HAVE BEEN THINKING 3405 02:09:16,225 --> 02:09:17,560 ABOUT YESTERDAY AND TODAY AND 3406 02:09:17,560 --> 02:09:19,595 WILL BE THINKING ABOUT MOVING 3407 02:09:19,595 --> 02:09:19,829 FORWARD. 3408 02:09:19,829 --> 02:09:20,763 SO LOOKING FORWARD TO THE 3409 02:09:20,763 --> 02:09:23,199 DISCUSSION AS WE MOVE ON. 3410 02:09:23,199 --> 02:09:24,767 ENJOY YOUR LUNCH, EVERYBODY. 3411 02:09:24,767 --> 02:09:25,635 AND SPEAKERS, THANK YOU AGAIN, 3412 02:09:25,635 --> 02:09:30,339 SO MUCH. 3413 02:09:30,339 --> 02:09:31,340 >> GHADA BOURJEILY: THANK YOU 3414 02:09:31,340 --> 02:10:36,049 FOR HAVING US. 3415 02:10:36,049 --> 02:10:39,919 OUR SECOND SPEAKER IS DR. 3416 02:10:39,919 --> 02:10:45,291 FITZPATRICK STEPHANIE, 3417 02:10:45,291 --> 02:10:47,427 FEINSTEIN INSTITUTE FOR MEDICAL 3418 02:10:47,427 --> 02:10:48,995 RESEARCH, TITLE IS IMPLEMENTING 3419 02:10:48,995 --> 02:10:52,799 INTEGRATED CARE APPROACHES TO 3420 02:10:52,799 --> 02:10:58,971 REDUCE DISPARITIES IN SEVERE 3421 02:10:58,971 --> 02:11:02,108 MATERNAL MORBIDITY. 3422 02:11:02,108 --> 02:11:08,081 OUR THIRD IS MEGAN PASSEY. 3423 02:11:08,081 --> 02:11:09,582 DAFFODIL CENTER, UNIVERSITY OF 3424 02:11:09,582 --> 02:11:13,686 SYDNEY, I WANT TO THANK DR. 3425 02:11:13,686 --> 02:11:14,821 PASSEY, IT'S 3:00 A.M. IN 3426 02:11:14,821 --> 02:11:19,058 SYDNEY. 3427 02:11:19,058 --> 02:11:20,560 EVIDENCE BASED SMOKING 3428 02:11:20,560 --> 02:11:23,396 CESSATION CARE IN PREGNANCY. 3429 02:11:23,396 --> 02:11:26,799 OUR FOURTH SPEAKER IS DR. 3430 02:11:26,799 --> 02:11:35,007 JENNIFER TAYLOR-COUSAR. 3431 02:11:35,007 --> 02:11:41,214 THE TITLE OF HER TALK IS 3432 02:11:41,214 --> 02:11:47,253 MATERNAL, LESSON FROM CYSTIC 3433 02:11:47,253 --> 02:11:50,089 FIBROSIS, AND WITH THAT, I WILL 3434 02:11:50,089 --> 02:11:55,394 HAND IT TO SONALI BOSE FOR HER 3435 02:11:55,394 --> 02:11:57,530 PRESENTATION. 3436 02:11:57,530 --> 02:11:59,365 >> SONALI BOSE: THANK YOU. 3437 02:11:59,365 --> 02:12:00,466 I'M REALLY EXCITED TO BE HERE 3438 02:12:00,466 --> 02:12:02,068 TO TALK TO YOU ABOUT SOME OF 3439 02:12:02,068 --> 02:12:03,770 THE WORK THAT OUR COLLEAGUES 3440 02:12:03,770 --> 02:12:05,872 AND OURSELVES HAVE BEEN DOING 3441 02:12:05,872 --> 02:12:07,440 IN THIS AREA OF INTEREST. 3442 02:12:07,440 --> 02:12:09,008 NEXT SLIDE. 3443 02:12:09,008 --> 02:12:11,911 I HAVE A FEW DISCLOSURES WHICH 3444 02:12:11,911 --> 02:12:13,546 ARE NOT PARTICULARLY RELEVANT 3445 02:12:13,546 --> 02:12:16,048 TO WHAT I'LL BE TALKING ABOUT 3446 02:12:16,048 --> 02:12:17,984 TODAY OTHER THAN STUDIES I WILL 3447 02:12:17,984 --> 02:12:19,919 BE PRESENTING FUNDED BY NIH AS 3448 02:12:19,919 --> 02:12:21,187 WELL AS THE AMERICAN LUNG 3449 02:12:21,187 --> 02:12:21,487 ASSOCIATION. 3450 02:12:21,487 --> 02:12:25,958 NEXT SLIDE. 3451 02:12:25,958 --> 02:12:28,561 SO, I WANT TO START OFF 3452 02:12:28,561 --> 02:12:30,963 ACTUALLY BY RELATING AN 3453 02:12:30,963 --> 02:12:34,066 EXPERIENCE I HAD IN 2008, 3454 02:12:34,066 --> 02:12:35,768 ALMOST 16 YEARS AGO. 3455 02:12:35,768 --> 02:12:38,404 AT THE TIME I DIDN'T KNOW IT 3456 02:12:38,404 --> 02:12:39,705 WOULD ESSENTIALLY HELP ME BE 3457 02:12:39,705 --> 02:12:42,708 WHERE I AM TODAY. 3458 02:12:42,708 --> 02:12:44,477 WE OFTEN DON'T KNOW WHAT 3459 02:12:44,477 --> 02:12:47,079 JOURNEYS WE ARE HEADING TOWARD 3460 02:12:47,079 --> 02:12:50,082 BUT I WAS A FIRST YEAR FELLOW 3461 02:12:50,082 --> 02:12:52,051 AT JOHNS HOPKINS AT THE TIME, 3462 02:12:52,051 --> 02:12:55,054 MY FIRST YEAR OF FELLOWSHIP IN 3463 02:12:55,054 --> 02:12:58,391 THE N ICU TAKING CARE OF 3464 02:12:58,391 --> 02:13:00,092 PATIENTS AND MY FELLOW HAD TO 3465 02:13:00,092 --> 02:13:05,064 LEAVE FOR HIS OUTPATIENT CLINIC 3466 02:13:05,064 --> 02:13:10,203 AND INFORMED ME HE WAS INFORMED 3467 02:13:10,203 --> 02:13:12,872 ON A BLACK WOMAN PREGNANT WITH 3468 02:13:12,872 --> 02:13:14,974 ASTHMA, AND IF I COULD PLEASE 3469 02:13:14,974 --> 02:13:16,909 BABYSIT HER. 3470 02:13:16,909 --> 02:13:18,611 WHILE HE HADN'T EVEN MADE IT TO 3471 02:13:18,611 --> 02:13:20,847 THE PARKING LOT THERE WAS AN 3472 02:13:20,847 --> 02:13:23,749 OVERHEAD QUALIFY FOR AN 3473 02:13:23,749 --> 02:13:26,385 EMERGENCY, THIS PATIENT WAS 3474 02:13:26,385 --> 02:13:29,922 WHEELED IN THE M ICU, SHE WAS 3475 02:13:29,922 --> 02:13:32,758 HYPOXIC DOWN TO THE 40s, I WAS 3476 02:13:32,758 --> 02:13:34,327 A FIRST YEAR FELLOW TRYING TO 3477 02:13:34,327 --> 02:13:36,729 FIGURE OUT WHAT TO DO, PROBABLY 3478 02:13:36,729 --> 02:13:38,998 ONE OF THE MOST DRAMATIC 3479 02:13:38,998 --> 02:13:41,601 INCIDENCES OF MY TRAINING, SHE 3480 02:13:41,601 --> 02:13:48,641 HAD REFRACTORY HYPOXEMIA, 3481 02:13:48,641 --> 02:13:51,477 COULDN'T GET HER SATS UP. 3482 02:13:51,477 --> 02:13:58,584 SHE DID AN EMERGENCY C-SECTION 3483 02:13:58,584 --> 02:14:01,153 HER BABY DID SURVIVE, FOR YEARS 3484 02:14:01,153 --> 02:14:04,123 THERE ON AT HOPKINS THIS LOVELY 3485 02:14:04,123 --> 02:14:07,393 WOMAN WAS UNFORTUNATELY IN A 3486 02:14:07,393 --> 02:14:07,994 PERSISTENT VEGETATIVE STATE, 3487 02:14:07,994 --> 02:14:10,396 KNOWN TO ALL THE FELLOWS AND WE 3488 02:14:10,396 --> 02:14:11,831 WATCHED THE CHILD GROW THROUGH 3489 02:14:11,831 --> 02:14:13,566 ALL THESE VISITS. 3490 02:14:13,566 --> 02:14:15,301 SO IT GOT ME REALLY THINKING IN 3491 02:14:15,301 --> 02:14:17,370 TERMS OF ALL OF THE THINGS WE 3492 02:14:17,370 --> 02:14:18,170 DIDN'T UNDERSTAND ABOUT THIS 3493 02:14:18,170 --> 02:14:20,206 CASE AT THE TIME IT HAPPENED. 3494 02:14:20,206 --> 02:14:22,141 AND ALL THE SYSTEMS IN PLACE 3495 02:14:22,141 --> 02:14:24,343 THAT HAD LED TO THE SITUATION 3496 02:14:24,343 --> 02:14:26,445 THAT SHE FACED AND CULMINATED 3497 02:14:26,445 --> 02:14:29,448 IN THE EVENTS THAT WE WITNESSED. 3498 02:14:29,448 --> 02:14:30,850 IN THE INTEREST OF TIME I WILL 3499 02:14:30,850 --> 02:14:33,819 MOVE ON TO THE NEXT SLIDE. 3500 02:14:33,819 --> 02:14:36,255 IT WAS THE FIRST APPRECIATION I 3501 02:14:36,255 --> 02:14:45,798 HAD THAT PREGNANCY IS AN 3502 02:14:45,798 --> 02:14:46,866 EXQUISITELY VULNERABLE STATE. 3503 02:14:46,866 --> 02:14:48,634 EVERYTHING ABOUT PREGNANCY A 3504 02:14:48,634 --> 02:14:50,102 SHARED EXPERIENCE BETWEEN 3505 02:14:50,102 --> 02:14:50,469 MOTHER AND BABY. 3506 02:14:50,469 --> 02:14:51,971 THE MRA TEN IS A IS THE CENTER 3507 02:14:51,971 --> 02:14:54,573 OF THE DISEASE UNIVERSE. 3508 02:14:54,573 --> 02:14:56,409 ANYTHING THAT MOTHER 3509 02:14:56,409 --> 02:14:57,977 EXPERIENCES, BABY IS EQUALLY 3510 02:14:57,977 --> 02:14:58,311 EXPERIENCING. 3511 02:14:58,311 --> 02:15:00,246 MUCH OF THIS IS UNFORTUNATELY A 3512 02:15:00,246 --> 02:15:03,549 RESULT OF NORMAL ADAPTATIONS TO 3513 02:15:03,549 --> 02:15:04,917 PREGNANCY. 3514 02:15:04,917 --> 02:15:07,520 WHICH MAKE PREGNANT WOMEN 3515 02:15:07,520 --> 02:15:08,321 EXQUISITELY VULNERABLE TO MANY 3516 02:15:08,321 --> 02:15:10,589 OF THE THINGS THEY COULD NORNL 3517 02:15:10,589 --> 02:15:12,591 ALLEY HANDLE IN A NON-PREGNANT 3518 02:15:12,591 --> 02:15:12,792 STATE. 3519 02:15:12,792 --> 02:15:13,993 NEXT. 3520 02:15:13,993 --> 02:15:15,661 THIS IS A NICE SCHEMATIC TO 3521 02:15:15,661 --> 02:15:17,997 SHOW HOW THE ENVIRONMENT OF THE 3522 02:15:17,997 --> 02:15:18,965 MOTHER WHETHER INHALED 3523 02:15:18,965 --> 02:15:20,800 ENVIRONMENT OR ANY OTHER 3524 02:15:20,800 --> 02:15:22,134 ENVIRONMENT IS TRANSMITTED 3525 02:15:22,134 --> 02:15:29,642 ACROSS THE PLACENTAL/FETAL 3526 02:15:29,642 --> 02:15:31,711 BARRIER AND IMPACTING MANY OF 3527 02:15:31,711 --> 02:15:35,081 THE MOLECULAR CELLULAR AND 3528 02:15:35,081 --> 02:15:35,948 PHYSIOLOGICAL CHANGES OCCURRING 3529 02:15:35,948 --> 02:15:37,116 TO CHANGE THE PHENOTYPE OF THE 3530 02:15:37,116 --> 02:15:39,051 NEWBORN. 3531 02:15:39,051 --> 02:15:40,553 UNFORTUNATELY THE FEATURE IS 3532 02:15:40,553 --> 02:15:42,922 VERY VULNERABLE STATE AS WELL, 3533 02:15:42,922 --> 02:15:44,523 UNDERGOING RAPID PERIOD OF 3534 02:15:44,523 --> 02:15:45,858 GROWTH AND MATURATION AND 3535 02:15:45,858 --> 02:15:47,960 BECOMES VERY SENSITIVE TO 3536 02:15:47,960 --> 02:15:48,995 INSULTS. NEXT SLIDE. 3537 02:15:48,995 --> 02:15:49,295 NEXT SLIDE. 3538 02:15:49,295 --> 02:15:51,397 NEXT. 3539 02:15:51,397 --> 02:15:53,132 SO THIS LEADS US TO 3540 02:15:53,132 --> 02:15:55,134 UNDERSTANDING ONE PARTICULAR 3541 02:15:55,134 --> 02:15:57,036 MATERNAL CO MORBIDITY WHICH HAS 3542 02:15:57,036 --> 02:15:58,471 A PROFOUND IMPACT ON THE 3543 02:15:58,471 --> 02:15:59,672 PROCESS I JUST SHOWED YOU. 3544 02:15:59,672 --> 02:16:02,208 I WILL BE SPEAKING ABOUT ASTHMA 3545 02:16:02,208 --> 02:16:03,809 AS MOST COMMON RESPIRATORY 3546 02:16:03,809 --> 02:16:04,310 CONDITION IN PREGNANCY. 3547 02:16:04,310 --> 02:16:06,178 NEXT. 3548 02:16:06,178 --> 02:16:08,381 20% OF PREGNANT WOMEN WHO HAVE 3549 02:16:08,381 --> 02:16:10,282 ASTHMA HAVE SEVERE DISEASE. 3550 02:16:10,282 --> 02:16:12,351 AND OF THESE ALMOST A THIRD CAN 3551 02:16:12,351 --> 02:16:13,085 HAVE UNCONTROLLED DISEASE. 3552 02:16:13,085 --> 02:16:15,021 NEXT. 3553 02:16:15,021 --> 02:16:17,757 THIS LEADS TO A LOSS OF CONTROL 3554 02:16:17,757 --> 02:16:19,792 DURING PREGNANCY, WHICH CAN BE 3555 02:16:19,792 --> 02:16:21,627 ATTRIBUTED TO A NUMEROUS NUMBER 3556 02:16:21,627 --> 02:16:23,829 OF THINGS, INCLUDING 3557 02:16:23,829 --> 02:16:25,164 SUSCEPTIBILITY TO INFECTIONS 3558 02:16:25,164 --> 02:16:27,099 SUCH AS THE FLU AND OTHER 3559 02:16:27,099 --> 02:16:30,002 VIRUSES AND CHANGES IN ADAPTIVE 3560 02:16:30,002 --> 02:16:31,837 IMMUNITY THAT ALSO IMPACT THE 3561 02:16:31,837 --> 02:16:32,671 WAY THAT MOMS HANDLE THEIR 3562 02:16:32,671 --> 02:16:33,139 ASTHMA. 3563 02:16:33,139 --> 02:16:34,740 NEXT SLIDE. 3564 02:16:34,740 --> 02:16:36,042 AND YOU KNOW, THAT'S THE 3565 02:16:36,042 --> 02:16:37,543 BIOLOGY BEHIND IT. 3566 02:16:37,543 --> 02:16:40,212 BUT AS MY KIDS WOULD SAY, IRL, 3567 02:16:40,212 --> 02:16:43,082 IN REAL LIFE, WHAT'S GOING ON. 3568 02:16:43,082 --> 02:16:45,651 WHY ARE ALL THESE PREGNANT 3569 02:16:45,651 --> 02:16:46,886 WOMEN LOSING THEIR ASTHMA 3570 02:16:46,886 --> 02:16:48,354 CONTROL IN PREGNANCY. 3571 02:16:48,354 --> 02:16:49,588 THIS IS BEING SEEN TIME AND 3572 02:16:49,588 --> 02:16:53,659 TIME AGAIN IN MY OWN CLINIC 3573 02:16:53,659 --> 02:16:55,461 WHERE PROVIDERS AND PATIENTS 3574 02:16:55,461 --> 02:16:56,996 HAVE SIGNIFICANT MEDICATION 3575 02:16:56,996 --> 02:16:59,298 HESITANCY AND WILL STOP THEIR 3576 02:16:59,298 --> 02:16:59,598 MEDICATIONS. 3577 02:16:59,598 --> 02:17:01,500 THEY SHOW ALMOST A QUARTER OF 3578 02:17:01,500 --> 02:17:04,136 WOMEN WHO ARE PREGNANT WILL 3579 02:17:04,136 --> 02:17:05,438 DISCONTINUE THEIR ASTHMA MEDS 3580 02:17:05,438 --> 02:17:06,372 FOR CONCERNS OF SAFETY. 3581 02:17:06,372 --> 02:17:16,582 NEXT POINT. 3582 02:17:19,285 --> 02:17:20,619 THIS UNFORTUNATELY ADDS TO A 3583 02:17:20,619 --> 02:17:22,021 LOT OF BURDEN TO PREGNANT WOMEN 3584 02:17:22,021 --> 02:17:26,358 WHO DON'T HAVE TIME TO GO TO 3585 02:17:26,358 --> 02:17:27,593 SEPARATE PREGNANCY PRENATAL 3586 02:17:27,593 --> 02:17:31,297 VISITS AS WELL AS SEE SUB 3587 02:17:31,297 --> 02:17:32,364 SPECIALTY. 3588 02:17:32,364 --> 02:17:34,066 A LOT OF THIS MANAGEMENT GETS 3589 02:17:34,066 --> 02:17:39,505 MISSED. 3590 02:17:39,505 --> 02:17:41,907 EXACERBATIONS HAVE BEEN SHOWN 3591 02:17:41,907 --> 02:17:43,142 TO INCREASE THE RISK OF 3592 02:17:43,142 --> 02:17:44,143 COMPLICATIONS. 3593 02:17:44,143 --> 02:17:47,179 I HAVE STATS HERE IN TERMS OF 3594 02:17:47,179 --> 02:17:47,847 SPECIFIC APOS WE ARE TALKING 3595 02:17:47,847 --> 02:17:48,814 ABOUT. 3596 02:17:48,814 --> 02:17:50,516 NEXT SLIDE. 3597 02:17:50,516 --> 02:17:55,521 THIS POINT WAS MADE EARLIER BY 3598 02:17:55,521 --> 02:17:58,491 SUZIE WHO DESCRIBED THAT YOU 3599 02:17:58,491 --> 02:18:00,893 KNEE, OTHER PATIENTS WHO ARE 3600 02:18:00,893 --> 02:18:01,760 UNCONTROLLED PRIOR TO PREGNANCY 3601 02:18:01,760 --> 02:18:03,229 HAVE THE HARDEST TIME. 3602 02:18:03,229 --> 02:18:04,730 THIS IS TRUE FOR ASTHMA AS WELL. 3603 02:18:04,730 --> 02:18:07,266 THE REALITY IS THERE'S A LOT OF 3604 02:18:07,266 --> 02:18:08,267 INEQUITIES, WE UNDERSTAND 3605 02:18:08,267 --> 02:18:12,438 THERE'S HUGE RACIAL AND ETHNIC 3606 02:18:12,438 --> 02:18:13,139 DISPARITIES IN PULMONARY 3607 02:18:13,139 --> 02:18:15,274 HEALTH, AND THIS IS TRUE IN 3608 02:18:15,274 --> 02:18:18,310 ASTHMA AS WELL. 3609 02:18:18,310 --> 02:18:21,113 MINE NOR TIESED INDIVIDUALS 3610 02:18:21,113 --> 02:18:24,583 HAVE HIGH RISK OF ASTHMA 3611 02:18:24,583 --> 02:18:24,850 MORBIDITY. 3612 02:18:24,850 --> 02:18:28,320 THEY ARE AT THIS CROSSROADS. 3613 02:18:28,320 --> 02:18:31,757 THERE ARE A LACK OF REALLY 3614 02:18:31,757 --> 02:18:33,659 PERSPECTIVE STUDIES THAT HAVE 3615 02:18:33,659 --> 02:18:34,960 SHOWN INTERVENTION TRIALS THAT 3616 02:18:34,960 --> 02:18:35,895 CAN HELP BRIDGE THESE GAPS. 3617 02:18:35,895 --> 02:18:37,897 NEXT SLIDE. 3618 02:18:37,897 --> 02:18:40,733 SO THAT'S A LOT OF 3619 02:18:40,733 --> 02:18:41,634 RETROSPECTIVE DATA THAT HAS 3620 02:18:41,634 --> 02:18:43,536 BEEN DONE IN THIS AREA. 3621 02:18:43,536 --> 02:18:45,771 OUR GROUP PROCEEDED TO TRY TO 3622 02:18:45,771 --> 02:18:46,939 DEMONSTRATE THESE RELATIONSHIPS 3623 02:18:46,939 --> 02:18:47,973 IN A PROSPECTIVE WAY. 3624 02:18:47,973 --> 02:18:56,649 WE WORKED WITH THE NUMOM2B, 3625 02:18:56,649 --> 02:18:59,285 WITH WELL ADJUDICATED CADRE OF 3626 02:18:59,285 --> 02:19:00,085 PREGNANCY OUTCOME DATA. 3627 02:19:00,085 --> 02:19:02,421 SO I'M JUST SHOWING YOU A 3628 02:19:02,421 --> 02:19:05,024 LITTLE ABOUT THE DEMOGRAPHICS 3629 02:19:05,024 --> 02:19:06,959 OF THIS BRILLIANT COHORT THAT 3630 02:19:06,959 --> 02:19:09,562 IS MULTI-SITE IN THE UNITED 3631 02:19:09,562 --> 02:19:09,795 STATES. 3632 02:19:09,795 --> 02:19:11,730 A PROFOUND NUMBER OF THESE 3633 02:19:11,730 --> 02:19:13,866 WOMEN ACTUALLY HAD SMOKED PRIOR 3634 02:19:13,866 --> 02:19:14,200 TO PREGNANCY. 3635 02:19:14,200 --> 02:19:15,401 WE WILL GET BACK TO THAT IN A 3636 02:19:15,401 --> 02:19:15,634 MINUTE. 3637 02:19:15,634 --> 02:19:17,903 NEXT SLIDE. 3638 02:19:17,903 --> 02:19:20,306 WHAT WE DID IS LOOKED AT 3639 02:19:20,306 --> 02:19:22,374 PATIENTS IN THIS COHORT WHO HAD 3640 02:19:22,374 --> 02:19:23,842 A HISTORY OF ASTHMA, THE NEED 3641 02:19:23,842 --> 02:19:25,077 FOR ASTHMA MEDICATION. 3642 02:19:25,077 --> 02:19:30,182 AND WE USED THAT AS A SURROGATE 3643 02:19:30,182 --> 02:19:32,017 FOR HAVING ACTIVE ASTHMA DURING 3644 02:19:32,017 --> 02:19:33,419 PREGNANCY. 3645 02:19:33,419 --> 02:19:35,788 WE LOOKED AT THESE IN ADJUSTED 3646 02:19:35,788 --> 02:19:37,756 MODELS WITH THEIR ASSOCIATIONS 3647 02:19:37,756 --> 02:19:39,225 WITH ADVERSE PREGNANCY OUTCOMES. 3648 02:19:39,225 --> 02:19:41,527 IN THE PANEL TO OF THE LEFT, 3649 02:19:41,527 --> 02:19:44,830 PANEL A, IT COULD SHOW YOU HOW 3650 02:19:44,830 --> 02:19:46,865 HAVING AN ASTHMA DIAGNOSIS AT 3651 02:19:46,865 --> 02:19:49,401 THE ENROLLMENT TIME PERIOD 3652 02:19:49,401 --> 02:19:52,137 INCREASES RISK FOR HYPER 3653 02:19:52,137 --> 02:19:57,176 TENSIVE DISORDERS OF PREGNANCY, 3654 02:19:57,176 --> 02:19:58,811 INCLUDING PREECLAMPSIA, AND 3655 02:19:58,811 --> 02:20:00,012 USING ASTHMA MEDICATION, 3656 02:20:00,012 --> 02:20:06,685 FURTHER INCREASES YOUR ODDS OF 3657 02:20:06,685 --> 02:20:07,386 HAVING NUMEROUS -- NEXT 3658 02:20:07,386 --> 02:20:08,654 SLIDE, PLEASE. 3659 02:20:08,654 --> 02:20:10,422 WHAT THIS DOES TO MOM IS 3660 02:20:10,422 --> 02:20:12,024 OBVIOUS BUT WHAT IT DOES TO 3661 02:20:12,024 --> 02:20:13,392 BABY IS MORE SIGNIFICANT. 3662 02:20:13,392 --> 02:20:19,465 IN THE SENSE MATERNAL 3663 02:20:19,465 --> 02:20:29,975 INFLAMMATORY RESPONSES COULD 3664 02:20:30,376 --> 02:20:32,911 IMPACT PLACENTA FLOW. 3665 02:20:32,911 --> 02:20:35,848 ALL THE INTERNAL AND EXTERNAL 3666 02:20:35,848 --> 02:20:37,383 ENVIRONMENTS THE MOTHER FACES 3667 02:20:37,383 --> 02:20:38,617 WHEN UNDERGOING PREGNANCY AND 3668 02:20:38,617 --> 02:20:40,586 HOW THIS IMPACTS THE HEALTH 3669 02:20:40,586 --> 02:20:41,186 RISK OF THEIR BABIES. 3670 02:20:41,186 --> 02:20:43,422 NEXT SLIDE. 3671 02:20:43,422 --> 02:20:45,824 AS A PROOF OF CONCEPT WE 3672 02:20:45,824 --> 02:20:47,760 THOUGHT CLOSELY ABOUT THE 3673 02:20:47,760 --> 02:20:48,927 INDOOR AIR POLLUTION, IT'S ONE 3674 02:20:48,927 --> 02:20:51,764 OF THE KEY FACTORS THAT LEAD TO 3675 02:20:51,764 --> 02:20:54,133 WORSE ASTHMA IN ADULTS AND 3676 02:20:54,133 --> 02:20:56,135 NON-PREGNANT POPULATIONS AND 3677 02:20:56,135 --> 02:20:58,771 HYPOTHESIZE THIS WILL INCREASE 3678 02:20:58,771 --> 02:21:00,773 THE ADVERSE PREGNANCY OUTCOMES 3679 02:21:00,773 --> 02:21:01,874 AND CHILDHOOD PHENOTYPES I JUST 3680 02:21:01,874 --> 02:21:02,207 MENTIONED. 3681 02:21:02,207 --> 02:21:03,709 NEXT SLIDE. 3682 02:21:03,709 --> 02:21:06,011 WE INCORPORATED A NUMBER OF 3683 02:21:06,011 --> 02:21:07,780 LOW-TOUCH STRATEGIES TO ADDRESS 3684 02:21:07,780 --> 02:21:09,848 THIS PROBLEM, MONITORING AIR 3685 02:21:09,848 --> 02:21:10,382 QUALITY DURING PREGNANCY. 3686 02:21:10,382 --> 02:21:15,120 AND WE HAVE DONE THIS THROUGH 3687 02:21:15,120 --> 02:21:15,721 REALLY IN-DEPTH IN-HOME 3688 02:21:15,721 --> 02:21:17,856 ASSESSMENTS. IN THIS WORK WE 3689 02:21:17,856 --> 02:21:19,858 DEMONSTRATED THE INDOOR AIR 3690 02:21:19,858 --> 02:21:21,660 QUALITY, PARTICULARLY FINE 3691 02:21:21,660 --> 02:21:25,230 PARTICULATE MATTER ARE 3692 02:21:25,230 --> 02:21:27,032 INCREASED BEYOND SIGNIFICANT 3693 02:21:27,032 --> 02:21:29,768 LEVELS BEYOND EPA LIMITS. 3694 02:21:29,768 --> 02:21:31,303 JUST PRELIMINARY DATA THAT 3695 02:21:31,303 --> 02:21:32,805 SHOWS YOU ACROSS 20 3696 02:21:32,805 --> 02:21:35,708 PARTICIPANTS HOW HIGH THE PM 3697 02:21:35,708 --> 02:21:37,209 LEVELS CAN GO, UNFORTUNATELY 3698 02:21:37,209 --> 02:21:39,545 THESE ARE NOT THINGS WE CAN 3699 02:21:39,545 --> 02:21:40,112 ASSESS, NECESSARILY, AS 3700 02:21:40,112 --> 02:21:42,715 AVERAGES. 3701 02:21:42,715 --> 02:21:44,550 BUT BECAUSE THE INHALED 3702 02:21:44,550 --> 02:21:45,718 EXPOSURES ARE SO DYNAMIC WE 3703 02:21:45,718 --> 02:21:51,390 LOOKED AT THIS IN A HIGHLY 3704 02:21:51,390 --> 02:21:51,857 TIME-RESOLVED FASHION. 3705 02:21:51,857 --> 02:21:53,625 ON LEFT SEE A PARTICIPANT'S 3706 02:21:53,625 --> 02:22:00,299 HOME OVER A 24 HOUR PERIOD. 3707 02:22:00,299 --> 02:22:03,068 HIGH PEAKS OF EXPOSURE. 3708 02:22:03,068 --> 02:22:05,938 AND ON THE RIGHT, 40 WEEKS OF 3709 02:22:05,938 --> 02:22:07,139 GESTATION, THERE ARE 3710 02:22:07,139 --> 02:22:08,574 SIGNIFICANT TIME PERIODS WITHIN 3711 02:22:08,574 --> 02:22:10,609 THESE 40 WEEKS WHERE MOM IS 3712 02:22:10,609 --> 02:22:15,214 GETTING EXPOSED TO VERY HIGH 3713 02:22:15,214 --> 02:22:16,849 LEVELS OF AIR POLLUTION. 3714 02:22:16,849 --> 02:22:19,685 THERE ARE WAYS WE CAN COLLECT 3715 02:22:19,685 --> 02:22:20,552 THIS DATA USING LOW-TOUCH 3716 02:22:20,552 --> 02:22:21,520 METHODS. 3717 02:22:21,520 --> 02:22:23,756 NEXT SLIDE. 3718 02:22:23,756 --> 02:22:25,391 SOME OF THE OUTCOMES WE HAVE 3719 02:22:25,391 --> 02:22:27,192 SEEN HAVE BEEN REALLY 3720 02:22:27,192 --> 02:22:28,794 ASTOUNDING, EVEN IN A SMALL 3721 02:22:28,794 --> 02:22:32,631 COHORT WE NOTICED THE INDOOR 3722 02:22:32,631 --> 02:22:33,799 P.M. CONCENTRATIONS ARE 3723 02:22:33,799 --> 02:22:35,434 ASSOCIATED WITH LOWER ASTHMA 3724 02:22:35,434 --> 02:22:37,436 CONTROL AS SEEN IN THE SCORES 3725 02:22:37,436 --> 02:22:40,406 IN PANEL A, THEY HAVE BEEN 3726 02:22:40,406 --> 02:22:41,673 ASSOCIATED WITH DECREASED 3727 02:22:41,673 --> 02:22:45,177 SYMPTOM-FREE DAYS AS SEEN IN 3728 02:22:45,177 --> 02:22:46,745 PANEL B, AND DECREASES IN PANEL 3729 02:22:46,745 --> 02:22:48,213 C AND D. 3730 02:22:48,213 --> 02:22:51,350 THIS IS HAVING A PROFOUND 3731 02:22:51,350 --> 02:22:54,953 EFFECT ON MATERNAL RESPIRATORY 3732 02:22:54,953 --> 02:22:55,187 HEALTH. 3733 02:22:55,187 --> 02:22:56,889 NEXT SLIDE, THERE ARE 3734 02:22:56,889 --> 02:23:01,226 SIGNIFICANT BARRIERS ONLY A FEW 3735 02:23:01,226 --> 02:23:03,829 I'VE ELUDED TO, THIS RELATES TO 3736 02:23:03,829 --> 02:23:05,964 BOTH FETAL AND MATERNAL 3737 02:23:05,964 --> 02:23:06,231 MORBIDITY. 3738 02:23:06,231 --> 02:23:07,399 NEXT SLIDE. 3739 02:23:07,399 --> 02:23:11,503 I SHOWED YOU A SMALL SNIPPET OF 3740 02:23:11,503 --> 02:23:12,438 THE INHALED ENVIRONMENT 3741 02:23:12,438 --> 02:23:13,639 PREGNANT MOTHERS HAVE TO 3742 02:23:13,639 --> 02:23:16,642 EXPERIENCE BUT THERE ARE MANY, 3743 02:23:16,642 --> 02:23:18,377 MANY MORE. 3744 02:23:18,377 --> 02:23:21,547 EMPHASIS I THINK HAS TO BE ON 3745 02:23:21,547 --> 02:23:22,381 INNOVATIVE APPROACHES TO REDUCE 3746 02:23:22,381 --> 02:23:23,649 THESE RISKS. 3747 02:23:23,649 --> 02:23:26,852 WE'VE SHOWN A FEW OF THEM THAT 3748 02:23:26,852 --> 02:23:28,787 NEEDS WIDE-SCALE EXPANSION. 3749 02:23:28,787 --> 02:23:30,122 THIS WAS BROUGHT UP IN THE 3750 02:23:30,122 --> 02:23:32,925 DISCUSSION PRIOR TO LUNCH WE 3751 02:23:32,925 --> 02:23:35,861 NEED MULTI-DISCIPLINARY 3752 02:23:35,861 --> 02:23:38,130 PARTNERSHIP, THE MFM'S AND MULL 3753 02:23:38,130 --> 02:23:39,731 MONOLOGISTS ARE THINKING VERY 3754 02:23:39,731 --> 02:23:40,833 MUCH IN PARALLEL BUT NOT 3755 02:23:40,833 --> 02:23:43,235 TALKING TO EACH OTHER. 3756 02:23:43,235 --> 02:23:44,102 SO REALLY INTEGRATED CLINICS 3757 02:23:44,102 --> 02:23:48,907 AND SPACES WHERE WE CAN 3758 02:23:48,907 --> 02:23:50,909 CO-MANAGE PATIENT IS REALLY 3759 02:23:50,909 --> 02:23:51,176 CRITICAL. 3760 02:23:51,176 --> 02:23:52,411 WHERE DO WE GO FROM HERE? 3761 02:23:52,411 --> 02:23:54,313 I THINK THE PANEL UPCOMING WILL 3762 02:23:54,313 --> 02:23:56,081 DIVE DEEP INTO THIS. 3763 02:23:56,081 --> 02:23:57,883 AS I MENTIONED WE UNDERSTAND 3764 02:23:57,883 --> 02:24:00,152 THE EXPOSURES ARE BAD. 3765 02:24:00,152 --> 02:24:02,120 WE UNDERSTAND MOM'S MORBIDITY 3766 02:24:02,120 --> 02:24:04,089 DURING PREGNANCY IS REALLY 3767 02:24:04,089 --> 02:24:06,091 AFFECTING TWO PATIENTS IN ONE 3768 02:24:06,091 --> 02:24:08,360 AND REALLY WE NEED TO COME UP 3769 02:24:08,360 --> 02:24:09,828 WITH INTERVENTIONS THAT ARE 3770 02:24:09,828 --> 02:24:11,430 REALLY DESIGNED TO COME UP WITH 3771 02:24:11,430 --> 02:24:14,032 BOTH PATIENTS AND HAVE THE NEXT 3772 02:24:14,032 --> 02:24:15,400 GENERATION HAVE OPTIMIZED 3773 02:24:15,400 --> 02:24:16,802 RESPIRATORY HEALTH ONGOING. 3774 02:24:16,802 --> 02:24:18,403 AND WITH THAT I WILL CLOSE AND 3775 02:24:18,403 --> 02:24:19,304 TAKE ANY QUESTIONS IN THE CHAT. 3776 02:24:19,304 --> 02:24:27,880 THANK YOU. 3777 02:24:27,880 --> 02:24:28,914 >> THANK YOU, SONALI, THE 3778 02:24:28,914 --> 02:24:32,117 QUESTIONS WILL BE AT THE END. 3779 02:24:32,117 --> 02:24:34,586 FOR THOSE ATTENDING YOU CAN PUT 3780 02:24:34,586 --> 02:24:37,322 THE QUESTIONS IN THE QUESTION 3781 02:24:37,322 --> 02:24:40,125 AND ANSWER DURING THE 3782 02:24:40,125 --> 02:24:41,426 PRESENTATION BUT WE WILL STILL 3783 02:24:41,426 --> 02:24:43,395 ANSWER AT THE END. 3784 02:24:43,395 --> 02:24:45,931 KNEW WE GO TO STEPHANIE 3785 02:24:45,931 --> 02:24:48,000 FITZPATRICK. 3786 02:24:48,000 --> 02:24:51,637 >> STEPHANIE FITZPATRICK. 3787 02:24:51,637 --> 02:24:52,938 THANK YOU FOR THIS. 3788 02:24:52,938 --> 02:24:55,507 I WILL TALK ABOUT INTEGRATED 3789 02:24:55,507 --> 02:24:57,209 CARE APPROACHES TO REDUCE 3790 02:24:57,209 --> 02:24:58,744 DISPARITIES AND SEVERE MATERNAL 3791 02:24:58,744 --> 02:24:59,511 MORBIDITY. 3792 02:24:59,511 --> 02:25:03,448 NEXT SLIDE, I WANT TO DISCLOSE 3793 02:25:03,448 --> 02:25:06,451 MY CURRENT CARE IS SFUNDED BY 3794 02:25:06,451 --> 02:25:07,452 THE NATIONAL INSTITUTE OF 3795 02:25:07,452 --> 02:25:07,953 NURSING RESEARCH. 3796 02:25:07,953 --> 02:25:10,956 NI. SLIDE. 3797 02:25:10,956 --> 02:25:15,227 JUST TO GIVE AN OVERVIEW, TO 3798 02:25:15,227 --> 02:25:16,161 DEFINE SEVERE MATERNITY 3799 02:25:16,161 --> 02:25:18,096 MORBIDITY I WILL DESCRIBE AS 3800 02:25:18,096 --> 02:25:23,769 SMM THROUGH MY TALK. 3801 02:25:23,769 --> 02:25:27,839 CONTRIBUTORS TO DISDISPARITIES 3802 02:25:27,839 --> 02:25:29,942 AND SMM, AND GIVE AN EXAMPLE 3803 02:25:29,942 --> 02:25:32,611 FROM OUR CURRENT TRIAL MOM CARE. 3804 02:25:32,611 --> 02:25:35,480 NEXT SLIDE. 3805 02:25:35,480 --> 02:25:38,417 THE CDC DEFINES VEER MATERNITY 3806 02:25:38,417 --> 02:25:40,619 MORBIDITY OR SMM AS UNEXPECTED 3807 02:25:40,619 --> 02:25:42,554 OUTCOMES OF LABOR AND DELIVERY 3808 02:25:42,554 --> 02:25:43,889 THAT RESULT IN SIGNIFICANT 3809 02:25:43,889 --> 02:25:45,757 SHORT OR LONG TERM CONSEQUENCES 3810 02:25:45,757 --> 02:25:47,726 TO A BIRTHING PERSON'S HEALTH. 3811 02:25:47,726 --> 02:25:56,168 EXAMPLES OF THAT COULD BE 3812 02:25:56,168 --> 02:25:58,203 MYOCARDIAL INFARCTION. 3813 02:25:58,203 --> 02:26:01,306 IT COULD SHOW UP DURING 3814 02:26:01,306 --> 02:26:02,441 POSTPARTUM ESPECIALLY IN THE 3815 02:26:02,441 --> 02:26:05,110 FIRST SIX WEEKS OR SO. 3816 02:26:05,110 --> 02:26:07,646 SMM INCREASES THE RISK FOR 3817 02:26:07,646 --> 02:26:08,647 RE-HOSPITALIZATION AFTER 3818 02:26:08,647 --> 02:26:11,116 DELIVERY AND INCREASES RISK FOR 3819 02:26:11,116 --> 02:26:11,617 DISABILITY AND MATERNAL 3820 02:26:11,617 --> 02:26:12,951 MORTALITY. 3821 02:26:12,951 --> 02:26:15,854 BUT MOST CASES SMM ARE 3822 02:26:15,854 --> 02:26:17,055 AVOIDABLE IF TIMELY APPROPRIATE 3823 02:26:17,055 --> 02:26:17,556 CARE IS PROVIDED. 3824 02:26:17,556 --> 02:26:22,694 NEXT SLIDE. 3825 02:26:22,694 --> 02:26:25,664 HERE WE SEE SOME DATA PRESENTED 3826 02:26:25,664 --> 02:26:28,700 LOOKING AT DISPARITIES AND 3827 02:26:28,700 --> 02:26:30,636 PREVALENCE OF SMM, NON-HISPANIC 3828 02:26:30,636 --> 02:26:32,037 BLACK BIRTHING PEOPLE ARE TWO 3829 02:26:32,037 --> 02:26:35,674 TIMES MORE LIKELY TO EXAM SMM 3830 02:26:35,674 --> 02:26:37,509 THAN ANY NON-HISPANIC WHITE 3831 02:26:37,509 --> 02:26:38,944 PATIENTS AND ACTUALLY BLACK 3832 02:26:38,944 --> 02:26:42,180 BIRTHING PATIENTS ARE MORE 3833 02:26:42,180 --> 02:26:44,149 LIKELY TO EXPERIENCE SMM 3834 02:26:44,149 --> 02:26:45,550 THROUGHOUT THE CONTINUUM, MORE 3835 02:26:45,550 --> 02:26:47,319 SO THAN ANY OTHER RACIAL ETHNIC 3836 02:26:47,319 --> 02:26:48,987 GROUP. 3837 02:26:48,987 --> 02:26:50,222 USUALLY DETECTED THROUGH LABOR 3838 02:26:50,222 --> 02:26:54,593 AND DELIVERY BUT CAN SHOW UP 3839 02:26:54,593 --> 02:26:56,128 DURING POSTPARTUM. 3840 02:26:56,128 --> 02:26:57,129 BLACK BIRTHING PEOPLE ARE MORE 3841 02:26:57,129 --> 02:26:58,664 LIKELY TO EXPERIENCE. 3842 02:26:58,664 --> 02:27:01,033 WILL THES DISPARITIES IN TERMS 3843 02:27:01,033 --> 02:27:03,602 OF AGE, EITHER YOUNGER OR OLDER 3844 02:27:03,602 --> 02:27:05,070 BIRTHING PEOPLE, MORE LIKELY TO 3845 02:27:05,070 --> 02:27:06,338 EXPERIENCE SMM. 3846 02:27:06,338 --> 02:27:09,675 CERTAINLY IF FOLKS ARE LIVING 3847 02:27:09,675 --> 02:27:10,676 IN LOW-INCOME, LOW-RESOURCE 3848 02:27:10,676 --> 02:27:11,643 NEIGHBORHOODS OR DELIVERING IN 3849 02:27:11,643 --> 02:27:12,644 PUBLIC HOSPITALS. 3850 02:27:12,644 --> 02:27:18,150 NEXT SLIDE. 3851 02:27:18,150 --> 02:27:19,951 WHAT'S INTERESTING ABOUT THE 3852 02:27:19,951 --> 02:27:22,688 DISPARITIES WE SEE RACIAL 3853 02:27:22,688 --> 02:27:24,823 ETHNIC DISPARITIES IN SMM NO 3854 02:27:24,823 --> 02:27:26,291 MATTER THE ECONOMIC BACKGROUND 3855 02:27:26,291 --> 02:27:27,292 OR MEDICAL COVERAGE OF BLACK 3856 02:27:27,292 --> 02:27:28,193 BIRTHING PEOPLE. 3857 02:27:28,193 --> 02:27:32,164 AS YOU SEE HERE, IN THIS DATA, 3858 02:27:32,164 --> 02:27:33,999 WHETHER BLACK BIRTHING PEOPLE 3859 02:27:33,999 --> 02:27:35,233 HAVE MEDICAID OR COMMERCIAL 3860 02:27:35,233 --> 02:27:37,035 INSURANCE THEY STILL HAVE 3861 02:27:37,035 --> 02:27:39,337 SIGNIFICANTLY HIGHER PREVALENCE 3862 02:27:39,337 --> 02:27:42,140 OF SMM, THIS IS DATA ACROSS NEW 3863 02:27:42,140 --> 02:27:42,574 YORK CITY HOSPITALS. 3864 02:27:42,574 --> 02:27:43,575 NEXT SLIDE. 3865 02:27:43,575 --> 02:27:46,411 SO WHAT ARE SOME OF THE 3866 02:27:46,411 --> 02:27:50,015 CONTRIBUTORS TO MATERNAL HEALTH 3867 02:27:50,015 --> 02:27:52,551 INEQUITIES PARTICULARLY IN TERM 3868 02:27:52,551 --> 02:27:55,987 OF SMM DISDISPARITIES. 3869 02:27:55,987 --> 02:27:57,622 HYPER TENSIVE DISORDERS ONE OF 3870 02:27:57,622 --> 02:28:01,126 THE LEADING CAUSE OF SMM, 3871 02:28:01,126 --> 02:28:02,360 PARTICULARLY PREECLAMPSIA. 3872 02:28:02,360 --> 02:28:03,762 BLACK BIRTHING PEOPLE ARE THREE 3873 02:28:03,762 --> 02:28:07,165 TIMES MORE LIKELY TO EXAM. 3874 02:28:07,165 --> 02:28:09,868 ALSO LACK OF SOCIAL SUPPORT, 3875 02:28:09,868 --> 02:28:11,303 WORKING PEOPLE WHO EXPERIENCE 3876 02:28:11,303 --> 02:28:13,371 SMM TEND TO HAVE SMALLER 3877 02:28:13,371 --> 02:28:15,874 SUPPORT NETWORKS AND ALSO LOWER 3878 02:28:15,874 --> 02:28:18,810 SATISFACTION WITH THEIR 3879 02:28:18,810 --> 02:28:19,211 PERCEIVED SUPPORT. 3880 02:28:19,211 --> 02:28:20,946 DURING PREGNANCY AND EVEN 3881 02:28:20,946 --> 02:28:21,246 POSTPARTUM. 3882 02:28:21,246 --> 02:28:22,380 LACK OF TRANSPORTATION AND 3883 02:28:22,380 --> 02:28:24,416 LIMITED OR NO MEDICAL COVERAGE 3884 02:28:24,416 --> 02:28:27,018 CAN EITHER DELAY OR INTERRUPT 3885 02:28:27,018 --> 02:28:28,620 GETTING TIMELY PRENATAL AND 3886 02:28:28,620 --> 02:28:32,624 POSTPARTUM CARE. 3887 02:28:32,624 --> 02:28:35,293 FOOD INSECURITY INCREASES RISK 3888 02:28:35,293 --> 02:28:40,766 FOR PREGNANCY COMPLICATIONS. 3889 02:28:40,766 --> 02:28:43,201 LACK OF ACCESS TO AFFORDABLE 3890 02:28:43,201 --> 02:28:45,737 HOUSING INCREASES RISK FOR SMM 3891 02:28:45,737 --> 02:28:47,405 ESPECIALLY AMONG THOSE WITH LOW 3892 02:28:47,405 --> 02:28:48,640 LEVELS OF EDUCATION. 3893 02:28:48,640 --> 02:28:50,976 NEXT SLIDE. 3894 02:28:50,976 --> 02:28:51,943 CERTAINLY INTEGRATED CARE 3895 02:28:51,943 --> 02:28:52,844 SETTINGS OR COMMUNITY SETTINGS 3896 02:28:52,844 --> 02:28:55,413 WE HAVE TO THINK OF THE 3897 02:28:55,413 --> 02:28:56,848 HISTORICAL, POLITICAL AND 3898 02:28:56,848 --> 02:28:58,884 SOCIAL CONTEXT, IN OUR CASE WE 3899 02:28:58,884 --> 02:29:00,752 ARE FOCUSED ON BLACK BIRTHING 3900 02:29:00,752 --> 02:29:03,421 PEOPLE WHICH THEY TRY TO MANAGE 3901 02:29:03,421 --> 02:29:05,524 HEALTH, I USE THIS FIGURE WHEN 3902 02:29:05,524 --> 02:29:07,292 I'M TRAINING RESEARCHERS ON MY 3903 02:29:07,292 --> 02:29:08,827 TEAM OR INTERVENTION STAFF TO 3904 02:29:08,827 --> 02:29:10,328 REALLY THINK OF THE CONTEXT 3905 02:29:10,328 --> 02:29:12,497 WHICH PEOPLE ARE TRYING TO HAVE 3906 02:29:12,497 --> 02:29:14,132 A HEALTHY PREGNANCY, BIRTH AND 3907 02:29:14,132 --> 02:29:15,033 HAVE A HEALTHY BABY AFTER 3908 02:29:15,033 --> 02:29:16,034 DELIVERY. 3909 02:29:16,034 --> 02:29:18,904 AND FOR WOMEN OF COLOR, THEY 3910 02:29:18,904 --> 02:29:20,071 ARE PARTICULARLY, MORE LIKELY 3911 02:29:20,071 --> 02:29:21,940 TO EXPERIENCE A NUMBER OF 3912 02:29:21,940 --> 02:29:22,908 DIFFERENT BARRIERS AS YOU CAN 3913 02:29:22,908 --> 02:29:25,210 SEE HERE IN THIS FIGURE, THAN 3914 02:29:25,210 --> 02:29:27,779 OTHER GROUPS OF PEOPLE. 3915 02:29:27,779 --> 02:29:29,881 WE HAVE TO TAKE THAT INTO 3916 02:29:29,881 --> 02:29:32,217 ACCOUNT WHEN TRYING TO DEVELOP 3917 02:29:32,217 --> 02:29:33,718 AN INTERVENTION AND MEET THEM 3918 02:29:33,718 --> 02:29:34,085 WHERE THEY ARE. 3919 02:29:34,085 --> 02:29:38,056 NEXT SLIDE. 3920 02:29:38,056 --> 02:29:42,027 SO FOR THE MOM AND CARE STUDY 3921 02:29:42,027 --> 02:29:43,929 WE THINK ABOUT ALL THE WAYS 3922 02:29:43,929 --> 02:29:45,564 THERE COULD BE DELAYS GREATING 3923 02:29:45,564 --> 02:29:46,364 THAT TIMELY APPROPRIATE CARE 3924 02:29:46,364 --> 02:29:48,867 THAT IS NEEDED TO PREVENT SMM. 3925 02:29:48,867 --> 02:29:54,439 WE LOOKED AT THE THREE DELAYS 3926 02:29:54,439 --> 02:30:02,013 MODEL FROM PACONELLA AND OTHERS. 3927 02:30:02,013 --> 02:30:04,115 THE FIRST DELAY IS THE BIRTHING 3928 02:30:04,115 --> 02:30:05,417 PERSON BEING ABLE TO RECOGNIZE 3929 02:30:05,417 --> 02:30:07,385 THEY NEED TO SEEK CARE. 3930 02:30:07,385 --> 02:30:09,187 CERTAINLY THAT HAS SOMETHING TO 3931 02:30:09,187 --> 02:30:11,256 DO WITH LEVEL OF KNOWLEDGE, IN 3932 02:30:11,256 --> 02:30:12,591 TERMS OF KNOWING WHEN SOMETHING 3933 02:30:12,591 --> 02:30:15,460 IS WRONG, KNOWING THE SIGNS AND 3934 02:30:15,460 --> 02:30:15,727 SYMPTOMS. 3935 02:30:15,727 --> 02:30:19,431 BUT ALSO, IN TERMS OF BEING 3936 02:30:19,431 --> 02:30:23,034 ABLE TO HAVE SUPPORT NETWORK, 3937 02:30:23,034 --> 02:30:24,603 WHETHER AT HOME OR IN THEIR 3938 02:30:24,603 --> 02:30:26,238 COMMUNITY TO HELP THEM IN TERMS 3939 02:30:26,238 --> 02:30:27,405 OF RECOGNIZING IT'S A TIME TO 3940 02:30:27,405 --> 02:30:28,506 SEEK CARE. 3941 02:30:28,506 --> 02:30:31,009 AND ALSO BEING ABLE TO TRUST 3942 02:30:31,009 --> 02:30:31,776 AND FEEL COMFORTABLE REACHING 3943 02:30:31,776 --> 02:30:33,211 OUT TO SEEK CARE. 3944 02:30:33,211 --> 02:30:35,213 THE SECOND DELAY IS BEING ABLE 3945 02:30:35,213 --> 02:30:38,083 TO REACH THE ACTUAL HEALTHCARE 3946 02:30:38,083 --> 02:30:39,951 FACILITY AND PROVIDER, 3947 02:30:39,951 --> 02:30:45,657 CERTAINLY THAT'S WHERE 3948 02:30:45,657 --> 02:30:47,292 HEALTH-RELATED SOCIAL NEEDS 3949 02:30:47,292 --> 02:30:49,160 COMES IN. 3950 02:30:49,160 --> 02:30:52,397 THE THIRD DELAY IS BEING ABLE 3951 02:30:52,397 --> 02:30:53,698 TO RECEIVE THAT TIMELY 3952 02:30:53,698 --> 02:31:00,672 APPROPRIATE CARE, ARE PROVIDERS 3953 02:31:00,672 --> 02:31:02,040 LISTENING TO THE PATIENTS 3954 02:31:02,040 --> 02:31:04,409 NEEDS, ARE THEY DOING THE RIGHT 3955 02:31:04,409 --> 02:31:06,011 TESTING AND DOING THE RIGHT 3956 02:31:06,011 --> 02:31:06,811 CARAT THE RIGHT TIME. 3957 02:31:06,811 --> 02:31:12,651 NEXT SLIDE. 3958 02:31:12,651 --> 02:31:19,057 THE MOMS CHAT AND CARE STUDY IS 3959 02:31:19,057 --> 02:31:21,159 PRAGMATIC CLINICAL TRIAL THAT 3960 02:31:21,159 --> 02:31:22,694 IS ACTIVELY ONGOING RIGHT NOW. 3961 02:31:22,694 --> 02:31:25,964 TRYING TO GET AND PREVENT THOSE 3962 02:31:25,964 --> 02:31:28,099 THREE DELAYS FROM HAPPENING TO 3963 02:31:28,099 --> 02:31:29,301 EVENTUALLY PREVENT SMM. 3964 02:31:29,301 --> 02:31:31,102 ONE OF THOSE IS UTILIZING A 3965 02:31:31,102 --> 02:31:33,538 CHAT BOT. 3966 02:31:33,538 --> 02:31:36,975 AT NORTHWELL WE HAVE THE 3967 02:31:36,975 --> 02:31:39,311 PREGNANCY AND PAGE CHAT 3968 02:31:39,311 --> 02:31:41,279 DELIVERED VIA A CHAT BOT. 3969 02:31:41,279 --> 02:31:43,048 THE BIRTHING PERSON RECEIVES 3970 02:31:43,048 --> 02:31:45,250 WEEKLY CHATS THAT CONNECT THEM 3971 02:31:45,250 --> 02:31:46,251 TO VARIOUS EDUCATIONAL 3972 02:31:46,251 --> 02:31:49,888 RESOURCES AND CONNECTS THEM TO 3973 02:31:49,888 --> 02:31:51,256 A 24/7 NURSE-LEAD CALL CENTER 3974 02:31:51,256 --> 02:31:53,625 IF THERE ARE QUESTIONS OR 3975 02:31:53,625 --> 02:31:54,793 CONCERNS, SYMPTOMS, IF THINGS 3976 02:31:54,793 --> 02:31:56,461 DON'T FEEL RIGHT THEY CAN REACH 3977 02:31:56,461 --> 02:32:01,533 OUT VIA THAT CHAT TO GET 3978 02:32:01,533 --> 02:32:02,367 SUPPORT BUT ALSO UNDERSTANDING 3979 02:32:02,367 --> 02:32:05,537 ABOUT WHAT'S GOING ON DURING 3980 02:32:05,537 --> 02:32:07,305 THEIR PREGNANCY AND POSTPARTUM 3981 02:32:07,305 --> 02:32:07,539 AS WELL. 3982 02:32:07,539 --> 02:32:08,273 NEXT. 3983 02:32:08,273 --> 02:32:12,711 IN ADDITION TO THE CHAT BOT 3984 02:32:12,711 --> 02:32:14,012 AVAILABLE TO PARTICIPANTS 3985 02:32:14,012 --> 02:32:16,614 THROUGHOUT THE STUDY FROM 3986 02:32:16,614 --> 02:32:17,282 PREGNANCY TO POSTPARTUM, THOSE 3987 02:32:17,282 --> 02:32:19,951 WHO ARE IN THE INTERVENTION 3988 02:32:19,951 --> 02:32:24,422 WILL ALSO RECEIVE 12 PRENATAL 3989 02:32:24,422 --> 02:32:25,790 SELF-MANAGEMENT SUPPORT 3990 02:32:25,790 --> 02:32:27,792 SESSIONS, FOCUSED ON NUTRITION, 3991 02:32:27,792 --> 02:32:30,795 PHYSICAL ACTIVITY, STRESS 3992 02:32:30,795 --> 02:32:31,696 MANAGEMENT, OVERALL DISEASE 3993 02:32:31,696 --> 02:32:32,764 PREVENTION AND MANAGEMENT, 3994 02:32:32,764 --> 02:32:36,868 ESPECIALLY IF THEY ARE DEALING 3995 02:32:36,868 --> 02:32:39,671 WITH PREECLAMPSIA, OR DIABETES. 3996 02:32:39,671 --> 02:32:42,540 GESTATIONAL DIABETES. 3997 02:32:42,540 --> 02:32:47,579 THEY CONNECT DIRECTLY TO THE 3998 02:32:47,579 --> 02:32:48,613 PROVIDER'S O.B. AND 3999 02:32:48,613 --> 02:32:50,815 CARDIOLOGIST IF THEY NEED TO BE 4000 02:32:50,815 --> 02:32:52,417 BROUGHT IN AND BEHAVIORAL 4001 02:32:52,417 --> 02:32:54,386 HEALTH SPECIALIST IF THEY NEED 4002 02:32:54,386 --> 02:32:57,789 TO BE BROUGHT IN. 4003 02:32:57,789 --> 02:33:00,125 A TRULY INTEGRATED TEAM. 4004 02:33:00,125 --> 02:33:01,993 THEN PATIENTS IN THE 4005 02:33:01,993 --> 02:33:04,329 INTERVENTION RECEIVE FIVE 4006 02:33:04,329 --> 02:33:06,364 POSTPARTUM CHECK-IN VISITS WITH 4007 02:33:06,364 --> 02:33:07,999 THE SAME MOMS TEAM AS WELL. 4008 02:33:07,999 --> 02:33:09,501 NEXT. 4009 02:33:09,501 --> 02:33:12,137 IN ADDITION TO THE CHAT BOT AND 4010 02:33:12,137 --> 02:33:15,273 TELEHEALTH VISITS WE ALSO 4011 02:33:15,273 --> 02:33:17,142 PROVIDE PATIENTS WITH 4012 02:33:17,142 --> 02:33:18,676 SELF-MONITORING TOOLS, TRACKING 4013 02:33:18,676 --> 02:33:21,880 THEIR ACTIVITY OVER TIME, 4014 02:33:21,880 --> 02:33:30,722 PROVIDE A FIT BIT AND MONITOR 4015 02:33:30,722 --> 02:33:31,189 THEIR BLOOD PRESSURE. 4016 02:33:31,189 --> 02:33:33,324 WE GIVE THEM A BLOOD PRESSURE 4017 02:33:33,324 --> 02:33:35,360 MONITOR. 4018 02:33:35,360 --> 02:33:37,595 YOU CAN SEE HERE HOW THEY KIND 4019 02:33:37,595 --> 02:33:39,664 OF LINEUP WITH THE THREE 4020 02:33:39,664 --> 02:33:43,234 DIFFERENT DELAYS I TALKED ABOUT 4021 02:33:43,234 --> 02:33:43,468 BEFORE. 4022 02:33:43,468 --> 02:33:46,037 IN TERMS OF MANAGEMENT SUPPORT 4023 02:33:46,037 --> 02:33:48,106 WITH TELEHEALTH VISITS THAT 4024 02:33:48,106 --> 02:33:50,208 WILL IDEALLY ADDRESS THE FIRST 4025 02:33:50,208 --> 02:33:52,377 DELAY, HELPING BIRTHING PEOPLE 4026 02:33:52,377 --> 02:33:53,378 RECOGNIZE WHEN THEY NEED TO 4027 02:33:53,378 --> 02:33:54,846 SEEK CARE. 4028 02:33:54,846 --> 02:33:58,083 AND CHAT BOT AND 24/7 NURSE-LED 4029 02:33:58,083 --> 02:33:59,217 CALL CENTER AND WORKING WITH 4030 02:33:59,217 --> 02:34:03,955 THE MOMS TEAM IN TERMS OF 4031 02:34:03,955 --> 02:34:05,990 PROVIDING CLINICAL, BEHAVIORAL 4032 02:34:05,990 --> 02:34:08,359 AND SOCIAL HEALTH CHECK-IN 4033 02:34:08,359 --> 02:34:10,795 VISITS AND CALLS AS WELL AS 4034 02:34:10,795 --> 02:34:12,964 NAVIGATION TO THE CLINICAL AND 4035 02:34:12,964 --> 02:34:14,732 SOCIAL SERVICES AS NEEDED TO 4036 02:34:14,732 --> 02:34:15,467 ADDRESS DELAY TWO AND THREE. 4037 02:34:15,467 --> 02:34:16,868 NEXT SLIDE. 4038 02:34:16,868 --> 02:34:18,136 I WANT TO ACKNOWLEDGE THE STUDY 4039 02:34:18,136 --> 02:34:21,005 TEAM. 4040 02:34:21,005 --> 02:34:22,540 CERTAINLY OUR FUNDERS NINR, AS 4041 02:34:22,540 --> 02:34:25,043 WELL AS OUR COMMUNITY ADVISORY 4042 02:34:25,043 --> 02:34:25,243 BOARD. 4043 02:34:25,243 --> 02:34:29,814 THIS TYPE OF WORK, ESPECIALLY 4044 02:34:29,814 --> 02:34:31,082 IMPLEMENTATION WORK DOESN'T 4045 02:34:31,082 --> 02:34:34,385 HAPPEN WITHOUT INVOLVING 4046 02:34:34,385 --> 02:34:36,154 COMMUNITY ADVISORS AND HEALTH 4047 02:34:36,154 --> 02:34:38,389 SYSTEM AND CLINICAL PROVIDERS 4048 02:34:38,389 --> 02:34:38,623 AS WELL. 4049 02:34:38,623 --> 02:34:40,125 WE DEPEND ON THEM VERY HEAVILY 4050 02:34:40,125 --> 02:34:42,727 IN TERMS OF ONE, UNDERSTANDING 4051 02:34:42,727 --> 02:34:44,629 OUR BLIND SPOTS AND ADDRESSING 4052 02:34:44,629 --> 02:34:46,764 THOSE BUT ALSO IN TERMS OF 4053 02:34:46,764 --> 02:34:49,667 MOVING THIS FROM IMPLEMENTATION 4054 02:34:49,667 --> 02:34:50,068 TO SUSTAINABILITY. 4055 02:34:50,068 --> 02:34:53,171 I ALSO WANT TO ACKNOWLEDGE NIH 4056 02:34:53,171 --> 02:34:54,539 PRAGUE NATICK TRIALS 4057 02:34:54,539 --> 02:34:58,209 COLLABORATORY AS WELL AS THE 4058 02:34:58,209 --> 02:34:59,777 CO-INVESTIGATORS ON THE MOM 4059 02:34:59,777 --> 02:35:00,411 CHAT CARE STUDY. 4060 02:35:00,411 --> 02:35:01,913 NEXT SLIDE. 4061 02:35:01,913 --> 02:35:03,548 HERE ARE SOME REFERENCES OF THE 4062 02:35:03,548 --> 02:35:04,749 WORK I COVERED DURING THE SLIDE 4063 02:35:04,749 --> 02:35:06,484 DECKS. 4064 02:35:06,484 --> 02:35:08,052 NEXT SLIDE, I HAVE SOME 4065 02:35:08,052 --> 02:35:08,620 ADDITIONAL REFERENCES. 4066 02:35:08,620 --> 02:35:10,221 THANK YOU. 4067 02:35:10,221 --> 02:35:20,431 NEXT SLIDE. 4068 02:35:24,536 --> 02:35:25,703 >> MIHAELA STEFAN: THANK YOU, 4069 02:35:25,703 --> 02:35:27,305 STEPHANIE. 4070 02:35:27,305 --> 02:35:37,549 NOW WE MOVE TO DR. PASSEY. 4071 02:35:37,549 --> 02:35:40,118 >> MEGAN PASSEY: THANK YOU FOR 4072 02:35:40,118 --> 02:35:41,753 THIS OPPORTUNITY DESPITE IT 4073 02:35:41,753 --> 02:35:43,188 BEING 3:00 IN THE MORNING. 4074 02:35:43,188 --> 02:35:45,089 NEXT SLIDE, PLEASE. 4075 02:35:45,089 --> 02:35:47,091 WHAT I WILL BRIEFLY COVER IS 4076 02:35:47,091 --> 02:35:52,197 WHY IT'S IMPORTANT TO OFFER 4077 02:35:52,197 --> 02:35:54,065 SMOKING CESSATION SUPPORT, 4078 02:35:54,065 --> 02:35:55,366 EVIDENCE FOR EFFECTIVE 4079 02:35:55,366 --> 02:35:57,502 INTERVENTIONS AND GUIDELINE 4080 02:35:57,502 --> 02:35:58,903 RECOMMENDATIONS AND 4081 02:35:58,903 --> 02:35:59,370 DISTURBINGLY LARGE 4082 02:35:59,370 --> 02:35:59,938 EVIDENCE-PRACTICE GAP. 4083 02:35:59,938 --> 02:36:02,473 THEN I WILL TALK ABOUT 4084 02:36:02,473 --> 02:36:03,374 EFFECTIVE IMPLEMENTATION 4085 02:36:03,374 --> 02:36:05,009 STRATEGIES TO CHANGE BEHAVIOR 4086 02:36:05,009 --> 02:36:05,877 OF CLINICIANS CARING FOR 4087 02:36:05,877 --> 02:36:08,079 PREGNANT WOMEN. 4088 02:36:08,079 --> 02:36:10,315 HERE I AM FOCUSING ON THE 4089 02:36:10,315 --> 02:36:12,183 CLINICIANS PROVIDING CARE, NOT 4090 02:36:12,183 --> 02:36:16,654 THE WOMEN THEMSELVES AND THEN I 4091 02:36:16,654 --> 02:36:20,758 WILL PRESENT AN EXAMPLE OF A 4092 02:36:20,758 --> 02:36:22,060 PROGRAM CALLED MOHM QUIT 4093 02:36:22,060 --> 02:36:25,396 PROGRAM. 4094 02:36:25,396 --> 02:36:26,464 MIDWIFES AND OBSTETRICIANS 4095 02:36:26,464 --> 02:36:27,966 HELPING MOTHERS TO QUIT SMOKING. 4096 02:36:27,966 --> 02:36:29,667 NEXT SLIDE, PLEASE. 4097 02:36:29,667 --> 02:36:32,904 THIS MAP IS FROM A REVIEW OF 4098 02:36:32,904 --> 02:36:37,408 PREVALENCE OF SMOKING DURING 4099 02:36:37,408 --> 02:36:42,080 PREGNANCY AROUND THE WORLD BY 4100 02:36:42,080 --> 02:36:51,089 SHARON LANGE ET AL.. 4101 02:36:51,089 --> 02:36:55,360 0.2% IN TANZANIA TO 38% IN 4102 02:36:55,360 --> 02:36:56,527 NATIONAL LEVEL. 4103 02:36:56,527 --> 02:36:57,395 RECOGNIZING SOME POPULATION 4104 02:36:57,395 --> 02:36:59,797 GROUPS THERE ARE ACTUALLY MORE 4105 02:36:59,797 --> 02:37:01,633 THAN 50% OF PREGNANT PEOPLE 4106 02:37:01,633 --> 02:37:03,668 WILL BE SMOKERS. SO THIS IS 4107 02:37:03,668 --> 02:37:05,236 REALLY VERY MUCH AN EQUITY 4108 02:37:05,236 --> 02:37:06,771 ISSUE. 4109 02:37:06,771 --> 02:37:09,107 IT'S GENERALLY MORE COMMON IN 4110 02:37:09,107 --> 02:37:12,877 HIGHER INCOME COUNTRIES BUT USE 4111 02:37:12,877 --> 02:37:15,179 OF SMOKELESS TOBACCO IS MORE 4112 02:37:15,179 --> 02:37:17,282 COMMON IN SOME LOW AND MIDDLE 4113 02:37:17,282 --> 02:37:19,384 INCOME COUNTRIES SO THAT ALSO 4114 02:37:19,384 --> 02:37:19,751 CAUSES PROBLEMS. 4115 02:37:19,751 --> 02:37:22,954 NEXT SLIDE, PLEASE. 4116 02:37:22,954 --> 02:37:27,191 SO WHAT IS THIS MEASURE? 4117 02:37:27,191 --> 02:37:31,896 SMOKING DURING PREGNANCY IS THE 4118 02:37:31,896 --> 02:37:33,164 MOST IMPORTANT PREVENTABLE 4119 02:37:33,164 --> 02:37:35,433 CAUSE OF ADVERSE PREGNANCY 4120 02:37:35,433 --> 02:37:36,934 OUTCOMES. 4121 02:37:36,934 --> 02:37:38,836 SMOKING DOUBLES AND TRIPLES 4122 02:37:38,836 --> 02:37:39,904 RISK OF MULTIPLE COMPLICATIONS 4123 02:37:39,904 --> 02:37:42,373 FOR THE BABY. 4124 02:37:42,373 --> 02:37:44,042 STILLBIRTH, PRE-TERM BIRTH AND 4125 02:37:44,042 --> 02:37:45,677 LOW BIRTH WEIGHT LISTED HERE 4126 02:37:45,677 --> 02:37:48,246 AND ALSO INCREASES THE RISK OF 4127 02:37:48,246 --> 02:37:49,614 OTHER ADVERSE OUTCOMES I HAVE 4128 02:37:49,614 --> 02:37:52,050 LISTED INTEREST FOR THE BABY. 4129 02:37:52,050 --> 02:37:54,085 IT ALSO INCREASES HEALTH RISK 4130 02:37:54,085 --> 02:37:55,687 TO THE MOTHER, INCREASING 4131 02:37:55,687 --> 02:37:57,889 PREGNANCY COMPLICATIONS AS WELL 4132 02:37:57,889 --> 02:37:59,357 AS ONGOING HARMS ASSOCIATED 4133 02:37:59,357 --> 02:38:00,591 WITH SMOKING GENERALLY. 4134 02:38:00,591 --> 02:38:02,160 SO THESE HARMS ARE BOTH 4135 02:38:02,160 --> 02:38:06,898 EXTENSIVE AND THEY ARE LIFELONG. 4136 02:38:06,898 --> 02:38:08,199 FORTUNATELY, THE RISKS TO 4137 02:38:08,199 --> 02:38:10,301 MOTHER AND BABY ARE 4138 02:38:10,301 --> 02:38:11,803 SIGNIFICANTLY REDUCED IF WOMEN 4139 02:38:11,803 --> 02:38:13,971 STOP SMOKING DURING PREGNANCY. 4140 02:38:13,971 --> 02:38:15,740 QUITTING SMOKING AT ANY STAGE 4141 02:38:15,740 --> 02:38:17,542 OF PREGNANCY IS BENEFICIAL, BUT 4142 02:38:17,542 --> 02:38:20,078 THE EARLIER IN PREGNANCY WOMEN 4143 02:38:20,078 --> 02:38:21,479 QUIT SMOKING, THE BETTER. 4144 02:38:21,479 --> 02:38:25,650 NEXT SLIDE, PLEASE. 4145 02:38:25,650 --> 02:38:30,221 SO THERE'S NOW EXTENSIVE AND 4146 02:38:30,221 --> 02:38:32,557 COMPELLING EVIDENCE THAT BRIEF 4147 02:38:32,557 --> 02:38:33,758 BEHAVIORAL INTERVENTIONS 4148 02:38:33,758 --> 02:38:35,960 DELIVERED BY PRENATAL CARE 4149 02:38:35,960 --> 02:38:36,627 PROVIDERS SIGNIFICANTLY 4150 02:38:36,627 --> 02:38:38,262 INCREASED QUITTING RATES AND 4151 02:38:38,262 --> 02:38:43,167 THEY REDUCE LOW BIRTH WEIGHT 4152 02:38:43,167 --> 02:38:46,971 AND NOW THERE IS EVIDENCE THAT 4153 02:38:46,971 --> 02:38:51,376 THEY REDUCE ADMISSIONS TO N 4154 02:38:51,376 --> 02:38:52,377 ICU'S. 4155 02:38:52,377 --> 02:38:54,178 BASED ON EVIDENCE WE HAVE 4156 02:38:54,178 --> 02:38:55,380 MULTIPLE GUIDELINES FOR MANY 4157 02:38:55,380 --> 02:38:58,950 COUNTRIES AND I'M SHOWING THE 4158 02:38:58,950 --> 02:38:59,917 WHO, AUSTRALIAN AND U.S. 4159 02:38:59,917 --> 02:39:01,819 GUIDELINES HERE. 4160 02:39:01,819 --> 02:39:03,721 ALL OF THIEZ RECOMMEND BRIEF 4161 02:39:03,721 --> 02:39:04,222 INTERVENTIONS SHOULD BE 4162 02:39:04,222 --> 02:39:05,723 PROVIDED. 4163 02:39:05,723 --> 02:39:10,027 MOST GUIDELINES RECOMMEND USE 4164 02:39:10,027 --> 02:39:13,998 OF FIVE A'S AND THESE SHOULD BE 4165 02:39:13,998 --> 02:39:15,366 PROVIDED CONSISTENTLY AND EVERY 4166 02:39:15,366 --> 02:39:17,201 CLINICAL ENCOUNTER. 4167 02:39:17,201 --> 02:39:22,707 THE FIVE A'S INVOLVE ASKING AT 4168 02:39:22,707 --> 02:39:25,710 THE FIRST ANTENATAL PRENATAL 4169 02:39:25,710 --> 02:39:25,910 VISIT. 4170 02:39:25,910 --> 02:39:29,680 IN AUSTRALIA WE CALL THAT 4171 02:39:29,680 --> 02:39:31,716 ANTENATAL, SO I'M TRYING TO GET 4172 02:39:31,716 --> 02:39:33,918 MY LANGUAGE RIGHT. 4173 02:39:33,918 --> 02:39:36,220 ASKING EVERY WOMAN WHETHER SHE 4174 02:39:36,220 --> 02:39:38,656 SMOKES, FOR EVERY WOMAN WHO 4175 02:39:38,656 --> 02:39:45,530 DOES SMOKE, ASSESSING THEIR 4176 02:39:45,530 --> 02:39:49,867 DEPENDENCY AND UNDERSTANDING 4177 02:39:49,867 --> 02:39:51,502 WHERE THEY LIVE, PROVIDING 4178 02:39:51,502 --> 02:39:53,204 ADVICE BEST THING YOU CAN DO 4179 02:39:53,204 --> 02:39:55,173 FOR YOUR HEALTH AND HEALTH OF 4180 02:39:55,173 --> 02:39:57,809 YOUR BABY IS TO STOP SMOKING 4181 02:39:57,809 --> 02:39:59,076 AND PROVIDING BRIEF COUNSELING 4182 02:39:59,076 --> 02:40:01,946 ON THE BENEFITS OF QUITTING. 4183 02:40:01,946 --> 02:40:05,183 PROVIDE ASSISTANCE WITH BRIEF 4184 02:40:05,183 --> 02:40:07,285 BEHAVIORAL COUNSELING, ADDING 4185 02:40:07,285 --> 02:40:07,785 NRT IF NEEDED. 4186 02:40:07,785 --> 02:40:09,120 THAT COULD BE TELEPHONE SUPPORT 4187 02:40:09,120 --> 02:40:10,121 OR FACE-TO-FACE. 4188 02:40:10,121 --> 02:40:20,465 NEXT SLIDE, PLEASE. 4189 02:40:23,100 --> 02:40:23,901 UNFORTUNATELY, DESPITE THE 4190 02:40:23,901 --> 02:40:26,504 STRONG EVIDENCE BASE AND THE 4191 02:40:26,504 --> 02:40:28,639 FACT WE HAVE HAD THESE 4192 02:40:28,639 --> 02:40:31,108 GUIDELINES FOR SEVERAL DECADES 4193 02:40:31,108 --> 02:40:37,715 NOW THERE'S AN INCREDIBLY LARGE 4194 02:40:37,715 --> 02:40:39,383 EVIDENCE PRACTICE GAP BASE. 4195 02:40:39,383 --> 02:40:42,153 IN OUR OWN RESEARCH IN NEW 4196 02:40:42,153 --> 02:40:45,156 SOUTH WALES WE FOUND ONLY 77% 4197 02:40:45,156 --> 02:40:46,991 OF MIDWIFES REPORT THEY ALWAYS 4198 02:40:46,991 --> 02:40:51,262 ASK WOMEN ABOUT SMOKING AT 4199 02:40:51,262 --> 02:40:51,829 THEIR FIRST APPOINTMENT. 4200 02:40:51,829 --> 02:40:54,131 LESS THAN 40% CONSISTENTLY 4201 02:40:54,131 --> 02:40:56,067 PROVIDE ANY COUNSELING AT THAT 4202 02:40:56,067 --> 02:40:58,503 APPOINTMENT AND LESS THAN 25% 4203 02:40:58,503 --> 02:41:00,204 ACTUALLY CONTINUE TO ASSESS 4204 02:41:00,204 --> 02:41:02,940 SMOKING STATUS AND SUBSEQUENT 4205 02:41:02,940 --> 02:41:03,941 APPOINTMENTS AND THEREFORE 4206 02:41:03,941 --> 02:41:06,077 PROVIDING CONTINUING CARE. 4207 02:41:06,077 --> 02:41:09,614 AUSTRALIA STILL HAS 9% OF WOMEN 4208 02:41:09,614 --> 02:41:12,583 SMOKING DURING PREGNANCY AND 4209 02:41:12,583 --> 02:41:14,852 SOME MARGINALIZED GROUPS HAVE 4210 02:41:14,852 --> 02:41:17,588 RATED OVER 50%. 4211 02:41:17,588 --> 02:41:20,424 WHILE MANY MANAGE TO QUIT, MANY 4212 02:41:20,424 --> 02:41:22,226 RELAPSE DURING THE PREGNANCY 4213 02:41:22,226 --> 02:41:24,862 AND 57% ARE STILL SMOKING IN 4214 02:41:24,862 --> 02:41:25,229 THE SECOND HALF. 4215 02:41:25,229 --> 02:41:27,198 WE KNOW WOMEN ARE HIGHLY 4216 02:41:27,198 --> 02:41:29,066 MOTIVATED TO QUIT SMOKING. 4217 02:41:29,066 --> 02:41:31,135 VAST MAJORITY OF WOMEN WANT TO 4218 02:41:31,135 --> 02:41:33,004 DO THE VERY BEST THEY CAN FOR 4219 02:41:33,004 --> 02:41:34,972 THEIR BABY BUT NOT GIVEN 4220 02:41:34,972 --> 02:41:36,440 ADEQUATE HELP TO ACHIEVE THIS. 4221 02:41:36,440 --> 02:41:38,042 THIS IS A MASSIVE MISSED 4222 02:41:38,042 --> 02:41:39,110 OPPORTUNITY TO IMPROVE THE 4223 02:41:39,110 --> 02:41:41,412 HEALTH AND WELL-BEING OF THE 4224 02:41:41,412 --> 02:41:42,513 BABY AND THE MOTHER. 4225 02:41:42,513 --> 02:41:45,116 NEXT SLIDE, PLEASE. 4226 02:41:45,116 --> 02:41:49,587 SO, HOW DO WE IMPROVE 4227 02:41:49,587 --> 02:41:51,856 IMPLEMENTATION SUPPORT? 4228 02:41:51,856 --> 02:41:53,057 THERE ARE SYSTEMATIC REVIEWS 4229 02:41:53,057 --> 02:41:55,793 THAT HAVE LOOKED AT 4230 02:41:55,793 --> 02:41:57,295 EFFECTIVENESS OF IMPLEMENTATION 4231 02:41:57,295 --> 02:42:06,437 STRATEGIES IN IMPROVING 4232 02:42:06,437 --> 02:42:07,271 IMPLEMENTATION OF SMOKING 4233 02:42:07,271 --> 02:42:15,947 CESSATION, INCLUDING AUDIT AND 4234 02:42:15,947 --> 02:42:17,248 FEEDBACK ENHANCES EFFECTIVENESS 4235 02:42:17,248 --> 02:42:18,749 OF OTHER STRATEGIES, IT'S NOT 4236 02:42:18,749 --> 02:42:21,352 EFFECTIVE ON ITS OWN. 4237 02:42:21,352 --> 02:42:22,954 USING MULTIPLE IMPLEMENTATION 4238 02:42:22,954 --> 02:42:24,322 STRATEGIES IS MORE EFFECTIVE 4239 02:42:24,322 --> 02:42:27,725 THAN ONE OR TWO, AND USING 4240 02:42:27,725 --> 02:42:28,326 THEORETICAL IMPLEMENTATION 4241 02:42:28,326 --> 02:42:30,394 SCIENCE FRAMEWORKS AND TOOLS TO 4242 02:42:30,394 --> 02:42:31,929 TAILOR INTERVENTIONS TO THE 4243 02:42:31,929 --> 02:42:34,031 LOCAL CONTEXT IS MORE E 4244 02:42:34,031 --> 02:42:34,465 FEKTDIVE. 4245 02:42:34,465 --> 02:42:36,200 THERE'S NO EVIDENCE OF 4246 02:42:36,200 --> 02:42:37,868 STRATEGIES THAT ACTUALLY 4247 02:42:37,868 --> 02:42:39,270 IMPROVE PROVISION OF FOLLOW-UP 4248 02:42:39,270 --> 02:42:39,604 SUPPORT. 4249 02:42:39,604 --> 02:42:41,572 BUT WE CONTINUE TO TRY. 4250 02:42:41,572 --> 02:42:45,209 NEXT SLIDE, PLEASE. 4251 02:42:45,209 --> 02:42:47,612 SO NOW I WILL JUST PRESENT AN 4252 02:42:47,612 --> 02:42:50,848 EXAMPLE OF HOW WE USE 4253 02:42:50,848 --> 02:42:51,349 IMPLEMENTATION SCIENCE 4254 02:42:51,349 --> 02:42:54,118 APPROACHES TO TRY TO IMPROVE 4255 02:42:54,118 --> 02:42:57,321 THE IMPLEMENTATION OF SMOKING 4256 02:42:57,321 --> 02:42:59,423 CESSATION SUPPORT HERE IN NEW 4257 02:42:59,423 --> 02:43:05,496 SOUTH WALES. THIS IS THE MOHM 4258 02:43:05,496 --> 02:43:07,064 QUIT PROGRAM STANDING FOR 4259 02:43:07,064 --> 02:43:15,139 MIDWIFES AND OBSTETRICIANS 4260 02:43:15,139 --> 02:43:16,140 HELPING MOTHERS TO QUIT SMOKING. 4261 02:43:16,140 --> 02:43:18,976 NEXT SLIDE. 4262 02:43:18,976 --> 02:43:20,544 WE USE THIS BEHAVIORAL CHANGE 4263 02:43:20,544 --> 02:43:25,249 WHEEL WHICH IS A METHOD FOR 4264 02:43:25,249 --> 02:43:26,050 DEVELOPING BEHAVIOR CHANGE 4265 02:43:26,050 --> 02:43:28,352 INTERVENTIONS, WORKING ON THE 4266 02:43:28,352 --> 02:43:30,388 TARGET BEHAVIOR TO DESIGN THE 4267 02:43:30,388 --> 02:43:31,322 INTERVENTION AND DELIVER THE 4268 02:43:31,322 --> 02:43:33,257 INTERVENTION. 4269 02:43:33,257 --> 02:43:35,359 THERE ARE MULTIPLE STEPS IN 4270 02:43:35,359 --> 02:43:36,127 EACH STAGE. 4271 02:43:36,127 --> 02:43:39,330 IN OUR CASE, TARGETING 4272 02:43:39,330 --> 02:43:40,665 INTERVENTION WITH CLINICIAN 4273 02:43:40,665 --> 02:43:42,233 BEHAVIOR WANTED TO PROVIDE 4274 02:43:42,233 --> 02:43:43,968 CESSATION SUPPORT TO WOMEN 4275 02:43:43,968 --> 02:43:45,603 CONSISTENT WITH THE GUIDELINES. 4276 02:43:45,603 --> 02:43:48,239 IN ORDER TO UNDERSTAND THE 4277 02:43:48,239 --> 02:43:50,007 BEHAVIOR, WE UNDERTOOK 4278 02:43:50,007 --> 02:43:51,509 QUALITATIVE RESEARCH AND 4279 02:43:51,509 --> 02:43:55,579 SURVEYS WITH MIDWIFE AND 4280 02:43:55,579 --> 02:43:57,281 OBSTETRICIANS AND MANAGEMENT OF 4281 02:43:57,281 --> 02:44:02,420 SERVICES GUIDED BY THEORETICAL 4282 02:44:02,420 --> 02:44:04,555 FRAMEWORK, IN ORDER TO 4283 02:44:04,555 --> 02:44:05,623 UNDERSTAND THE BARRIERS AND 4284 02:44:05,623 --> 02:44:07,491 COME TO A COMPREHENSIVE 4285 02:44:07,491 --> 02:44:09,727 UNDERSTANDING WHAT WAS THE 4286 02:44:09,727 --> 02:44:10,061 PROBLEM HERE. 4287 02:44:10,061 --> 02:44:11,128 AND THEN WE FOLLOWED THE 4288 02:44:11,128 --> 02:44:12,530 REMAINING STEPS IN THE SLIDE. 4289 02:44:12,530 --> 02:44:19,704 NEXT SLIDE, PLEASE. 4290 02:44:19,704 --> 02:44:21,839 I REALIZE THE WRITING IS SMALL, 4291 02:44:21,839 --> 02:44:23,307 I WANT TO DEMONSTRATE BRIEFLY 4292 02:44:23,307 --> 02:44:26,644 THE PROCESS WE FOLLOWED IN THE 4293 02:44:26,644 --> 02:44:28,546 BEHAVIOR CHANGE WHEEL METHOD. 4294 02:44:28,546 --> 02:44:31,849 THE BARRIER IS KNOWLEDGE OF THE 4295 02:44:31,849 --> 02:44:32,650 GUIDELINES AND 5A'S WAS VERY 4296 02:44:32,650 --> 02:44:33,617 POOR. 4297 02:44:33,617 --> 02:44:39,790 THAT COMES INTO THE TDF DOMAIN, 4298 02:44:39,790 --> 02:44:42,326 THEORETICAL DOMAIN FRAMEWORK 4299 02:44:42,326 --> 02:44:43,961 DOMAIN, POTENTIAL INTERVENTION 4300 02:44:43,961 --> 02:44:45,763 FUNCTIONS WE SELECT OPTIONS TO 4301 02:44:45,763 --> 02:44:47,598 CHANGE THAT, WE SELECTED 4302 02:44:47,598 --> 02:44:50,134 EDUCATION, WHICH IS FAIRLY 4303 02:44:50,134 --> 02:44:50,367 OBVIOUS. 4304 02:44:50,367 --> 02:44:52,436 SOME ARE LESS OBVIOUS AND 4305 02:44:52,436 --> 02:44:55,072 BEHAVIOR CHANGE TECHNIQUES WE 4306 02:44:55,072 --> 02:44:57,875 MAPPED THIS TO, ED INSTRUCTION 4307 02:44:57,875 --> 02:45:00,611 HOW TO PERFORM A BEHAVIOR, HOW 4308 02:45:00,611 --> 02:45:05,850 AND WHEN TO PROVIDE THE 5A'S 4309 02:45:05,850 --> 02:45:08,486 AND INFORMATION ABOUT OTHERS. 4310 02:45:08,486 --> 02:45:10,721 AND INCREDIBLE SOURCE, HIGHLY 4311 02:45:10,721 --> 02:45:11,555 RESPECTED SENIOR MIDWIFE WELL 4312 02:45:11,555 --> 02:45:13,491 KNOWN A CAOS THE STATE. 4313 02:45:13,491 --> 02:45:15,659 SO THAT'S PRETTY OBVIOUS AND 4314 02:45:15,659 --> 02:45:17,795 STANDARD PRACTICE, I THINK. 4315 02:45:17,795 --> 02:45:21,932 WE NOW LOOK AT THE BOTTOM LINE 4316 02:45:21,932 --> 02:45:24,268 IN THIS TABLE. 4317 02:45:24,268 --> 02:45:26,570 PRIORITIZING OTHER HEALTH 4318 02:45:26,570 --> 02:45:28,072 ISSUES OVER SMOKING WITH NOT 4319 02:45:28,072 --> 02:45:30,508 SUCH AN OBVIOUS ONE TO START. 4320 02:45:30,508 --> 02:45:35,246 WITH THIS WE SELECTED PER -- 4321 02:45:35,246 --> 02:45:37,414 PERSUASION, WE WANTED TO 4322 02:45:37,414 --> 02:45:40,484 PERSUADE PEOPLE TO PRIORITIZE 4323 02:45:40,484 --> 02:45:41,986 SMOKING MORE HIGHLY, NOT 4324 02:45:41,986 --> 02:45:43,420 NECESSARILY OVER OTHER THINGS 4325 02:45:43,420 --> 02:45:45,756 BUT MORE HIGHLY. 4326 02:45:45,756 --> 02:45:47,725 WE HIGHLIGHTED THE HEALTH 4327 02:45:47,725 --> 02:45:49,660 CONSEQUENCES OF SMOKING AND 4328 02:45:49,660 --> 02:45:51,562 COMPARED TO PREECLAMPSIA. 4329 02:45:51,562 --> 02:45:53,397 THEY HAVE SIMILAR HEALTH 4330 02:45:53,397 --> 02:45:57,334 OUTCOMES AND PREVALENCE AND 4331 02:45:57,334 --> 02:45:59,570 PROBLEMS IN TERMS OF HEALTH 4332 02:45:59,570 --> 02:46:01,972 OUTCOMES FOR THE MOTHER AND 4333 02:46:01,972 --> 02:46:02,173 BABY. 4334 02:46:02,173 --> 02:46:03,407 AND THEN DEMONSTRATE THE CLEAR 4335 02:46:03,407 --> 02:46:08,312 DIFFERENCES IN THE RESPONSE AND 4336 02:46:08,312 --> 02:46:08,946 EXTREME SIGNIFICANT DIFFERENCES 4337 02:46:08,946 --> 02:46:11,248 IN THE WAY THEY ARE MANAGED. 4338 02:46:11,248 --> 02:46:13,384 WE HAD FEEDBACK, THIS IS 4339 02:46:13,384 --> 02:46:14,819 EXTREMELY POWERFUL AND MANY 4340 02:46:14,819 --> 02:46:17,855 PEOPLE DESCRIBE THIS TO US AS 4341 02:46:17,855 --> 02:46:20,191 BEING THEIR A-HA MOMENT. 4342 02:46:20,191 --> 02:46:21,258 THEY FINALLY UNDERSTOOD WHY 4343 02:46:21,258 --> 02:46:22,092 THIS MATTERED. 4344 02:46:22,092 --> 02:46:23,694 NEXT SLIDE, PLEASE. 4345 02:46:23,694 --> 02:46:27,665 I DON'T HAVE TIME TO GO INTO 4346 02:46:27,665 --> 02:46:28,566 THE DETAILS THE PROCESS 4347 02:46:28,566 --> 02:46:29,834 FOLLOWING THAT. 4348 02:46:29,834 --> 02:46:33,304 THERE'S A LOT MORE TO THE 4349 02:46:33,304 --> 02:46:33,737 CO-DESIGN THAN THIS. 4350 02:46:33,737 --> 02:46:44,215 IT WAS A CO-DESIGN PROCESS 4351 02:46:45,482 --> 02:46:47,785 WORKING WITH MIDWIFES, 4352 02:46:47,785 --> 02:46:49,353 OBSTETRICIANS AND MANAGERS 4353 02:46:49,353 --> 02:46:50,654 POLICY MAKERS CONTROL PEOPLE. 4354 02:46:50,654 --> 02:46:53,190 BUT THIS IS THE FINAL DIAGRAM 4355 02:46:53,190 --> 02:46:55,059 OF THE FINAL INTERVENTION. 4356 02:46:55,059 --> 02:46:57,228 INNOVATIVE PROGRAM. 4357 02:46:57,228 --> 02:46:59,129 IT TAKES A WHOLE SYSTEM 4358 02:46:59,129 --> 02:47:08,239 APPROACH AND DESIGNED TO BE 4359 02:47:08,239 --> 02:47:10,207 REPLICABLE, SUSTAINABLE AND 4360 02:47:10,207 --> 02:47:11,775 SCAPABLE. 4361 02:47:11,775 --> 02:47:17,982 IT'S INTENDED TO BE VIRTUAL 4362 02:47:17,982 --> 02:47:21,952 VISUAL REPRESENTATION BECAUSE 4363 02:47:21,952 --> 02:47:22,453 EACH IS INTERDEPENDENT. 4364 02:47:22,453 --> 02:47:28,459 WE CAN'T JUST HAVE ONE WHIRING 4365 02:47:28,459 --> 02:47:30,361 AWAY ON ITS OWN AND NOT 4366 02:47:30,361 --> 02:47:31,595 ACHIEVING ANY OUTCOMES. 4367 02:47:31,595 --> 02:47:33,731 NEXT SLIDE, PLEASE. 4368 02:47:33,731 --> 02:47:37,301 THIS IS MY FINAL SLIDE. 4369 02:47:37,301 --> 02:47:38,569 TAKE-HOME MESSAGES IT'S 4370 02:47:38,569 --> 02:47:40,838 CRITICAL THAT WE PROVIDE GOOD 4371 02:47:40,838 --> 02:47:43,307 EVIDENCE-BASED SUPPORT TO WOMEN 4372 02:47:43,307 --> 02:47:43,707 AND STOP SMOKING. 4373 02:47:43,707 --> 02:47:46,443 DUTY OF CARE THAT WE FACE. 4374 02:47:46,443 --> 02:47:47,311 CHANGING BEHAVIOR ISN'T THAT 4375 02:47:47,311 --> 02:47:53,684 SIMPLE. 4376 02:47:53,684 --> 02:47:54,618 IT REQUIRES TAILORED 4377 02:47:54,618 --> 02:47:56,020 INTERVENTIONS. NEW SOUTH WALES 4378 02:47:56,020 --> 02:47:58,355 IT'S BEEN THE RESPONSE TO DATE. 4379 02:47:58,355 --> 02:47:59,857 WE TRAIN THE MIDWIFES WE DO 4380 02:47:59,857 --> 02:48:04,528 NOTHING ELSE. 4381 02:48:04,528 --> 02:48:06,363 NOW WE HAVE CHANGED THAT. 4382 02:48:06,363 --> 02:48:12,169 THANK YOU. 4383 02:48:12,169 --> 02:48:13,437 >> MIHAELA STEFAN: THANK YOU. 4384 02:48:13,437 --> 02:48:19,877 NOW WE MOVE TO OUR LAST 4385 02:48:19,877 --> 02:48:22,613 SPEAKER, JENNIFER TAYLOR-COUSAR. 4386 02:48:22,613 --> 02:48:23,747 >> JENNIFER: THANK YOU FOR 4387 02:48:23,747 --> 02:48:24,949 INVITING ME. 4388 02:48:24,949 --> 02:48:26,951 I WILL FOCUS ON SOMETHING 4389 02:48:26,951 --> 02:48:32,523 THAT'S QUITE RARE COMPARED TO 4390 02:48:32,523 --> 02:48:43,067 ASTHMA AND USE CYSTIC FIBROSIS. 4391 02:48:44,702 --> 02:48:49,873 I DO RECEIVE FUNDING. 4392 02:48:49,873 --> 02:48:51,241 BECAUSE IT AFFECTS 200,000 4393 02:48:51,241 --> 02:48:54,645 PEOPLE WORLDWIDE I WANT TO GIVE 4394 02:48:54,645 --> 02:48:57,281 A LITTLE CONTEXT FOR THOSE WHO 4395 02:48:57,281 --> 02:49:00,918 DON'T THINK OF CYSTIC FIBROSIS 4396 02:49:00,918 --> 02:49:03,053 EVERY DAY AND THERE'S 4397 02:49:03,053 --> 02:49:06,590 MISCONCEPTION WHO IS AFFECTED. 4398 02:49:06,590 --> 02:49:12,629 GENETIC DISORDER CAUSED BY 4399 02:49:12,629 --> 02:49:15,833 VARIANCE IN CFTCR GENE, ENCODES 4400 02:49:15,833 --> 02:49:23,040 SAME NAME, CFTR PROTEIN 4401 02:49:23,040 --> 02:49:24,875 FUNCTIONS ANION CHANNEL. 4402 02:49:24,875 --> 02:49:31,548 THE MAJOR MAN FESS STATIONS ARE 4403 02:49:31,548 --> 02:49:35,586 CHRONIC BRONCO PULMONO YAIRY 4404 02:49:35,586 --> 02:49:38,956 INFECTIONS, PANCREO ATE K 4405 02:49:38,956 --> 02:49:40,090 INSUFFICIENCY, BOTH ENDOCRINE 4406 02:49:40,090 --> 02:49:43,427 AND EX CIN AND SUBSEQUENT CF 4407 02:49:43,427 --> 02:49:46,363 SDIEB AT ABOUT 40% 2050%. 4408 02:49:46,363 --> 02:49:49,666 THE MAJORITY OF MALES ARE 4409 02:49:49,666 --> 02:49:52,302 INFERTILE BECAUSE OF 4410 02:49:52,302 --> 02:49:57,941 CONGENITAL BILATERAL ABSENCES 4411 02:49:57,941 --> 02:49:58,709 OF VAS DEFERENS. 4412 02:49:58,709 --> 02:50:02,112 BACK IN 1938 WHEN DR. DOROTHY 4413 02:50:02,112 --> 02:50:04,148 ANDERSEN DESCRIBES AS A 4414 02:50:04,148 --> 02:50:05,282 CLINICAL ENTITY, SHE POINTED 4415 02:50:05,282 --> 02:50:07,985 OUT THERE WAS A BLACK CHILD AND 4416 02:50:07,985 --> 02:50:11,055 HISPANIC CHILD AND SHE SAID THE 4417 02:50:11,055 --> 02:50:13,023 RACIAL AND GEOGRAPHIC 4418 02:50:13,023 --> 02:50:14,324 DISTRIBUTION OF CYSTIC FIBROSIS 4419 02:50:14,324 --> 02:50:15,926 WAS WIDE. 4420 02:50:15,926 --> 02:50:21,832 BUT THIS MESSAGE WAS NOD HEEDED 4421 02:50:21,832 --> 02:50:23,200 AND CYSTIC FIBROSIS HAS BEEN 4422 02:50:23,200 --> 02:50:25,202 TAUGHT TO BE A DISEASE THAT 4423 02:50:25,202 --> 02:50:27,271 OCCURS IN PEOPLE WHO ARE WHITE 4424 02:50:27,271 --> 02:50:30,507 TO THE DETRIMENT OF PEOPLE OF 4425 02:50:30,507 --> 02:50:30,707 COLOR. 4426 02:50:30,707 --> 02:50:32,342 WE ARE ACKNOWLEDGING MORE AND 4427 02:50:32,342 --> 02:50:35,012 MORE WHAT DR. ANDERSEN TOLD US 4428 02:50:35,012 --> 02:50:39,083 BACK IN 19 38. 4429 02:50:39,083 --> 02:50:41,051 CYSTIC FIBROSIS CAN OCCUR WITH 4430 02:50:41,051 --> 02:50:42,319 ANY ETHNICITY. 4431 02:50:42,319 --> 02:50:44,288 BECAUSE IT IS TAUGHT TO BE ONLY 4432 02:50:44,288 --> 02:50:46,090 OCCURRING IN PEOPLE WHO ARE 4433 02:50:46,090 --> 02:50:46,290 WHITE. 4434 02:50:46,290 --> 02:50:48,425 WE HAVE SEEN LATE AND MISSED 4435 02:50:48,425 --> 02:50:50,894 DIAGNOSIS OF PEOPLE WITH CF. 4436 02:50:50,894 --> 02:50:52,329 IN FACT, PEOPLE CONTINUE TO BE 4437 02:50:52,329 --> 02:50:55,499 TOLD YOU HAVE THE CLASSIC SIGNS 4438 02:50:55,499 --> 02:50:57,901 AND SYMPTOMS OF CF, I WOULD 4439 02:50:57,901 --> 02:50:59,803 HAVE DIAGNOSED YOU WITH IT IF 4440 02:50:59,803 --> 02:51:02,272 YOU WEREN'T SOMEONE OF COLOR. 4441 02:51:02,272 --> 02:51:05,275 BECAUSE OF LATE AND MISSED 4442 02:51:05,275 --> 02:51:06,677 DIAGNOSIS AND SOCIAL 4443 02:51:06,677 --> 02:51:08,512 DETERMINANTS OF HEALTH 4444 02:51:08,512 --> 02:51:09,646 INCLUDING RACISM IN MEDICINE, 4445 02:51:09,646 --> 02:51:13,784 PEOPLE OF COLOR HAVE MORE 4446 02:51:13,784 --> 02:51:16,987 MORBIDITY AND MORTALITY WITH 4447 02:51:16,987 --> 02:51:17,354 CYSTIC FIBROSIS. 4448 02:51:17,354 --> 02:51:18,889 NEXT SLIDE. 4449 02:51:18,889 --> 02:51:21,658 IN 2019, THE APPROVAL OF 4450 02:51:21,658 --> 02:51:25,195 GAME-CHANGING ORAL MEDICATIONS 4451 02:51:25,195 --> 02:51:29,967 THAT IMPACT THE CFTR PROTEIN 4452 02:51:29,967 --> 02:51:31,168 DEFECT IMPROVE CHLORIDE 4453 02:51:31,168 --> 02:51:32,569 TRANSPORT AND THEREFORE AFFECT 4454 02:51:32,569 --> 02:51:34,438 THE BASIC DEFECT IN CF WERE 4455 02:51:34,438 --> 02:51:36,807 APPROVED FOR THE MAJORITY OF 4456 02:51:36,807 --> 02:51:38,976 PEOPLE IN HIGH-INCOME COUNTRIES. 4457 02:51:38,976 --> 02:51:39,576 HOWEVER BECAUSE OF VARIANTS 4458 02:51:39,576 --> 02:51:42,312 OCCUR IN PEOPLE OF COLOR ARE 4459 02:51:42,312 --> 02:51:44,648 LESS WELL STUDIED AND MORE 4460 02:51:44,648 --> 02:51:47,518 RARE, PEOPLE OF COLOR CONTINUE 4461 02:51:47,518 --> 02:51:51,522 TO HAVE SIGNIFICANT HEALTH AND 4462 02:51:51,522 --> 02:51:53,157 EQUITY IN CYSTIC FIBROSIS. 4463 02:51:53,157 --> 02:51:56,393 WHEN THEY ARE DIAGNOSED. 4464 02:51:56,393 --> 02:51:58,929 THEY ARE LESS LIKELY TO BE 4465 02:51:58,929 --> 02:51:59,530 PRESCRIBED THESE NEW DRUGS. 4466 02:51:59,530 --> 02:52:02,966 NEXT SLIDE. 4467 02:52:02,966 --> 02:52:05,502 WHAT WE DO KNOW ABOUT HOW THESE 4468 02:52:05,502 --> 02:52:09,706 DRUGS ARE AFFECTING PEOPLE WITH 4469 02:52:09,706 --> 02:52:11,041 CYSTIC FIBROSIS, INCLUDING SOME 4470 02:52:11,041 --> 02:52:13,177 PEOPLE OF CF WHO QUALIFY FOR 4471 02:52:13,177 --> 02:52:14,978 THESE DRUGS IS PREGNANCY RATES 4472 02:52:14,978 --> 02:52:16,780 HAVE SKY ROCKETED SINCE THE 4473 02:52:16,780 --> 02:52:27,191 APPROVAL OF THESE DRUGS. 4474 02:52:33,463 --> 02:52:34,231 ALESCATTIR, IVAKAFTER WERE 4475 02:52:34,231 --> 02:52:35,566 APPROVED. 4476 02:52:35,566 --> 02:52:37,100 CHANNELS IN THE CERVIX MAKING 4477 02:52:37,100 --> 02:52:38,902 IT EASIER FOR PEOPLE TO GET 4478 02:52:38,902 --> 02:52:42,439 PREGNANT BUT ALSO THEIR HEALTH, 4479 02:52:42,439 --> 02:52:43,340 LUNG FUNCTION, NUTRITION 4480 02:52:43,340 --> 02:52:45,609 STATUS, RATE OF MULL MON NAIR 4481 02:52:45,609 --> 02:52:46,610 RY EXACERBATIONS ARE ALL 4482 02:52:46,610 --> 02:52:51,315 IMPROVED WITH THE USE OF THESE 4483 02:52:51,315 --> 02:52:56,587 NEW ORAL DRUGS. 4484 02:52:56,587 --> 02:52:57,988 [ TEZ IFA ] 4485 02:52:57,988 --> 02:52:59,156 NEXT SLIDE. 4486 02:52:59,156 --> 02:53:01,258 WHAT DO WE KNOW ABOUT 4487 02:53:01,258 --> 02:53:04,228 DEMOGRAPHICS OF PEOPLE WITH 4488 02:53:04,228 --> 02:53:06,863 CYSTIC FIBROSIS AND PEOPLE WHO 4489 02:53:06,863 --> 02:53:07,197 ARE PREGNANT. 4490 02:53:07,197 --> 02:53:09,166 THE FIRST COLUMN SHOWS GENERAL 4491 02:53:09,166 --> 02:53:11,401 CF POPULATION AND SECOND COLUMN 4492 02:53:11,401 --> 02:53:20,043 IS PREGNANT CF. 4493 02:53:20,043 --> 02:53:26,350 ABOUT 3.5% IDENTIFY AS BLACK. 4494 02:53:26,350 --> 02:53:29,786 5% OTHER RACE AND 10% HISPANIC. 4495 02:53:29,786 --> 02:53:33,357 NUMERICALLY THE RATES ARE A 4496 02:53:33,357 --> 02:53:33,924 LITTLE DISPROPORTIONATE 4497 02:53:33,924 --> 02:53:35,292 COMPARED TO PEOPLE IN THE 4498 02:53:35,292 --> 02:53:37,961 GENERAL POPULATION OF CF IN 4499 02:53:37,961 --> 02:53:38,328 PEOPLE OF COLOR. 4500 02:53:38,328 --> 02:53:40,931 I SUSPECT THIS GOES BACK TO THE 4501 02:53:40,931 --> 02:53:41,898 SOCIAL DETERMINANTS OF HEALTH 4502 02:53:41,898 --> 02:53:43,500 BUT IT'S SOMETHING THAT HAS TO 4503 02:53:43,500 --> 02:53:44,201 BE STUDIED. 4504 02:53:44,201 --> 02:53:45,936 NEXT SLIDE. 4505 02:53:45,936 --> 02:53:48,372 SO WHAT DO WE KNOW ABOUT HEALTH 4506 02:53:48,372 --> 02:53:49,906 OUTCOMES IN PREGNANT PEOPLE 4507 02:53:49,906 --> 02:53:51,708 WITH THIS RARE LUNG DISEASE? 4508 02:53:51,708 --> 02:53:53,610 MOST OF THE DATA WE HAVE AT 4509 02:53:53,610 --> 02:53:57,514 THIS POINT IS FROM SINGLE SITE 4510 02:53:57,514 --> 02:53:59,383 STUDIES AND RETROSPECTIVE DATA. 4511 02:53:59,383 --> 02:54:01,985 THERE'S A REGISTRY ANALYSIS BUT 4512 02:54:01,985 --> 02:54:04,755 DONE ALMOST 30 YEARS AGO, WELL 4513 02:54:04,755 --> 02:54:06,723 BEFORE THE CURRENT ERA OF 4514 02:54:06,723 --> 02:54:06,957 MODULATE 4515 02:54:06,957 --> 02:54:07,591 >>ER TREATMENT OF PEOPLE WITH 4516 02:54:07,591 --> 02:54:08,859 CF. 4517 02:54:08,859 --> 02:54:11,295 PEOPLE WITH CF HAVE CHRONIC 4518 02:54:11,295 --> 02:54:11,928 ILLNESS. 4519 02:54:11,928 --> 02:54:13,730 THE SAME CHRONIC PROBLEMS THEY 4520 02:54:13,730 --> 02:54:15,432 HAD BEFORE THEY GOT PREGNANT 4521 02:54:15,432 --> 02:54:18,035 BUT HAVE TO BE MANAGED 4522 02:54:18,035 --> 02:54:19,303 INCLUDING WITH DRUGS THAT 4523 02:54:19,303 --> 02:54:21,938 AREN'T WELL STUDIED IN 4524 02:54:21,938 --> 02:54:22,205 PREGNANCY. 4525 02:54:22,205 --> 02:54:24,374 IN THE ERA BEFORE MODULATORS WE 4526 02:54:24,374 --> 02:54:27,377 KNOW PEOPLE WITH CF WHO BECAME 4527 02:54:27,377 --> 02:54:29,513 PREGNANT HAD HIGHER RATES OF 4528 02:54:29,513 --> 02:54:31,982 DIABETESES DURING PREGNANCY. 4529 02:54:31,982 --> 02:54:34,551 HIGHER RATES OF INFECTIONS, 4530 02:54:34,551 --> 02:54:37,421 HIGHER RATES OF PRE-TERM LABOR 4531 02:54:37,421 --> 02:54:38,955 AND PREECLAMPSIA, AND INFANTS 4532 02:54:38,955 --> 02:54:41,024 ALSO HAD MORE COMPLICATIONS. 4533 02:54:41,024 --> 02:54:42,225 MORE PRE-TERM BIRTH WERE MORE 4534 02:54:42,225 --> 02:54:45,062 LIKELY TO BE LOWER IN BIRTH 4535 02:54:45,062 --> 02:54:46,029 WEIGHT. 4536 02:54:46,029 --> 02:54:55,372 MORE LIKELY TO HAVE HYPER 4537 02:54:55,372 --> 02:54:57,174 BILLIRUBIN A NIEMI WRA. 4538 02:54:57,174 --> 02:54:59,309 USUALLY FROM SINGLE SITE 4539 02:54:59,309 --> 02:54:59,743 CENTERS. NEXT SLIDE. 4540 02:54:59,743 --> 02:55:01,611 PFAFF PRAF WHAT WE ARE REALLY 4541 02:55:01,611 --> 02:55:03,180 SUFFERING FROM IN RARE LUNG 4542 02:55:03,180 --> 02:55:10,587 DISEASE IS A PAUCITY OF SCIENCE. 4543 02:55:10,587 --> 02:55:12,422 BECAUSE OF THIS PAUCITY OF 4544 02:55:12,422 --> 02:55:14,324 DATA, MYSELF AND SEVERAL OTHERS 4545 02:55:14,324 --> 02:55:17,361 SHOWN ON THIS SLIDE WENT TO THE 4546 02:55:17,361 --> 02:55:18,395 CYSTIC FIBROSIS FOUNDATION TO 4547 02:55:18,395 --> 02:55:20,197 SAY WE THOUGHT WE REALLY NEEDED 4548 02:55:20,197 --> 02:55:23,300 THEM TO FUND A RESEARCH WORKING 4549 02:55:23,300 --> 02:55:24,134 GROUP. 4550 02:55:24,134 --> 02:55:27,671 OUR GOAL WITH THE SEXUAL HEALTH 4551 02:55:27,671 --> 02:55:28,705 REPRODUCTION AND GENDER 4552 02:55:28,705 --> 02:55:29,973 RESEARCH WORKING GROUP IS 4553 02:55:29,973 --> 02:55:31,108 IDENTIFY THE GAPS IN KNOWLEDGE 4554 02:55:31,108 --> 02:55:35,178 IN THE AREAS OF SEXUAL 4555 02:55:35,178 --> 02:55:36,980 REPRODUCTIVE DYSFUNCTION IN 4556 02:55:36,980 --> 02:55:40,050 PEOPLE WITH CF AND DEVELOP THE 4557 02:55:40,050 --> 02:55:41,885 INFRASTRUCTURE TO EFFICIENTLY 4558 02:55:41,885 --> 02:55:42,519 MOVE THESE RESEARCH PRIORITIES 4559 02:55:42,519 --> 02:55:43,387 FORWARD. 4560 02:55:43,387 --> 02:55:44,921 WHILE THE FOUNDING GROUP WAS 4561 02:55:44,921 --> 02:55:48,024 MADE UP OF MULL MONOLOGISTS WE 4562 02:55:48,024 --> 02:55:50,293 HAVE SUBSEQUENTLY ADDED A 4563 02:55:50,293 --> 02:55:52,062 MENTAL HEALTH SPECIALIST, 4564 02:55:52,062 --> 02:55:52,729 DIETICIAN AND RESEARCH 4565 02:55:52,729 --> 02:55:55,332 COORDINATOR AND TWO PEOPLE WITH 4566 02:55:55,332 --> 02:55:55,732 CF. 4567 02:55:55,732 --> 02:55:57,868 WE BELIEVE CO-PRODUCTION AND 4568 02:55:57,868 --> 02:55:59,069 CO-DEVELOPMENT OF THE STUDIES 4569 02:55:59,069 --> 02:56:01,772 IS CRITICAL FOR THE SUBSEQUENT 4570 02:56:01,772 --> 02:56:02,139 IMPLEMENTATION. 4571 02:56:02,139 --> 02:56:03,573 NEXT SLIDE. 4572 02:56:03,573 --> 02:56:05,776 ONE OF THE THINGS YOU HEARD OUR 4573 02:56:05,776 --> 02:56:07,644 KEYNOTE SPEAKER TALK ABOUT 4574 02:56:07,644 --> 02:56:08,612 EARLIER WAS A WEB-BASED 4575 02:56:08,612 --> 02:56:11,281 PLATFORM TO GET THE INPUT OF 4576 02:56:11,281 --> 02:56:13,083 THE KEY STAKEHOLDERS. SO CF 4577 02:56:13,083 --> 02:56:14,317 COMMUNITY VOICE IS SOMETHING 4578 02:56:14,317 --> 02:56:16,386 FOUNDED BY THE CF FOUNDATION 4579 02:56:16,386 --> 02:56:18,188 WHICH PEOPLE WITH CF AND THEIR 4580 02:56:18,188 --> 02:56:19,356 FAMILY MEMBERS OR PARTNERS CAN 4581 02:56:19,356 --> 02:56:21,391 SIGN UP AND THEY ARE CONTACTED 4582 02:56:21,391 --> 02:56:22,926 BY THE FOUNDATION WHEN THERE 4583 02:56:22,926 --> 02:56:23,827 ARE RESEARCH QUESTIONS THAT 4584 02:56:23,827 --> 02:56:25,929 NEED TO BE ASKED. 4585 02:56:25,929 --> 02:56:28,432 AGAIN WE HAVE CO-PRODUCTION AND 4586 02:56:28,432 --> 02:56:32,702 CO-DEVELOPMENT OF THE RESEARCH 4587 02:56:32,702 --> 02:56:35,372 PROTOCOLS. THERE'S A AN ADULT 4588 02:56:35,372 --> 02:56:37,040 ADVISORY GROUP MADE UP OF 4589 02:56:37,040 --> 02:56:38,675 PEOPLE WITH CF WHO GIVES US 4590 02:56:38,675 --> 02:56:40,911 THEIR OPINION AND THEY OFTEN 4591 02:56:40,911 --> 02:56:43,613 SAY NO WORK ABOUT US WITHOUT US 4592 02:56:43,613 --> 02:56:45,715 AND WE TAKE THAT SERIOUSLY. 4593 02:56:45,715 --> 02:56:47,083 ONE STUDY TO COME OUT OF 4594 02:56:47,083 --> 02:56:49,820 DISCUSSION WITH PEOPLE WITH 4595 02:56:49,820 --> 02:56:53,356 CYSTIC FIBROSIS DONE IN 4596 02:56:53,356 --> 02:56:55,725 CONJUNCTION WITH PEOPLE WITH 4597 02:56:55,725 --> 02:56:58,795 CYSTIC FIBROSIS IN TERMS OF 4598 02:56:58,795 --> 02:57:03,166 DESIGN IS MAY FLOWER STUDY. 4599 02:57:03,166 --> 02:57:04,134 PROSPECTIVE MULTI-CENTER 4600 02:57:04,134 --> 02:57:05,268 OBSERVATIONAL STUDY IN PREGNANT 4601 02:57:05,268 --> 02:57:07,637 PEOPLE WITH CF AND THEIR 4602 02:57:07,637 --> 02:57:09,606 INFANTS DURING WHICH WE ARE 4603 02:57:09,606 --> 02:57:10,674 FOLLOWING THEM THROUGHOUT 4604 02:57:10,674 --> 02:57:11,675 PREGNANCY AND TWO YEARS AFTER 4605 02:57:11,675 --> 02:57:13,944 PREGNANCY. 4606 02:57:13,944 --> 02:57:14,978 THE FIRST PROSPECTIVE STUDY 4607 02:57:14,978 --> 02:57:19,783 DONE WITH PEOPLE IN CF BOTH ON 4608 02:57:19,783 --> 02:57:21,017 MODULATORS AND OFF MODULATORS 4609 02:57:21,017 --> 02:57:22,786 SO WE CAN PROVIDE GUIDANCE 4610 02:57:22,786 --> 02:57:25,055 ABOUT USE OF THESE DRUGS DURING 4611 02:57:25,055 --> 02:57:27,791 PREGNANCY AND OUTCOMES OF THE 4612 02:57:27,791 --> 02:57:31,194 CFTR MODULATOR ERA AND IN THE 4613 02:57:31,194 --> 02:57:31,495 MODERN ERA. 4614 02:57:31,495 --> 02:57:32,596 SPECIFICALLY ONE THING WE 4615 02:57:32,596 --> 02:57:37,000 CHANGED ABOUT OUR DESIGN BASED 4616 02:57:37,000 --> 02:57:39,202 ON THE FEEDBACK OF PEOPLE WITH 4617 02:57:39,202 --> 02:57:41,738 CF TO ENSURE WE HAD A LOT OF 4618 02:57:41,738 --> 02:57:43,807 VISITS ESPECIALLY IN THE 4619 02:57:43,807 --> 02:57:45,809 POSTPARTUM PERIOD THAT COULD BE 4620 02:57:45,809 --> 02:57:47,244 DONE WITH TELEHEALTH, THEY SAID 4621 02:57:47,244 --> 02:57:49,813 WE WILL BE TIRED AND BUSY 4622 02:57:49,813 --> 02:57:52,315 TAKING CARE OF OUR CF AND OUR 4623 02:57:52,315 --> 02:57:54,518 BABY AND WE NEED TO CONTRIBUTE 4624 02:57:54,518 --> 02:57:57,754 OUR DATA BUT NEED TO DO IT FROM 4625 02:57:57,754 --> 02:57:59,456 HOME SO IT'S EASIER TO 4626 02:57:59,456 --> 02:58:00,857 PARTICIPATE. 4627 02:58:00,857 --> 02:58:04,561 AGAIN, THERE'S A PAUCITY OF 4628 02:58:04,561 --> 02:58:05,562 EVIDENCE-BASED GUIDANCE. 4629 02:58:05,562 --> 02:58:09,199 THERE WAS A TASK FORCE FOR THE 4630 02:58:09,199 --> 02:58:10,734 EUROPEAN RESPIRATORY SOCIETY 4631 02:58:10,734 --> 02:58:12,736 AND THORACIC SOCIETY OF 4632 02:58:12,736 --> 02:58:15,338 AUSTRALIA AND NEW ZEALAND BUT 4633 02:58:15,338 --> 02:58:17,974 MOST WAS BASED ON RETROSPECTIVE 4634 02:58:17,974 --> 02:58:20,443 DATA AND DATA AT SINGLE SITE 4635 02:58:20,443 --> 02:58:22,445 CENTERS WE ARE IN THE PROCESS 4636 02:58:22,445 --> 02:58:24,447 OF CREATING A POSITION PAPER 4637 02:58:24,447 --> 02:58:26,349 ABOUT SEXUAL AND REPRODUCTIVE 4638 02:58:26,349 --> 02:58:28,018 HEALTH THROUGH THE CF 4639 02:58:28,018 --> 02:58:29,786 FOUNDATION FACILITATION OF THE 4640 02:58:29,786 --> 02:58:31,421 GATHERING OF THE LATEESTED 4641 02:58:31,421 --> 02:58:32,422 EVIDENCE AND HOPEFULLY 4642 02:58:32,422 --> 02:58:35,258 INCLUDING SOME OF THE MAY 4643 02:58:35,258 --> 02:58:35,592 FLOWER'S DATA. 4644 02:58:35,592 --> 02:58:37,394 WE ARE INCLUDING PEOPLE WITH CF 4645 02:58:37,394 --> 02:58:39,029 ON THIS POSITION PAPER WHO ARE 4646 02:58:39,029 --> 02:58:40,297 HELPING US WITH THEIR OPINIONS 4647 02:58:40,297 --> 02:58:42,799 IN THE WRITING OF THIS PAPER 4648 02:58:42,799 --> 02:58:43,366 BECAUSE CO-PRODUCTION IS 4649 02:58:43,366 --> 02:58:43,633 CRITICAL. 4650 02:58:43,633 --> 02:58:46,269 NEXT SLIDE. 4651 02:58:46,269 --> 02:58:48,538 SO YOU ALSO HEARD OUR KEYNOTE 4652 02:58:48,538 --> 02:58:50,106 SPEAKER YESTERDAY TALK ABOUT 4653 02:58:50,106 --> 02:58:51,841 THE FACT THAT IT'S IMPORTANT 4654 02:58:51,841 --> 02:58:53,977 NOT ONLY TO INCLUDE PEOPLE IN 4655 02:58:53,977 --> 02:58:56,479 THE DEVELOPMENT OF THESE 4656 02:58:56,479 --> 02:58:56,980 RESEARCH PROTOCOLS 4657 02:58:56,980 --> 02:58:59,182 PARTICIPATING IN THE TRIALS BUT 4658 02:58:59,182 --> 02:58:59,816 ALSO THE DISSEMINATION OF THE 4659 02:58:59,816 --> 02:59:04,187 INFORMATION. 4660 02:59:04,187 --> 02:59:06,957 SO RESEARCHCON IS A WEBINAR PUT 4661 02:59:06,957 --> 02:59:12,662 ON PEOPLE WITH CYSTIC FIBROSIS, 4662 02:59:12,662 --> 02:59:14,331 WE DISSEMINATE THE RESULTS OF 4663 02:59:14,331 --> 02:59:19,402 THE STUDY DIRECTLY TO THE C.F. 4664 02:59:19,402 --> 02:59:21,438 COMMUNITY. 4665 02:59:21,438 --> 02:59:30,580 BREATHECONBY PEOPLE WITH 4666 02:59:30,580 --> 02:59:30,947 CYSTIC FIBROSIS. 4667 02:59:30,947 --> 02:59:32,148 WITH THAT I WILL STOP AND SAY 4668 02:59:32,148 --> 02:59:34,150 THANKS TO THE PEOPLE WITH CF 4669 02:59:34,150 --> 02:59:36,152 AND THEIR FAMILIES WHO HAVE 4670 02:59:36,152 --> 02:59:39,489 PARTICIPATED IN THE STUDIES TO 4671 02:59:39,489 --> 02:59:41,291 DATE. 4672 02:59:41,291 --> 02:59:42,959 ALL THE PARTICIPATING CF CARE 4673 02:59:42,959 --> 02:59:44,928 AND RESEARCH CENTERS AND AGAIN 4674 02:59:44,928 --> 02:59:47,263 THE NIH FOR FUNDING AND HOSTING 4675 02:59:47,263 --> 02:59:47,764 THIS IMPORTANT WEBINAR. 4676 02:59:47,764 --> 02:59:53,236 THANK YOU. 4677 02:59:53,236 --> 03:00:03,780 >> HIHAELA STEFAN: THANK YOU TO 4678 03:00:05,115 --> 03:00:06,383 JENNIFER AND THE PRESENTERS. I 4679 03:00:06,383 --> 03:00:08,218 WILL START WITH GENERAL WES TO 4680 03:00:08,218 --> 03:00:10,553 THE SPEAKERS, ANY OF YOU OR ALL 4681 03:00:10,553 --> 03:00:13,089 OF YOU WHO WANT TO COMMENT ON 4682 03:00:13,089 --> 03:00:13,289 THIS. 4683 03:00:13,289 --> 03:00:16,693 HOW DO YOU PROMOTE 4684 03:00:16,693 --> 03:00:18,728 COLLABORATION BETWEEN CLINICAL 4685 03:00:18,728 --> 03:00:20,397 SCIENTISTS, RESEARCHERS, HEALTH 4686 03:00:20,397 --> 03:00:22,899 CASE SYSTEM, HEALTH POLICY 4687 03:00:22,899 --> 03:00:23,733 GOVERNMENT, COMMUNITY 4688 03:00:23,733 --> 03:00:24,300 ORGANIZATIONS AND BIRTHING 4689 03:00:24,300 --> 03:00:33,543 PEOPLE? 4690 03:00:33,543 --> 03:00:35,512 >> MEGAN PASSEY: WOULD YOU LIKE 4691 03:00:35,512 --> 03:00:40,850 TO GO FIRST, JENNIFER? 4692 03:00:40,850 --> 03:00:45,555 >> JENNIFER TAYLOR-COUSAR: SURE. 4693 03:00:45,555 --> 03:00:50,093 WEBINARS LIKE THIS ARE HELPFUL, 4694 03:00:50,093 --> 03:00:51,961 IT'S UP TO RESEARCHERS TO REACH 4695 03:00:51,961 --> 03:00:54,330 OUT TO COMMUNITY GROUPS TO GET 4696 03:00:54,330 --> 03:00:55,932 THEIR INVOLVEMENT BECAUSE WE 4697 03:00:55,932 --> 03:00:57,233 CAN'T EXPECT YOU KNOW, THERE 4698 03:00:57,233 --> 03:01:00,070 WILL BE SOME WHO COME TO US BUT 4699 03:01:00,070 --> 03:01:01,337 WE CAN'T EXPECT THEM TO DO IT 4700 03:01:01,337 --> 03:01:03,106 ON THEIR OWN. 4701 03:01:03,106 --> 03:01:05,442 THEN ALSO I THINK TO PARTNER 4702 03:01:05,442 --> 03:01:07,377 WITH THEM TO RESEARCH, THERE 4703 03:01:07,377 --> 03:01:10,380 HAVE BEEN MARCHES ON THE HILL, 4704 03:01:10,380 --> 03:01:14,617 WE WILL OFTEN WRITE THIS PAPER 4705 03:01:14,617 --> 03:01:18,922 IN CONJUNCTION WITH PEOPLE WITH 4706 03:01:18,922 --> 03:01:20,924 CF. 4707 03:01:20,924 --> 03:01:23,693 IT TAKES EFFORT BUT ALSO OUR 4708 03:01:23,693 --> 03:01:24,894 EFFORT AS RESEARCHERS AND 4709 03:01:24,894 --> 03:01:26,529 CLINICIANS TO INVOLVE THE 4710 03:01:26,529 --> 03:01:27,230 STAKEHOLDERS THAT NEED TOE BE 4711 03:01:27,230 --> 03:01:37,407 INVOLVED. 4712 03:01:40,510 --> 03:01:43,413 >> MEGAN PASSEY: I AGREE WITH 4713 03:01:43,413 --> 03:01:44,547 JENNIFER. 4714 03:01:44,547 --> 03:01:46,983 IT WAS INITIATED BY A SENIOR 4715 03:01:46,983 --> 03:01:49,252 MIDWIFE WHO CAME TO US AND SAID 4716 03:01:49,252 --> 03:01:50,520 WHO WE WORKED WITH ON ANOTHER 4717 03:01:50,520 --> 03:01:51,454 PROJECT. 4718 03:01:51,454 --> 03:01:55,458 SAID WE HAVE A PROBLEM, CAN YOU 4719 03:01:55,458 --> 03:02:03,199 HELP. 4720 03:02:03,199 --> 03:02:05,401 SHE WAS FUNDAMENTAL ENGAGING 4721 03:02:05,401 --> 03:02:07,303 OTHER PEOPLE ACROSS THE 4722 03:02:07,303 --> 03:02:09,072 HEALTHCARE SYSTEM. 4723 03:02:09,072 --> 03:02:11,307 SHE HAD REALLY GOOD EXTENSIVE 4724 03:02:11,307 --> 03:02:13,943 NETWORKS WITHIN THE NEW SOUTH 4725 03:02:13,943 --> 03:02:15,178 WALES HEALTH SYSTEM WITHIN 4726 03:02:15,178 --> 03:02:17,747 MATERNITY CARE. 4727 03:02:17,747 --> 03:02:19,816 THE WORK WE HAVE BEEN DOING IS 4728 03:02:19,816 --> 03:02:22,385 TOUGH, NOT SO MUCH INVOLVING 4729 03:02:22,385 --> 03:02:23,920 COMMUNITY GROUPS AND WOMEN 4730 03:02:23,920 --> 03:02:25,989 BECAUSE THE TARGET AUDIENCE FOR 4731 03:02:25,989 --> 03:02:26,923 OUR PROGRAM, IT'S THE HEALTH 4732 03:02:26,923 --> 03:02:27,857 SYSTEM. 4733 03:02:27,857 --> 03:02:30,693 WE ARE ABOUT TO START WORKING 4734 03:02:30,693 --> 03:02:32,162 ON POSTPARTUM RHODE ISLAND 4735 03:02:32,162 --> 03:02:33,429 LAPSE PREVENTION WORK AND THAT 4736 03:02:33,429 --> 03:02:35,498 IS VERY MUCH WORKING WITH 4737 03:02:35,498 --> 03:02:37,133 CONSUMERS BECAUSE THERE ISN'T 4738 03:02:37,133 --> 03:02:39,536 GOOD EVIDENCE BASE ALREADY 4739 03:02:39,536 --> 03:02:40,370 THERE. 4740 03:02:40,370 --> 03:02:42,305 JUST REACHING OUT TO ALL THE 4741 03:02:42,305 --> 03:02:44,307 LOCAL COMMUNITY GROUPS THAT 4742 03:02:44,307 --> 03:02:46,376 WORK WITH YOUNG MUMPS. 4743 03:02:46,376 --> 03:02:47,410 -- MUMS. 4744 03:02:47,410 --> 03:02:49,179 YOU JUST HAVE TO MAKE THE 4745 03:02:49,179 --> 03:02:49,412 EFFORT. 4746 03:02:49,412 --> 03:02:51,080 IT IS HARD WORK. 4747 03:02:51,080 --> 03:02:52,115 MY EXPERIENCE, PARTICULARLY 4748 03:02:52,115 --> 03:02:53,650 WITH THE COMMUNITY GROUPS, THEY 4749 03:02:53,650 --> 03:02:55,351 DON'T NECESSARILY SEE THE 4750 03:02:55,351 --> 03:02:57,353 RELEVANCE TO THEM. 4751 03:02:57,353 --> 03:02:58,922 I MEAN, IT'S OBVIOUSLY 4752 03:02:58,922 --> 03:03:02,358 DIFFERENT FOR PEOPLE SUFFERING 4753 03:03:02,358 --> 03:03:03,726 FROM CYSTIC FIBROSIS. 4754 03:03:03,726 --> 03:03:05,829 BUT WE ARE REACHING OUT TO PLAY 4755 03:03:05,829 --> 03:03:09,566 GROUPS AND OTHER GROUPS WORKING 4756 03:03:09,566 --> 03:03:15,305 WITH YOUNG MOMS, NOT 4757 03:03:15,305 --> 03:03:15,805 NECESSARILY IMMEDIATELY 4758 03:03:15,805 --> 03:03:17,707 INTERESTED. 4759 03:03:17,707 --> 03:03:19,409 >> I THINK THERE'S SOME 4760 03:03:19,409 --> 03:03:21,244 CHALLENGES AS WELL AS 4761 03:03:21,244 --> 03:03:22,445 OPPORTUNITIES HERE, BECAUSE 4762 03:03:22,445 --> 03:03:24,647 PREGNANCY, UNFORTUNATELY ON ONE 4763 03:03:24,647 --> 03:03:27,417 HAND ONLY LASTS 40 WEEKS, MINUS 4764 03:03:27,417 --> 03:03:28,051 OR PLUS. 4765 03:03:28,051 --> 03:03:29,953 AND SO THERE'S THIS VERY SORT 4766 03:03:29,953 --> 03:03:33,189 OF TIME PRESSURE TO TRY TO GET 4767 03:03:33,189 --> 03:03:34,457 THE IMPLEMENTATION AND 4768 03:03:34,457 --> 03:03:36,626 ENGAGEMENT, YOU KNOW, AND OFTEN 4769 03:03:36,626 --> 03:03:37,861 TIMES BECAUSE PATIENTS PRESENT 4770 03:03:37,861 --> 03:03:39,796 LATER IN PREGNANCY THIS MIGHT 4771 03:03:39,796 --> 03:03:41,564 BE A REALLY CONTRACTED 4772 03:03:41,564 --> 03:03:41,831 TIMEFRAME. 4773 03:03:41,831 --> 03:03:44,801 ON THE OTHER HAND, YOU KNOW, 4774 03:03:44,801 --> 03:03:45,902 PATIENTS GET PREGNANT MULTIPLE 4775 03:03:45,902 --> 03:03:46,769 TIMES, RIGHT? 4776 03:03:46,769 --> 03:03:49,772 YOU HAVE THE OPPORTUNITY TO 4777 03:03:49,772 --> 03:03:52,642 ENGAGE MOTHERS OF EXISTING 4778 03:03:52,642 --> 03:03:54,143 CHILDREN AND HELP THEM THINK 4779 03:03:54,143 --> 03:03:56,546 ABOUT WHAT THEIR NEXT PREGNANCY 4780 03:03:56,546 --> 03:03:56,913 WILL LOOK LIKE. 4781 03:03:56,913 --> 03:03:59,182 I SEE IT AS A DISADVANTAGE AND 4782 03:03:59,182 --> 03:04:04,754 ADVANTAGE ALL ROLLED INTO ONE. 4783 03:04:04,754 --> 03:04:06,956 >> MIHAELA STEFAN: THANK YOU. 4784 03:04:06,956 --> 03:04:08,725 JENNIFER, I HAVE A QUESTION FOR 4785 03:04:08,725 --> 03:04:11,361 YOU, YOU MENTIONED THE ADVISORY 4786 03:04:11,361 --> 03:04:12,862 BEING ON THE SAME IDEA BUT 4787 03:04:12,862 --> 03:04:15,198 DIDN'T HAVE TIME TO ELABORATE. 4788 03:04:15,198 --> 03:04:17,300 CAN YOU GIVE IDEAS HOW THEY 4789 03:04:17,300 --> 03:04:19,736 SHAPE INTERVENTION, IF YOU USE 4790 03:04:19,736 --> 03:04:23,573 CO-DESIGN, WE HEARD A LOT ABOUT 4791 03:04:23,573 --> 03:04:25,742 CO-DESIGN WHICH SEEMS LIKE 4792 03:04:25,742 --> 03:04:27,543 GREAT METHODOLOGY TO INVOLVE 4793 03:04:27,543 --> 03:04:28,711 PATIENTS, CLINICIANS AND OTHERS. 4794 03:04:28,711 --> 03:04:31,281 IF YOU USE THIS AND CONTINUE TO 4795 03:04:31,281 --> 03:04:32,148 USE COMMUNITY ADVISORY. 4796 03:04:32,148 --> 03:04:34,550 WHAT WE HAVE SEEN IS MANY TIMES 4797 03:04:34,550 --> 03:04:37,687 WE USE IT AT THE BEGINNING TO 4798 03:04:37,687 --> 03:04:39,289 GET INPUT BUT NOT AFTER OR 4799 03:04:39,289 --> 03:04:39,689 DURING THE STUDY. 4800 03:04:39,689 --> 03:04:43,192 THANK YOU. 4801 03:04:43,192 --> 03:04:45,828 >> STEPHANIE: THANK YOU, 4802 03:04:45,828 --> 03:04:48,631 MIHAELA, WE HAVE ABOUT FOUR 4803 03:04:48,631 --> 03:04:51,534 MATERNAL HEALTH JUSTICE 4804 03:04:51,534 --> 03:04:55,038 ORGANIZATIONS, IN NEW YORK. 4805 03:04:55,038 --> 03:04:57,573 BLACK WOMAN OWNED AND RAN. 4806 03:04:57,573 --> 03:04:59,909 WE INCLUDE IN THE GRANT WRITING 4807 03:04:59,909 --> 03:05:10,053 ITSELF. 4808 03:05:15,825 --> 03:05:18,895 WE MEET WITH OUR COMMUNITY 4809 03:05:18,895 --> 03:05:19,929 ADVISORY BOARD ACTUALLY EVERY 4810 03:05:19,929 --> 03:05:22,231 THREE MONTHS, IF NOT A LITTLE 4811 03:05:22,231 --> 03:05:25,935 SOONER IN BETWEEN, IT DEPENDS 4812 03:05:25,935 --> 03:05:26,302 WHAT'S GOING ON. 4813 03:05:26,302 --> 03:05:27,503 WE HAVE A MEETING COMING UP 4814 03:05:27,503 --> 03:05:30,106 WITH THEM NEXT WEEK. 4815 03:05:30,106 --> 03:05:31,207 AS WE DEVELOP RECRUITMENT 4816 03:05:31,207 --> 03:05:32,442 MATERIALS AND THOUGHT ABOUT THE 4817 03:05:32,442 --> 03:05:35,878 WHOLE DESIGN OF THE STUDY, WE 4818 03:05:35,878 --> 03:05:37,747 BROUGHT THEM IN EARLY ONTO HELP 4819 03:05:37,747 --> 03:05:39,248 US THINK ABOUT WHAT ARE WE 4820 03:05:39,248 --> 03:05:41,317 MISSING, WHAT IS THE BEST WAY 4821 03:05:41,317 --> 03:05:44,220 TO LET PATIENTS KNOW ABOUT THIS 4822 03:05:44,220 --> 03:05:45,722 PROGRAM AND GET THEM ENGAGED 4823 03:05:45,722 --> 03:05:47,223 AND ONCE WE GET FINDINGS WHAT 4824 03:05:47,223 --> 03:05:50,293 IS THE BEST WAY TO DISSEMINATE 4825 03:05:50,293 --> 03:05:51,260 OUR FINDINGS. THAT'S PROBABLY 4826 03:05:51,260 --> 03:05:53,062 WHY WE ARE WORKING WITH THEM 4827 03:05:53,062 --> 03:05:54,664 THROUGHOUT THE FIVE YEARS OF 4828 03:05:54,664 --> 03:05:55,698 THE RO1. 4829 03:05:55,698 --> 03:05:58,001 WE WANT THEM TO REALLY FEEL 4830 03:05:58,001 --> 03:06:00,036 THIS IS SOMETHING THEY ARE A 4831 03:06:00,036 --> 03:06:02,772 PART OF AND HELP US DISSEMINATE 4832 03:06:02,772 --> 03:06:04,574 IF IT IS EFFECTIVE OR FURTHER 4833 03:06:04,574 --> 03:06:06,709 REFINE IT FOR THE NEXT PROJECT 4834 03:06:06,709 --> 03:06:12,448 AND FOR THE NEXT GRANT. 4835 03:06:12,448 --> 03:06:13,916 >> MIHAEL STEFAN: YEAH, IT'S 4836 03:06:13,916 --> 03:06:15,718 IMPORTANT BECAUSE WE ARE 4837 03:06:15,718 --> 03:06:16,919 TRAINED AT CLINICAL TRIALS WE 4838 03:06:16,919 --> 03:06:21,457 HAVE TO KEEP THE INTERVENTION 4839 03:06:21,457 --> 03:06:23,092 THE SAME AND NOT CHANGE IT, 4840 03:06:23,092 --> 03:06:25,728 THAT'S NOT THE RIGHT WAY TO DO 4841 03:06:25,728 --> 03:06:26,763 AN IMPLEMENTATION, BUT THERE'S 4842 03:06:26,763 --> 03:06:28,531 STILL A STRUGGLE WHEN YOU WRITE 4843 03:06:28,531 --> 03:06:30,500 YOUR APPLICATION HOW WOULD YOU 4844 03:06:30,500 --> 03:06:30,833 DESCRIBE THAT. 4845 03:06:30,833 --> 03:06:32,735 I KNOW WE KEEP THE CORE 4846 03:06:32,735 --> 03:06:35,104 COMPONENT AND WORK ON THE 4847 03:06:35,104 --> 03:06:36,773 MARGINS. BUT THAT'S, I THINK, 4848 03:06:36,773 --> 03:06:38,141 VERY IMPORTANT. 4849 03:06:38,141 --> 03:06:39,909 AND WHAT THEY LEARN IS THAT 4850 03:06:39,909 --> 03:06:44,047 CONTINUING TO GET INPUT FROM 4851 03:06:44,047 --> 03:06:49,052 THOSE WHO ARE RECIPIENTS OF THE 4852 03:06:49,052 --> 03:06:59,295 INTERVENTION. 4853 03:07:00,296 --> 03:07:01,297 >> JENNIFER TAYLOR-COUSAR: I 4854 03:07:01,297 --> 03:07:04,634 WANT TO BRING THAT UP, THEY 4855 03:07:04,634 --> 03:07:10,940 ALREADY DESIGNED THE STUDY AND 4856 03:07:10,940 --> 03:07:15,311 NEVER TALKED TO THE 4857 03:07:15,311 --> 03:07:17,180 PARTICIPANTS. 4858 03:07:17,180 --> 03:07:18,848 >> MIHAELA STEFAN: I WAS A 4859 03:07:18,848 --> 03:07:19,715 INVESTIGATOR AND NOW PART OF 4860 03:07:19,715 --> 03:07:21,117 THE FUNDER. 4861 03:07:21,117 --> 03:07:25,188 HOW DO YOU DO ALL THIS WORK 4862 03:07:25,188 --> 03:07:34,030 PRIOR TO GETTING YOU DO ALL 4863 03:07:34,030 --> 03:07:36,666 THIS COMMUNITY ADVISORY. 4864 03:07:36,666 --> 03:07:38,101 MARY DIXON SAID IT TAKES A LOT 4865 03:07:38,101 --> 03:07:39,469 OF WORK AND TIME BUT NEEDS 4866 03:07:39,469 --> 03:07:46,109 FUNDING. 4867 03:07:46,109 --> 03:07:49,679 I'M WONDERING DO YOU HAVE 4868 03:07:49,679 --> 03:07:51,347 IDEAS, MAKE THE INSTITUTION 4869 03:07:51,347 --> 03:07:51,647 RESPONSIBLE. 4870 03:07:51,647 --> 03:07:53,616 THEY HAVE TO PUT SOME 4871 03:07:53,616 --> 03:07:55,017 RESOURCES,MAYBE NOT SPECIFIC 4872 03:07:55,017 --> 03:07:58,121 FOR AN INVESTIGATOR BUT FOR IN 4873 03:07:58,121 --> 03:07:59,222 GENERAL FOR THE INVESTIGATORS 4874 03:07:59,222 --> 03:08:09,599 TO DO THIS WORK PRIOR? 4875 03:08:14,804 --> 03:08:16,372 >> JENNIFER: THERE ARE PLANNING 4876 03:08:16,372 --> 03:08:18,808 GRANTS AND DURING THE PLANNING 4877 03:08:18,808 --> 03:08:21,511 GRANT PERIOD IS WHEN WE HAVE 4878 03:08:21,511 --> 03:08:22,378 ASSEMBLED THE COMMUNITY 4879 03:08:22,378 --> 03:08:23,913 ADVISORY BOARDS FOR THE STUDIES 4880 03:08:23,913 --> 03:08:25,948 SO WE CAN PAY THE PARTICIPANTS 4881 03:08:25,948 --> 03:08:26,983 APPROPRIATELY FOR THEIR TIME 4882 03:08:26,983 --> 03:08:28,050 AND NOT JUST ASK THEM TO 4883 03:08:28,050 --> 03:08:29,218 VOLUNTEER. 4884 03:08:29,218 --> 03:08:32,421 BUT IT REQUIRES SOME FUNDING 4885 03:08:32,421 --> 03:08:33,623 WHETHER THAT'S AN INTERNAL 4886 03:08:33,623 --> 03:08:36,826 GRANT OR PLANNING GRANT. 4887 03:08:36,826 --> 03:08:40,596 >> STEPHANIE: I WOULD ASK THAT 4888 03:08:40,596 --> 03:08:42,865 BACORE ALSO HAS COMMUNITY 4889 03:08:42,865 --> 03:08:47,203 ENGAGEMENT AND GRANTS I THINK 4890 03:08:47,203 --> 03:08:52,308 FOR PEOPLE WHO ARE STARTING OUT. 4891 03:08:52,308 --> 03:08:54,143 >> MEGAN PASSEY: WE HAVE 4892 03:08:54,143 --> 03:08:56,412 SIMILAR PROCESS AT THE DAFFODIL 4893 03:08:56,412 --> 03:08:57,780 CENTER AND COMMUNITY ADVISORY 4894 03:08:57,780 --> 03:08:57,980 BOARD. 4895 03:08:57,980 --> 03:08:59,482 I CAN'T REMEMBER THEIR EXACT 4896 03:08:59,482 --> 03:09:00,816 NAME. 4897 03:09:00,816 --> 03:09:04,720 THEY WILL REVIEW AND PROVIDE 4898 03:09:04,720 --> 03:09:06,455 ADVICE ON INDIVIDUAL PROJECTS 4899 03:09:06,455 --> 03:09:11,394 BUT THEY AREN'T ONGOING 4900 03:09:11,394 --> 03:09:13,563 INVOLVEMENT WITH THE PROJEKTS 4901 03:09:13,563 --> 03:09:17,099 BUT THEY WILL HELP YOU CONNECT 4902 03:09:17,099 --> 03:09:19,936 WITH, THEY WILL WORK WELL FOR 4903 03:09:19,936 --> 03:09:21,704 THE YOUNG EARLY CAREER 4904 03:09:21,704 --> 03:09:22,905 INVESTIGATORS TO START 4905 03:09:22,905 --> 03:09:28,177 DEVELOPING THEIR PROJECTS. 4906 03:09:28,177 --> 03:09:30,513 >> MIHAELA STEFAN COAL THANK 4907 03:09:30,513 --> 03:09:33,482 YOU, THAT'S SO IMPORTANT. 4908 03:09:33,482 --> 03:09:35,952 >> MEGAN PASSEY: WE HAVE 4909 03:09:35,952 --> 03:09:37,620 FUNDING TO PROVIDE CONSUMERS TO 4910 03:09:37,620 --> 03:09:42,391 PROVIDE ADVICE. 4911 03:09:42,391 --> 03:09:43,626 >> MIHAELA STEFAN: AT THE 4912 03:09:43,626 --> 03:09:45,628 INSTITUTION WE HAVE THE CTA 4913 03:09:45,628 --> 03:09:47,997 THAT MAY PROVIDE SOME TYPE OF 4914 03:09:47,997 --> 03:09:50,866 SUPPORT BUT SOME YOUNG 4915 03:09:50,866 --> 03:09:52,134 INVESTIGATORS DON'T EVEN KNOW 4916 03:09:52,134 --> 03:09:54,103 THIS EXISTS AND THEY NEED TO DO 4917 03:09:54,103 --> 03:09:55,071 THE WORK AND AFTERTHOUGHTS 4918 03:09:55,071 --> 03:09:56,539 ISN'T THE BEST WAY. 4919 03:09:56,539 --> 03:09:57,773 I SEE WE DON'T HAVE ANY 4920 03:09:57,773 --> 03:09:59,075 QUESTIONS IN THE Q&A. 4921 03:09:59,075 --> 03:10:01,677 SO I WILL KEEP ASKING SOME THAT 4922 03:10:01,677 --> 03:10:06,415 WE ALREADY HAVE PLANNED. 4923 03:10:06,415 --> 03:10:09,552 SO SONALI I HAVE A QUESTION, WE 4924 03:10:09,552 --> 03:10:14,624 KNOW THE PRENATAL EXPOSURE TO 4925 03:10:14,624 --> 03:10:15,958 ENVIRONMENTAL CONTAMINANTS MAY 4926 03:10:15,958 --> 03:10:19,095 AFFECT FETAL HEALTH AND 4927 03:10:19,095 --> 03:10:20,329 PREGNANCY ARE CRITICAL 4928 03:10:20,329 --> 03:10:22,198 SENSITIVE WINDOWS OF 4929 03:10:22,198 --> 03:10:26,035 SUSCEPTIBILITY AS YOU SAID, 4930 03:10:26,035 --> 03:10:30,172 WHAT PRENATAL INTERVENTIONS CAN 4931 03:10:30,172 --> 03:10:32,842 BE IMPLEMENTED TO MITIGATE THE 4932 03:10:32,842 --> 03:10:35,111 EFFECT OF MATERNAL 4933 03:10:35,111 --> 03:10:37,680 ENVIRONMENTAL EXPOSURE ON FETAL 4934 03:10:37,680 --> 03:10:41,484 AND POST NATAL DEVELOPMENT. 4935 03:10:41,484 --> 03:10:42,985 DON'T TALK ABOUT TOBACCO 4936 03:10:42,985 --> 03:10:47,056 BECAUSE THAT IS MEGAN'S. 4937 03:10:47,056 --> 03:10:49,392 >> SONALI BOSE: MY ANSWER WILL 4938 03:10:49,392 --> 03:10:54,864 BE SHORT BECAUSE I THINK 4939 03:10:54,864 --> 03:10:55,264 THERE'S A DEARTH. 4940 03:10:55,264 --> 03:10:57,199 THERE'S SMALL TRIALS WE BUILT 4941 03:10:57,199 --> 03:11:00,603 OUR WORK ONTO REDUCE EXPOSURE 4942 03:11:00,603 --> 03:11:02,338 TO ENVIRONMENTAL HAZARDS 4943 03:11:02,338 --> 03:11:05,641 REDUCTION OF INDOOR AIR 4944 03:11:05,641 --> 03:11:07,543 POLLUTION VIA FREE-STANDING AIR 4945 03:11:07,543 --> 03:11:09,679 PURIFIERS THIS HAS BEEN SHOWN 4946 03:11:09,679 --> 03:11:11,781 TO REDUCE EXPOSURES IN 4947 03:11:11,781 --> 03:11:13,182 NON-PREGNANT POPULATIONS AND WE 4948 03:11:13,182 --> 03:11:18,154 ARE TRYING TO DEMONSTRATE IN A 4949 03:11:18,154 --> 03:11:22,024 NON-PREGNANT POPULATION THAT 4950 03:11:22,024 --> 03:11:24,427 TRANSLATES TO BENEFIT. 4951 03:11:24,427 --> 03:11:31,467 THAT WOULD BE ONE POTENTIAL 4952 03:11:31,467 --> 03:11:34,103 AREA OF BENEFIT. 4953 03:11:34,103 --> 03:11:40,009 THE HARDER PART ARE THE 4954 03:11:40,009 --> 03:11:44,180 EXTERNAL EXTERNALISM POSE URS 4955 03:11:44,180 --> 03:11:50,353 LIKE AMBIENT POLLUTION. 4956 03:11:50,353 --> 03:11:53,089 WE HOPE FOR DIET TO HELP MAKE 4957 03:11:53,089 --> 03:11:58,461 THEM RESILIENT. 4958 03:11:58,461 --> 03:12:00,396 TO UNDERSTAND THE EXOMEIC, 4959 03:12:00,396 --> 03:12:02,765 THESE ARE EXISTING IN MIXTURES 4960 03:12:02,765 --> 03:12:03,632 THEY DON'T EXIST INDIVIDUALLY. 4961 03:12:03,632 --> 03:12:06,402 IF YOU ARE TRYING TO COMBAT A 4962 03:12:06,402 --> 03:12:07,002 PARTICULAR ENVIRONMENTAL 4963 03:12:07,002 --> 03:12:09,438 EXPOSURE YOU HAVE TO THINK OF 4964 03:12:09,438 --> 03:12:10,172 WAYS OF INCREASING RESILIENCE 4965 03:12:10,172 --> 03:12:11,774 OF THE INDIVIDUAL. 4966 03:12:11,774 --> 03:12:14,310 SOME COULD HAPPEN THROUGH 4967 03:12:14,310 --> 03:12:16,145 DIETARY, STRESS REDUCTION AND 4968 03:12:16,145 --> 03:12:19,415 OTHER LIFESTYLE AND WELL-BEING 4969 03:12:19,415 --> 03:12:20,349 TARGETED INTERVENTIONS. 4970 03:12:20,349 --> 03:12:22,118 THE SHORT ANSWER IS THEY DON'T 4971 03:12:22,118 --> 03:12:22,918 EXIST YET. 4972 03:12:22,918 --> 03:12:25,221 WE HAVE BEEN TRYING TO PUT IN 4973 03:12:25,221 --> 03:12:27,556 GRANTS TO GET THAT WORK STARTED. 4974 03:12:27,556 --> 03:12:29,992 BUT I'M SURE WITH BRAINSTORMING 4975 03:12:29,992 --> 03:12:34,730 ACROSS EXPERTS WE COULD COME UP 4976 03:12:34,730 --> 03:12:36,866 WITH EVEN MORE INTERVENTIONS TO 4977 03:12:36,866 --> 03:12:38,601 HELP MATE GATE SOME OF THOSE 4978 03:12:38,601 --> 03:12:42,805 ENVIRONMENTAL THREATS. 4979 03:12:42,805 --> 03:12:44,140 >> MIHAELA STEFAN: THANK YOU. 4980 03:12:44,140 --> 03:12:46,175 THERE'S A GAP IN RESEARCH WHERE 4981 03:12:46,175 --> 03:12:48,244 PREGNANT WOMEN ARE NOT INCLUDED. 4982 03:12:48,244 --> 03:12:50,946 BECAUSE WE HAVE STUDIS WITH 4983 03:12:50,946 --> 03:12:53,015 PURIFIERS BUT PREGNANT WOMEN 4984 03:12:53,015 --> 03:12:53,949 ARE NOT SPECIFICALLY TARGETED 4985 03:12:53,949 --> 03:12:55,951 OR INCLUDED IN SOME OF THEM. 4986 03:12:55,951 --> 03:12:57,686 WE KNOW THEY ARE KIND OF 4987 03:12:57,686 --> 03:13:02,425 EXCLUDED FROM THE BEGINNING. 4988 03:13:02,425 --> 03:13:04,427 >> SONALI BOSE: EDUCATION IS 4989 03:13:04,427 --> 03:13:06,929 IMPORTANT, EVEN MANY ANY 4990 03:13:06,929 --> 03:13:09,799 CLINICAL PRACTICE, AN 4991 03:13:09,799 --> 03:13:11,267 ASTOUNDING NUMBER OF PATIENTS 4992 03:13:11,267 --> 03:13:13,436 AREN'T AWARE, AN THEIR EARS ARE 4993 03:13:13,436 --> 03:13:15,304 PRETTY PERKED UP WHEN THEY ARE 4994 03:13:15,304 --> 03:13:16,472 PREGNANT. 4995 03:13:16,472 --> 03:13:17,873 SEEING BEFORE AND AFTER, THEY 4996 03:13:17,873 --> 03:13:19,809 COME IN AND SAY WHAT DO I NEED 4997 03:13:19,809 --> 03:13:22,211 TO WATCH OUT FOR NOW THAT I'M 4998 03:13:22,211 --> 03:13:22,845 PREGNANT. 4999 03:13:22,845 --> 03:13:24,647 IT'S A VERY TEACHABLE MOMENT. 5000 03:13:24,647 --> 03:13:27,983 I THINK MASK WEARING HAS BECOME 5001 03:13:27,983 --> 03:13:35,891 MORE NORMALIZED ESPECIALLY IN 5002 03:13:35,891 --> 03:13:37,993 NEW YORK AFTER COVID. 5003 03:13:37,993 --> 03:13:39,762 PATIENTS ARE NOT AWARE WHAT TO 5004 03:13:39,762 --> 03:13:45,801 WATCH OUT FOR AS A WHOLE. 5005 03:13:45,801 --> 03:13:48,204 >> MIHAELA STEFAN: I GUESS 5006 03:13:48,204 --> 03:13:50,439 PATIENTS ARE NOT AWARE, 5007 03:13:50,439 --> 03:13:53,876 CLINICIANS OR PHYSICIANS ARE 5008 03:13:53,876 --> 03:13:57,146 AWARE, SAME WITH TOBACCO, HOW 5009 03:13:57,146 --> 03:13:59,281 MUCH EFFORT WE MAKE TO TELL THE 5010 03:13:59,281 --> 03:14:00,449 PATIENT. 5011 03:14:00,449 --> 03:14:02,585 MEGAN, I HAVE A QUESTION FOR 5012 03:14:02,585 --> 03:14:02,751 YOU. 5013 03:14:02,751 --> 03:14:04,086 YOU SHOWED US ABOUT YOUR STUDY 5014 03:14:04,086 --> 03:14:06,822 AND HOW YOU WORK TO EDUCATE 5015 03:14:06,822 --> 03:14:09,291 CLINICIAN AND GET THEM MORE 5016 03:14:09,291 --> 03:14:09,558 INVOLVED. 5017 03:14:09,558 --> 03:14:12,161 CAN YOU DISCUSS A BIT MAIN 5018 03:14:12,161 --> 03:14:17,700 BARRIERS FOR THE CLINICIAN IN 5019 03:14:17,700 --> 03:14:22,238 DOING SMOKING CESSATION, 5020 03:14:22,238 --> 03:14:24,073 SPECIFICALLY FOR PREGNANT WOMEN 5021 03:14:24,073 --> 03:14:26,509 AND KEY LEARNING STRATEGIES FOR 5022 03:14:26,509 --> 03:14:26,742 SUCCESS. 5023 03:14:26,742 --> 03:14:29,445 I WAS STRUCK THAT YOU SAID NRT 5024 03:14:29,445 --> 03:14:32,915 CAN BE USED BUT I WONDER IF YOU 5025 03:14:32,915 --> 03:14:37,419 CAN ALSO COMMENT ON CLINICIANS 5026 03:14:37,419 --> 03:14:38,721 AN PATIENT RELUCTANCE TO USE 5027 03:14:38,721 --> 03:14:45,261 NRT. 5028 03:14:45,261 --> 03:14:47,796 THINKING FOR EXAMPLE WHAT 5029 03:14:47,796 --> 03:14:50,833 SONALI TALKED ABOUT WITH 5030 03:14:50,833 --> 03:14:52,735 ASTHMA, MIGHT BE A SIDE EFFECT 5031 03:14:52,735 --> 03:14:54,603 OF THE N.R.T., IF YOU COULD 5032 03:14:54,603 --> 03:15:00,042 COMMENT ON THAT, THANK YOU. 5033 03:15:00,042 --> 03:15:02,444 >> MEGAN PASSEY: THANK YOU. 5034 03:15:02,444 --> 03:15:04,313 I WILL START WITH THE NRT, I 5035 03:15:04,313 --> 03:15:06,015 THINK FOR A LONG TIME THEY HAVE 5036 03:15:06,015 --> 03:15:08,584 BEEN AFRAID TO USE IT IN 5037 03:15:08,584 --> 03:15:11,754 PREGNANCY BUT THERE'S BEEN 5038 03:15:11,754 --> 03:15:15,357 TRIALS, CERTAINLY IN THE U.K. 5039 03:15:15,357 --> 03:15:17,860 I'VE BEEN FAMILIAR WITH, TRIALS 5040 03:15:17,860 --> 03:15:19,895 OOZING NRT IN PREGNANCY. 5041 03:15:19,895 --> 03:15:22,398 THEY DO DEMONSTRATE IMPROVED 5042 03:15:22,398 --> 03:15:22,898 OUTCOMES. 5043 03:15:22,898 --> 03:15:25,634 IT'S MARGINAL AND THE PROBLEM 5044 03:15:25,634 --> 03:15:28,437 IS ADHERENCE TO USE OF NRT AS 5045 03:15:28,437 --> 03:15:30,172 MUCH AS ANYTHING ELSE. 5046 03:15:30,172 --> 03:15:32,341 CLINICIANS ARE CONCERNED ABOUT 5047 03:15:32,341 --> 03:15:34,410 THE SIDE EFFECTS, BUT SO ARE 5048 03:15:34,410 --> 03:15:35,945 OUR PATIENTS. 5049 03:15:35,945 --> 03:15:37,947 THE WOMEN WHO ARE PREG NAONT 5050 03:15:37,947 --> 03:15:40,983 ARE AT LEAST IN MY EXPERIENCE 5051 03:15:40,983 --> 03:15:43,586 AFRAID TO USE IT, BUT 5052 03:15:43,586 --> 03:15:46,822 SIGNIFICANTLY I THINK THAT IS 5053 03:15:46,822 --> 03:15:49,358 COMING OUT THAT, WHILE NICOTINE 5054 03:15:49,358 --> 03:15:51,493 IS STILL HARMFUL, ANY FORM OF 5055 03:15:51,493 --> 03:15:52,695 NICOTINE IS HARMFUL, IT DOESN'T 5056 03:15:52,695 --> 03:15:55,364 MAT IRWHAT FORM IT TAKES, IT IS 5057 03:15:55,364 --> 03:15:56,332 ALWAYS HARMFUL. 5058 03:15:56,332 --> 03:15:58,734 BUT NRT DOES NOT CONTAIN ALL 5059 03:15:58,734 --> 03:16:01,170 THE OTHER HARMFUL COMPONENTS OF 5060 03:16:01,170 --> 03:16:02,638 TOBACCO SMOKE AND THEREFORE IT 5061 03:16:02,638 --> 03:16:06,342 IS SAFER. 5062 03:16:06,342 --> 03:16:09,645 AND THE EVIDENCE IS NOW THAT 5063 03:16:09,645 --> 03:16:10,980 THE RATES OF COMPLICATIONS 5064 03:16:10,980 --> 03:16:15,351 ASSOCIATED WITH USE OF NRT IS 5065 03:16:15,351 --> 03:16:16,251 LOW. 5066 03:16:16,251 --> 03:16:19,788 SO WE THINK IT CAN BE 5067 03:16:19,788 --> 03:16:21,090 CAUTIOUSLY PRESCRIBED BUT IN 5068 03:16:21,090 --> 03:16:24,059 AUSTRALIA THE POLICY IS YOU 5069 03:16:24,059 --> 03:16:25,127 ONLY RECOMMEND NRT ONCE, IF 5070 03:16:25,127 --> 03:16:27,863 THEY ARE TRYING TO QUIT USING 5071 03:16:27,863 --> 03:16:29,798 BEHAVIORAL STRATEGIES AND HAD 5072 03:16:29,798 --> 03:16:31,100 SOME COUNSELING AND STILL 5073 03:16:31,100 --> 03:16:33,035 HAVEN'T BEEN ABLE TO WE OFFER 5074 03:16:33,035 --> 03:16:33,736 NRT. 5075 03:16:33,736 --> 03:16:35,371 THAT'S THE STATE WHERE WE ARE 5076 03:16:35,371 --> 03:16:36,405 IN AUSTRALIA. 5077 03:16:36,405 --> 03:16:40,743 IN THE U.K. THEY RECOMMEND 5078 03:16:40,743 --> 03:16:42,111 E-CIGARETTES WHICH I THINK IS 5079 03:16:42,111 --> 03:16:43,712 PROBABLY NOT RECOMMENDED IN THE 5080 03:16:43,712 --> 03:16:45,948 U.S., CERTAINLY NOT RECOMMENDED 5081 03:16:45,948 --> 03:16:46,281 IN AUSTRALIA. 5082 03:16:46,281 --> 03:16:47,816 BUT YOU KNOW, WE ALL HAVE 5083 03:16:47,816 --> 03:16:52,888 DIFFERENT POLICIES AND THE U.K. 5084 03:16:52,888 --> 03:16:58,060 HAS, IS VERY POSITIVE TOWARD 5085 03:16:58,060 --> 03:17:01,964 USE OF E-CIGARETTES FOR SMOKING 5086 03:17:01,964 --> 03:17:03,332 CESSATION INCLUDING IN 5087 03:17:03,332 --> 03:17:03,599 PREGNANCY. 5088 03:17:03,599 --> 03:17:05,634 I WORK WITH QUITE A FEW U.K. 5089 03:17:05,634 --> 03:17:07,770 COLLEAGUES AND I ALWAYS FIND IT 5090 03:17:07,770 --> 03:17:09,104 RATHER DISTRESSING. 5091 03:17:09,104 --> 03:17:10,506 XWU ANYWAY THAT'S WHAT IT IS. 5092 03:17:10,506 --> 03:17:12,041 GETTING BACK TO YOUR QUESTION 5093 03:17:12,041 --> 03:17:15,244 ABOUT THE BARRIERS, IF YOU ASK 5094 03:17:15,244 --> 03:17:16,578 CLINICIANS ABOUT THE BARRIERS 5095 03:17:16,578 --> 03:17:18,013 THEY FACE THEY WILL TELL YOU 5096 03:17:18,013 --> 03:17:19,515 IT'S TIME, THEY DON'T HAVE TIME. 5097 03:17:19,515 --> 03:17:21,950 BUT IF YOU GO THROUGH AND 5098 03:17:21,950 --> 03:17:22,851 COMPREHENSIVELY MAP IT OUT, THE 5099 03:17:22,851 --> 03:17:25,654 THAT IT IS NOT A PRIORITY FOR 5100 03:17:25,654 --> 03:17:26,555 CLINICIANS. THEY DON'T HAVE THE 5101 03:17:26,555 --> 03:17:28,390 K*FRDS, THEY DON'T HAVE THE 5102 03:17:28,390 --> 03:17:30,192 SKILLS, THEY DON'T HAVE 5103 03:17:30,192 --> 03:17:30,793 ADEQUATE TRAIN ORGANIZE 5104 03:17:30,793 --> 03:17:32,728 RESOURCES TO USE IT. 5105 03:17:32,728 --> 03:17:33,495 THERE ARE SYSTEMS BARRIERS 5106 03:17:33,495 --> 03:17:36,265 WHICH IS WHY YOU HAVE TO USE A 5107 03:17:36,265 --> 03:17:37,499 WHOLE OF SYSTEMS APPROACH. 5108 03:17:37,499 --> 03:17:40,969 IN OUR CASE WE FOUND THE 5109 03:17:40,969 --> 03:17:43,539 ELECTRONIC HEALTH RECORD REALLY 5110 03:17:43,539 --> 03:17:45,908 DIDN'T FACILITATE IN ANY WAY 5111 03:17:45,908 --> 03:17:47,643 PROVIDES CESSATION SUPPORT, IT 5112 03:17:47,643 --> 03:17:49,111 HAD THE FIRST PRENATAL VISIT, 5113 03:17:49,111 --> 03:17:51,413 ONE SPACE TO RECORD THE SMOKING 5114 03:17:51,413 --> 03:17:52,548 STATE US, NOTHING TO RECORD 5115 03:17:52,548 --> 03:17:54,616 WHAT WAS DONE ABOUT IT, AND 5116 03:17:54,616 --> 03:17:56,151 NOTHING TO FLAG THIS PERSON AS 5117 03:17:56,151 --> 03:17:58,921 A SMOKER AND NOTHING TO SORT OF 5118 03:17:58,921 --> 03:18:02,291 DEMONSTRATE WHAT HAD BEEN DONE 5119 03:18:02,291 --> 03:18:02,591 PREVIOUSLY. 5120 03:18:02,591 --> 03:18:05,227 SO VERY DIFFICULT TO MANAGE 5121 03:18:05,227 --> 03:18:06,495 SMOKING CESSATION SUPPORT. 5122 03:18:06,495 --> 03:18:09,131 THAT'S A BIG SYSTEM BARRIER WE 5123 03:18:09,131 --> 03:18:10,733 HAVE MANAGED TO ADDRESS. 5124 03:18:10,733 --> 03:18:13,268 WE NOW GOT MUCH BETTER 5125 03:18:13,268 --> 03:18:14,837 ELECTRONIC HEALTH SYSTEM. 5126 03:18:14,837 --> 03:18:16,371 LACK OF LEADERSHIP, IF YOU 5127 03:18:16,371 --> 03:18:17,873 DON'T HAVE YOUR CLINIC MANAGER 5128 03:18:17,873 --> 03:18:19,575 SAYING THIS IS AN IMPORTANT 5129 03:18:19,575 --> 03:18:21,610 THING FOR OUR CLINIC, IT'S NOT 5130 03:18:21,610 --> 03:18:23,545 GOING TO BE PRIORITIZED. 5131 03:18:23,545 --> 03:18:26,482 IT'S VERY COMPLEX BUT THE 5132 03:18:26,482 --> 03:18:27,049 ENTIRE WORKING ENVIRONMENT. 5133 03:18:27,049 --> 03:18:27,716 TRAINING OF THE INDIVIDUAL 5134 03:18:27,716 --> 03:18:29,318 CLINICIANS ON THEIR OWN IS NOT 5135 03:18:29,318 --> 03:18:31,453 ENOUGH BECAUSE IT'S THE BIGGER 5136 03:18:31,453 --> 03:18:33,255 ENVIRONMENT THAT IS SO CRITICAL 5137 03:18:33,255 --> 03:18:34,890 TO WHETHER OR NOT IT ENABLES 5138 03:18:34,890 --> 03:18:38,060 THEM TO DO THIS WORK. 5139 03:18:38,060 --> 03:18:39,361 THAT WOULD APPLY 5140 03:18:39,361 --> 03:18:40,229 ACROSS-THE-BOARD FOR ALL THESE 5141 03:18:40,229 --> 03:18:43,499 CONDITIONS THAT WE ARE TALKING 5142 03:18:43,499 --> 03:18:46,602 ABOUT. 5143 03:18:46,602 --> 03:18:48,737 TIME IS ALWAYS A BARRIER BUT 5144 03:18:48,737 --> 03:18:50,672 IT'S ALSO A QUESTION OF 5145 03:18:50,672 --> 03:18:53,408 PRIORITY YOU PUT ON THINSINGS. 5146 03:18:53,408 --> 03:18:59,748 -- THINGS. 5147 03:18:59,748 --> 03:19:00,916 >> MIHAELA STEFAN: I SEE A 5148 03:19:00,916 --> 03:19:03,352 QUESTION IN THE CHAT. 5149 03:19:03,352 --> 03:19:05,387 KAREN, DO YOU WANT TO UNMUTE 5150 03:19:05,387 --> 03:19:06,655 AND ASK IT, OR WANT US TO READ 5151 03:19:06,655 --> 03:19:08,357 IT? 5152 03:19:08,357 --> 03:19:10,025 >> KAUREN: SURE I CAN GO AHEAD 5153 03:19:10,025 --> 03:19:11,059 AND JUST READ IT. 5154 03:19:11,059 --> 03:19:12,427 I THINK WE HAVE HEARD A LOT 5155 03:19:12,427 --> 03:19:14,329 OVER THE PAST COUPLE OF DAYS 5156 03:19:14,329 --> 03:19:16,165 ABOUT BUNDLING CARE AND TRYING 5157 03:19:16,165 --> 03:19:18,200 TO DECREASE BURDEN ON CARE 5158 03:19:18,200 --> 03:19:19,735 PROVIDERS AS MUCH AS POSSIBLE. 5159 03:19:19,735 --> 03:19:23,739 I'M JUST CURIOUS THE PANEL'S 5160 03:19:23,739 --> 03:19:25,874 THOUGHTS HOW TO ENSURE THAT WE 5161 03:19:25,874 --> 03:19:28,277 ARE TARGETS THOSE THAT ARE 5162 03:19:28,277 --> 03:19:30,512 HIGHEST RISK WHILE ENSURING WE 5163 03:19:30,512 --> 03:19:31,380 ARE NOT SUBSTANTIALLY 5164 03:19:31,380 --> 03:19:32,514 INCREASING BURDEN ON CARE 5165 03:19:32,514 --> 03:19:40,489 PROVIDERS. 5166 03:19:40,489 --> 03:19:43,125 >> SONALI BOSE: I WILL OFFER 5167 03:19:43,125 --> 03:19:44,893 ONE PIECE OF INFORMATION, THERE 5168 03:19:44,893 --> 03:19:46,395 HAVE BEEN SCATTERED STUDIES 5169 03:19:46,395 --> 03:19:48,197 SHOWING THAT BUNDING OR HAVING 5170 03:19:48,197 --> 03:19:50,999 PROVIDERS IN A SINGLE CLINIC 5171 03:19:50,999 --> 03:19:52,534 INTEGRATED CARE FOR CO-MORBID 5172 03:19:52,534 --> 03:19:53,936 CONDITIONS DURING PREGNANCY HAS 5173 03:19:53,936 --> 03:19:56,371 BEEN FEASIBLE AND SUCCESSFUL. 5174 03:19:56,371 --> 03:19:58,207 WE'RE NOLING THE MODEL HERE WE 5175 03:19:58,207 --> 03:20:02,511 HAVE A NUMBER OF JOINT CLINICS 5176 03:20:02,511 --> 03:20:06,281 BETWEEN MFM AND ARDOLOGY AS 5177 03:20:06,281 --> 03:20:09,117 WELL AS MFM AND IN ASTHMA. 5178 03:20:09,117 --> 03:20:12,187 TO HAVE A SPECIALIST IN THE MFM 5179 03:20:12,187 --> 03:20:13,422 CLINIC TO HELP PROVIDE THAT 5180 03:20:13,422 --> 03:20:15,290 JOINT CARE CAN BE CONSIDERED. 5181 03:20:15,290 --> 03:20:18,227 I KNOW THIS IS NOT POSSIBLE IN 5182 03:20:18,227 --> 03:20:19,595 ALL RESOURCE AREAS. SO IT'S 5183 03:20:19,595 --> 03:20:20,996 SOMETHING TO THINK ABOUT, YOU 5184 03:20:20,996 --> 03:20:25,601 KNOW, HOW DO WE COLLECTIVELY 5185 03:20:25,601 --> 03:20:27,536 MAKE THAT POSSIBLE AND 5186 03:20:27,536 --> 03:20:28,704 EQUITABLE. 5187 03:20:28,704 --> 03:20:31,273 IT MAY NOT BE POSSIBLE IN AREAS 5188 03:20:31,273 --> 03:20:41,650 THAT HAVE LOW ACCESS. 5189 03:21:00,435 --> 03:21:03,372 >> WHILE I DO UNDERSTAND THE 5190 03:21:03,372 --> 03:21:04,907 QUESTION ABOUT REDUCING THE 5191 03:21:04,907 --> 03:21:05,974 BURDEN ON PROVIDERS I DON'T 5192 03:21:05,974 --> 03:21:07,376 THINK WE SHOULD PUT THAT BACK 5193 03:21:07,376 --> 03:21:08,844 ON INDIVIDUAL WHO IS PREGNANT 5194 03:21:08,844 --> 03:21:13,348 AND TRYING TO DEAL WITH THEIR 5195 03:21:13,348 --> 03:21:16,118 CO MORBID CONDITION ON TOP OF 5196 03:21:16,118 --> 03:21:26,395 BEING PREGNANT. 5197 03:21:32,501 --> 03:21:34,670 FOR PATIENTS IN GRAND JUNCTION, 5198 03:21:34,670 --> 03:21:36,171 COLORADO, IT'S DIFFICULT TO GET 5199 03:21:36,171 --> 03:21:38,907 HERE AND SEE TWO DIFFERENT 5200 03:21:38,907 --> 03:21:40,075 PROVIDERS, SO USING TELEHEALTH 5201 03:21:40,075 --> 03:21:40,876 THEY HAVE BEEN LIBERAL ABOUT 5202 03:21:40,876 --> 03:21:43,445 THE USE OF THAT HERE IN 5203 03:21:43,445 --> 03:21:45,414 COLORADO, HAS ACTUALLY HELPED 5204 03:21:45,414 --> 03:21:47,382 US CO-MANAGE SOME OF THESE 5205 03:21:47,382 --> 03:21:48,617 PATIENTS. 5206 03:21:48,617 --> 03:21:50,218 >> STEPHANIE: I WILL ADD TO 5207 03:21:50,218 --> 03:21:51,920 THAT IN TERMS OF THINKING ABOUT 5208 03:21:51,920 --> 03:21:52,621 OTHER PEOPLE AS PART OF THE 5209 03:21:52,621 --> 03:21:54,923 CARE TEAM. 5210 03:21:54,923 --> 03:21:57,092 AS I MENTIONED BEFORE, WE HAVE 5211 03:21:57,092 --> 03:21:59,094 CARE MANAGEMENT COORDINATORS 5212 03:21:59,094 --> 03:21:59,995 WHO ARE TECHNICALLY 5213 03:21:59,995 --> 03:22:04,099 NON-CLINICAL BUT THEY STILL CAN 5214 03:22:04,099 --> 03:22:07,970 PROVIDE MANAGEMENT SUPPORT AND 5215 03:22:07,970 --> 03:22:10,138 NAVIGATE PATIENTS TO PROVIDERS. 5216 03:22:10,138 --> 03:22:12,174 THINKING ABOUT APPROPRIATE CARE 5217 03:22:12,174 --> 03:22:13,275 COMMUNITY HEALTH WORKER IS 5218 03:22:13,275 --> 03:22:15,277 ANOTHER GROUP OF FOLKS WHO CAN 5219 03:22:15,277 --> 03:22:18,180 BE REALLY HELPFUL IN TERMS OF 5220 03:22:18,180 --> 03:22:18,613 SUPPORTING PATIENTS. 5221 03:22:18,613 --> 03:22:19,681 CERTAINLY WHO ARE AT HIGH RISK 5222 03:22:19,681 --> 03:22:21,850 AND WE WANT TO PREVENT THEM 5223 03:22:21,850 --> 03:22:23,385 FROM HAVING ANY ADDITIONAL 5224 03:22:23,385 --> 03:22:26,188 COMPLICATIONS OR EVEN IN THOSE 5225 03:22:26,188 --> 03:22:26,989 WHO ARE LOW-TO-MODERATE RISK AS 5226 03:22:26,989 --> 03:22:37,099 WELL. 5227 03:22:39,601 --> 03:22:41,069 >> MIHAELA STEFAN: JENNIFER I 5228 03:22:41,069 --> 03:22:43,905 HAVE A BRIEF STORY, WHEN WAY I 5229 03:22:43,905 --> 03:22:46,608 WAS AT ATS THIS YEAR WE HAVE 5230 03:22:46,608 --> 03:22:49,444 SYMPOSIUM HOW TO INCREASE THE 5231 03:22:49,444 --> 03:22:50,612 RECRUITMENT, IMPROVE THE 5232 03:22:50,612 --> 03:22:51,613 RECRUITMENT IN CLINICAL TRIALS 5233 03:22:51,613 --> 03:22:56,518 AND OUR SPEAKER WAS A PATIENT 5234 03:22:56,518 --> 03:23:00,155 WHOM WAS COLORED WOMAN AND SHE 5235 03:23:00,155 --> 03:23:03,492 TOLD US THE STORY OF HAVING HER 5236 03:23:03,492 --> 03:23:07,295 CF NOT BEING DIAGNOSED FOR 5237 03:23:07,295 --> 03:23:08,130 YEARS AND YEARS. 5238 03:23:08,130 --> 03:23:09,564 EXACTLY WHAT YOU DESCRIBED. 5239 03:23:09,564 --> 03:23:11,700 AND THEN SHE CAME TO YOUR 5240 03:23:11,700 --> 03:23:12,768 CLINIC AND WAS DIAGNOSED AND 5241 03:23:12,768 --> 03:23:15,203 SHE WAS TALKING ABOUT HOW 5242 03:23:15,203 --> 03:23:16,271 WONDERFUL OF A PHYSICIAN YOU 5243 03:23:16,271 --> 03:23:16,938 ARE. 5244 03:23:16,938 --> 03:23:18,340 SO IT'S JUST LIKE EVERYTHING 5245 03:23:18,340 --> 03:23:24,446 COMING AROUND. 5246 03:23:24,446 --> 03:23:28,050 I WANT TO ASK YOU, SAID THERE 5247 03:23:28,050 --> 03:23:30,252 ARE NOT REALLY IMPLEMENTABLE 5248 03:23:30,252 --> 03:23:33,055 GUIDELINES FOR CYSTIC FIBROSIS 5249 03:23:33,055 --> 03:23:36,958 OR RARE LUNG DISEASES FOR 5250 03:23:36,958 --> 03:23:39,461 PREGNANT OR LOOKING TO BECOME 5251 03:23:39,461 --> 03:23:39,728 PREGNANT. 5252 03:23:39,728 --> 03:23:42,130 CAN YOU TALK A LITTLE MORE 5253 03:23:42,130 --> 03:23:43,265 ABOUT THE BARRIERS AND WHAT 5254 03:23:43,265 --> 03:23:44,733 NEEDS TO BE DONE SO YOU ARE 5255 03:23:44,733 --> 03:23:46,234 PLANNING A STUDY AND THAT'S 5256 03:23:46,234 --> 03:23:50,639 GREAT. 5257 03:23:50,639 --> 03:23:53,008 BUT WHAT ELSE NEEDS TO BE DONE, 5258 03:23:53,008 --> 03:23:55,143 IN A WAY CF IS A RARE DISEASE 5259 03:23:55,143 --> 03:23:56,344 BUT WHEN YOU PUT IT ALL 5260 03:23:56,344 --> 03:23:58,180 TOGETHER, RIGHT? 5261 03:23:58,180 --> 03:24:01,650 IT'S CURIOUS THAT WE DON'T HAVE 5262 03:24:01,650 --> 03:24:02,717 ANY EVIDENCE-BASED GUIDELINES. 5263 03:24:02,717 --> 03:24:06,088 >> I THINK PART OF IT, AS MANY 5264 03:24:06,088 --> 03:24:07,856 SPEAKERS ELUDED TO ALREADY, IN 5265 03:24:07,856 --> 03:24:10,392 SPITE OF SOME OF THE ATTEMPTED 5266 03:24:10,392 --> 03:24:11,793 GOVERNMENT INTERVENTIONS TO 5267 03:24:11,793 --> 03:24:13,528 FORCE SPONSORS, FOR EXAMPLE, TO 5268 03:24:13,528 --> 03:24:15,430 INCLUDE PREGNANT PEOPLE WITH 5269 03:24:15,430 --> 03:24:17,599 CF, OR PREGNANT PEOPLE WITH ANY 5270 03:24:17,599 --> 03:24:19,000 DISEASE, IT GETS HARD TO SEE 5271 03:24:19,000 --> 03:24:21,303 HOW WE ARE GOING TO CHANGE 5272 03:24:21,303 --> 03:24:23,572 THINGS IF THOSE AREN'T ENFORCED 5273 03:24:23,572 --> 03:24:24,406 MORE. 5274 03:24:24,406 --> 03:24:27,142 YOU KNOW, FOR EXAMPLE, THESE 5275 03:24:27,142 --> 03:24:30,145 NEW DRUGS DRAMATICALLY IMPROVE 5276 03:24:30,145 --> 03:24:31,847 LUNG FUNCTION BUT IN A SHORT 5277 03:24:31,847 --> 03:24:36,451 AMOUNT OF TIME, IN 14 5278 03:24:36,451 --> 03:24:37,586 DAY-ACHAUERS YOUR LUNG FUNCTION 5279 03:24:37,586 --> 03:24:40,455 MAY GO UP 15% BUT THAT'S A 5280 03:24:40,455 --> 03:24:42,090 SHORT ACTING DRUG, MEANING IF 5281 03:24:42,090 --> 03:24:43,792 YOU TOP YOUR LUNG FUNCTION IS 5282 03:24:43,792 --> 03:24:46,027 GOING TO GO BACK DOWN AND 5283 03:24:46,027 --> 03:24:47,295 YOU'RE GOING TO FEEL REALLY 5284 03:24:47,295 --> 03:24:48,063 SICK. 5285 03:24:48,063 --> 03:24:50,031 WHAT WE DON'T ALLOW PREGNANT 5286 03:24:50,031 --> 03:24:51,333 PEOPLE TO THOUGHTFULLY BE 5287 03:24:51,333 --> 03:24:53,034 INCLUDED IN STUDIES IT MAKES IT 5288 03:24:53,034 --> 03:24:54,903 VERY DIFFICULT TO HAVE GUIDANCE. 5289 03:24:54,903 --> 03:24:58,173 THAT DOESN'T JUST GO FOR CF BUT 5290 03:24:58,173 --> 03:24:59,641 ASTHMA AND OTHER LUNG DISEASES. 5291 03:24:59,641 --> 03:25:02,677 I THINK THAT'S ONE BIG STEP IS 5292 03:25:02,677 --> 03:25:04,779 HAVING THE FDA PUSH HARDER ON 5293 03:25:04,779 --> 03:25:06,214 SPONSORS. THERE ARE STILL 5294 03:25:06,214 --> 03:25:07,782 STUDIES THAT COME THROUGH I 5295 03:25:07,782 --> 03:25:10,185 REVIEW, IN PHASE ONE, THEY ARE 5296 03:25:10,185 --> 03:25:11,853 EXCLUDING ANYONE WHO BECOME 5297 03:25:11,853 --> 03:25:13,421 PREGNANT, IT'S EASIER TO GET 5298 03:25:13,421 --> 03:25:15,190 THE STUDY DONE IF THEY DON'T 5299 03:25:15,190 --> 03:25:18,860 HAVE TO CONSIDER THAT. 5300 03:25:18,860 --> 03:25:20,095 THAT'S NOT ACCEPTABLE AND 5301 03:25:20,095 --> 03:25:22,130 SHOULDN'T BE ACCEPTABLE BY THE 5302 03:25:22,130 --> 03:25:26,501 FDA. 5303 03:25:26,501 --> 03:25:27,435 EXCLUDING PREGNANT AND 5304 03:25:27,435 --> 03:25:28,737 LACTATING FOR THOSE WHO HAVE 5305 03:25:28,737 --> 03:25:29,771 CHRONIC CONDITIONS. 5306 03:25:29,771 --> 03:25:33,875 I THINK THE OTHER BIG ISSUES IS 5307 03:25:33,875 --> 03:25:34,209 THAT FUNDING. 5308 03:25:34,209 --> 03:25:36,578 SO WE ARE INCREDIBLY LUCKY IN 5309 03:25:36,578 --> 03:25:38,079 CYSTIC FIBROSIS TO HAVE THE 5310 03:25:38,079 --> 03:25:41,683 FOUNDATION WHO IS WILLING TO 5311 03:25:41,683 --> 03:25:43,618 BASICALLY FUND A $9 MILLION 5312 03:25:43,618 --> 03:25:46,054 STUDY LOOKING AT PREGNANCY AND 5313 03:25:46,054 --> 03:25:46,922 CF. 5314 03:25:46,922 --> 03:25:49,124 NOT EVERY DISEASE STATE THAT IS 5315 03:25:49,124 --> 03:25:51,293 AN ORPHANED DISEASE HAS THAT 5316 03:25:51,293 --> 03:25:52,127 ORGANIZATION BEHIND THEM. 5317 03:25:52,127 --> 03:25:53,728 WE NEED OTHER FUNDERS BEHIND 5318 03:25:53,728 --> 03:25:55,397 THEM TO RECOGNIZE THE RESPONSER 5319 03:25:55,397 --> 03:25:56,898 OF STUDYING RARE DISEASE. 5320 03:25:56,898 --> 03:25:58,200 EVEN THE FINDINGS IN RARE 5321 03:25:58,200 --> 03:26:01,336 DISEASE WILL APPLY TO THAT 5322 03:26:01,336 --> 03:26:10,412 POPULATION BUT LIKELY TO APPLY 5323 03:26:10,412 --> 03:26:16,218 TO ANOTHERS, COPD IN COULD BE, 5324 03:26:16,218 --> 03:26:20,255 STUDYING AND FUNDING IS STILL 5325 03:26:20,255 --> 03:26:21,523 IMPORTANT AND RELEVANT FOR 5326 03:26:21,523 --> 03:26:22,757 OTHER DISEASE STATES. 5327 03:26:22,757 --> 03:26:25,727 I DON'T KNOW IF ANYBODY ELSE 5328 03:26:25,727 --> 03:26:32,267 HAS THOUGHTS. 5329 03:26:32,267 --> 03:26:33,902 >> MIHAELA STEFAN: I THINK WHAT 5330 03:26:33,902 --> 03:26:35,770 WE HEARD IN OTHER PRESENTATION, 5331 03:26:35,770 --> 03:26:38,373 AT LEAST IN U.S., THE LACK OF 5332 03:26:38,373 --> 03:26:40,108 HAVING ACCESS TO DATA WHICH IS 5333 03:26:40,108 --> 03:26:40,709 ALREADY COLLECTED. 5334 03:26:40,709 --> 03:26:41,843 I DON'T KNOW HOW IT IS IN 5335 03:26:41,843 --> 03:26:44,179 AUSTRALIA. 5336 03:26:44,179 --> 03:26:46,181 BUT HERE, IT'S HARD. 5337 03:26:46,181 --> 03:26:48,750 THE H.R. DATA, WE KNOW, OF 5338 03:26:48,750 --> 03:26:51,419 COURSE THEY ARE NOT BUILT FOR 5339 03:26:51,419 --> 03:26:55,390 RESEARCH AND IT'S HARD TO 5340 03:26:55,390 --> 03:26:57,325 NORMALIZE THE DATA BETWEEN 5341 03:26:57,325 --> 03:26:59,594 DIFFERENT DATASETS AND BEING 5342 03:26:59,594 --> 03:27:02,163 ABLE TO, AT LEAST EVEN GETTING 5343 03:27:02,163 --> 03:27:03,498 THE OUTCOME AND CHARACTERISTICS 5344 03:27:03,498 --> 03:27:05,967 OF THE PATIENTS FROM WHATEVER 5345 03:27:05,967 --> 03:27:07,402 IS ELECTED AND ACCESSING THIS 5346 03:27:07,402 --> 03:27:08,503 IN REAL-TIME, RIGHT? 5347 03:27:08,503 --> 03:27:10,572 TO BE ABLE TO PUT ALERTS IN THE 5348 03:27:10,572 --> 03:27:11,840 SYSTEM AND SO ON. 5349 03:27:11,840 --> 03:27:18,146 SO THAT IS SOMETHING ELSE THAT 5350 03:27:18,146 --> 03:27:20,215 WE NEED TO HAVE THE ACCESS TO 5351 03:27:20,215 --> 03:27:20,415 DATA. 5352 03:27:20,415 --> 03:27:24,119 I DON'T KNOW IF YOU HAVE ANY 5353 03:27:24,119 --> 03:27:26,921 COMMENTS, JENNIFER, PROBABLY 5354 03:27:26,921 --> 03:27:29,991 YOU HAVE MORE DATA BECAUSE OF 5355 03:27:29,991 --> 03:27:31,726 THE CYSTIC FIBROSIS IS EASIER 5356 03:27:31,726 --> 03:27:34,229 TO ACCESS THAN IN OTHER 5357 03:27:34,229 --> 03:27:35,297 CONDITIONS. 5358 03:27:35,297 --> 03:27:37,932 EVEN FOR COMMON DISEASE LIKE 5359 03:27:37,932 --> 03:27:41,569 ASTHMA, WHAT YOU DESCRIBE 5360 03:27:41,569 --> 03:27:45,307 STEPHANIE WITH THE CO 5361 03:27:45,307 --> 03:27:46,641 MORBIDITY, IT'S SOMETHING THAT 5362 03:27:46,641 --> 03:27:50,178 WE NEED THE FUNDERS OR JUST TO 5363 03:27:50,178 --> 03:27:52,080 BE ABLE TO GET THE DATA IN THE 5364 03:27:52,080 --> 03:27:53,915 HANDS OF NOT ONLY THE 5365 03:27:53,915 --> 03:27:55,383 RESEARCHERS BUT ALSO THE 5366 03:27:55,383 --> 03:27:55,817 CLINICIANS. 5367 03:27:55,817 --> 03:27:57,952 >> YEAH, AND ONE OF THE THINGS 5368 03:27:57,952 --> 03:28:00,355 WE ARE DOING, WE WON'T JUST 5369 03:28:00,355 --> 03:28:02,490 MAKE THE DATA ACCESSIBLE BUT 5370 03:28:02,490 --> 03:28:05,060 CREATING A BIO BANK WITH 5371 03:28:05,060 --> 03:28:06,094 SAMPLES WE ARE GETING FROM 5372 03:28:06,094 --> 03:28:08,063 PEOPLE, WE ARE GETTING CONSENT, 5373 03:28:08,063 --> 03:28:09,664 OF COURSE, BUT ANYBODY CAN 5374 03:28:09,664 --> 03:28:11,099 APPLY WITH A REASONABLE STUDY 5375 03:28:11,099 --> 03:28:13,001 AND FUNDING TO USE THOSE 5376 03:28:13,001 --> 03:28:15,403 SAMPLES. I THINK THAT'S REALLY 5377 03:28:15,403 --> 03:28:16,504 IMPORTANT PARTICULARLY IN RARE 5378 03:28:16,504 --> 03:28:19,274 DISEASE BUT JUST IN GENERAL AND 5379 03:28:19,274 --> 03:28:20,208 PREGNANCY AS WELL. 5380 03:28:20,208 --> 03:28:22,010 >> STEPHANIE: I AGREE, I THINK 5381 03:28:22,010 --> 03:28:23,211 THERE'S CERTAINLY SOME WORK TO 5382 03:28:23,211 --> 03:28:25,013 BE DONE, IN TERMS OF IMPROVING 5383 03:28:25,013 --> 03:28:26,614 ACCESS TO THE DATA AND 5384 03:28:26,614 --> 03:28:27,582 PARTICULARLY IMPROVING THE WAY 5385 03:28:27,582 --> 03:28:31,486 THE DATA SHOWS UP IN E.H.R. TO 5386 03:28:31,486 --> 03:28:33,755 CLINICIANS IN A WAY THAT IS 5387 03:28:33,755 --> 03:28:35,223 FUNCTIONAL AND MEANINGFUL FOR 5388 03:28:35,223 --> 03:28:37,092 THEM SO THEY KNOW NEXT STEPS 5389 03:28:37,092 --> 03:28:39,461 WHAT TO DO WITH THE INFORMATION. 5390 03:28:39,461 --> 03:28:40,995 WITH SSM IT'S USUALLY CAPTURED 5391 03:28:40,995 --> 03:28:42,397 AT LABOR AND DELIVERY, BUT 5392 03:28:42,397 --> 03:28:45,166 THERE ARE SOME SIGNS AND RISK 5393 03:28:45,166 --> 03:28:46,668 FACTORS, I THINK, CERTAINLY WE 5394 03:28:46,668 --> 03:28:49,704 NEED TO BE COLLECTING THAT. 5395 03:28:49,704 --> 03:28:57,078 AT NORTH WE BUILT A DATA MART 5396 03:28:57,078 --> 03:28:59,481 WE COLLECT THE CO MORBIDITY 5397 03:28:59,481 --> 03:29:00,915 INDEX RISK SCORE TO FIND OF 5398 03:29:00,915 --> 03:29:03,885 GIVE US A SENSE WHO MIGHT BE 5399 03:29:03,885 --> 03:29:07,155 KIND OF UNFORTUNATELY HEADING 5400 03:29:07,155 --> 03:29:09,124 TO SMM, INTERVENE WHETHER 5401 03:29:09,124 --> 03:29:11,993 THAT'S LOW DOSE ASPIRIN FOR 5402 03:29:11,993 --> 03:29:13,628 PREECLAMPSIA OR OTHER 5403 03:29:13,628 --> 03:29:16,531 INTERVENTION TREATMENTS TO GET 5404 03:29:16,531 --> 03:29:19,367 THAT DATA TO SHOW UP WITH THE 5405 03:29:19,367 --> 03:29:20,568 ACTUAL ENCOUNTER WITH THE 5406 03:29:20,568 --> 03:29:24,038 CLINICAL PROVIDER. 5407 03:29:24,038 --> 03:29:26,775 >> SONALI: I THINK BACK TO BUY 5408 03:29:26,775 --> 03:29:29,177 YO SPECIMENS, I THINK JENNIFER 5409 03:29:29,177 --> 03:29:32,213 MENTIONED EARLIER AS WELL, TO 5410 03:29:32,213 --> 03:29:35,417 COLLECT PLACENTA AND CORE 5411 03:29:35,417 --> 03:29:36,885 BLOOD, THESE AREN'T NECESSARILY 5412 03:29:36,885 --> 03:29:39,154 BURDENS ON THE PATIENT BUT HUGE 5413 03:29:39,154 --> 03:29:41,823 BURDENS ON THE INSTITUTION AND 5414 03:29:41,823 --> 03:29:42,490 RESEARCHERS BECAUSE TRYING TO 5415 03:29:42,490 --> 03:29:44,726 GET A TEAM TO BE ON CALL, YOU 5416 03:29:44,726 --> 03:29:46,494 KNOW 24 HOURS A DAY EVERY 5417 03:29:46,494 --> 03:29:49,864 SINGLE DAY TO BE THERE TO CATCH 5418 03:29:49,864 --> 03:29:52,033 PLACENTA IS REALLY, REALLY HARD 5419 03:29:52,033 --> 03:29:52,634 AND VERY EXPENSIVE. 5420 03:29:52,634 --> 03:29:56,037 IF THERE'S A WAY TO INCLUDE 5421 03:29:56,037 --> 03:29:56,805 THAT INFRASTRUCTURE IN 5422 03:29:56,805 --> 03:29:58,873 INSTITUTIONS OR SOME KIND OF 5423 03:29:58,873 --> 03:30:00,675 CTA OR SOMETHING THAT WOULD BE 5424 03:30:00,675 --> 03:30:03,344 REALLY HELPFUL I THINK AT THE 5425 03:30:03,344 --> 03:30:06,414 INVESTIGATOR LEVEL. 5426 03:30:06,414 --> 03:30:07,582 >> MIHAELA STEFAN: WE ARE 5427 03:30:07,582 --> 03:30:09,584 ALMOST AT THE HOUR. 5428 03:30:09,584 --> 03:30:11,419 WE HAVE ANOTHER FIVE MINUTES I 5429 03:30:11,419 --> 03:30:13,621 WILL ASK A QUESTION THAT ANY OF 5430 03:30:13,621 --> 03:30:16,925 YOU IN THE PANEL CAN ANSWER. 5431 03:30:16,925 --> 03:30:18,226 YOU PRESENTED SOME 5432 03:30:18,226 --> 03:30:18,860 EVIDENCE-BASED INTERVENTIONS. 5433 03:30:18,860 --> 03:30:21,196 CAN YOU COMMENT HOW WE CAN 5434 03:30:21,196 --> 03:30:23,298 IMPLEMENT, HOW CAN YOU GET TO 5435 03:30:23,298 --> 03:30:27,969 THE SUSTAINABLE PHASE, TOTTEN 5436 03:30:27,969 --> 03:30:30,071 TO THE ENGAGEMENT OF THE 5437 03:30:30,071 --> 03:30:30,338 COMMUNITY. 5438 03:30:30,338 --> 03:30:31,573 HOW CAN WE ACHIEVE SUCCESS, 5439 03:30:31,573 --> 03:30:33,508 ANYTHING FROM YOUR OWN WORK? 5440 03:30:33,508 --> 03:30:34,943 I KNOW THAT MEGAN, YOU DID A 5441 03:30:34,943 --> 03:30:36,744 LOOT OF WORK IN SMOKING 5442 03:30:36,744 --> 03:30:38,613 CESSATION IF YOU WANT TO TAKE 5443 03:30:38,613 --> 03:30:40,448 IT FIRST, STEPHANIE? 5444 03:30:40,448 --> 03:30:42,116 >> THANK YOU, APOLOGIES I 5445 03:30:42,116 --> 03:30:43,618 DROPPED OUT EARLIER. 5446 03:30:43,618 --> 03:30:48,756 I HAVE JUST COME BACK. 5447 03:30:48,756 --> 03:30:50,058 SUSTAINABILITY AND SUSTAINMENT 5448 03:30:50,058 --> 03:30:51,392 ARE ALSO THINGS YOU HAVE TO 5449 03:30:51,392 --> 03:31:01,936 THINK ABOUT FROM THE BEGINNING. 5450 03:31:05,874 --> 03:31:07,342 I THINK IT'S IMPORTANT TO BUILD 5451 03:31:07,342 --> 03:31:10,612 IN FROM THE BEGINNING AND THINK 5452 03:31:10,612 --> 03:31:11,980 ABOUT, OFTEN IMPLEMENTATION 5453 03:31:11,980 --> 03:31:15,850 TRIALS OR ANY TRIAL REALLY 5454 03:31:15,850 --> 03:31:16,751 INVOLVES THE INVESTIGATORS, 5455 03:31:16,751 --> 03:31:19,087 RESEARCH TEAM DOING A HUGE 5456 03:31:19,087 --> 03:31:21,122 AMOUNT OF ENGAGEMENT AND 5457 03:31:21,122 --> 03:31:21,389 ACTIVITY. 5458 03:31:21,389 --> 03:31:23,491 AND THAT IS NOT A SUSTAINABLE 5459 03:31:23,491 --> 03:31:23,791 MODEL. 5460 03:31:23,791 --> 03:31:25,894 SO YOU HAVE TO BE BUILDING IN 5461 03:31:25,894 --> 03:31:30,665 FROM THE BEGINNING, THINKING 5462 03:31:30,665 --> 03:31:32,267 WHAT IS THE IMPACT OF THE 5463 03:31:32,267 --> 03:31:34,068 ACTUAL RESEARCH FROM THE 5464 03:31:34,068 --> 03:31:34,302 PROCESS. 5465 03:31:34,302 --> 03:31:35,603 WHEN WE WITHDRAW THE RESEARCH 5466 03:31:35,603 --> 03:31:37,939 WHAT'S LEFT AND MAKE SURE 5467 03:31:37,939 --> 03:31:39,807 WHAT'S LEFT IS SUSTAINABLE. 5468 03:31:39,807 --> 03:31:42,143 I WILL JUST GIVE YOU ONE 5469 03:31:42,143 --> 03:31:44,712 EXAMPLE, AS I SAID EARLIER, 5470 03:31:44,712 --> 03:31:46,214 AUDIT AND FEEDBACK IS KNOWN TO 5471 03:31:46,214 --> 03:31:47,415 WORK. 5472 03:31:47,415 --> 03:31:49,551 THERE'S PLENTY OF EVIDENCE THAT 5473 03:31:49,551 --> 03:31:52,420 IMPROVES CLINICAL BEHAVIOR. 5474 03:31:52,420 --> 03:31:55,290 BUT AUDIT AND FEEDBACK IS 5475 03:31:55,290 --> 03:31:56,224 USUALLY DEPENDENT PARTICULARLY 5476 03:31:56,224 --> 03:31:58,693 IN A STUDY AND TRIAL USUALLY 5477 03:31:58,693 --> 03:31:59,994 DEPENDENT ON THE RESEARCH TEAM 5478 03:31:59,994 --> 03:32:01,663 TO DO THE AUDITING AND PROVIDE 5479 03:32:01,663 --> 03:32:03,565 THE REPORTS BACK TO PEOPLE. 5480 03:32:03,565 --> 03:32:04,899 THAT'S NOT A SUSTAINABLE MODEL. 5481 03:32:04,899 --> 03:32:08,369 SO WHAT WE TRIED TO DO, WITH 5482 03:32:08,369 --> 03:32:09,771 SOME MIXED SUCCESS, I HAVE TO 5483 03:32:09,771 --> 03:32:13,274 SAY, WHAT WE TRIED TO DO IN THE 5484 03:32:13,274 --> 03:32:15,610 MOHM QUIT TRIAL WHICH WE ARE 5485 03:32:15,610 --> 03:32:17,645 CURRENTLY CONDUCT, WE BUILT A 5486 03:32:17,645 --> 03:32:19,013 REPORTING MECHANISM WHERE THEY 5487 03:32:19,013 --> 03:32:22,216 CAN EXTRACT DATA AND DO THEIR 5488 03:32:22,216 --> 03:32:22,684 OWN AUDIT EFFECTIVELY. 5489 03:32:22,684 --> 03:32:24,485 DO THEIR OWN AUDIT. 5490 03:32:24,485 --> 03:32:26,955 WE DEVELOPED THAT WITH ONE 5491 03:32:26,955 --> 03:32:28,690 VERSION OF THE NEW ELECTRONIC 5492 03:32:28,690 --> 03:32:31,092 HEALTH RECORD. 5493 03:32:31,092 --> 03:32:33,061 UNFORTUNATELY THEN THE 5494 03:32:33,061 --> 03:32:34,996 ELECTRONIC HEALTH RECORD GOT 5495 03:32:34,996 --> 03:32:37,265 COMPLETELY REBUILT AND OUR DATA 5496 03:32:37,265 --> 03:32:38,333 EXTRACTION NO LONESINGER WORKED. 5497 03:32:38,333 --> 03:32:42,070 SO THEN WE HAD TO COME BACK AND 5498 03:32:42,070 --> 03:32:43,504 REINVENT ANOTHER WAY WHICH IS 5499 03:32:43,504 --> 03:32:47,275 NO LONGER QUITE AS GOOD OR 5500 03:32:47,275 --> 03:32:48,676 REALISTIC AS AN EFFECTIVE AUDIT 5501 03:32:48,676 --> 03:32:50,144 AND FEEDBACK. 5502 03:32:50,144 --> 03:32:51,613 BUT THAT WOULD ALSO RELY ON 5503 03:32:51,613 --> 03:32:52,447 THEM USING IT. 5504 03:32:52,447 --> 03:32:55,416 SO THAT'S PART OF THE CHALLENGE. 5505 03:32:55,416 --> 03:32:57,185 YOU CAN PROVIDE PEOPLE WITH 5506 03:32:57,185 --> 03:33:00,655 TOOLS AND MECHANISMS BUT IT'S 5507 03:33:00,655 --> 03:33:03,458 NOT ALWAYS SOMETHING THEY WILL 5508 03:33:03,458 --> 03:33:04,258 TAKE UP. 5509 03:33:04,258 --> 03:33:10,231 I WILL SAY THAT TOO, WE WORKED 5510 03:33:10,231 --> 03:33:12,567 REALLY CLOSELY WITH REGULARLY 5511 03:33:12,567 --> 03:33:14,969 DO REPORTS AND CHECKS AND 5512 03:33:14,969 --> 03:33:16,638 REVIEWING QUALITY OF CARE. 5513 03:33:16,638 --> 03:33:19,841 SO THEY HELPED US DESIGN THAT. 5514 03:33:19,841 --> 03:33:21,976 IN FACT THEY DESIGNED IT. 5515 03:33:21,976 --> 03:33:23,845 WE HAD THE IDEA. 5516 03:33:23,845 --> 03:33:26,314 SO IF YOU ARE DESIGNING IT WITH 5517 03:33:26,314 --> 03:33:27,649 PEOPLE WHO ARE PART OF THE 5518 03:33:27,649 --> 03:33:29,183 SYSTEM IT COULD WORK. 5519 03:33:29,183 --> 03:33:34,656 SO THAT'S OUR EXAMPLE. 5520 03:33:34,656 --> 03:33:35,990 >> MIHAELA STEFAN: THANK YOU, I 5521 03:33:35,990 --> 03:33:37,959 WILL JUST BRING UP A QUESTION 5522 03:33:37,959 --> 03:33:39,594 IN THE VIDEOCAST, SO JENNIFER, 5523 03:33:39,594 --> 03:33:41,729 I SENT THIS TO YOU. 5524 03:33:41,729 --> 03:33:43,398 I THINK YOU RESPONDED BUT I 5525 03:33:43,398 --> 03:33:43,765 CANNOT. 5526 03:33:43,765 --> 03:33:45,400 I THINK IT'S INTERESTING FROM 5527 03:33:45,400 --> 03:33:46,000 THE PERSPECTIVE OF OWNINGERS, 5528 03:33:46,000 --> 03:33:47,201 RIGHT. 5529 03:33:47,201 --> 03:33:48,236 -- OTHERS, RIGHT. 5530 03:33:48,236 --> 03:33:49,437 THIS WILL BE BRIEF, WE ARE 5531 03:33:49,437 --> 03:33:53,508 ALMOST AT THE HOUR. 5532 03:33:53,508 --> 03:34:00,815 VIDEOCAST IS DNA THAT IS USE TO 5533 03:34:00,815 --> 03:34:02,884 TREAT CF DURING PREGNANCY, I'M 5534 03:34:02,884 --> 03:34:05,486 NOT A PHYSICIAN BUT THERE'S A 5535 03:34:05,486 --> 03:34:07,689 RESEARCHER, I WILL FEED THE 5536 03:34:07,689 --> 03:34:10,425 INFORMATION THERE ABOUT SAFETY 5537 03:34:10,425 --> 03:34:12,493 OF THIS DRUGGING PREGNANT 5538 03:34:12,493 --> 03:34:15,096 PEOPLE AND ANIMAL MODELS. 5539 03:34:15,096 --> 03:34:15,897 JUST A BRIEF COMMENT MAYBE 5540 03:34:15,897 --> 03:34:17,398 BEFORE WE END? 5541 03:34:17,398 --> 03:34:19,767 >> JENNIFER: I THINK IT GOES 5542 03:34:19,767 --> 03:34:21,536 BACK TO THE COMMENT I MADE 5543 03:34:21,536 --> 03:34:23,204 EARLIER ABOUT THE FDA HELPING 5544 03:34:23,204 --> 03:34:25,840 TO PUSH THE USE OF PREGNANT 5545 03:34:25,840 --> 03:34:28,843 PEOPLE IN RESEARCH, SAFELY. 5546 03:34:28,843 --> 03:34:34,582 BUT TO SPECIFICALLY ANSWER THE 5547 03:34:34,582 --> 03:34:38,419 DORNAIS ALPHA QUESTION, MANY 5548 03:34:38,419 --> 03:34:40,855 MORE MEDS, NEARLY ALL WE ARE 5549 03:34:40,855 --> 03:34:42,924 USING IN PREGNANT PEOPLE. 5550 03:34:42,924 --> 03:34:44,292 IT'S REALLY THE MODULATORS WE 5551 03:34:44,292 --> 03:34:46,594 ARE USING, WE DON'T HAVE MUCH 5552 03:34:46,594 --> 03:34:52,200 DATA, HOPEFULLY WE GET THAT 5553 03:34:52,200 --> 03:34:53,901 FROM MAYFLOWERS. BUT WE DO NEED 5554 03:34:53,901 --> 03:34:58,239 THE FDA TO HELP US TO USE THE 5555 03:34:58,239 --> 03:35:00,942 MEDS IN PREGNANCY. 5556 03:35:00,942 --> 03:35:03,511 >> MIHAELA STEFAN: THANK YOU. 5557 03:35:03,511 --> 03:35:05,179 I WANT TO THANK ALL OF OUR 5558 03:35:05,179 --> 03:35:07,281 SPEAKERS. AND WE HAVE A FIVE 5559 03:35:07,281 --> 03:35:08,716 MINUTE BREAK, RIGHT? 5560 03:35:08,716 --> 03:35:09,817 >> YES, WE DO. 5561 03:35:09,817 --> 03:35:11,385 >> OKAY, WE WILL SEE YOU NEXT. 5562 03:35:11,385 --> 03:35:12,820 THANK YOU VERY MUCH FOR YOUR 5563 03:35:12,820 --> 03:35:14,088 PARTICIPATION. 5564 03:35:14,088 --> 03:35:14,889 >> THANK YOU, 5565 03:35:14,889 --> 03:35:17,892 >> THANK YOU. 5566 03:35:17,892 --> 03:35:28,069 [ BREAK ] 5567 03:40:27,168 --> 03:40:29,537 I HAVE THE HONOR OF MODERATING 5568 03:40:29,537 --> 03:40:31,439 THIS PANEL DISCUSSION TODAY. 5569 03:40:31,439 --> 03:40:34,208 THIS PANEL IS FOCUSED ON 5570 03:40:34,208 --> 03:40:35,342 EXAMINING HOW INNOVATIVE 5571 03:40:35,342 --> 03:40:37,411 METHODS FOR CARE DELIVERY CAN 5572 03:40:37,411 --> 03:40:39,013 ADDRESS PRESSING NEEDS AND 5573 03:40:39,013 --> 03:40:40,581 TRANSFORM MATERNAL CARE AS AN 5574 03:40:40,581 --> 03:40:42,383 IMPLEMENTATION STRATEGY. 5575 03:40:42,383 --> 03:40:44,018 THE PANELISTS WILL HIGHLIGHT 5576 03:40:44,018 --> 03:40:46,020 INNOVATIVE METHOD THAT'S HAVE 5577 03:40:46,020 --> 03:40:49,857 BEEN USE BOTH DOMESTICALLY AND 5578 03:40:49,857 --> 03:40:50,124 GLOBALLY. 5579 03:40:50,124 --> 03:40:53,160 A SEASONED MIDWIFE, TELEHEALTH 5580 03:40:53,160 --> 03:40:55,162 SPECIALIST, DRONE DELIVERY 5581 03:40:55,162 --> 03:40:58,232 INNOVATOR AND INTERDISCIPLINARY 5582 03:40:58,232 --> 03:40:58,766 COLLABORATOR. 5583 03:40:58,766 --> 03:41:01,068 IN THE INTEREST OF TIME I WILL 5584 03:41:01,068 --> 03:41:03,270 GIVE VERY BRIEF DEDESCRIPTION 5585 03:41:03,270 --> 03:41:06,974 SHUN OF OUR ESTEEMED 5586 03:41:06,974 --> 03:41:08,242 PANELISTS. WE INVITE YOU TO 5587 03:41:08,242 --> 03:41:11,879 LOOK AT THE PROGRAM BOOKLET FOR 5588 03:41:11,879 --> 03:41:14,682 BACKGROUND OP OUR SPEAKERS. 5589 03:41:14,682 --> 03:41:20,488 INCLUDES JOAN SHEPHERD, 5590 03:41:20,488 --> 03:41:21,622 REGISTERED NURSE-MIDWIFE, 5591 03:41:21,622 --> 03:41:22,556 RESEARCH, EDUCATOR, ASSOCIATE 5592 03:41:22,556 --> 03:41:25,826 LECTURE UR AND HEAD OF THE 5593 03:41:25,826 --> 03:41:28,262 DEPARTMENT OF MIDWAY FREE 5594 03:41:28,262 --> 03:41:31,398 COLLEGE OF MEDICINE AND ALLIED 5595 03:41:31,398 --> 03:41:34,635 HEALTH SERVICES SIERRA LEONE. 5596 03:41:34,635 --> 03:41:36,804 SHE SERVED AS PAST PRESIDENT OF 5597 03:41:36,804 --> 03:41:40,241 THE ASSOCIATION AND BOARD 5598 03:41:40,241 --> 03:41:42,977 MEMBER OF SCIENTIFIC REVIEW AND 5599 03:41:42,977 --> 03:41:46,380 NURSING AID MIDWIFES COUNCIL. 5600 03:41:46,380 --> 03:41:53,621 WE HAVE DR. NGOZI 5601 03:41:53,621 --> 03:41:56,390 IDEMILI-ARONU, DIRECTOR 5602 03:41:56,390 --> 03:41:58,359 OPERATIONS, IVAN RESEARCH, 5603 03:41:58,359 --> 03:41:59,360 SOCIOLOGY, ANTHROPOLOGY AND 5604 03:41:59,360 --> 03:42:01,929 COMMUNITY MEDICINE. 5605 03:42:01,929 --> 03:42:04,265 TEAM LEADERSHIP AND PRAO JECT 5606 03:42:04,265 --> 03:42:05,199 MANAGEMENT ESPECIALLY IN THE 5607 03:42:05,199 --> 03:42:08,135 FIELD OF PRIMARY CARE. 5608 03:42:08,135 --> 03:42:18,646 WE ALSO HAVE ZALEHA ABDULLAH 5609 03:42:19,680 --> 03:42:21,649 MAHDY. 5610 03:42:21,649 --> 03:42:25,986 SHE HAS A INTEREST IN HEALTH 5611 03:42:25,986 --> 03:42:28,422 TECHNOLOGY INNOVATION AND HEADS 5612 03:42:28,422 --> 03:42:30,224 HEALTH TECHNOLOGY INNOVATION 5613 03:42:30,224 --> 03:42:32,793 LAB AT UNIVERSITY OF MALAYSIA 5614 03:42:32,793 --> 03:42:39,833 AND MEMBER OF THE NATIONAL 5615 03:42:39,833 --> 03:42:43,270 CONFIDENTIAL INQUIRIES INTO 5616 03:42:43,270 --> 03:42:43,804 MATERNAL DEATHS COMMITTEE. 5617 03:42:43,804 --> 03:42:48,409 FINALLY WE HAVE SARAH CHEN, 5618 03:42:48,409 --> 03:42:53,747 CLINICAL PRAO GRAMING McKENZIE 5619 03:42:53,747 --> 03:42:58,085 AND HEALTHCARE START UPS, 5620 03:42:58,085 --> 03:42:59,186 INTERSECTING CLINICAL 5621 03:42:59,186 --> 03:42:59,687 PERSPECTIVE AND PRODUCT 5622 03:42:59,687 --> 03:43:01,088 STRATEGY. 5623 03:43:01,088 --> 03:43:02,456 THIS PANEL IS SLIGHTLY 5624 03:43:02,456 --> 03:43:02,723 DIFFERENT. 5625 03:43:02,723 --> 03:43:04,325 WE WILL START WITH THREE 5626 03:43:04,325 --> 03:43:06,327 PANELISTS WHO WILL GIVE VERY 5627 03:43:06,327 --> 03:43:07,895 SHORT GROUNDING TALKS FOLLOWED 5628 03:43:07,895 --> 03:43:08,996 BY MODERATED Q&A SESSION WITH 5629 03:43:08,996 --> 03:43:10,864 THE ENTIRE PANEL. 5630 03:43:10,864 --> 03:43:12,399 THE GROUNDING TALKS ARE SHORT, 5631 03:43:12,399 --> 03:43:14,368 THEY ARE TEN MINUTES. I WILL 5632 03:43:14,368 --> 03:43:16,337 CALL ON EACH SPEAKER WITH A 5633 03:43:16,337 --> 03:43:18,439 QUICK INTRO TO THEIR TALK 5634 03:43:18,439 --> 03:43:18,839 BEFORE THEY BEGIN. 5635 03:43:18,839 --> 03:43:21,108 SO WITH THAT, I WILL HAND OFF 5636 03:43:21,108 --> 03:43:23,177 TO JOAN SHEPHERD WHO WILL BE 5637 03:43:23,177 --> 03:43:26,914 TALKING ABOUT USING GLOBAL 5638 03:43:26,914 --> 03:43:28,349 SUCCESSES, ESPECIALLY IN LOW 5639 03:43:28,349 --> 03:43:36,390 AND MIDDLE INCOME TO TALK ABOUT 5640 03:43:36,390 --> 03:43:39,560 PRACTICES CAN BE CONTEXTUALLY 5641 03:43:39,560 --> 03:43:39,827 ADAPTED. 5642 03:43:39,827 --> 03:43:40,894 WITH THAT, JOAN SHEPHERD ARE 5643 03:43:40,894 --> 03:43:51,205 YOU ABLE TO START? 5644 03:44:02,483 --> 03:44:04,351 HI, JOAN, WE CAN'T HEAR YOU 5645 03:44:04,351 --> 03:44:14,528 JUST YET. 5646 03:44:18,832 --> 03:44:21,368 OKAY, WHILE I.T. HELPS US CAN 5647 03:44:21,368 --> 03:44:22,670 WE MOVE ON TO THE NEXT PANELIST 5648 03:44:22,670 --> 03:44:24,305 IN THE INTEREST OF TIME? 5649 03:44:24,305 --> 03:44:26,907 SO IF THE I.T. CAN QUEUE UP THE 5650 03:44:26,907 --> 03:44:28,275 NEXT SET OF SLIDES, PLEASE, 5651 03:44:28,275 --> 03:44:29,243 REALLY QUICKLY. 5652 03:44:29,243 --> 03:44:35,683 I WOULD LIKE TO CALL ON NGOZI 5653 03:44:35,683 --> 03:44:37,418 IDEMILI-ARONU WHO WILL TALK 5654 03:44:37,418 --> 03:44:40,421 ABOUT INNOVATIONS IN HEALTH 5655 03:44:40,421 --> 03:44:41,922 DELIVERY IN RESOURCE-LIMITED 5656 03:44:41,922 --> 03:44:44,391 SETTINGS, EXPERIENCES FROM 5657 03:44:44,391 --> 03:44:44,625 NIGERIA. 5658 03:44:44,625 --> 03:44:45,693 ARE YOU ABLE TO JOIN US? 5659 03:44:45,693 --> 03:44:47,394 >> YES, CAN YOU HEAR ME? 5660 03:44:47,394 --> 03:44:48,562 >> YES, LOUD AND CLEAR. 5661 03:44:48,562 --> 03:44:52,966 GO AHEAD. 5662 03:44:52,966 --> 03:44:55,536 >> NGOZI: OKAY, SO, NEXT SLIDE, 5663 03:44:55,536 --> 03:44:59,206 PLEASE. 5664 03:44:59,206 --> 03:45:01,008 GOOD EVERYONE, I WILL BE 5665 03:45:01,008 --> 03:45:03,444 DISCUSSING THE CRITICAL ISSUES 5666 03:45:03,444 --> 03:45:06,413 OF MATERNAL HEALTH IN NIGERIA 5667 03:45:06,413 --> 03:45:07,481 AND DIFFERENT INNOVATIVE 5668 03:45:07,481 --> 03:45:09,283 APPROACHES TO DEPLOY AT IVAN 5669 03:45:09,283 --> 03:45:12,986 RESEARCH INSTITUTE. 5670 03:45:12,986 --> 03:45:15,989 TO DELIVER TIMELY INTERVENTIONS 5671 03:45:15,989 --> 03:45:18,092 AND OVERCOME SPECIFIC 5672 03:45:18,092 --> 03:45:19,393 CHALLENGES. NIGERIA REMAINS ONE 5673 03:45:19,393 --> 03:45:22,396 OF THE COUNTRIES WITH THE 5674 03:45:22,396 --> 03:45:23,297 HIGHEST MATERNAL MORTALITY RATE 5675 03:45:23,297 --> 03:45:25,499 IN THE WORLD. 5676 03:45:25,499 --> 03:45:26,900 THIS ALARMING STATISTICS IS 5677 03:45:26,900 --> 03:45:30,404 PRIMARILY DUE TO THREE FACTORS. 5678 03:45:30,404 --> 03:45:33,741 LIMITED ACCESS TO SKILLED 5679 03:45:33,741 --> 03:45:34,608 HEALTHCARE PROVIDERS, POOR 5680 03:45:34,608 --> 03:45:36,377 HEALTHCARE INFRASTRUCTURE AND 5681 03:45:36,377 --> 03:45:37,144 SIGNIFICANT DELAYS IN ACCESSING 5682 03:45:37,144 --> 03:45:38,212 NECESSARY CARE. 5683 03:45:38,212 --> 03:45:42,049 SO MOST OF THE RURAL REGIONS IN 5684 03:45:42,049 --> 03:45:45,819 NIGERIA SUFFER FROM LACK OF 5685 03:45:45,819 --> 03:45:47,321 HEALTHCARE FACILITY, EDUCATED 5686 03:45:47,321 --> 03:45:49,089 STAFFING AND COMPOUNDING POOR 5687 03:45:49,089 --> 03:45:52,292 ACCESS TO ESSENTIAL MATERNAL 5688 03:45:52,292 --> 03:45:54,862 HEALTHCARE SERVICES. ALSO IN 5689 03:45:54,862 --> 03:45:56,363 NIGERIA MANY WOMEN LACK 5690 03:45:56,363 --> 03:45:58,565 SUFFICIENT EDUCATION ON SOCIAL 5691 03:45:58,565 --> 03:45:59,166 HEALTH SERVICES. ADDRESSING 5692 03:45:59,166 --> 03:46:01,268 THIS ISSUE IS NOT JUST ABOUT 5693 03:46:01,268 --> 03:46:03,203 IMPROVING STA TIFPT ICS. 5694 03:46:03,203 --> 03:46:05,139 IT'S ABOUT SAVING LIVES AND 5695 03:46:05,139 --> 03:46:07,274 RESPECTING THE DIGNITY OF EVERY 5696 03:46:07,274 --> 03:46:07,674 MOTHER AND CHILD. 5697 03:46:07,674 --> 03:46:11,678 NEXT SLIDE, PLEASE. 5698 03:46:11,678 --> 03:46:15,382 SO, I'M GOING TO SHOW YOU SOME 5699 03:46:15,382 --> 03:46:16,517 STATISTICS HERE. 5700 03:46:16,517 --> 03:46:27,060 IN NIGERIA WE HAVE 1.7 MILLION 5701 03:46:33,667 --> 03:46:37,037 WOMEN LIVING WITH H.I.V. AND 5702 03:46:37,037 --> 03:46:41,675 ALMOST 400,000. 5703 03:46:41,675 --> 03:46:45,946 11.5% DIAGNOSED WITH HEPATITIS 5704 03:46:45,946 --> 03:46:48,482 AND 14% OF CHILDREN, MAKING 5705 03:46:48,482 --> 03:46:52,152 LIVER CANCER THE MOST COMMON 5706 03:46:52,152 --> 03:46:55,289 CAUSE OF CANCER-RELATED DEATHS 5707 03:46:55,289 --> 03:46:55,589 IN NIGERIA. 5708 03:46:55,589 --> 03:46:58,892 NEXT SLIDE, PLEASE. 5709 03:46:58,892 --> 03:47:02,029 SO INTERESTING TO NOTE 25% OF 5710 03:47:02,029 --> 03:47:06,900 INDIVIDUALS IN NIGERIA CARRY 5711 03:47:06,900 --> 03:47:09,603 THE SICKLE CELL TRAIT AND 5712 03:47:09,603 --> 03:47:11,405 150,000 CHILDREN BORN YEARLY 5713 03:47:11,405 --> 03:47:13,073 AND 50% OF THOSE BORN DIE 5714 03:47:13,073 --> 03:47:14,875 BEFORE THE AGE OF 5. 5715 03:47:14,875 --> 03:47:19,713 NEXT, PLEASE. 5716 03:47:19,713 --> 03:47:24,384 SO HYPERTENSION IN NIGERIA IS A 5717 03:47:24,384 --> 03:47:28,188 COMMON DISORDER, ESPECIALLY 5718 03:47:28,188 --> 03:47:29,890 THESE DAYS, PEOPLE ARE JUST 5719 03:47:29,890 --> 03:47:31,358 DROPPING DEAD FROM HEART 5720 03:47:31,358 --> 03:47:34,528 DISEASE AND 25% OF WOMEN ARE 5721 03:47:34,528 --> 03:47:35,095 DIAGNOSED WITH HYPERTENSION 5722 03:47:35,095 --> 03:47:35,662 EVERY YEAR. 5723 03:47:35,662 --> 03:47:37,598 NEXT SLIDE, PLEASE. 5724 03:47:37,598 --> 03:47:40,400 ONE OF THE FEW THINGS WE DID 5725 03:47:40,400 --> 03:47:42,402 EARLIER ON WHEN WE STARTED 5726 03:47:42,402 --> 03:47:43,770 INTERVENTIONS WAS THE BABY 5727 03:47:43,770 --> 03:47:47,174 SHOWER INITIATIVE. 5728 03:47:47,174 --> 03:47:50,077 SO THIS IS A PERSON OR 5729 03:47:50,077 --> 03:47:51,879 PEOPLE-CENTERED APPROACH TO 5730 03:47:51,879 --> 03:47:54,281 MATERNAL AND INFANT HEALTH. 5731 03:47:54,281 --> 03:47:56,216 THIS PROGRAM EMBODIES OUR 5732 03:47:56,216 --> 03:47:57,417 COMMITMENT TO EARLY ENGAGEMENT, 5733 03:47:57,417 --> 03:48:00,587 CONTINUOUS CARE AND THESE ARE 5734 03:48:00,587 --> 03:48:02,589 VERY IMPORTANT IMPROVING 5735 03:48:02,589 --> 03:48:03,490 MATERNAL AND CHILD HEALTH 5736 03:48:03,490 --> 03:48:06,226 OUTCOMES. 5737 03:48:06,226 --> 03:48:09,096 WE KNOW IN NIGERIA IT'S A 5738 03:48:09,096 --> 03:48:10,764 FAITH-BASED NATION. 5739 03:48:10,764 --> 03:48:13,867 THERE MIGHT BE NO HEALTHCARE 5740 03:48:13,867 --> 03:48:15,402 CENTERS IN SOME RURAL 5741 03:48:15,402 --> 03:48:17,070 COMMUNITIES BUT, I TELL YOU 5742 03:48:17,070 --> 03:48:20,340 THAT IN EVERY COMMUNITY, EVERY 5743 03:48:20,340 --> 03:48:22,009 RURAL COMMUNITY, THERE IS 5744 03:48:22,009 --> 03:48:24,411 EITHER A CHURCH OR MOSQUE THAT 5745 03:48:24,411 --> 03:48:27,447 IS IN WALKING DISTANCE IN THESE 5746 03:48:27,447 --> 03:48:28,315 COMMUNITIES. 5747 03:48:28,315 --> 03:48:31,485 SO WHEN WE STARTED OUR 5748 03:48:31,485 --> 03:48:32,419 INTERVENTIONED IN UNDERSERVED 5749 03:48:32,419 --> 03:48:35,289 COMMUNITIES, WE STARTED WITH 5750 03:48:35,289 --> 03:48:37,224 OUR COMMUNITY ENTRY. 5751 03:48:37,224 --> 03:48:40,360 WE APPROACHED COMMUNITY 5752 03:48:40,360 --> 03:48:41,562 LEADERS, RELIGIOUS LEADERS, WE 5753 03:48:41,562 --> 03:48:43,564 SENSITIZE THEM ON THE PROJECT 5754 03:48:43,564 --> 03:48:44,865 OR INTERVENTION THAT WE WERE 5755 03:48:44,865 --> 03:48:47,034 COMING TO DO. 5756 03:48:47,034 --> 03:48:48,869 SO WITH SUPPORT WE WERE ABLE TO 5757 03:48:48,869 --> 03:48:50,637 LAUNCH THE BABY SHOWER 5758 03:48:50,637 --> 03:48:53,440 INITIATIVE IN THIS COMMUNITIES. 5759 03:48:53,440 --> 03:48:55,375 THIS INITIATIVE STARTS WITH THE 5760 03:48:55,375 --> 03:48:58,011 PRAYER SECTION. 5761 03:48:58,011 --> 03:49:01,281 IN NIGERIA EVERYBODY PRAYS. SO 5762 03:49:01,281 --> 03:49:04,418 AFTER THE PRAYERS, CALL THIS 5763 03:49:04,418 --> 03:49:07,087 WOMAN OUT AND PRAY THE RELIGION 5764 03:49:07,087 --> 03:49:08,689 LEADER PRAYS FOR THEM. 5765 03:49:08,689 --> 03:49:12,192 THEN WE INTRODUCE THE PROGRAM, 5766 03:49:12,192 --> 03:49:14,394 WE SECURE A GENERAL CONSENT, 5767 03:49:14,394 --> 03:49:16,964 AFTER THAT CONSENT IS SECURED 5768 03:49:16,964 --> 03:49:18,765 WE GIVE THEM INFORMED CONSENT 5769 03:49:18,765 --> 03:49:20,734 SHEET TO TAKE HOME AND DISCUSS 5770 03:49:20,734 --> 03:49:21,635 WITH THEIR SIGNIFICANT ORDER 5771 03:49:21,635 --> 03:49:23,270 AND GIVE A MORE INFORMED 5772 03:49:23,270 --> 03:49:24,871 CONSENT. 5773 03:49:24,871 --> 03:49:26,440 THEN WE WILL REGISTER 5774 03:49:26,440 --> 03:49:28,475 PARTICIPANTS FOR THE UPCOMING 5775 03:49:28,475 --> 03:49:29,376 BABY SHOWER. 5776 03:49:29,376 --> 03:49:31,378 NEXT WE WILL MOVE TO THE BABY 5777 03:49:31,378 --> 03:49:31,778 SHOWER ITSELF. 5778 03:49:31,778 --> 03:49:34,748 THIS IS THE WESTERN CONCEPT. 5779 03:49:34,748 --> 03:49:37,651 THE BABY SHOWER, IS NOT ANI 5780 03:49:37,651 --> 03:49:38,785 JEERIAN THEME, AFRICA, BUT FOR 5781 03:49:38,785 --> 03:49:44,925 US IT WASN'T JUST A CELEBRATION 5782 03:49:44,925 --> 03:49:49,730 , IT WAS A CRITICAL PART OF OUR 5783 03:49:49,730 --> 03:49:51,365 INTERVENTION. 5784 03:49:51,365 --> 03:49:54,101 WE WILL MOVE AHEAD TO CONDUCT 5785 03:49:54,101 --> 03:49:55,469 OUR IMPORTANT HEALTH CHECK ON 5786 03:49:55,469 --> 03:49:58,472 EDUCATION. 5787 03:49:58,472 --> 03:50:00,841 AT THIS POINT, WE DRAW SPECIMEN 5788 03:50:00,841 --> 03:50:02,909 AND BECAUSE WE ARE PRIMARILY IN 5789 03:50:02,909 --> 03:50:07,080 THIS COMMUNITY TO DO HIV 5790 03:50:07,080 --> 03:50:07,347 SCREENING. 5791 03:50:07,347 --> 03:50:10,317 AS WE ALL KNOW HIV HAS STIGMA 5792 03:50:10,317 --> 03:50:11,118 ATTACHED TO IT. 5793 03:50:11,118 --> 03:50:13,387 SO RATHER THAN JUST GOING TO 5794 03:50:13,387 --> 03:50:15,589 THE COMMUNITIES AND SAY WE ARE 5795 03:50:15,589 --> 03:50:17,090 SCREENING FOR HIV, WE SAID WE 5796 03:50:17,090 --> 03:50:19,292 ARE DOING A GENERAL HEALTH 5797 03:50:19,292 --> 03:50:19,726 CHECK. 5798 03:50:19,726 --> 03:50:24,464 WE WILL SCREEN FOR HEPATITIS, 5799 03:50:24,464 --> 03:50:25,432 HYPERTENSION, MALARIA, GENOTYPE 5800 03:50:25,432 --> 03:50:27,367 AND ALSO SCREEN FOR HIV AT THAT 5801 03:50:27,367 --> 03:50:30,170 POINT. 5802 03:50:30,170 --> 03:50:33,407 SO AFTER SOME TIME WE WILL MOVE 5803 03:50:33,407 --> 03:50:37,344 OVER TO THE BABY RECEPTION. 5804 03:50:37,344 --> 03:50:39,346 THIS IS IN NIGERIAN CONCEPT, 5805 03:50:39,346 --> 03:50:42,683 AFTER THE BABY IS BORN THERE IS 5806 03:50:42,683 --> 03:50:43,483 ALWAYS A BIG PARTY. 5807 03:50:43,483 --> 03:50:44,885 WE COME BACK TO THE COMMUNITY 5808 03:50:44,885 --> 03:50:47,921 TO DO A BABY RECEPTION. 5809 03:50:47,921 --> 03:50:50,023 AT THIS POINT IT'S LIKE A 5810 03:50:50,023 --> 03:50:52,426 FOLLOW-UP FACE FOR US. 5811 03:50:52,426 --> 03:50:55,896 WE DO EARLY INFANT DIAGNOSIS. 5812 03:50:55,896 --> 03:50:59,499 WE EVALUATE THE BABIES FOR 5813 03:50:59,499 --> 03:51:01,968 SICKLE CELL OR EVEN HIV OR 5814 03:51:01,968 --> 03:51:03,270 OTHER. 5815 03:51:03,270 --> 03:51:04,638 NEXT SLIDE, PLEASE. 5816 03:51:04,638 --> 03:51:07,040 THESE ARE PICTURES FROM THE 5817 03:51:07,040 --> 03:51:07,340 COMMUNITIES. 5818 03:51:07,340 --> 03:51:09,109 DURING THE BABY SHOWER WE GIVE 5819 03:51:09,109 --> 03:51:10,610 GIFTS WHEN THEY ARE PREGNANT 5820 03:51:10,610 --> 03:51:12,345 AND WHEN THE BABY IS BORN WE 5821 03:51:12,345 --> 03:51:14,581 ALSO HAVE A PARTY AND GIVE THEM 5822 03:51:14,581 --> 03:51:16,249 GIFTS WHEN THE BABY IS BORN. 5823 03:51:16,249 --> 03:51:18,018 NEXT SLIDE, PLEASE. 5824 03:51:18,018 --> 03:51:22,355 SO WE DID THIS ACROSS THE 5825 03:51:22,355 --> 03:51:22,956 COUNTRY. 5826 03:51:22,956 --> 03:51:25,892 ALMOST IN ALL THE SIX REGIONS 5827 03:51:25,892 --> 03:51:27,961 OF THE COUNTRY WHEN WE WERE 5828 03:51:27,961 --> 03:51:30,230 DOING OUR INTERVENTION. 5829 03:51:30,230 --> 03:51:34,401 SO NEXT SLIDE, PLEASE. 5830 03:51:34,401 --> 03:51:38,205 SO AS WE IMPLEMENTED THE BABY 5831 03:51:38,205 --> 03:51:41,608 SHOWER INITIATIVE, WE 5832 03:51:41,608 --> 03:51:42,809 ENCOUNTERED SEVERAL CHALLENGES. 5833 03:51:42,809 --> 03:51:44,644 WE ARE GENERATING LOTS OF DATA 5834 03:51:44,644 --> 03:51:48,882 FROM THESE COMMUNITIES. 5835 03:51:48,882 --> 03:51:51,318 HOW DO WE STORE PATIENT DATA. 5836 03:51:51,318 --> 03:51:53,653 HOW DO WE MANAGE THE IDENTITY 5837 03:51:53,653 --> 03:51:55,188 OF PATIENTS SCREENED. 5838 03:51:55,188 --> 03:51:57,257 HOW DO WE TRANSMIT INFORMATION 5839 03:51:57,257 --> 03:51:59,092 TO HEALTHCARE PROVIDERS? HOW 5840 03:51:59,092 --> 03:52:02,462 DO WE EFFICIENTLY FOLLOW-UP 5841 03:52:02,462 --> 03:52:02,796 WITH PATIENTS? 5842 03:52:02,796 --> 03:52:04,698 THE SOURCES OF BABY SHOWER 5843 03:52:04,698 --> 03:52:07,000 INITIATIVE HINGES NOT ONLY ON 5844 03:52:07,000 --> 03:52:08,101 MEDICAL AND EDUCATIONAL 5845 03:52:08,101 --> 03:52:09,569 INTERVENTIONS WE ARE GIVING IN 5846 03:52:09,569 --> 03:52:11,538 THESE COMMUNITIES. 5847 03:52:11,538 --> 03:52:13,707 IT WAS ALSO HOW EFFECTIVELY 5848 03:52:13,707 --> 03:52:15,575 WOULD WE MANAGE THAT DATA. 5849 03:52:15,575 --> 03:52:17,344 HOW DO WE MAINTAIN THE PRIVACY 5850 03:52:17,344 --> 03:52:19,346 OF THESE WOMEN AND ENSURE 5851 03:52:19,346 --> 03:52:20,814 COMMUNICATION AND CONDUCT 5852 03:52:20,814 --> 03:52:21,081 FOLLOW-UP? 5853 03:52:21,081 --> 03:52:26,853 NEXT SLIDE, PLEASE. 5854 03:52:26,853 --> 03:52:28,889 SO THERE COMES OUR MHEALTH 5855 03:52:28,889 --> 03:52:33,393 APPROACH. 5856 03:52:33,393 --> 03:52:37,631 WE WENT WITH mHealth APPROACH. 5857 03:52:37,631 --> 03:52:38,965 IT WAS AN INNOVATIVE IDEA TO 5858 03:52:38,965 --> 03:52:42,068 USE TO BE ABLE TO TAKE CARE OF 5859 03:52:42,068 --> 03:52:43,703 MOST OF THESE CHALLENGES WE 5860 03:52:43,703 --> 03:52:45,372 HAVE TO SOLVE THESE PROBLEMS 5861 03:52:45,372 --> 03:52:46,540 THAT WAS COMING UP WITH THE 5862 03:52:46,540 --> 03:52:47,407 BABY SHOWER. 5863 03:52:47,407 --> 03:52:49,176 NEXT SLIDE, PLEASE. 5864 03:52:49,176 --> 03:52:59,419 NEXT, PLEASE. 5865 03:53:03,890 --> 03:53:05,926 SO, THE mHEALTH CARD, BACK TO 5866 03:53:05,926 --> 03:53:08,395 THE LAST SLIDE, SO THE MY 5867 03:53:08,395 --> 03:53:10,664 HEALTH CARD WAS AN INNOVATIVE 5868 03:53:10,664 --> 03:53:13,567 APPROACH TO ADDRESS SOME OF 5869 03:53:13,567 --> 03:53:16,036 THESE CHALLENGES. THE MY HEALTH 5870 03:53:16,036 --> 03:53:19,706 CARD WAS DESIGNED TO MAKE 5871 03:53:19,706 --> 03:53:20,941 PATIENTS ACTIVE PARTICIPANTS IN 5872 03:53:20,941 --> 03:53:23,610 THEIR OWN HEALTHCARE. 5873 03:53:23,610 --> 03:53:24,978 SO EACH PARTICIPANT RECEIVED 5874 03:53:24,978 --> 03:53:26,246 THIS HEALTH CARD. 5875 03:53:26,246 --> 03:53:31,818 IT'S SET LIKE A DIGITAL HEALTH 5876 03:53:31,818 --> 03:53:33,720 PASSPORT, CONTAINING THEIR 5877 03:53:33,720 --> 03:53:35,622 HEALTH RECORDS, TREATMENT PLANS 5878 03:53:35,622 --> 03:53:37,290 AND FOLLOW-UP SCHEDULES AND 5879 03:53:37,290 --> 03:53:38,859 THIS EMPOWERED PATIENTS TO HAVE 5880 03:53:38,859 --> 03:53:41,361 DIRECT ACCESS TO THEIR HEALTH 5881 03:53:41,361 --> 03:53:42,195 INFORMATION AND ENCOURAGING 5882 03:53:42,195 --> 03:53:44,631 THEM TO BE INVOLVED AND ACTIVE 5883 03:53:44,631 --> 03:53:49,870 IN THEIR CARE DECISIONS. 5884 03:53:49,870 --> 03:53:52,439 MY HEADth CARD ALSO ENSURED THE 5885 03:53:52,439 --> 03:53:55,208 PATIENTS DATA WAS SECURED AND 5886 03:53:55,208 --> 03:53:58,345 WAS EASILY ACCESSIBLE. 5887 03:53:58,345 --> 03:54:00,680 AND IN OUR REFERRAL SYSTEM. 5888 03:54:00,680 --> 03:54:02,148 SO SINCE THE IMPLEMENTATION OF 5889 03:54:02,148 --> 03:54:06,319 MY HEALTH CARD WE HAVE SEEN 5890 03:54:06,319 --> 03:54:09,522 REMARKABLE IMPROVEMENTS IN 5891 03:54:09,522 --> 03:54:11,124 PATIENT ENGAGEMENT AND 5892 03:54:11,124 --> 03:54:12,158 HEALTHCARE DONATIONS. THE 5893 03:54:12,158 --> 03:54:13,593 PATIENTS REPORTS FEELING MORE 5894 03:54:13,593 --> 03:54:14,961 INFORMED AND INVOLVED IN THEIR 5895 03:54:14,961 --> 03:54:16,963 HEALTHCARE MANAGEMENT. 5896 03:54:16,963 --> 03:54:20,734 SO THIS MY HEADth CARD WILL 5897 03:54:20,734 --> 03:54:24,037 ALSO BE IMPLEMENTED IN OTHER 5898 03:54:24,037 --> 03:54:26,840 STUDIES. 5899 03:54:26,840 --> 03:54:31,311 ACCESS IS FUNDED BY NCI, WHERE 5900 03:54:31,311 --> 03:54:34,414 WE ARE SCREENING WOMEN ACROSS 5901 03:54:34,414 --> 03:54:37,617 THE PBR AND ACROSS THE COUNTRY 5902 03:54:37,617 --> 03:54:40,921 FOR CERVICAL CANCER. 5903 03:54:40,921 --> 03:54:42,722 WE ARE SCREENING COMMUNITY 5904 03:54:42,722 --> 03:54:45,959 MEMBERS FOR HYPERTENSION. 5905 03:54:45,959 --> 03:54:50,797 SO THIS OTHER INNOVATIVE 5906 03:54:50,797 --> 03:54:52,399 APPROACHES WERE ALSO INTEGRATED 5907 03:54:52,399 --> 03:54:57,804 WITH THE MY HEALTH CARD IS 5908 03:54:57,804 --> 03:55:03,810 TELEMENTAL HEALTH PROGRAM, HOW 5909 03:55:03,810 --> 03:55:06,613 mHEALTH PROGRAM CAN BE USED TO 5910 03:55:06,613 --> 03:55:09,983 BRIDGE HEALTHCARE GAPS. 5911 03:55:09,983 --> 03:55:14,487 IN THIS PROGRAM WE SCREEN WOMEN 5912 03:55:14,487 --> 03:55:17,490 FOR DEPRESSION AND ANXIETY AND 5913 03:55:17,490 --> 03:55:21,761 LINK THEM DIRECTLY TO MENTAL 5914 03:55:21,761 --> 03:55:23,830 HEALTH SERVICES THROUGH 5915 03:55:23,830 --> 03:55:24,864 TELEHEALTH PLATFORMS. THIS 5916 03:55:24,864 --> 03:55:27,300 OFFERS THEM IMMEDIATE AND 5917 03:55:27,300 --> 03:55:31,471 REMOTE ACCESS TO YOU KNOW, THIS 5918 03:55:31,471 --> 03:55:31,972 APPROACH. 5919 03:55:31,972 --> 03:55:37,010 NOT ONLY REDUCE BARRIER OF 5920 03:55:37,010 --> 03:55:38,645 ACCESS, BUT PROVIDES TIMELY 5921 03:55:38,645 --> 03:55:40,347 SERVICE FOR THOSE WHO NEED IT. 5922 03:55:40,347 --> 03:55:43,083 THE INTEGRATION OF MY HEALTH 5923 03:55:43,083 --> 03:55:45,719 CARD INTO THIS MODEL ENSURES 5924 03:55:45,719 --> 03:55:47,487 CARE WAS PROVIDED EFFECTIVELY 5925 03:55:47,487 --> 03:55:48,955 AND DOCUMENTED AND INFORMATION 5926 03:55:48,955 --> 03:55:50,557 REGARDING THE MENTAL HEALTH 5927 03:55:50,557 --> 03:55:52,058 ASSESSMENT AND TREATMENT PLANS 5928 03:55:52,058 --> 03:55:55,662 WAS ALSO UPLOADED TO THEIR 5929 03:55:55,662 --> 03:55:59,265 PERSONAL MY HEALTH CARD. 5930 03:55:59,265 --> 03:55:59,933 THIS COMBINED INNOVATIVE 5931 03:55:59,933 --> 03:56:04,671 APPROACH OF THE BABY SHOWER 5932 03:56:04,671 --> 03:56:08,742 INITIATIVE WHICH IS A 5933 03:56:08,742 --> 03:56:09,709 PERSON-CENTERED INNOVATIVE 5934 03:56:09,709 --> 03:56:11,811 APPROACH HAS TRANSFORMED OUR 5935 03:56:11,811 --> 03:56:13,913 HEALTHCARE DELIVERY IN SEVERAL 5936 03:56:13,913 --> 03:56:14,814 KEY UNDERSERVED AREAS. NEXT 5937 03:56:14,814 --> 03:56:17,884 SLIDE, PLEASE. 5938 03:56:17,884 --> 03:56:20,553 SO IT HAS INCREASED ACCESS TO 5939 03:56:20,553 --> 03:56:22,422 CARE, IT HAS REDUCED ATTRITION 5940 03:56:22,422 --> 03:56:23,623 AND FOLLOW-UP. 5941 03:56:23,623 --> 03:56:27,861 IT HAS HELPED IN IDENTITY AND 5942 03:56:27,861 --> 03:56:29,295 MANAGEMENT BY LINKING PATIENTS 5943 03:56:29,295 --> 03:56:30,196 TO THE HEALTH INFORMATION ON 5944 03:56:30,196 --> 03:56:31,931 THE CARD. 5945 03:56:31,931 --> 03:56:33,500 IT HAS ALSO HELPED IN 5946 03:56:33,500 --> 03:56:34,601 INFORMATION MANAGEMENT IN OUR 5947 03:56:34,601 --> 03:56:36,503 HEALTHCARE SYSTEM. 5948 03:56:36,503 --> 03:56:41,908 AND IT HAS DRASTICALLY REDUCED 5949 03:56:41,908 --> 03:56:42,442 WORKLOAD FOR HEALTHCARE 5950 03:56:42,442 --> 03:56:43,676 PROVIDERS. 5951 03:56:43,676 --> 03:56:47,280 SO IN CONCLUSION, OUR 5952 03:56:47,280 --> 03:56:56,089 INNOVATIVE APPROACH TO 5953 03:56:56,089 --> 03:56:58,725 HEALTHCARE, TELEHEALTH, 5954 03:56:58,725 --> 03:56:59,325 PERSON-CENTER APPROACHES 5955 03:56:59,325 --> 03:57:00,727 TRANSFORMING HEALTHCARE 5956 03:57:00,727 --> 03:57:02,595 DELIVERY IN UNDERSERVED 5957 03:57:02,595 --> 03:57:02,896 COMMUNITIES. 5958 03:57:02,896 --> 03:57:03,897 SO BY INTEGRATING THIS 5959 03:57:03,897 --> 03:57:05,865 INNOVATIVE TOOLS WE ARE NOT A 5960 03:57:05,865 --> 03:57:10,336 DIRECTION CRITICAL GAPS BUT 5961 03:57:10,336 --> 03:57:13,773 ALSO EMPOWER WOMEN TO CONTROL, 5962 03:57:13,773 --> 03:57:16,076 TAKE CONTROL OF THEIR OWN 5963 03:57:16,076 --> 03:57:18,211 HEALTH SO THIS DECENTRALIZED 5964 03:57:18,211 --> 03:57:20,747 PATIENT CENTER SLICINGS ALSO 5965 03:57:20,747 --> 03:57:22,415 OFFERS SCALABLE MODENS FOR 5966 03:57:22,415 --> 03:57:24,084 IMPROVING. 5967 03:57:24,084 --> 03:57:31,491 >> MALIHA ILIAS: THANK YOU, 5968 03:57:31,491 --> 03:57:34,060 NGOZI. 5969 03:57:34,060 --> 03:57:36,463 WHAT A GREAT EXAMPLE OF 5970 03:57:36,463 --> 03:57:37,597 MEANINGFUL ENGAGING COMMUNITY 5971 03:57:37,597 --> 03:57:40,266 PARTNERS LIKE FAITH BASED 5972 03:57:40,266 --> 03:57:42,102 ORGANIZATIONS, USING INNOVATIVE 5973 03:57:42,102 --> 03:57:43,369 DIGITAL TECHNOLOGIESES AND 5974 03:57:43,369 --> 03:57:45,805 HEALTH APPROACHES, TO GET 5975 03:57:45,805 --> 03:57:46,573 COMMUNITY INVOLVED IN THEIR 5976 03:57:46,573 --> 03:57:47,507 HEALTHCARE. 5977 03:57:47,507 --> 03:57:52,078 I SEE WE HAVE JOAN. 5978 03:57:52,078 --> 03:57:56,049 >> JOAN: GOOD EVENING, EVERYONE. 5979 03:57:56,049 --> 03:58:00,620 IT'S ACTUALLY EVENING NOW. 5980 03:58:00,620 --> 03:58:03,690 I WILL BE TAKING YOU THROUGH 5981 03:58:03,690 --> 03:58:05,258 GLOBAL SUCCESSES TO DETERMINE 5982 03:58:05,258 --> 03:58:07,227 HOW EVIDENCE THIS PRACTICE CAN 5983 03:58:07,227 --> 03:58:09,195 BE CONTEXTUALLY ADOPTED TO 5984 03:58:09,195 --> 03:58:10,563 IMPROVE MATERNAL HEALTH IN 5985 03:58:10,563 --> 03:58:12,332 VULNERABLE LOCATIONS. 5986 03:58:12,332 --> 03:58:14,467 NEXT SLIDE, PLEASE. 5987 03:58:14,467 --> 03:58:16,169 THE PRESENTATION POINTS I HAVE, 5988 03:58:16,169 --> 03:58:19,405 I WILL BRIEFLY LOOK AT THE 5989 03:58:19,405 --> 03:58:22,942 BACKGROUND IN MATERNAL AND 5990 03:58:22,942 --> 03:58:27,380 CHILDHOOD IN SIERRA LEONE 5991 03:58:27,380 --> 03:58:33,386 CONTEXT, AND GLOBAL STRATEGIES 5992 03:58:33,386 --> 03:58:34,587 AND INTERVENTIONS TOWARD 5993 03:58:34,587 --> 03:58:37,490 IMPROVING CHILD AND MATERNAL 5994 03:58:37,490 --> 03:58:39,058 AND WHAT HAS BEEN DONE AND 5995 03:58:39,058 --> 03:58:40,527 LESSONS LEARNED. 5996 03:58:40,527 --> 03:58:42,262 NEXT SLIDE, PLEASE. 5997 03:58:42,262 --> 03:58:46,733 THE REASON I DECIDED TO TALK 5998 03:58:46,733 --> 03:58:49,502 ABOUT REVIEW OF SOME CONTEXT 5999 03:58:49,502 --> 03:58:51,871 SIMILAR ALSO IN TERMS OF 6000 03:58:51,871 --> 03:58:53,673 PROGRESS AND DIFFERENCES IN 6001 03:58:53,673 --> 03:58:58,311 TERMS OF PACE MADE BY SOME 6002 03:58:58,311 --> 03:58:58,578 COUNTRIES. 6003 03:58:58,578 --> 03:59:00,747 JUST SOME BACKGROUND. 6004 03:59:00,747 --> 03:59:04,617 SIGH ERA LEONE IS A COUNTRY 6005 03:59:04,617 --> 03:59:05,485 WITH UNACCEPTABLE MORTALITY 6006 03:59:05,485 --> 03:59:07,420 RATES, HOWEVER, QUITE A LOT OF 6007 03:59:07,420 --> 03:59:14,060 PROGRESS HAS BID MADE. 6008 03:59:14,060 --> 03:59:19,899 FROM 857, 717 AND NOW 6009 03:59:19,899 --> 03:59:23,436 443/100,000 LIVE BIRTHS, 6010 03:59:23,436 --> 03:59:25,271 31/1000 NEONATAL MR. 6011 03:59:25,271 --> 03:59:28,074 WE ARE NOT EXCITED BECAUSE MOST 6012 03:59:28,074 --> 03:59:31,444 WOMEN ARE DYING FROM EVENTABLE 6013 03:59:31,444 --> 03:59:32,078 CAUSES. 6014 03:59:32,078 --> 03:59:39,419 THESE ARE -- WE ARE AIMING TO 6015 03:59:39,419 --> 03:59:41,788 REACH THE GLOBAL TARGET. 6016 03:59:41,788 --> 03:59:43,022 AND REGIONAL RECOMMENDATIONS 6017 03:59:43,022 --> 03:59:45,558 AND GLOBAL RECOMMENDATIONS ARE 6018 03:59:45,558 --> 03:59:48,695 BEING IMPLEMENTED IN SIERRA 6019 03:59:48,695 --> 03:59:50,997 LEONE, WHICH IS A LOW-MIDDLE 6020 03:59:50,997 --> 03:59:53,099 INCOME COUNTRY. 6021 03:59:53,099 --> 03:59:55,368 THE CAUSES ITSELF FOR DEATH IS 6022 03:59:55,368 --> 03:59:58,004 SIMILAR TO WEST AFRICA OR 6023 03:59:58,004 --> 03:59:58,371 AFRICAN REGION. 6024 03:59:58,371 --> 04:00:01,407 NEXT SLIDE, PLEASE. 6025 04:00:01,407 --> 04:00:06,012 SO THIS, WE HAVE EXPERIENCED 6026 04:00:06,012 --> 04:00:08,348 CIVIL WAR, EBOLA OUTBREAK, 6027 04:00:08,348 --> 04:00:10,617 FLOODS AND MUDSLIDES. ALL CAUSE 6028 04:00:10,617 --> 04:00:14,020 SERIOUS IMPACT ON OUR HEALTH 6029 04:00:14,020 --> 04:00:14,254 INDICATE 6030 04:00:14,254 --> 04:00:17,423 >>ERS COMPARED TO MANY SUB 6031 04:00:17,423 --> 04:00:22,362 SAHARAN AFRICAN COUNTRIES. 6032 04:00:22,362 --> 04:00:24,264 WE HAVE SEEN IMPROVEMENT IN 6033 04:00:24,264 --> 04:00:26,766 TERMS OF WOMEN SEEKING 6034 04:00:26,766 --> 04:00:27,367 INSTITUTIONAL DELIVERIES IN 6035 04:00:27,367 --> 04:00:28,301 HEALTH FACILITY. 6036 04:00:28,301 --> 04:00:34,507 SO BY AND LARGE WE HAVE 6037 04:00:34,507 --> 04:00:38,244 NATIONAL EFFORT TO IMPROVE 6038 04:00:38,244 --> 04:00:47,920 STATISTICS AN UTILIZING 6039 04:00:47,920 --> 04:00:52,525 TECHNOLOGY ADVANCEMENTS GEARED 6040 04:00:52,525 --> 04:00:55,561 TOWARDS REDUCING HIGH MORTALITY 6041 04:00:55,561 --> 04:00:57,230 RATES. 6042 04:00:57,230 --> 04:01:01,167 WE HAVE SUB-OPTIMAL QUALITY OF 6043 04:01:01,167 --> 04:01:04,637 ANTENATAL CARE. 6044 04:01:04,637 --> 04:01:06,773 WE HAVE FRAGILE ECONOMIES AND 6045 04:01:06,773 --> 04:01:10,543 LOW LITERACY LEVELS ESPECIALLY 6046 04:01:10,543 --> 04:01:10,910 AMONG WOMEN. 6047 04:01:10,910 --> 04:01:21,454 BUT NOT LIMITED TO SIERRA LEONE. 6048 04:01:26,225 --> 04:01:27,894 IT CONTRIBUTES TO THE GLOWS 6049 04:01:27,894 --> 04:01:31,264 BALL HEALTH AGENDA AND 6050 04:01:31,264 --> 04:01:31,864 SUSTAINABLE DEVELOPMENT GOAL. 6051 04:01:31,864 --> 04:01:35,535 NEXT SLIDE, PLEASE. 6052 04:01:35,535 --> 04:01:37,270 GLOBAL STANDARDS IMPLEMENTATION 6053 04:01:37,270 --> 04:01:40,807 SUCCESS WE HAVE PACKAGES FOR 6054 04:01:40,807 --> 04:01:41,874 SPECIFIC LIFE-SAVING 6055 04:01:41,874 --> 04:01:46,546 INTERVENTIONS WHEN IMPLEMENTED 6056 04:01:46,546 --> 04:01:50,717 IN COUNTRIES ARE ACCREDITED TO 6057 04:01:50,717 --> 04:01:53,586 LOMA TERNAL MORTALITY RATES, 6058 04:01:53,586 --> 04:01:56,055 LOW INFANT MORTALITY RATES. 6059 04:01:56,055 --> 04:01:58,057 GOOD OUTCOMES FOR MOTHER AND 6060 04:01:58,057 --> 04:01:58,324 THE BABY. 6061 04:01:58,324 --> 04:02:00,493 WE ARE WORKING ON THIS 6062 04:02:00,493 --> 04:02:03,129 GENERALLY AND FOCUS ON PRENATAL 6063 04:02:03,129 --> 04:02:05,465 CARE, WE HAVE REVERTED TO THE 6064 04:02:05,465 --> 04:02:10,103 OLD SYSTEM WHERE WOMEN ATTEND 6065 04:02:10,103 --> 04:02:12,672 VISITS ON A MONTHLY, TWO WEEKLY 6066 04:02:12,672 --> 04:02:14,907 AND THEN WEEKLY BASIS. 6067 04:02:14,907 --> 04:02:20,213 WE ARE NOW UTILIZING THE 6068 04:02:20,213 --> 04:02:24,083 INTEGRATED CARE GUIDELINES. 6069 04:02:24,083 --> 04:02:29,889 ALSO THE WHO LABOR AND CARE GUY 6070 04:02:29,889 --> 04:02:34,060 REPLACE THE CARE GUIDE THAT WAS 6071 04:02:34,060 --> 04:02:34,327 IN PLACE. 6072 04:02:34,327 --> 04:02:36,329 NEXT SLIDE, PLEASE. 6073 04:02:36,329 --> 04:02:41,401 IF WE ARE GOING TO IMPLEMENT 6074 04:02:41,401 --> 04:02:43,002 SOME EVIDENCE-BASED STRATEGIES 6075 04:02:43,002 --> 04:02:43,970 IMPLEMENTATION SUCCESSFULLY WE 6076 04:02:43,970 --> 04:02:47,840 NEED TO ADDRESS SOME OF THESE 6077 04:02:47,840 --> 04:02:50,610 ISSUES. SO WE HAVE ADDITIONAL 6078 04:02:50,610 --> 04:02:54,347 BELIEFS AND PRACTICES THAT'S A 6079 04:02:54,347 --> 04:02:57,517 TEKTING WOMEN'S UTILIZATION OF 6080 04:02:57,517 --> 04:02:58,117 SERVICES. THERE'S STAKEHOLDER 6081 04:02:58,117 --> 04:03:02,922 ENGAGEMENT. 6082 04:03:02,922 --> 04:03:04,791 TRADITIONAL AND LEGISLATION 6083 04:03:04,791 --> 04:03:07,593 LEADERS HAVE BEEN ENGAGED. 6084 04:03:07,593 --> 04:03:12,865 THERE'S BEEN TWO FACE-TO-FACE 6085 04:03:12,865 --> 04:03:14,934 MEETINGS. 6086 04:03:14,934 --> 04:03:16,636 ADVOCACY AND EMPOWERMENT WHERE 6087 04:03:16,636 --> 04:03:19,105 WE EDUCATE THE GIRL CHILD AND 6088 04:03:19,105 --> 04:03:20,873 THERE'S ALSO FREE EDUCATION IN 6089 04:03:20,873 --> 04:03:23,976 SIERRA LEONE. 6090 04:03:23,976 --> 04:03:27,280 AND SEXUALITY EDUCATION HAS 6091 04:03:27,280 --> 04:03:29,048 BEEN ADVOCATED FOR. 6092 04:03:29,048 --> 04:03:31,417 WE ALSO ABOLITIONED ADOLESCENT 6093 04:03:31,417 --> 04:03:33,119 FRIENDLY CLINICS AND PROGRAM. 6094 04:03:33,119 --> 04:03:36,389 IN TERMS OF ADDRESSING 6095 04:03:36,389 --> 04:03:38,191 INADEQUATE NUMBER OF SKILLED WE 6096 04:03:38,191 --> 04:03:40,760 DO NOT HAVE ENOUGH NURSES, WE 6097 04:03:40,760 --> 04:03:49,101 DO NOT HAVE ENOUGH DOCTORS AND 6098 04:03:49,101 --> 04:03:52,572 ANESTHETICKS. WE HAVE DOCTORS 6099 04:03:52,572 --> 04:03:54,674 AND CHO'S ALSO CONDUCTING SEE 6100 04:03:54,674 --> 04:03:59,579 SYRIAN SEKSZ. 6101 04:03:59,579 --> 04:04:05,384 GO TO THE COMMUNITY TO JUST ADD 6102 04:04:05,384 --> 04:04:08,888 ELEMENTS. 6103 04:04:08,888 --> 04:04:10,523 NEXT SLIDE, PLEASE. 6104 04:04:10,523 --> 04:04:11,991 IT'S SEEN AS A PRIORITY. 6105 04:04:11,991 --> 04:04:14,093 IT'S ON ON THE AGENDA THE 6106 04:04:14,093 --> 04:04:15,628 GOVERNMENT AS AWE PRIORITY. 6107 04:04:15,628 --> 04:04:17,330 THIS IS THE FLAGSHIP PROJECT 6108 04:04:17,330 --> 04:04:19,131 OWNED BY THE GOVERNMENT OF 6109 04:04:19,131 --> 04:04:20,500 SIERRA LEONE. 6110 04:04:20,500 --> 04:04:25,671 WE ESTABLISH AID DIRECT RAT OF 6111 04:04:25,671 --> 04:04:28,674 PRODUCTIVE AND CHILD HEALTH 6112 04:04:28,674 --> 04:04:30,176 WITH QUALITY IMPROVEMENT UNIT. 6113 04:04:30,176 --> 04:04:33,913 WE HAVE IN PLACE MDSR REVIEW 6114 04:04:33,913 --> 04:04:35,915 MEETINGS. THE COMMUNITY 6115 04:04:35,915 --> 04:04:38,084 STAKEHOLDERS ARE ACTIVELY 6116 04:04:38,084 --> 04:04:39,585 ENGAGED IN SUCH MEETINGS. IN 6117 04:04:39,585 --> 04:04:41,120 TERMS OF ADDRESSING THE 6118 04:04:41,120 --> 04:04:44,457 SHORTAGE OF MIDWIFES WE ALSO 6119 04:04:44,457 --> 04:04:48,294 ESTABLISHED MORE TRAINING OF 6120 04:04:48,294 --> 04:04:51,397 MIDWIFES IN SCHOOL, AND THROUGH 6121 04:04:51,397 --> 04:04:52,665 THE SUPPORT OF UNFPA. 6122 04:04:52,665 --> 04:04:59,238 WE USE TO HAVE THE OLD BRITISH 6123 04:04:59,238 --> 04:05:02,241 SYSTEM WHERE YOU NEED TO -- 6124 04:05:02,241 --> 04:05:04,310 BEFORE YOU CAN BECOME A MIDWIFE. 6125 04:05:04,310 --> 04:05:07,313 SO NOW WE HAVE CHANGED THAT. 6126 04:05:07,313 --> 04:05:09,916 WE ARE NOW OFFERING DIRECT MEET 6127 04:05:09,916 --> 04:05:13,986 WITH ME ENTER PROGRAM. 6128 04:05:13,986 --> 04:05:15,955 NEXT SLIDE. 6129 04:05:15,955 --> 04:05:19,859 WE HAVE ISSUES OF ACCESS. 6130 04:05:19,859 --> 04:05:20,993 WE HAVE AMBULANCE SERVICE IN 6131 04:05:20,993 --> 04:05:26,232 PLACE TO TAKE CARE OF WOMEN WHO 6132 04:05:26,232 --> 04:05:27,199 ARE HAVE MULTIPLE CHALLENGES 6133 04:05:27,199 --> 04:05:30,970 AND RESEARCH IN THE AREA OF 6134 04:05:30,970 --> 04:05:34,473 MATERNAL AND CHILDHOOD HEALTH 6135 04:05:34,473 --> 04:05:37,610 BY THE PROJECT. 6136 04:05:37,610 --> 04:05:43,549 WE ARE USING MOBILE TRACKING 6137 04:05:43,549 --> 04:05:54,060 APPS. WE HAVE A ESTABLISHMENT 6138 04:05:57,196 --> 04:06:00,232 OF DISTRICTS, THAT HAVE 6139 04:06:00,232 --> 04:06:03,169 VULNERABLE POPULATIONS, IN 6140 04:06:03,169 --> 04:06:05,638 TERMS OF SKILLS, WOULD HE HAVE 6141 04:06:05,638 --> 04:06:13,579 HIGH FIDELITY AND LOW FIDELITY 6142 04:06:13,579 --> 04:06:14,413 MANNEQUINS AND ANATOMICAL 6143 04:06:14,413 --> 04:06:17,049 MODELS DONATED TO THE SCHOOL. 6144 04:06:17,049 --> 04:06:19,518 ALSO RECEIVING TECHNICAL 6145 04:06:19,518 --> 04:06:25,024 SUPPORT FOR TWO MIDWIFERY 6146 04:06:25,024 --> 04:06:27,393 SCHOOLS, THROUGH SEED SGLOE 6147 04:06:27,393 --> 04:06:27,860 BALL HEALTH. 6148 04:06:27,860 --> 04:06:29,695 THEY GIVE 30% OF THEIR TIME IN 6149 04:06:29,695 --> 04:06:31,297 THE CLASSROOM AND 70% OF THEIR 6150 04:06:31,297 --> 04:06:32,865 TIME IN THE CLINICAL SETTING. 6151 04:06:32,865 --> 04:06:34,033 NEXT SLIDE, PLEASE. 6152 04:06:34,033 --> 04:06:35,635 NEXT SLIDE, PLEASE. 6153 04:06:35,635 --> 04:06:39,138 SO IN TERMS OF THE INNOVATIVE 6154 04:06:39,138 --> 04:06:40,840 APPROACHES TOWARDS IMPROVING 6155 04:06:40,840 --> 04:06:41,907 MATERNAL AND CHILD HEALTH WE 6156 04:06:41,907 --> 04:06:45,044 HAVE DONE A LOT. 6157 04:06:45,044 --> 04:06:47,079 I MENTIONED EARLIER, SKILLED 6158 04:06:47,079 --> 04:06:48,114 BIRTH ATTENDANTS HAVE BEEN 6159 04:06:48,114 --> 04:06:54,954 RETAINED. 6160 04:06:54,954 --> 04:06:56,822 AND INFRASTRUCTURAL DEVELOPMENT. 6161 04:06:56,822 --> 04:06:58,024 AND FACILITIES HAVE BEEN 6162 04:06:58,024 --> 04:07:01,527 ASSESSED TO MAKE SURE THEY ARE 6163 04:07:01,527 --> 04:07:05,064 READY FOR SERVICES AND REVISED 6164 04:07:05,064 --> 04:07:08,768 POLICY GUIDELINES AND OPERATING 6165 04:07:08,768 --> 04:07:10,536 PROCEDURES. AND ALSO SOME 6166 04:07:10,536 --> 04:07:11,337 FACILITIES LACK WATER AND 6167 04:07:11,337 --> 04:07:13,205 ELECTRICITY. 6168 04:07:13,205 --> 04:07:15,441 SO THERE IS INSTALLATION OF 6169 04:07:15,441 --> 04:07:17,643 SOLAR PANELS IN SOME OF THE 6170 04:07:17,643 --> 04:07:17,943 FACILITIES. 6171 04:07:17,943 --> 04:07:19,011 NEXT SLIDE, PLEASE. 6172 04:07:19,011 --> 04:07:27,920 NEXT SLIDE, PLEASE. 6173 04:07:27,920 --> 04:07:35,928 A LOT OF PROGRESS HAS BEEN MADE. 6174 04:07:35,928 --> 04:07:39,331 DEVELOPMENT OF NEW CURE LICK RA 6175 04:07:39,331 --> 04:07:42,301 FOR MIDWIFES. DEVELOPMENT OF 6176 04:07:42,301 --> 04:07:45,037 COME PEN SY-BASED TRAINING, 6177 04:07:45,037 --> 04:07:46,372 HELPING MOTHERS SURVIVE 6178 04:07:46,372 --> 04:07:47,540 BLEEDING, HELPING BABIES 6179 04:07:47,540 --> 04:07:49,108 BREATHE. 6180 04:07:49,108 --> 04:07:51,811 HIGH FREQUENCY AND LOW DOSE 6181 04:07:51,811 --> 04:07:55,481 TRAINING FOR COME PEN SY BASED 6182 04:07:55,481 --> 04:07:57,016 TRAININGS. AND CARE AND SCOPE 6183 04:07:57,016 --> 04:07:59,518 OF PRACTICE HAS BEEN REVISED. 6184 04:07:59,518 --> 04:08:00,753 NEXT SLIDE, PLEASE. 6185 04:08:00,753 --> 04:08:03,689 NEXT SLIDE, PLEASE. 6186 04:08:03,689 --> 04:08:07,493 SO NOW WE ARE EMBARKING ON OUR 6187 04:08:07,493 --> 04:08:11,731 STUDENTS ON ACTIVE PRACTICE. 6188 04:08:11,731 --> 04:08:13,065 BEFORE THEY GRADUATE 6189 04:08:13,065 --> 04:08:14,333 MIDWIFE-LED COMMUNITY PROJECTS 6190 04:08:14,333 --> 04:08:16,702 WHERE THEY GIVE HEALTH TALKS TO 6191 04:08:16,702 --> 04:08:18,704 PREGNANT WOMEN AND ALSO CARRY 6192 04:08:18,704 --> 04:08:19,605 OUT ASSESSMENT OF PREGNANT 6193 04:08:19,605 --> 04:08:25,244 WOMEN AND THESE ARE RECORDED 6194 04:08:25,244 --> 04:08:28,347 AND WE GRADE THE STIENTDS. WE 6195 04:08:28,347 --> 04:08:30,916 HAVE COME A LONG WAY IN TERMS 6196 04:08:30,916 --> 04:08:33,152 OF SUCCESS STORY, THIS IS 6197 04:08:33,152 --> 04:08:38,257 SIMILAR TO OTHER COUNTRIES. 6198 04:08:38,257 --> 04:08:42,261 OUR FACILITIES ARE NOW 6199 04:08:42,261 --> 04:08:42,762 COMPLICATION READINESS 6200 04:08:42,762 --> 04:08:53,172 EMERGENCY PREPAREDNESS. 6201 04:08:54,740 --> 04:08:55,674 REGIONAL CARE, RENOVATED. 6202 04:08:55,674 --> 04:08:57,610 NEXT SLIDE, PLEASE. 6203 04:08:57,610 --> 04:09:02,148 NEXT SLIDE, PLEASE. 6204 04:09:02,148 --> 04:09:05,117 AND THIS GOES, WE HAVE LAUNCHED 6205 04:09:05,117 --> 04:09:06,418 THE FREE HEALTHCARE INITIATIVE 6206 04:09:06,418 --> 04:09:12,825 BY THE PRESIDENT IN 2012 AND 6207 04:09:12,825 --> 04:09:15,895 ALSO USING -- TO MEASURE THE 6208 04:09:15,895 --> 04:09:17,530 BLOOD PRESSURE FOR DETECTION OF 6209 04:09:17,530 --> 04:09:18,531 PREECLAMPSIA. 6210 04:09:18,531 --> 04:09:21,700 THIS IS ALSO SEEN IN OTHER 6211 04:09:21,700 --> 04:09:22,301 COUNTRIES THAT ARE UTILIZING 6212 04:09:22,301 --> 04:09:24,236 SUCH. 6213 04:09:24,236 --> 04:09:26,305 WE HAVE FEELING NO COMMUNITY 6214 04:09:26,305 --> 04:09:28,040 SHOULD BE OUT OF REACH. 6215 04:09:28,040 --> 04:09:30,643 SO WE ARE SCALING UP 6216 04:09:30,643 --> 04:09:31,377 LIFE-SAIFPING INTERVENTION IN 6217 04:09:31,377 --> 04:09:31,877 ALL DISTRICT. 6218 04:09:31,877 --> 04:09:33,579 NEXT SLIDE, PLEASE. 6219 04:09:33,579 --> 04:09:35,447 THE ROLE OF PARTNERS. 6220 04:09:35,447 --> 04:09:36,816 WE HAVE VARIOUS PARTNERS THAT 6221 04:09:36,816 --> 04:09:40,452 ARE SUPPORTING US THROUGH THEIR 6222 04:09:40,452 --> 04:09:41,353 SYSTEMS STRENGTHENING PROJECT 6223 04:09:41,353 --> 04:09:43,489 AND SUPPORTING US IN TERMS OF 6224 04:09:43,489 --> 04:09:44,056 INFRASTRUCTURE AND CAPACITY 6225 04:09:44,056 --> 04:09:44,623 BUILDING. 6226 04:09:44,623 --> 04:09:54,967 NEXT SLIDE, PLEASE. 6227 04:10:09,148 --> 04:10:10,883 IT'S CLEAR COMMUNITIES NEED TO 6228 04:10:10,883 --> 04:10:12,084 BE INVOLVED IN HEALTHCARE NEEDS 6229 04:10:12,084 --> 04:10:16,989 AND CLEAR WE NEED TO ESTABLISH 6230 04:10:16,989 --> 04:10:17,990 RESPONSIVE RESILIENT STRUCTURES 6231 04:10:17,990 --> 04:10:18,924 AND POLICIES THAT WILL 6232 04:10:18,924 --> 04:10:20,159 WITHSTAND THE TEST OF TIME. 6233 04:10:20,159 --> 04:10:21,427 NEXT SLIDE, PLEASE. 6234 04:10:21,427 --> 04:10:24,129 NEXT SLIDE, PLEASE. 6235 04:10:24,129 --> 04:10:25,831 IN CONCLUSION, LOW AND MIDDLE 6236 04:10:25,831 --> 04:10:31,337 INCOME COUNTRIES ARE 6237 04:10:31,337 --> 04:10:33,272 CHALLENGED WITH ISSUES OF LOW 6238 04:10:33,272 --> 04:10:36,108 LEVELS OF EDUCATION, POVERTY, 6239 04:10:36,108 --> 04:10:40,246 REMOTE UNREACHABLE SETTINGS 6240 04:10:40,246 --> 04:10:41,814 WITH POOR KNEW TRACING, BAD 6241 04:10:41,814 --> 04:10:43,449 TERRAIN AMONG OTHERS. 6242 04:10:43,449 --> 04:10:45,284 CRITICAL TO SUCCESS IS THE NEED 6243 04:10:45,284 --> 04:10:47,152 TO EMPOWER WOMEN AND GIRLS AND 6244 04:10:47,152 --> 04:10:48,187 COMMUNITIES THROUGH EDUCATION 6245 04:10:48,187 --> 04:10:50,723 TO BE BETTER ABLE TO MAKE SAFE 6246 04:10:50,723 --> 04:10:52,591 DECISION REGARDING THEIR HEALTH 6247 04:10:52,591 --> 04:10:53,359 AND WELL-BEING, AND COMMUNITY 6248 04:10:53,359 --> 04:10:54,226 ENGAGEMENT. 6249 04:10:54,226 --> 04:10:55,561 NEXT SLIDE, PLEASE. 6250 04:10:55,561 --> 04:10:56,629 NEXT SLIDE, PLEASE. 6251 04:10:56,629 --> 04:10:59,331 THESE ARE SOME POINTS FOR 6252 04:10:59,331 --> 04:11:00,032 REFLECTIONS. ALL AROUND 6253 04:11:00,032 --> 04:11:00,833 DISPARITIES THAT NEEDS TO BE 6254 04:11:00,833 --> 04:11:01,767 ADDRESSED. 6255 04:11:01,767 --> 04:11:10,643 IT HAS TO DO WITH DISCREPANCIES 6256 04:11:10,643 --> 04:11:17,917 THAT ARE INIMICAL TO THE HEALTH 6257 04:11:17,917 --> 04:11:18,817 OF WOMEN. 6258 04:11:18,817 --> 04:11:20,452 NEXT SLIDE, PLEASE. 6259 04:11:20,452 --> 04:11:22,922 WE BELIEVE THE BURDEN WITH BE 6260 04:11:22,922 --> 04:11:25,024 REDUCED IF ALL COUNTRIES 6261 04:11:25,024 --> 04:11:25,324 CONTRIBUTE. 6262 04:11:25,324 --> 04:11:28,327 WE HAVE MISSED OUT ON THE MGDS 6263 04:11:28,327 --> 04:11:30,963 THAT WE ARE NOW AIMING FOR THE 6264 04:11:30,963 --> 04:11:31,964 SDGS. NEXT SLIDE, PLEASE. 6265 04:11:31,964 --> 04:11:33,632 NEXT SLIDE, PLEASE. 6266 04:11:33,632 --> 04:11:35,267 IN CONCLUSION, MOVING INTO THE 6267 04:11:35,267 --> 04:11:38,304 FUTURE AS WE TALK ABOUT ALL OF 6268 04:11:38,304 --> 04:11:38,771 THESE, IT'S IMPORTANT. 6269 04:11:38,771 --> 04:11:40,105 THE CLOCK IS TICKING, WOMEN AND 6270 04:11:40,105 --> 04:11:41,974 YOUNG GIRLS ARE CONTINUING TO 6271 04:11:41,974 --> 04:11:42,141 DIE. 6272 04:11:42,141 --> 04:11:44,209 SO WE NEED TO HAVE MORE 6273 04:11:44,209 --> 04:11:48,180 SUSTAINED EFFORT TO MAKE SURE 6274 04:11:48,180 --> 04:11:54,353 MATERNAL AND CHILDHOOD 6275 04:11:54,353 --> 04:11:57,690 INDICATORS FOR SIERRA LEONE. 6276 04:11:57,690 --> 04:11:59,725 >> THANK YOU, JOANN, WHAT A 6277 04:11:59,725 --> 04:12:01,827 GREAT PRESENTATION ON USING THE 6278 04:12:01,827 --> 04:12:04,396 LESSONS LEARNED GLOBALLY TO 6279 04:12:04,396 --> 04:12:05,831 INFORM HOW EVIDENCE-BASED 6280 04:12:05,831 --> 04:12:07,333 PRACTICES CAN BE CONTEXTUALLY 6281 04:12:07,333 --> 04:12:09,835 ADAPTED TO ANY COMMUNITY BY 6282 04:12:09,835 --> 04:12:10,369 CENTERING AND EMPOWERING 6283 04:12:10,369 --> 04:12:10,936 COMMUNITIES. 6284 04:12:10,936 --> 04:12:15,407 SO WITH THAT, I WANT TO MOVE 6285 04:12:15,407 --> 04:12:25,951 FORWARD TO ZALIHA ABDULLAHATI, 6286 04:12:27,486 --> 04:12:29,154 MAHDY, WHO IS OUR NEXT SPEAKER. 6287 04:12:29,154 --> 04:12:31,490 >> THANK YOU. 6288 04:12:31,490 --> 04:12:36,428 NEXT SLIDE, PLEASE. 6289 04:12:36,428 --> 04:12:45,404 DRONES IN BLOOD TRANSPORTATION. 6290 04:12:45,404 --> 04:12:49,742 AS YOU CAN SEE, RATIO HAS 6291 04:12:49,742 --> 04:12:50,909 DESIGNED TREMENDOUSLY WITH 6292 04:12:50,909 --> 04:12:52,411 PROVISION OF TRAINED BIRTH 6293 04:12:52,411 --> 04:12:54,980 ATTENDANCE. 6294 04:12:54,980 --> 04:12:57,950 ALMOST 100% OF CHILD BIRTHS 6295 04:12:57,950 --> 04:13:02,688 BEING CONDUCTED IN HOSPITALS. 6296 04:13:02,688 --> 04:13:06,792 AND SUBSEQUENTLY, CHECK BELOW 6297 04:13:06,792 --> 04:13:10,362 THE 30% PER 100,000. 6298 04:13:10,362 --> 04:13:14,900 A MOONING THE NON CLINICAL 6299 04:13:14,900 --> 04:13:16,301 FACTORS WAS INADEQUATE HANDLING 6300 04:13:16,301 --> 04:13:22,474 OF EMERGENCY CASES AND 6301 04:13:22,474 --> 04:13:32,985 INACCESSIBILITY OR REMOTENESS. 6302 04:13:33,752 --> 04:13:38,924 IF YOU LOOK AT DISTRIBUTION OF 6303 04:13:38,924 --> 04:13:40,359 PRIMARY POSTPARTUM HEMORRHAGE 6304 04:13:40,359 --> 04:13:46,398 IN MALAYSIA YOU WILL FIND 6305 04:13:46,398 --> 04:13:50,469 SAMBA, THE TERRAIN IS QUITE 6306 04:13:50,469 --> 04:13:51,370 CHALLENGING AND TRANSPORT 6307 04:13:51,370 --> 04:13:55,107 SYSTEM IS NOT WELL DEVELOPED. 6308 04:13:55,107 --> 04:13:57,009 WE VISITED EXPLORED PROBLEMS 6309 04:13:57,009 --> 04:13:59,244 WITH BLOOD TRANSPORTATION, WE 6310 04:13:59,244 --> 04:14:01,246 FOUND THREE MAIN THEMES WHICH 6311 04:14:01,246 --> 04:14:02,147 ARE EFFICIENCY, SAFETY AND 6312 04:14:02,147 --> 04:14:03,015 HUMAN RESOURCE. 6313 04:14:03,015 --> 04:14:04,783 NEXT SLIDE, PLEASE. 6314 04:14:04,783 --> 04:14:07,619 THESE ARE THE MODES OF 6315 04:14:07,619 --> 04:14:09,354 TRANSPORTATION AVAILABLE FOR 6316 04:14:09,354 --> 04:14:11,256 TRANSPORT OF BLOOD PRODUCTS. AS 6317 04:14:11,256 --> 04:14:13,959 WE KNOW MAINTAINING THE CODE 6318 04:14:13,959 --> 04:14:16,462 CHAIN IS IMPORTANT IN BLOOD 6319 04:14:16,462 --> 04:14:17,629 PRODUCT TRANSPORTATION. 6320 04:14:17,629 --> 04:14:19,431 NEXT SLIDE, PLEASE. 6321 04:14:19,431 --> 04:14:21,233 THERE ARE VARIOUS BARRIERS TO 6322 04:14:21,233 --> 04:14:23,569 MEDICAL TRANSPORTATION THAT ARE 6323 04:14:23,569 --> 04:14:25,437 CURRENTLY AVAILABLE MODES, FOR 6324 04:14:25,437 --> 04:14:26,638 EXAMPLE, DELAY IN 6325 04:14:26,638 --> 04:14:29,007 TRANSPORTATION TIME, HIGH RATE 6326 04:14:29,007 --> 04:14:31,110 OF ACCIDENTS, GEOGRAPHICAL 6327 04:14:31,110 --> 04:14:34,680 BARRIERS AND INACCESSIBILITY 6328 04:14:34,680 --> 04:14:36,281 DUE TO MOUNTAINOUS TERRAINS, 6329 04:14:36,281 --> 04:14:39,751 RIVERS WITHOUT BRIDGES AND 6330 04:14:39,751 --> 04:14:41,620 THICK TROPICAL RAIN FORESTS. 6331 04:14:41,620 --> 04:14:44,423 ISSUES THAT NEED TO BE 6332 04:14:44,423 --> 04:14:47,559 CONSIDERED ARE URGENCY OF BLOOD 6333 04:14:47,559 --> 04:14:50,362 REQUIREMENTS AND RISK OF BLOOD 6334 04:14:50,362 --> 04:14:51,296 PRODUCTS WITH BLOOD BANKING 6335 04:14:51,296 --> 04:14:51,663 SYSTEM. 6336 04:14:51,663 --> 04:14:54,366 NEXT SLIDE, PLEASE. 6337 04:14:54,366 --> 04:14:56,435 ONE OF THE POTENTIAL 6338 04:14:56,435 --> 04:14:58,437 APPLICATIONS OF DRONE USE IS 6339 04:14:58,437 --> 04:15:00,639 FOR DELIVERY OF BLOOD SAMPLES 6340 04:15:00,639 --> 04:15:02,274 AND PRODUCTS WITH POSSIBLE 6341 04:15:02,274 --> 04:15:04,710 BENEFITS OF REDUCED TRAVEL 6342 04:15:04,710 --> 04:15:06,278 TIME, BETTER ACCESSIBILITY, 6343 04:15:06,278 --> 04:15:09,348 REDUCED CARBON EMISSION AND 6344 04:15:09,348 --> 04:15:10,415 PERHAPS ENHANCED COST 6345 04:15:10,415 --> 04:15:10,749 EFFECTIVENESS. 6346 04:15:10,749 --> 04:15:12,284 THERE ARE OF COURSE SEVERAL 6347 04:15:12,284 --> 04:15:13,986 CHALLENGES NOT LEAST OF WHICH 6348 04:15:13,986 --> 04:15:15,921 IS THE LOCAL AIR TRAFFIC 6349 04:15:15,921 --> 04:15:16,889 LEGISLATION AND REGULATIONS. 6350 04:15:16,889 --> 04:15:20,859 NEXT SLIDE, PLEASE. 6351 04:15:20,859 --> 04:15:23,695 THE ZIP LINE DRONE DELIVERY 6352 04:15:23,695 --> 04:15:25,197 SYSTEM IN RWANDA INSPIRED US TO 6353 04:15:25,197 --> 04:15:27,866 LOOK INTO A SIMILAR SYSTEM TO 6354 04:15:27,866 --> 04:15:30,135 OVERCOME THE PROBLEM IN SUB 6355 04:15:30,135 --> 04:15:32,571 SAHARAN AND OTHER PARTS OF 6356 04:15:32,571 --> 04:15:34,306 MALAYSIA WHERE ROAD AND 6357 04:15:34,306 --> 04:15:35,307 TRANSPORTATION PROBLEMS EXIST 6358 04:15:35,307 --> 04:15:36,975 IN DELIVERING MEDICAL SERVICE. 6359 04:15:36,975 --> 04:15:39,545 THE DRONE SEEMED TO BE AN 6360 04:15:39,545 --> 04:15:40,078 ATTRACTIVE ALTERNATIVE, 6361 04:15:40,078 --> 04:15:41,747 NONETHELESS IT NEEDS TO BE 6362 04:15:41,747 --> 04:15:43,248 TESTED AGAINST THE DIFFERENT 6363 04:15:43,248 --> 04:15:46,318 CLIMATE AND TERRAIN HERE IN 6364 04:15:46,318 --> 04:15:48,053 MALAYSIA WITH MUCH WARMER AM 6365 04:15:48,053 --> 04:15:50,455 BEE ENT TEMPERATURE AND HARSHER 6366 04:15:50,455 --> 04:15:52,124 WEATHER. 6367 04:15:52,124 --> 04:15:55,127 ALSO ZIP LINE USED A FIXED WING 6368 04:15:55,127 --> 04:15:57,996 DRONE THAT IS SUITABLE FOR 6369 04:15:57,996 --> 04:16:03,368 GEOGRAPHICAL TERRAIN IN RWANDA, 6370 04:16:03,368 --> 04:16:07,306 WHEREAS NOT SUITABLE IN 6371 04:16:07,306 --> 04:16:10,542 MALAYSIA. 6372 04:16:10,542 --> 04:16:14,713 VERTICAL TAKE OFF AND LANDING 6373 04:16:14,713 --> 04:16:18,450 IS PROBABLY MORE SUITABLE. 6374 04:16:18,450 --> 04:16:20,385 HOME GROWN DRONE SERVICE 6375 04:16:20,385 --> 04:16:22,187 PROVIDER ACTUALLY THIRD IN 6376 04:16:22,187 --> 04:16:25,824 WORLD RANKING IN 2019, DRONE 6377 04:16:25,824 --> 04:16:31,296 OPERATOR COMPANY CALLED 6378 04:16:31,296 --> 04:16:34,266 AERODYNE. 6379 04:16:34,266 --> 04:16:38,637 BEGIN FOOD, MEDICINE AND BLOOD 6380 04:16:38,637 --> 04:16:42,808 DELIVERY IN PAPUA NEW GUINEA 6381 04:16:42,808 --> 04:16:43,275 TOGETHER WITH UNICEF. 6382 04:16:43,275 --> 04:16:45,310 NEXT SLIDE, PLEASE. 6383 04:16:45,310 --> 04:16:47,813 DESPITE THE HYPE ABOUT DRONE, 6384 04:16:47,813 --> 04:16:51,917 WE FOUND ONLY THREE 6385 04:16:51,917 --> 04:16:53,018 PEER-REVIEWED PUBLICATIONS AS A 6386 04:16:53,018 --> 04:16:54,753 MODE OF TRANSPORTATION FOR 6387 04:16:54,753 --> 04:16:56,521 BLOOD SAMPLES AND PRODUCTS FOR 6388 04:16:56,521 --> 04:17:00,826 MATERNAL HEALTHCARE. 6389 04:17:00,826 --> 04:17:04,830 THIS SPURRED US TO PURSUE OUR 6390 04:17:04,830 --> 04:17:06,265 RESEARCH FURTHER PUBLISH OUR 6391 04:17:06,265 --> 04:17:07,532 FINDINGS. NEXT SLIDE, PLEASE. 6392 04:17:07,532 --> 04:17:12,437 WE PROCEEDED TO LOOK AT COST 6393 04:17:12,437 --> 04:17:14,273 EFFECTIVENESS OF DRONES IN 6394 04:17:14,273 --> 04:17:18,910 MEDICAL DELIVERY COMPARED TO 6395 04:17:18,910 --> 04:17:20,412 THE COMMONEST CONVENTIONAL MODE 6396 04:17:20,412 --> 04:17:23,415 OF TRANSPORT USED HERE IN 6397 04:17:23,415 --> 04:17:26,184 MALAYSIA WHICH IS AMBULANCE. 6398 04:17:26,184 --> 04:17:27,719 WE FOUND DRONE TRANSPORTATION 6399 04:17:27,719 --> 04:17:29,354 OF BLOOD PRODUCTS CAUSED MORE 6400 04:17:29,354 --> 04:17:31,890 PER MINUTE COMPARED TO THE 6401 04:17:31,890 --> 04:17:32,658 AMBULANCE, THE SIGNIFICANT 6402 04:17:32,658 --> 04:17:36,595 SHORTER TRANSPORT TIME OF THE 6403 04:17:36,595 --> 04:17:38,664 DRONE OFFSET WHEREAS AMBULANCE 6404 04:17:38,664 --> 04:17:40,432 TOOK 34 MINUTE. 6405 04:17:40,432 --> 04:17:42,367 THE DRONE TOOK ONLY 18 MINUTES 6406 04:17:42,367 --> 04:17:46,405 TO COVER THE SAME DISTANCE, 6407 04:17:46,405 --> 04:17:46,838 NEXT SLIDE, PLEASE. 6408 04:17:46,838 --> 04:17:49,908 WE LOOKED AT INFLUENCE OF DRONE 6409 04:17:49,908 --> 04:17:51,076 CARRIAGE MATERIAL ON 6410 04:17:51,076 --> 04:17:52,177 MAINTENANCE OF STORAGE 6411 04:17:52,177 --> 04:17:53,912 TEMPERATURE AND QUALITY OF 6412 04:17:53,912 --> 04:17:55,614 BLOOD SAMPLES DURING 6413 04:17:55,614 --> 04:17:55,981 TRANSPORTATION. 6414 04:17:55,981 --> 04:17:58,116 BEARING IN MIND IT IS TAKING 6415 04:17:58,116 --> 04:18:00,886 PLACE IN A HOT EQUATORIAL 6416 04:18:00,886 --> 04:18:02,754 CLIMATE, NEXT SLIDE, WE USED 6417 04:18:02,754 --> 04:18:05,390 THREE TYPES OF CARRIAGE 6418 04:18:05,390 --> 04:18:09,528 MATERIAL, ALUMINUM IN FIGURE 6419 04:18:09,528 --> 04:18:17,736 THREE, BOX C, POLY PROPYLENE 6420 04:18:17,736 --> 04:18:23,375 PLASTIC IN BOX B, EXPANDED 6421 04:18:23,375 --> 04:18:26,211 POLYSTYRENE OR EPS FORM AS 6422 04:18:26,211 --> 04:18:30,148 SEENS IN BOX A, WHICH IS THE 6423 04:18:30,148 --> 04:18:31,950 COMMONEST MATERIAL USED TO 6424 04:18:31,950 --> 04:18:33,752 MAINTAIN THE BLOOD CODE CHAIN 6425 04:18:33,752 --> 04:18:35,821 HERE IN MALAYSIA. 6426 04:18:35,821 --> 04:18:37,189 SECOND PHASE PRESERVATION OF 6427 04:18:37,189 --> 04:18:40,158 QUALITY OF THE BLOOD SAMPLES. 6428 04:18:40,158 --> 04:18:42,361 WE DPOUND BOTH PARAMETERS ARE 6429 04:18:42,361 --> 04:18:45,530 BEST MAINTAINED USING THE EPS 6430 04:18:45,530 --> 04:18:47,566 FOAM BOX AS THE DRONE CARRIAGE 6431 04:18:47,566 --> 04:18:47,833 MATERIAL. 6432 04:18:47,833 --> 04:18:51,370 NEXT SLIDE, PLEASE. 6433 04:18:51,370 --> 04:18:54,172 LAST BUT NOT LEAST WE LOOKED AT 6434 04:18:54,172 --> 04:18:55,807 COMMUNITY ACCEPTANCE OF DRONES 6435 04:18:55,807 --> 04:18:58,610 AS A MEANS OF DELIVERING 6436 04:18:58,610 --> 04:18:58,977 MEDICAL SERVICE. 6437 04:18:58,977 --> 04:19:01,113 IT WAS REASSURING TO FIND A 6438 04:19:01,113 --> 04:19:05,283 GOOD ACCEPTANCE RATE OF 82.9% 6439 04:19:05,283 --> 04:19:09,087 OUT OF 557 RESPONDENTS WHO 6440 04:19:09,087 --> 04:19:11,523 COMPLETED OUR SURVEY. 6441 04:19:11,523 --> 04:19:12,958 THE RATE WAS CORRELATED WITH 6442 04:19:12,958 --> 04:19:15,360 KNOWLEDGE, AT TAOUT AND 6443 04:19:15,360 --> 04:19:17,863 PERCEPTION SCORES BUT NOT 6444 04:19:17,863 --> 04:19:19,431 SOCIAL DEMOGRAPHIC FACTORS. 6445 04:19:19,431 --> 04:19:20,432 THIS INDICATED RAISING 6446 04:19:20,432 --> 04:19:21,767 AWARENESS AND EDUCATING THE 6447 04:19:21,767 --> 04:19:24,336 COMMUNITY IS KEY TO GAINING 6448 04:19:24,336 --> 04:19:26,338 ACCEPTANCE OF THIS INNOVATION. 6449 04:19:26,338 --> 04:19:29,608 NEXT SLIDE, PLEASE. 6450 04:19:29,608 --> 04:19:32,944 SO IN CONCLUSION I WISH TO 6451 04:19:32,944 --> 04:19:35,914 HIGHLIGHT THE DRONE TECHNOLOGY 6452 04:19:35,914 --> 04:19:41,686 IS ADVANCING RAPIDLY. 6453 04:19:41,686 --> 04:19:44,055 IN ORDER FOR COMMUNITY TO 6454 04:19:44,055 --> 04:19:46,491 EMBRACE THE CHANGE THEY MUST BE 6455 04:19:46,491 --> 04:19:46,992 INFORMED. 6456 04:19:46,992 --> 04:19:48,593 DRONE TRANSPORTATION IS COST 6457 04:19:48,593 --> 04:19:50,128 EFFECTIVE AND CAPABLE OF 6458 04:19:50,128 --> 04:19:52,564 TEMPERATURE AND BLOOD QUALITY 6459 04:19:52,564 --> 04:19:54,933 PRESERVATION EVEN IN A TROPICAL 6460 04:19:54,933 --> 04:19:56,201 CLIMATE I BELIEVE THIS 6461 04:19:56,201 --> 04:19:58,403 EXPERIMENT OF OURS HAS BEEN 6462 04:19:58,403 --> 04:19:59,371 DUPLICATED ELSEWHERE WITH THE 6463 04:19:59,371 --> 04:20:02,474 SAME OUTCOMES. 6464 04:20:02,474 --> 04:20:03,642 NEVERTHELESS CHALLENGES REMAIN 6465 04:20:03,642 --> 04:20:05,877 IN TERMS OF CAPITAL COSTS OF 6466 04:20:05,877 --> 04:20:07,813 DRONES, LOCAL LAW AND 6467 04:20:07,813 --> 04:20:09,514 REGULATIONS, FLYING BEYOND THE 6468 04:20:09,514 --> 04:20:11,817 VISUAL LINE OF SIGHT VERSUS 6469 04:20:11,817 --> 04:20:14,386 LOCAL INTERNET CONNECTIVITY. 6470 04:20:14,386 --> 04:20:16,054 DRONE POWER SOURCE, BATTERY 6471 04:20:16,054 --> 04:20:18,323 SOURCE VERSUS FLIGHT RANGE ,Z 6472 04:20:18,323 --> 04:20:19,925 NAVIGATION ACCURACY AND FLYING 6473 04:20:19,925 --> 04:20:23,061 IN HARSH WEATHER CONDITIONS. 6474 04:20:23,061 --> 04:20:26,832 NEXT SLIDE, PLEASE. 6475 04:20:26,832 --> 04:20:28,066 FINALLY I THANK YOU FOR THE 6476 04:20:28,066 --> 04:20:29,634 OPPORTUNITY TO SHARE OUR WORK 6477 04:20:29,634 --> 04:20:31,002 FROM THE DRONE TEAM. 6478 04:20:31,002 --> 04:20:34,573 THANK YOU. 6479 04:20:34,573 --> 04:20:37,042 >> THANK YOU, ZALEHA, THIS WAS 6480 04:20:37,042 --> 04:20:39,711 SUCH A FASCINATING STORY OF USE 6481 04:20:39,711 --> 04:20:41,012 OF INNOVATIVE METHODOLOGY TO 6482 04:20:41,012 --> 04:20:43,448 REALLY ADDRESS SOME OF THE 6483 04:20:43,448 --> 04:20:45,417 COMMUNITY'S SPECIFIC AND 6484 04:20:45,417 --> 04:20:46,885 CONTEXTUAL BARRIERS TO 6485 04:20:46,885 --> 04:20:47,752 EVIDENCE-BASED INTERVENTIONS 6486 04:20:47,752 --> 04:20:48,753 REACHING THE COMMUNITIES THAT 6487 04:20:48,753 --> 04:20:50,355 THIS ARE MEANT TO SERVE. 6488 04:20:50,355 --> 04:20:52,190 THANK YOU TO ALL OF OUR GREAT 6489 04:20:52,190 --> 04:20:55,494 SPEAKERS, I WOULD LIKE TO BRING 6490 04:20:55,494 --> 04:20:57,762 FORTH ALL OF OUR PANELISTS 6491 04:20:57,762 --> 04:21:03,702 INCLUDING SARAH CHEN TO COME 6492 04:21:03,702 --> 04:21:07,372 TO THE DISCUSSION TABLE, SO TO 6493 04:21:07,372 --> 04:21:08,540 SPEAK. 6494 04:21:08,540 --> 04:21:13,578 YOU ENCOURAGE AUDIENCE TO PASTE 6495 04:21:13,578 --> 04:21:17,082 QUESTIONS IN THE Q&A BOX SO 6496 04:21:17,082 --> 04:21:18,316 MYSELF AND THE ORGANIZERS CAN 6497 04:21:18,316 --> 04:21:19,651 KEEP STRACHOVA OF THEM. 6498 04:21:19,651 --> 04:21:22,821 I SEE SOME QUESTIONS ALREADY, 6499 04:21:22,821 --> 04:21:24,656 THIS STARTS WITH NGOZI, KUDOS 6500 04:21:24,656 --> 04:21:26,224 FOR HER PRESENTATION. 6501 04:21:26,224 --> 04:21:27,893 GREAT WORK, I WOULD LIKE TO 6502 04:21:27,893 --> 04:21:29,761 HEAR MORE ABOUT METHODS TO KEEP 6503 04:21:29,761 --> 04:21:31,162 WOMEN ENGAGED IN THE STUDY 6504 04:21:31,162 --> 04:21:33,031 FOLLOWING DELIVER YU. 6505 04:21:33,031 --> 04:21:36,201 OUR ADDITIONAL HOME BASED OR 6506 04:21:36,201 --> 04:21:37,302 COMMUNITY-BASED VISITS 6507 04:21:37,302 --> 04:21:40,005 CONDUCKED THROUGH 12 MONTHS 6508 04:21:40,005 --> 04:21:42,040 POSTPARTUM, WHAT OTHER METHODS 6509 04:21:42,040 --> 04:21:43,608 HAVE YOU UTILIZED TO IMPROVE 6510 04:21:43,608 --> 04:21:44,976 FOLLOW-UP? 6511 04:21:44,976 --> 04:21:51,416 >> I WILL JUST SAY MAYBE ONE 6512 04:21:51,416 --> 04:21:56,788 WORD [ INDISCERNIBLE ] DM OUR 6513 04:21:56,788 --> 04:22:04,362 COMMUNITY WE HAVE COMMUNITY 6514 04:22:04,362 --> 04:22:05,363 RESEARCH ENGAGEMENT OFFICERS, 6515 04:22:05,363 --> 04:22:06,498 WE RECRUIT FROM THE COMMUNITY 6516 04:22:06,498 --> 04:22:10,135 AND THEY ARE PART AND PARCEL, 6517 04:22:10,135 --> 04:22:13,872 THEY KNOW THESE WOMEN, THEY DO 6518 04:22:13,872 --> 04:22:15,774 THE BABY SHOWER, THEY GO TO THE 6519 04:22:15,774 --> 04:22:16,908 SAME CHURCH AND GO TO THE SAME 6520 04:22:16,908 --> 04:22:18,109 MARKET. 6521 04:22:18,109 --> 04:22:20,078 SO THEY ARE VERY FAMILIAR. 6522 04:22:20,078 --> 04:22:21,780 OFTEN TIMES BECAUSE THEY HAVE 6523 04:22:21,780 --> 04:22:23,248 BEEN ENGAGING THEM FROM THE 6524 04:22:23,248 --> 04:22:24,950 BEGINNING, TO THE PROCESS OF 6525 04:22:24,950 --> 04:22:26,885 BABY SHOWER, THE SCREENING AND 6526 04:22:26,885 --> 04:22:29,721 DIFFERENT TYPES OF SCREENING 6527 04:22:29,721 --> 04:22:31,590 AND HELP DESK, THESE WOMEN 6528 04:22:31,590 --> 04:22:33,858 TRUST THEM. 6529 04:22:33,858 --> 04:22:38,363 SO THEY ALSO REMIND THEM ABOUT 6530 04:22:38,363 --> 04:22:43,301 THEIR FOLLOW-UPS. MY HEALTH 6531 04:22:43,301 --> 04:22:51,009 CARD HAS AN POTENTIAL TO REMIND. 6532 04:22:51,009 --> 04:22:56,181 BUT ALSO COMES TO YOUR DOOR, 6533 04:22:56,181 --> 04:22:57,816 LOOKS LIKE YOUR DAUGHTER, YOUR 6534 04:22:57,816 --> 04:23:00,418 CHILD, SAY HI TO YOU, TALK TO 6535 04:23:00,418 --> 04:23:10,562 YOU ABOUT HIGH PRICES OF STUFF. 6536 04:23:10,562 --> 04:23:14,165 -- HAVE BEEN WONDERFUL. 6537 04:23:14,165 --> 04:23:16,101 THEY FOLLOW-UP WITH THESE WOMEN. 6538 04:23:16,101 --> 04:23:17,469 THEY WILL BEFRIEND THE WOMEN 6539 04:23:17,469 --> 04:23:19,504 AND THEIR CHILDREN, THEY WILL 6540 04:23:19,504 --> 04:23:20,939 BABYSIT AT TIMES TO TELL YOU 6541 04:23:20,939 --> 04:23:24,609 THE TRUTH. 6542 04:23:24,609 --> 04:23:30,248 SO WE HAVE PBR IN ALL THE SIX 6543 04:23:30,248 --> 04:23:31,416 REGIONS ENGAGE THESE WOMEN 6544 04:23:31,416 --> 04:23:32,884 CONTINUOUSLY. 6545 04:23:32,884 --> 04:23:34,919 THAT'S OUR MAGIC WORD. 6546 04:23:34,919 --> 04:23:37,722 >> WHAT A GREAT RESPONSE, NG OO 6547 04:23:37,722 --> 04:23:37,889 ZI. 6548 04:23:37,889 --> 04:23:40,091 I THINK IT ALSO REALLY CENTERS 6549 04:23:40,091 --> 04:23:43,294 THE IMPORTANCE OF REALLY 6550 04:23:43,294 --> 04:23:44,095 EMPOWERING THE COMMUNITY. 6551 04:23:44,095 --> 04:23:47,399 I THINK, YOU KNOW, ONE OF OUR 6552 04:23:47,399 --> 04:23:49,300 INVESTIGATORS FOR THE COMMUNITY 6553 04:23:49,300 --> 04:23:51,469 ENGAGEMENT ALLIANCE TEAMS IN 6554 04:23:51,469 --> 04:23:52,804 ALABAMA, LIKES TO SAY IF THE 6555 04:23:52,804 --> 04:23:55,573 PROBLEM IS IN THE COMMUNITY 6556 04:23:55,573 --> 04:23:57,909 THEN THE SOLUTION IS IN THE 6557 04:23:57,909 --> 04:24:00,245 COMMUNITY AND YOUR ONE-WORD 6558 04:24:00,245 --> 04:24:00,712 EXAMPLE CAPTURES THAT. 6559 04:24:00,712 --> 04:24:01,913 SO THANK YOU. 6560 04:24:01,913 --> 04:24:07,352 I HAVE ANOTHER QUESTION FOR DR. 6561 04:24:07,352 --> 04:24:07,552 MAHDY. 6562 04:24:07,552 --> 04:24:09,888 INCREDIBLE WORK AND USE OF 6563 04:24:09,888 --> 04:24:10,188 TECHNOLOGY. 6564 04:24:10,188 --> 04:24:13,758 I WONDER WHAT CHALLENGES YOU 6565 04:24:13,758 --> 04:24:16,895 ENCOUNTERED OR HAD TO DEAL WITH 6566 04:24:16,895 --> 04:24:18,196 PROACTIVELY IN TERMS OF 6567 04:24:18,196 --> 04:24:19,297 ENSURING DRONE SECURITY. 6568 04:24:19,297 --> 04:24:19,898 >> RIGHT, THANK YOU FOR THE 6569 04:24:19,898 --> 04:24:21,232 QUESTION. 6570 04:24:21,232 --> 04:24:23,234 VERY RELEVANT INDEED. 6571 04:24:23,234 --> 04:24:24,469 IT IS INDEED CHALLENGING. 6572 04:24:24,469 --> 04:24:27,839 IT'S NOT EASY. 6573 04:24:27,839 --> 04:24:29,641 IT'S NOT LOW-HANGING FRUIT, I 6574 04:24:29,641 --> 04:24:31,242 WOULD SAY IN TERMS OF 6575 04:24:31,242 --> 04:24:32,610 TECHNOLOGY INNOVATION TO BE 6576 04:24:32,610 --> 04:24:34,679 USING A DRONE TO REACH PEOPLE 6577 04:24:34,679 --> 04:24:39,050 IN REMOTE AREAS. THERE'S A LOT 6578 04:24:39,050 --> 04:24:40,151 OF CHALLENGES, NOT LEAST OF 6579 04:24:40,151 --> 04:24:48,960 WHICH IS THE LEGISLATION, THE 6580 04:24:48,960 --> 04:24:52,564 REGULATIONS THAT GOVERN FLYING 6581 04:24:52,564 --> 04:24:57,102 DRONES IN THESE AREAS AS WELL 6582 04:24:57,102 --> 04:24:57,635 AS INTERNET CONNECTIVITY. 6583 04:24:57,635 --> 04:24:58,636 THOSE ARE THINGS WE NEED TO 6584 04:24:58,636 --> 04:25:08,813 OVERCOME. 6585 04:25:20,558 --> 04:25:22,594 TO REACH HARD TO REACH AREAS. 6586 04:25:22,594 --> 04:25:23,695 >> THANK YOU. 6587 04:25:23,695 --> 04:25:27,165 I WANT TO DIRECT A QUESTION TO 6588 04:25:27,165 --> 04:25:28,032 SARAH CHEN AROUND DECENTRALIZED 6589 04:25:28,032 --> 04:25:30,034 APPROACHES. 6590 04:25:30,034 --> 04:25:32,137 HOW CAN INNOVATIVE CARE 6591 04:25:32,137 --> 04:25:35,173 DELIVERY METHODS SUCH AS 6592 04:25:35,173 --> 04:25:37,075 TELEHEALTH, DOULA AND MIDWIFE 6593 04:25:37,075 --> 04:25:39,711 CARE BETTER REACH UNDERSERVED 6594 04:25:39,711 --> 04:25:42,580 AREAS AND MOVE TOWARDS 6595 04:25:42,580 --> 04:25:43,047 DECREASED DISPARITIES? 6596 04:25:43,047 --> 04:25:45,150 >> SURE, I KNOW I SPEAK MORE 6597 04:25:45,150 --> 04:25:47,852 FROM U.S. AND HIGH INCOME 6598 04:25:47,852 --> 04:25:49,254 COUNTRY SETTING, BUT INSTEAD OF 6599 04:25:49,254 --> 04:25:51,356 TRYING TO DO EVERYTHING IN AN 6600 04:25:51,356 --> 04:25:53,825 IN-PERSON VISIT, WHICH IS THE 6601 04:25:53,825 --> 04:25:54,993 TRADITIONAL MODEL, WE FORCE THE 6602 04:25:54,993 --> 04:25:57,829 PATIENT TO SEE THE DOCTOR AND 6603 04:25:57,829 --> 04:26:00,198 EVERYTHING HAS TO BE DONE 6604 04:26:00,198 --> 04:26:02,066 THERE, BUT THE INNOVATIVE PART, 6605 04:26:02,066 --> 04:26:04,002 WHICH MAYBE NOT BE SO 6606 04:26:04,002 --> 04:26:05,770 INNOVATIVE IF WE THINK ABOUT 6607 04:26:05,770 --> 04:26:07,972 IT, BREAKING APART THE CARE AND 6608 04:26:07,972 --> 04:26:09,607 DLERING IT DIFFERENTLY BASED ON 6609 04:26:09,607 --> 04:26:13,678 WHAT EXACTLY YOU ARE DOING. 6610 04:26:13,678 --> 04:26:17,315 WE CAN PROVIDE TELEHEALTH FOR 6611 04:26:17,315 --> 04:26:19,117 INITIAL RISK ASSESSMENT AND 6612 04:26:19,117 --> 04:26:22,220 CONSULTATIONS AND CHECKING IN 6613 04:26:22,220 --> 04:26:22,587 ON THE PATIENT. 6614 04:26:22,587 --> 04:26:24,155 BUT WITH MONITORING, FOR 6615 04:26:24,155 --> 04:26:25,156 EXAMPLE, BLOOD PRESSURE, THINGS 6616 04:26:25,156 --> 04:26:27,125 LIKE THAT, WE HAVE THE 6617 04:26:27,125 --> 04:26:28,793 TECHNOLOGY FOR REMOTE PATIENT 6618 04:26:28,793 --> 04:26:29,694 MONITORING BUT IT'S ACTUALLY 6619 04:26:29,694 --> 04:26:31,196 NOT USED THAT MUCH. 6620 04:26:31,196 --> 04:26:36,467 A LOT OF OUR PHYSICIAN CLINICS 6621 04:26:36,467 --> 04:26:38,203 DON'TED USE REMOTE PATIENT MON 6622 04:26:38,203 --> 04:26:39,504 OR TOING, THEY STILL FORCE THE 6623 04:26:39,504 --> 04:26:41,673 PATIENT TO COME TO THE CLINIC 6624 04:26:41,673 --> 04:26:43,575 TO GET THEIR BLOOD PRESSURE 6625 04:26:43,575 --> 04:26:44,475 MONITOREDMENT THERE'S ALSO 6626 04:26:44,475 --> 04:26:46,511 THINGS WE CAN SEND THROUGH THE 6627 04:26:46,511 --> 04:26:48,646 MAIL. 6628 04:26:48,646 --> 04:26:59,190 OR DR. ZALEHA, DRONE TECHNOLOGY. 6629 04:27:01,426 --> 04:27:04,562 VANS THAT ACTUALLY TRAVEL TO 6630 04:27:04,562 --> 04:27:06,831 OUR PATIENTS. 6631 04:27:06,831 --> 04:27:09,300 IT'S JUST REALLY BREAKING IT 6632 04:27:09,300 --> 04:27:10,268 APART AND BEING SPECIFIC ABOUT 6633 04:27:10,268 --> 04:27:12,937 WHAT WE ARE TRYING TO DO 6634 04:27:12,937 --> 04:27:14,639 INSTEAD OF BEING WEDDED TO THIS 6635 04:27:14,639 --> 04:27:16,307 OLD MODEL WHERE YOU FORCE THE 6636 04:27:16,307 --> 04:27:18,977 PATIENT TO GO TO ONE PLACE TO 6637 04:27:18,977 --> 04:27:19,844 GET EVERYTHING DONE. 6638 04:27:19,844 --> 04:27:23,181 IN THE U.S. WE ARE VERY MUCH 6639 04:27:23,181 --> 04:27:24,449 PHYSICIAN-DRIVEN CULTURE BUT WE 6640 04:27:24,449 --> 04:27:27,085 ALSO NEED TO THINK BROADER 6641 04:27:27,085 --> 04:27:27,485 ABOUT THAT, RIGHT? 6642 04:27:27,485 --> 04:27:29,254 WE DON'T HAVE TO HAVE A 6643 04:27:29,254 --> 04:27:30,755 PHYSICIAN DELIVERING CARE, WE 6644 04:27:30,755 --> 04:27:32,156 SHOULD BE INVESTING AND 6645 04:27:32,156 --> 04:27:35,293 TRAINING IN DOULAS AND MIDWIFES 6646 04:27:35,293 --> 04:27:36,027 IN THESE COMMUNITIES. 6647 04:27:36,027 --> 04:27:38,062 THIS IS WHAT WE ARE SEEING 6648 04:27:38,062 --> 04:27:39,430 GLOBALLY, RIGHT? 6649 04:27:39,430 --> 04:27:43,468 TO YOUR POINT, IF THE PROBLEM 6650 04:27:43,468 --> 04:27:45,503 IS IN THE COMMUNITY, THE 6651 04:27:45,503 --> 04:27:46,905 SOLUTION IS ALSO THERE, THERE 6652 04:27:46,905 --> 04:27:50,074 ARE WOMEN WHO HAVE GIVEN BIRTH 6653 04:27:50,074 --> 04:27:53,478 BEFORE IN THE COMMUNITY, WHY 6654 04:27:53,478 --> 04:27:55,914 AREN'T WE LEVERAGING THEM. 6655 04:27:55,914 --> 04:27:58,683 OR A COMMENT LIKE OLDER WOMAN, 6656 04:27:58,683 --> 04:28:00,451 OLDER GENERATIONS OF WOMEN. 6657 04:28:00,451 --> 04:28:03,688 WE NEED TO STOP PUSHING THIS 6658 04:28:03,688 --> 04:28:05,723 IDEAL TRADITIONAL MODEL IN 6659 04:28:05,723 --> 04:28:06,858 ORDER TO REALLY INNOVATE. 6660 04:28:06,858 --> 04:28:08,359 >> THAT'S A GREAT RESPONSE AND 6661 04:28:08,359 --> 04:28:10,695 I THINK THAT A LOT OF OUR 6662 04:28:10,695 --> 04:28:13,498 SPEAKERS TODAY TOUCHED ON SOME 6663 04:28:13,498 --> 04:28:15,400 OF THOSE INNOVATIVE METHODS. 6664 04:28:15,400 --> 04:28:16,701 EMPOWERING THE COMMUNITIES LIKE 6665 04:28:16,701 --> 04:28:17,769 YOU WERE SAYING, SARAH. 6666 04:28:17,769 --> 04:28:19,070 BECAUSE A LOT OF THOSE 6667 04:28:19,070 --> 04:28:20,905 SOLUTIONS ARE THERE AND THE 6668 04:28:20,905 --> 04:28:22,774 COMMUNITY PARTNERS WITH THEIR 6669 04:28:22,774 --> 04:28:24,142 LIVED EXPERIENCE CAN PROVIDE 6670 04:28:24,142 --> 04:28:25,476 THAT CONFE. THAT IS SOMETIMES 6671 04:28:25,476 --> 04:28:28,980 MISSING WHEN WE ARE REALLY JUST 6672 04:28:28,980 --> 04:28:29,647 FOLLOWING THAT TRADITIONAL 6673 04:28:29,647 --> 04:28:30,248 NON-CREATIVE WAY OF DOING 6674 04:28:30,248 --> 04:28:31,516 THINGS. 6675 04:28:31,516 --> 04:28:32,717 SO THANKS FOR THAT RESPONSE. 6676 04:28:32,717 --> 04:28:34,585 I WOULD LIKE TO MAKE SURE IF 6677 04:28:34,585 --> 04:28:38,156 ANYBODY ELSE WOULD LIKE TO ADD 6678 04:28:38,156 --> 04:28:38,957 INTO SARAH'S THOUGHTS, PLEASE 6679 04:28:38,957 --> 04:28:40,358 GO AHEAD. 6680 04:28:40,358 --> 04:28:41,292 OTHERWISE I CAN KEEP GOING DOWN 6681 04:28:41,292 --> 04:28:42,293 THE LIST. 6682 04:28:42,293 --> 04:28:48,466 QUESTIONS ARE COMING UP. 6683 04:28:48,466 --> 04:28:53,237 I WILL KEEP GOING, IN NIGERIA 6684 04:28:53,237 --> 04:28:55,239 SIERRA LEONE HAVE THEY THOUGHT 6685 04:28:55,239 --> 04:28:57,342 OF OLDER WOMEN PAST THEIR 6686 04:28:57,342 --> 04:29:00,578 CHILDBEARING YEARS IN THEIR 6687 04:29:00,578 --> 04:29:01,879 INTERVENTIONS. OFTEN MOTHERS 6688 04:29:01,879 --> 04:29:03,247 AND GRANDMOTHERS ARE ACTIVE 6689 04:29:03,247 --> 04:29:04,215 PROVIDERS OF CHILD CARE. 6690 04:29:04,215 --> 04:29:06,317 THIS IS A LITTLE IN LINE WITH 6691 04:29:06,317 --> 04:29:07,752 WHAT YOU WERE SAYING, SARAH. 6692 04:29:07,752 --> 04:29:10,722 DO YOU WANT TO CONTINUE THAT 6693 04:29:10,722 --> 04:29:12,623 THOUGHT? 6694 04:29:12,623 --> 04:29:14,759 IT'S PRETTY MUCH AN OPEN 6695 04:29:14,759 --> 04:29:16,661 QUESTION, IF YOU WANT TO 6696 04:29:16,661 --> 04:29:16,894 RESPOND. 6697 04:29:16,894 --> 04:29:19,397 >> I WILL LET NGOZI RESPOND TO 6698 04:29:19,397 --> 04:29:20,198 WHAT HAPPENS. 6699 04:29:20,198 --> 04:29:28,606 >> CAN I ADD MY VOICE TO THAT? 6700 04:29:28,606 --> 04:29:31,309 WE HAVE TOLDER WOMEN WHO LIVE 6701 04:29:31,309 --> 04:29:34,112 IN THE COMMUNITY. 6702 04:29:34,112 --> 04:29:36,247 IN AN EVENT THEY GO TO THE 6703 04:29:36,247 --> 04:29:38,049 MIDDLE OF THE NIGHT THEY TAKE 6704 04:29:38,049 --> 04:29:40,518 CARE OF THE WOMEN AND ALSO IN 6705 04:29:40,518 --> 04:29:40,718 LABOR. 6706 04:29:40,718 --> 04:29:48,159 SO WHAT WE HAVE DONE, WE HAVE 6707 04:29:48,159 --> 04:29:50,395 DEVOLVED THE RULES OF 6708 04:29:50,395 --> 04:29:52,130 ATTENDANCE, THESE ARE OLDER 6709 04:29:52,130 --> 04:29:54,599 WOMEN WHO IN THE COMMUNITY NOW 6710 04:29:54,599 --> 04:29:57,902 THEY ARE IN COLLEGE, NOT AT 6711 04:29:57,902 --> 04:30:00,338 HOME BUT GIVE ADVICE, WE CANNOT 6712 04:30:00,338 --> 04:30:02,673 DISMISS THEM BECAUSE THE BABIES 6713 04:30:02,673 --> 04:30:03,941 DO COME SOMETIMES IN THE MIDDLE 6714 04:30:03,941 --> 04:30:05,843 OF THE NIGHT AND IN TERMS OF 6715 04:30:05,843 --> 04:30:08,880 ISSUE OF ACCESS, WE HAVE WOMEN 6716 04:30:08,880 --> 04:30:11,015 IN THE MOST REMOTE RURAL AREAS 6717 04:30:11,015 --> 04:30:15,420 SO SOME OF THESE TRADITIONAL 6718 04:30:15,420 --> 04:30:17,455 ATTENDANCE ARE OLDER WOMEN 6719 04:30:17,455 --> 04:30:19,590 WITHIN THEIR COMMUNITIES BUT WE 6720 04:30:19,590 --> 04:30:21,092 ARE TRYING TO AVOID HOME 6721 04:30:21,092 --> 04:30:23,061 DELIVERIES BECAUSE OF THE 6722 04:30:23,061 --> 04:30:23,561 COMPLICATIONS AND RISKS 6723 04:30:23,561 --> 04:30:25,129 INVOLVED. 6724 04:30:25,129 --> 04:30:26,931 WE ARE ENCOURAGING THEM IN 6725 04:30:26,931 --> 04:30:29,300 TERMS OF BABY CARE WE ARE 6726 04:30:29,300 --> 04:30:30,468 ENCOURAGING THEM TO BE FOR 6727 04:30:30,468 --> 04:30:32,136 WOMEN TO THE HOSPITAL INSTEAD 6728 04:30:32,136 --> 04:30:33,971 OF DELIVERING THEM AT HOME. 6729 04:30:33,971 --> 04:30:35,840 SO THAT IS MY TAKE ON THAT. 6730 04:30:35,840 --> 04:30:38,276 >> THANK YOU VERY MUCH. 6731 04:30:38,276 --> 04:30:48,553 GO AHEAD, NGOZI. 6732 04:30:55,193 --> 04:30:57,528 >> WHEN A WOMAN DELIVERS HER 6733 04:30:57,528 --> 04:31:00,198 WOMAN COMES AND STAYS WITH HER 6734 04:31:00,198 --> 04:31:01,232 IN THE POSTPARTUM PERIOD, LIKE 6735 04:31:01,232 --> 04:31:03,734 SIX WEEKS. 6736 04:31:03,734 --> 04:31:14,278 SO YOU SEE MOTHERS COME IN FOR 6737 04:31:15,413 --> 04:31:16,147 POSTPARTUM CHECKUP, FOR 6738 04:31:16,147 --> 04:31:16,781 CIRCUMCISION OF THE BOY, ALL 6739 04:31:16,781 --> 04:31:20,785 THAT. 6740 04:31:20,785 --> 04:31:23,321 OLDER WOMEN ARE INTEGRAL PART. 6741 04:31:23,321 --> 04:31:26,190 THEY ALSO PROVIDE MENTAL HEALTH 6742 04:31:26,190 --> 04:31:26,424 SUPPORT. 6743 04:31:26,424 --> 04:31:29,060 A LOT OF YOUNGER WOMEN WHEN 6744 04:31:29,060 --> 04:31:31,295 THEY HAVE CHILDREN, THEY ARE 6745 04:31:31,295 --> 04:31:32,530 STRESSED AND OVERWHELMED. 6746 04:31:32,530 --> 04:31:35,133 SO THE MOTHERS, OLDER WOMEN, 6747 04:31:35,133 --> 04:31:36,534 BACKBONE, SOME WOMEN WILL BREAK 6748 04:31:36,534 --> 04:31:39,303 IF THEIR MOTHERS ARE NOT THERE 6749 04:31:39,303 --> 04:31:40,938 IN PROVIDING POSTPARTUM CARE. 6750 04:31:40,938 --> 04:31:44,142 MOST TIMES WHEN YOU ARE IN THE 6751 04:31:44,142 --> 04:31:44,942 HOSPITAL AND PERSON LABORING, 6752 04:31:44,942 --> 04:31:47,245 THE PERSON THEY ARE CRYING FOR 6753 04:31:47,245 --> 04:31:51,916 ISN'T THE HUB, HUSBAND, THEY 6754 04:31:51,916 --> 04:31:54,018 JUST WANT THE MOTHER THERE. 6755 04:31:54,018 --> 04:31:55,186 WE USUALLY ENGAGE MOTHER WHEN 6756 04:31:55,186 --> 04:31:57,255 IT COMES TO HEALTHCARE 6757 04:31:57,255 --> 04:31:58,256 INTERVENTION. 6758 04:31:58,256 --> 04:32:00,791 WE TELL THE WOMEN TAKE INFORMED 6759 04:32:00,791 --> 04:32:04,929 CONSENT HOME AND TALK TO YOUR 6760 04:32:04,929 --> 04:32:06,931 SIGNIFICANT OTHER, THEY ALSO 6761 04:32:06,931 --> 04:32:10,268 NEED THEY NEED TO TALK TO THEIR 6762 04:32:10,268 --> 04:32:11,402 MOTHERS. MOTHERS NEVER LIE THEY 6763 04:32:11,402 --> 04:32:12,703 TELL YOU THE TRUTH AND HAVE A 6764 04:32:12,703 --> 04:32:14,071 LOT OF EXPERIENCE AND JUST WANT 6765 04:32:14,071 --> 04:32:16,274 THE BEST FOR THEIR KIDS. 6766 04:32:16,274 --> 04:32:18,910 WE ALWAYS INTEGRATE THEM IN OUR 6767 04:32:18,910 --> 04:32:19,610 COMMUNITY ENGAGEMENT AND FOCUS 6768 04:32:19,610 --> 04:32:20,711 GROUP DISCUSSIONS. 6769 04:32:20,711 --> 04:32:23,714 OLDER WOMEN IN THE SOCIETY IS 6770 04:32:23,714 --> 04:32:27,485 VERY IMPORTANT FABRIC FOR 6771 04:32:27,485 --> 04:32:30,087 SOCIETY. 6772 04:32:30,087 --> 04:32:31,122 >> ABSOLUTELY. 6773 04:32:31,122 --> 04:32:32,723 VERY WELL SAID. 6774 04:32:32,723 --> 04:32:34,258 THE COMMENTS RESONATED WITH A 6775 04:32:34,258 --> 04:32:35,760 LOT OF OUR AUDIENCES. I SEE 6776 04:32:35,760 --> 04:32:37,495 THERE'S A COMMENT IN THE CHAT 6777 04:32:37,495 --> 04:32:38,563 YOUR NOVEL APPROACHES COULD BE 6778 04:32:38,563 --> 04:32:41,299 USEFUL HERE IN THE U.S. WHERE 6779 04:32:41,299 --> 04:32:42,466 ESPECIALLY RURAL COMMUNITIES 6780 04:32:42,466 --> 04:32:44,468 HAVE LIMITED ACCESS TO 6781 04:32:44,468 --> 04:32:44,969 HEALTHCARE AND INTERNET 6782 04:32:44,969 --> 04:32:47,672 CONNECTIVITY. 6783 04:32:47,672 --> 04:32:52,543 ISSUES SUCH AS LMIC. 6784 04:32:52,543 --> 04:32:53,744 LEVERAGE THE EXISTING STRENGTHS 6785 04:32:53,744 --> 04:32:55,413 WITHIN THE COMMUNITY, WHETHER 6786 04:32:55,413 --> 04:32:56,948 THAT BE THROUGH COMMUNITY 6787 04:32:56,948 --> 04:32:59,083 HEALTH WORKERS OR OLDER WOMEN, 6788 04:32:59,083 --> 04:33:01,452 INCLUDING THEM IN COMMUNITY 6789 04:33:01,452 --> 04:33:02,853 ENGAGEMENT AND IMPLEMENTATION 6790 04:33:02,853 --> 04:33:05,022 STRATEGY BUT JUST LARGELY THE 6791 04:33:05,022 --> 04:33:07,558 WAY YOU ARE INNOVATIVELY USING 6792 04:33:07,558 --> 04:33:09,594 YOUR INTERVENTIONS TO 6793 04:33:09,594 --> 04:33:11,362 ESSENTIALLY TARGET SOME 6794 04:33:11,362 --> 04:33:15,333 BARRIERS ACROSS-THE-BOARD, NOT 6795 04:33:15,333 --> 04:33:16,834 JUST IN LMIC'S. 6796 04:33:16,834 --> 04:33:19,470 SARAH, DID YOU WANT TO SPEAK TO 6797 04:33:19,470 --> 04:33:19,870 THAT? 6798 04:33:19,870 --> 04:33:21,872 >> I THINK WHAT I LOVE HEARING 6799 04:33:21,872 --> 04:33:23,341 IS REGARDLESS WHERE WE ARE IN 6800 04:33:23,341 --> 04:33:25,009 THE WORLD THERE'S MORE WE CAN 6801 04:33:25,009 --> 04:33:26,377 DO FOR WOMEN BEFORE AND AFTER 6802 04:33:26,377 --> 04:33:27,378 THEIR CARE. 6803 04:33:27,378 --> 04:33:30,214 I KNOW SO MUCH IS FOCUSED ON 6804 04:33:30,214 --> 04:33:31,816 THE ACTUAL DELIVERY, THAT'S A 6805 04:33:31,816 --> 04:33:33,317 VERY INTENSE MOMENT AND A LOT 6806 04:33:33,317 --> 04:33:34,652 OF THINGS CAN GO WRONG. 6807 04:33:34,652 --> 04:33:37,021 BUT SO MUCH OF MATERNAL CARE IS 6808 04:33:37,021 --> 04:33:38,389 ACTUALLY THE MANY MONTHS 6809 04:33:38,389 --> 04:33:39,357 BEFOREHAND AND EVEN A COUPLE 6810 04:33:39,357 --> 04:33:40,491 MONTHS AFTER. 6811 04:33:40,491 --> 04:33:43,294 BECAUSE YOU COULD HAVE 6812 04:33:43,294 --> 04:33:44,228 PREECLAMPSIA AFTERWARDS, RIGHT? 6813 04:33:44,228 --> 04:33:46,364 I THINK THAT IS WHAT IS SO 6814 04:33:46,364 --> 04:33:48,032 AMAZING, THERE IS A LOT OF 6815 04:33:48,032 --> 04:33:50,935 INNOVATION, I THINK, THAT WE 6816 04:33:50,935 --> 04:33:52,603 CAN BRING FORWARD. 6817 04:33:52,603 --> 04:33:55,306 THROUGH ALL THE DIFFERENT 6818 04:33:55,306 --> 04:33:57,475 PRESENTATIONS, REGARDLESS OF 6819 04:33:57,475 --> 04:33:59,176 YOUR LOCATION. 6820 04:33:59,176 --> 04:34:02,413 I'M COMING FROM A FOR-PROFIT 6821 04:34:02,413 --> 04:34:03,648 COMPANY THAT SELLS DIGITAL 6822 04:34:03,648 --> 04:34:07,451 HEALTH TO A CERTAIN KIND OF 6823 04:34:07,451 --> 04:34:08,052 PATIENT. 6824 04:34:08,052 --> 04:34:09,787 EVEN THEN WHAT WE ARE TRYING TO 6825 04:34:09,787 --> 04:34:14,659 DO IS GIVE WOMEN SUPPORT BEFORE 6826 04:34:14,659 --> 04:34:15,559 THE DELIVERY AND OPTIMIZE TO 6827 04:34:15,559 --> 04:34:17,228 MAKE SURE THEY ARE THE 6828 04:34:17,228 --> 04:34:19,297 HEALTHIEST THEY CAN BE FOR THE 6829 04:34:19,297 --> 04:34:20,031 DELIVERY. 6830 04:34:20,031 --> 04:34:22,900 I THINK THAT IS SOMETHING THAT 6831 04:34:22,900 --> 04:34:23,834 IS JUST APPLICABLE EVERYWHERE 6832 04:34:23,834 --> 04:34:25,636 ACROSS THE WORLD. 6833 04:34:25,636 --> 04:34:27,004 >> COMPLETELY AGREE. 6834 04:34:27,004 --> 04:34:27,905 THANK YOU SO MUCH, SARAH. 6835 04:34:27,905 --> 04:34:34,478 I WANT TO BRING A QUESTION 6836 04:34:34,478 --> 04:34:34,912 FORWARD FOR ZALEHA. 6837 04:34:34,912 --> 04:34:36,647 ESSENTIALLY, HOW CAN HEALTHCARE 6838 04:34:36,647 --> 04:34:38,683 PROVIDERS AND ORGANIZATIONS BE 6839 04:34:38,683 --> 04:34:39,850 BETTER INTEGRATED WHEN 6840 04:34:39,850 --> 04:34:45,122 APPROPRIATE TO SUPPORT ADOPTION 6841 04:34:45,122 --> 04:34:46,791 OF INNOVATIVE MATERNAL 6842 04:34:46,791 --> 04:34:48,159 HEALTHCARE DELIVERY METHODS, I 6843 04:34:48,159 --> 04:34:49,460 MEAN YOU TOUCHED UPON IT A 6844 04:34:49,460 --> 04:34:51,395 LITTLE BIT WITH YOUR 6845 04:34:51,395 --> 04:34:54,332 PUBLICATION ON ACCEPTABILITY BY 6846 04:34:54,332 --> 04:34:55,866 THE HEALTHCARE PROVIDERS AND 6847 04:34:55,866 --> 04:34:57,335 PARTICULAR AUDIENCE MEMBER? 6848 04:34:57,335 --> 04:35:02,206 >> ALL RIGHT, THANK YOU, MALIHA. 6849 04:35:02,206 --> 04:35:03,574 IT'S ACTUALLY QUITE CHALLENGING 6850 04:35:03,574 --> 04:35:06,310 TO ENGAGE THE COMMUNITY WITH 6851 04:35:06,310 --> 04:35:08,879 TECHNOLOGICAL INNOVATION 6852 04:35:08,879 --> 04:35:13,017 BECAUSE IT'S SOMETHING NEW AND 6853 04:35:13,017 --> 04:35:15,286 THERE'S AULTZ THIS RESISTANCE 6854 04:35:15,286 --> 04:35:19,390 TO CHANGE. 6855 04:35:19,390 --> 04:35:20,558 THIS MULTI--PRONGED APPROACH 6856 04:35:20,558 --> 04:35:22,927 YOU HAVE TO TAKE, RIGHT FROM 6857 04:35:22,927 --> 04:35:25,596 THE TOP ENGAGING THE HIGHEST 6858 04:35:25,596 --> 04:35:26,797 AUTHORITIES IN THE MINISTRY, 6859 04:35:26,797 --> 04:35:29,233 FOR EX E., RIGHT DOWN TO THE 6860 04:35:29,233 --> 04:35:31,001 MASSES, LIKE THE KNOWLEDGE, 6861 04:35:31,001 --> 04:35:32,036 ATTITUDE AND PERCEPTIONS, THE 6862 04:35:32,036 --> 04:35:38,709 WAY THAT WE DID TO ASSESS THE 6863 04:35:38,709 --> 04:35:42,079 THOUGHTS AND FEELINGS OF PEOPLE 6864 04:35:42,079 --> 04:35:44,382 AT THE BOTTOM, WHAT THEY 6865 04:35:44,382 --> 04:35:46,784 THOUGHT ABOUT A CERTAIN 6866 04:35:46,784 --> 04:35:48,219 TECHNOLOGICAL INNOVATION. 6867 04:35:48,219 --> 04:35:50,221 FOR EXAMPLE, IF I COULD GIVE 6868 04:35:50,221 --> 04:35:52,256 YOU ANOTHER EXAMPLE OF AN 6869 04:35:52,256 --> 04:36:01,165 INNOVATION THAT WE DID. 6870 04:36:01,165 --> 04:36:11,709 SOMETHING LIKE WHAT NGOZI DID IN 6871 04:36:12,042 --> 04:36:16,881 NIGERIA, MALAYSIAN OBSTETRIC 6872 04:36:16,881 --> 04:36:20,151 MONITORING SYSTEM OR MY MOMS. 6873 04:36:20,151 --> 04:36:22,686 WE CONDUCTED A PUBLIC WEBINAR 6874 04:36:22,686 --> 04:36:22,920 AS WELL. 6875 04:36:22,920 --> 04:36:25,256 I BELIEVE THE VISIBILITY THE 6876 04:36:25,256 --> 04:36:26,424 EXISTENCE OF THE INNOVATION IS 6877 04:36:26,424 --> 04:36:29,727 VERY IMPORTANT. 6878 04:36:29,727 --> 04:36:31,962 MY MOMS IS THE DIGITAL VERSION 6879 04:36:31,962 --> 04:36:39,036 OF OUR PATIENT HEALTH AND CARE 6880 04:36:39,036 --> 04:36:42,406 RECORDS WITH DUAL USER 6881 04:36:42,406 --> 04:36:43,974 INTERFACE, PATIENT USER 6882 04:36:43,974 --> 04:36:46,544 INTERVASE, VIA SMARTPHONE LIKE 6883 04:36:46,544 --> 04:36:48,913 WHAT NGOZI PRESENTED. 6884 04:36:48,913 --> 04:36:50,581 AND PARTNERED WITH LOCAL I.T. 6885 04:36:50,581 --> 04:36:51,549 INDUSTRY IN DEVELOPING THE 6886 04:36:51,549 --> 04:36:55,186 SYSTEM. 6887 04:36:55,186 --> 04:36:57,455 MOST RECENTLY MY MONS HAS BEEN 6888 04:36:57,455 --> 04:37:00,157 APPROVED FOR CLINICAL USE BY 6889 04:37:00,157 --> 04:37:02,626 THE MANAGEMENT TEAM OF ACADEMIC 6890 04:37:02,626 --> 04:37:04,028 MEDICAL CENTER WHICH IS 6891 04:37:04,028 --> 04:37:04,728 SIGNIFICANT BREAK THROUGH FOR 6892 04:37:04,728 --> 04:37:07,398 US. 6893 04:37:07,398 --> 04:37:15,105 SYSTEM CAN , EVENTUALLY TURN 6894 04:37:15,105 --> 04:37:18,075 BIG DATA BEGINNING OF DIGITAL 6895 04:37:18,075 --> 04:37:19,643 COHORT FOR OUR POPULATION. 6896 04:37:19,643 --> 04:37:22,279 I WOULD SAY THAT'S THE 6897 04:37:22,279 --> 04:37:25,549 BEGINNING TO GET THE COMMUNITY 6898 04:37:25,549 --> 04:37:27,017 ACCEPT YOUR TECHNOLOGICAL 6899 04:37:27,017 --> 04:37:28,686 INNOVATION BY KEEP, WORKING AT 6900 04:37:28,686 --> 04:37:30,421 MAKING PEOPLE AWARE THAT THE 6901 04:37:30,421 --> 04:37:31,288 PRODUCT IS AVAILABLE FOR THEM 6902 04:37:31,288 --> 04:37:35,926 TO USE. 6903 04:37:35,926 --> 04:37:37,628 INDUSTRY COLLABORATION I WOULD 6904 04:37:37,628 --> 04:37:40,164 SAY IS VITAL AND VERY USEFUL. 6905 04:37:40,164 --> 04:37:41,499 THERE IS LESS BUREAUCRACY AND 6906 04:37:41,499 --> 04:37:45,236 YOU WILL BE ABLE TO PROGRESS 6907 04:37:45,236 --> 04:37:46,437 FASTER, INDUSTRY COLLABORATION 6908 04:37:46,437 --> 04:37:47,738 PROVIDES STRONG SUPPORT SYSTEM 6909 04:37:47,738 --> 04:37:50,508 ESPECIALLY IF THERE IS GENERAL 6910 04:37:50,508 --> 04:37:51,642 ENCOURAGEMENT FROM THE 6911 04:37:51,642 --> 04:37:52,276 GOVERNMENT FOR PUBLIC PRIVATE 6912 04:37:52,276 --> 04:37:52,576 PARTNERSHIP. 6913 04:37:52,576 --> 04:37:53,777 THANK YOU. 6914 04:37:53,777 --> 04:37:59,416 >> THANK YOU SO MUCH, ZALEHA, 6915 04:37:59,416 --> 04:38:01,318 MANY ARE JOINING FROM DIFFERENT 6916 04:38:01,318 --> 04:38:06,323 TIME ZONES AND THROUGHOUT THE 6917 04:38:06,323 --> 04:38:07,825 WORKSHOP MODERATORS AND 6918 04:38:07,825 --> 04:38:10,594 SPEAKERS HAVE BEEN FABULOUS. 6919 04:38:10,594 --> 04:38:12,730 BUT ZALEHA AS WE ARE CHATTING I 6920 04:38:12,730 --> 04:38:13,864 KNOW IT'S 3:00 IN THE MORNING 6921 04:38:13,864 --> 04:38:14,732 FOR YOU. 6922 04:38:14,732 --> 04:38:17,101 THANK YOU FOR BEING HERE AND 6923 04:38:17,101 --> 04:38:18,102 SHARING SO MUCH MAZING 6924 04:38:18,102 --> 04:38:19,370 INFORMATION, AND SO MUCH OF THE 6925 04:38:19,370 --> 04:38:20,504 WORK YOU ARE DOING. 6926 04:38:20,504 --> 04:38:24,341 I WILL KEEP THE QUESTIONS 6927 04:38:24,341 --> 04:38:25,843 GOING, UNLESS ANYONE ELSE, AND 6928 04:38:25,843 --> 04:38:28,012 PANEL IF THERE'S A QUESTION YOU 6929 04:38:28,012 --> 04:38:29,780 WANT TO ADD, GO AHEAD, WE DON'T 6930 04:38:29,780 --> 04:38:31,715 HAVE TO KEEP IT STRUCTURED WE 6931 04:38:31,715 --> 04:38:33,450 CAN KEEP IT VERY ORGANIC. 6932 04:38:33,450 --> 04:38:35,819 BUT I WAS GOING TO DIRECT MY 6933 04:38:35,819 --> 04:38:37,888 NEXT QUESTION TO SARAH, WHAT 6934 04:38:37,888 --> 04:38:39,924 ARE THE COMMON CHALLENGES AND 6935 04:38:39,924 --> 04:38:41,725 BARRIERS TO ADOPTION THAT YOU 6936 04:38:41,725 --> 04:38:44,795 HAVE ENCOUNTERED WHEN TRYING TO 6937 04:38:44,795 --> 04:38:45,863 INTRODUCE INNOVATIVE CARE 6938 04:38:45,863 --> 04:38:47,464 DELIVERY METHODS IN MATERNAL 6939 04:38:47,464 --> 04:38:49,900 HEALTH AND HOW DO YOU THINK 6940 04:38:49,900 --> 04:38:50,834 IMPLEMENTATION SCIENCE COULD 6941 04:38:50,834 --> 04:38:52,937 HELP ADDRESS THE I CHALLENGE. 6942 04:38:52,937 --> 04:38:57,942 >> SO YOU KNOW, WE ARE DIGITAL 6943 04:38:57,942 --> 04:38:59,009 HEALTH, TELEHEALTH DIGITAL 6944 04:38:59,009 --> 04:39:02,446 HEALTH STRENGTH IS THE GREATEST 6945 04:39:02,446 --> 04:39:02,947 STRENGTH AND CHALLENGE. 6946 04:39:02,947 --> 04:39:04,315 IF YOU HAVE SMARTPHONE, WI-FI, 6947 04:39:04,315 --> 04:39:06,150 BUT IT'S ALSO MUCH EASIER TO 6948 04:39:06,150 --> 04:39:08,819 MISS A CALL, THAN TO MISS AN 6949 04:39:08,819 --> 04:39:09,620 IN-PERSON APPOINTMENT THAT YOU 6950 04:39:09,620 --> 04:39:14,058 HAVE TO TAKE A HALF DAY OFF OF 6951 04:39:14,058 --> 04:39:14,325 WORK FOR. 6952 04:39:14,325 --> 04:39:16,961 SO IN THE BRICK AND MORTAR 6953 04:39:16,961 --> 04:39:19,597 SYSTEM, EXPERIENCE IS OFTEN 6954 04:39:19,597 --> 04:39:20,531 SECONDARY, WE EXPECT PATIENTS 6955 04:39:20,531 --> 04:39:22,666 TO COME AND WE DON'T REALLY 6956 04:39:22,666 --> 04:39:24,234 WORRY WHAT THE OFFICE LOOKS 6957 04:39:24,234 --> 04:39:26,604 LIKE OR SOMEBODY IS LIKE, 6958 04:39:26,604 --> 04:39:28,205 BEFORE DIGITAL HEALTH AND 6959 04:39:28,205 --> 04:39:29,306 TELEHEALTH, EXPERIENCE IS HOW 6960 04:39:29,306 --> 04:39:31,342 WE GET ACCESS TO THE PATIENT. 6961 04:39:31,342 --> 04:39:32,242 BECAUSE IF YOU DON'T ENGAGE 6962 04:39:32,242 --> 04:39:33,644 THEM THEY DON'T HAVE TO TURN 6963 04:39:33,644 --> 04:39:36,280 THE PHONE ON OR OPEN THE APP OR 6964 04:39:36,280 --> 04:39:37,915 ANSWER YOUR CALL, RIGHT? 6965 04:39:37,915 --> 04:39:40,751 I THINK ONE OF THE THINGS WE 6966 04:39:40,751 --> 04:39:43,053 SEE, FOR PROVIDERS IN THIS KIND 6967 04:39:43,053 --> 04:39:45,222 OF CARE DELIVERY SPACE, WE HAVE 6968 04:39:45,222 --> 04:39:47,124 TO MAKE THE EXPERIENCE ENGAGING 6969 04:39:47,124 --> 04:39:49,093 AND WE CAN'T JUST BLAME THE 6970 04:39:49,093 --> 04:39:50,828 PATIENT FOR NOT ENGAGING. 6971 04:39:50,828 --> 04:39:52,162 SOMETIMES THE CONVERSATION IS 6972 04:39:52,162 --> 04:39:55,599 THE PATIENT IS NOT ENGAGING, 6973 04:39:55,599 --> 04:40:01,038 THEY ARE NOT ADHERENT. 6974 04:40:01,038 --> 04:40:03,741 WE PUT THAT BURDEN ON THEM. 6975 04:40:03,741 --> 04:40:06,010 BUT OUR JOB, WHERE 6976 04:40:06,010 --> 04:40:07,177 IMPLEMENTATION SCIENCE COMES 6977 04:40:07,177 --> 04:40:09,980 IN, THERE'S NO ONE SIZE FITS 6978 04:40:09,980 --> 04:40:10,147 ALL. 6979 04:40:10,147 --> 04:40:11,415 EVERY COMMUNITY IS DIFFERENT. 6980 04:40:11,415 --> 04:40:15,352 EVERY TYPE OF PATIENT ENGAGES 6981 04:40:15,352 --> 04:40:15,653 DIFFERENTLY. 6982 04:40:15,653 --> 04:40:17,021 SOME PEOPLE LOVE APPOINTMENTS 6983 04:40:17,021 --> 04:40:17,955 WITH THEIR PROVIDERS. OTHERS 6984 04:40:17,955 --> 04:40:19,790 DON'T WANT TO MEET WITH A PRAO 6985 04:40:19,790 --> 04:40:21,992 VIEDER, THEY WANT TO LEARN 6986 04:40:21,992 --> 04:40:26,997 EVERYTHING THEMSELVES, WHAT WE 6987 04:40:26,997 --> 04:40:27,865 CALL ASYNCHRONOUS LEARNERS, SO 6988 04:40:27,865 --> 04:40:30,000 WE HAVE TO USE IMPLEMENTATION 6989 04:40:30,000 --> 04:40:32,236 SCIENCE FRAME WONGERS TO 6990 04:40:32,236 --> 04:40:33,837 UNDERSTAND AND BREAK DOWN WHERE 6991 04:40:33,837 --> 04:40:37,574 THE GAPS ARE FOR UNIQUE MENTOR 6992 04:40:37,574 --> 04:40:40,778 SEGMENTS BUT ANOTHER WORD IS 6993 04:40:40,778 --> 04:40:41,679 COMMUNITIES JUST DIFFERENT 6994 04:40:41,679 --> 04:40:44,048 TYPESES OF MEMBERS OR PATIENTS. 6995 04:40:44,048 --> 04:40:46,417 MAYBE MORE OF A TECH FIELD WORD 6996 04:40:46,417 --> 04:40:47,685 BUT AB TESTING. 6997 04:40:47,685 --> 04:40:49,453 YOU TRY SOMETHING, YOU MEASURE 6998 04:40:49,453 --> 04:40:51,288 IT, YOU PILOT IT, FIGURE OUT 6999 04:40:51,288 --> 04:40:51,922 WHAT DIDN'T WORK. 7000 04:40:51,922 --> 04:40:53,524 YOU TRY IT AGAIN, MEASURE IT 7001 04:40:53,524 --> 04:40:54,491 AND USE DATA. 7002 04:40:54,491 --> 04:40:57,294 I THINK THAT IS REALLY WHERE 7003 04:40:57,294 --> 04:40:58,729 IMPLEMENTATION SCIENCE COMES IN. 7004 04:40:58,729 --> 04:41:00,631 >> COMPLETELY AGREE. 7005 04:41:00,631 --> 04:41:04,101 I WONDER HOW YOU WERE TALKING 7006 04:41:04,101 --> 04:41:04,768 ABOUT ASYNCHRONOUS LEARNING, 7007 04:41:04,768 --> 04:41:07,504 VERSUS BEING IN THE PROVIDER'S 7008 04:41:07,504 --> 04:41:07,738 OFFICE. 7009 04:41:07,738 --> 04:41:08,706 I'M GUESSING THERE'S PROBABLY 7010 04:41:08,706 --> 04:41:10,974 AN AGE DIFFERENCE OR 7011 04:41:10,974 --> 04:41:13,043 DEMOGRAPHIC DIFFERENCE YOU 7012 04:41:13,043 --> 04:41:16,146 PROBABLY SEE IN TERMS 7013 04:41:16,146 --> 04:41:17,548 DEMOGRAPHIC YOU SEE. 7014 04:41:17,548 --> 04:41:20,150 >> YEAH, IT'S INTERESTING, WE 7015 04:41:20,150 --> 04:41:21,919 ARE FOCUSED ON MATERNAL HEALTH 7016 04:41:21,919 --> 04:41:24,888 HERE BUT WE ALSO PROVIDE 7017 04:41:24,888 --> 04:41:27,858 MENOPAUSE SUPPORTMENT WE SEE 7018 04:41:27,858 --> 04:41:30,427 DIGITAL LITERACY IS DIFFERENT 7019 04:41:30,427 --> 04:41:31,161 BETWEEN MENOPAUSE MEMBERS, ALSO 7020 04:41:31,161 --> 04:41:32,496 DPER TILT. 7021 04:41:32,496 --> 04:41:34,098 SOMETIMES WHEN YOU GO YOUNGER, 7022 04:41:34,098 --> 04:41:35,499 THE WAY THEY USE TECHNOLOGY IS 7023 04:41:35,499 --> 04:41:36,200 DIFFERENT. 7024 04:41:36,200 --> 04:41:37,534 THAT IS SOMETHING YOU HAVE TO 7025 04:41:37,534 --> 04:41:41,939 ACCOUNT FOR. 7026 04:41:41,939 --> 04:41:43,207 >> ABSOLUTELY. 7027 04:41:43,207 --> 04:41:44,208 THANK YOU, SARAH. 7028 04:41:44,208 --> 04:41:46,677 IF WE ARE OKAY, I WILL KEEP 7029 04:41:46,677 --> 04:41:47,544 MOVING FORWARD. 7030 04:41:47,544 --> 04:41:49,847 THANK YOU TO OUR PANELISTS FOR 7031 04:41:49,847 --> 04:41:50,881 ANSWERING THESE QUESTIONS AND 7032 04:41:50,881 --> 04:41:52,850 HELPING US MOVE THE DISCUSSION 7033 04:41:52,850 --> 04:41:55,085 ALONG. 7034 04:41:55,085 --> 04:41:59,289 MY NEXT QUESTION WAS FOR NGOZI. 7035 04:41:59,289 --> 04:42:01,291 HOW CAN IMPLEMENTATION SCIENCE 7036 04:42:01,291 --> 04:42:04,361 PRINCIPLES BE APPLIED TONE SURE 7037 04:42:04,361 --> 04:42:05,896 INNOVATIVE MATERNAL HEALTHCARE 7038 04:42:05,896 --> 04:42:06,697 DELIVERY METHODS ARE 7039 04:42:06,697 --> 04:42:08,465 SUSTAINABLE AND SCAPABLE IN THE 7040 04:42:08,465 --> 04:42:10,134 LONG TERM? 7041 04:42:10,134 --> 04:42:12,302 >> OKAY, SO LIKE SARAH SAID, 7042 04:42:12,302 --> 04:42:18,075 YOU KNOW, YOU NEED TO APPLY 7043 04:42:18,075 --> 04:42:20,144 THIS IMPLEMENTATION FRAMEWORKS 7044 04:42:20,144 --> 04:42:22,212 TO YOUR INTERVENTION, 7045 04:42:22,212 --> 04:42:25,015 DELIVERING YOUR INTERVENTION, 7046 04:42:25,015 --> 04:42:35,559 FOR INSTANCE WE HAVE -- WHEN 7047 04:42:35,859 --> 04:42:37,928 YOU ARE DOING THE EXPLORATION, 7048 04:42:37,928 --> 04:42:39,997 THERE'S A LOT OF COMMUNITY 7049 04:42:39,997 --> 04:42:41,532 ENGAGEMENT GOING ON. 7050 04:42:41,532 --> 04:42:44,234 YOU ARE USING THOSE FRAMEWORKS. 7051 04:42:44,234 --> 04:42:45,402 YOU ALSO ARE LOOKING AT WHEN 7052 04:42:45,402 --> 04:42:47,237 YOU ARE LOOKING AT THE PLANNING 7053 04:42:47,237 --> 04:42:49,373 STAGE, THERE'S ALSO A LOT OF 7054 04:42:49,373 --> 04:42:52,976 COMMUNITY ENGAGEMENT AND YOU 7055 04:42:52,976 --> 04:42:54,878 ARE ALSO ACCESSING THE BARRIERS 7056 04:42:54,878 --> 04:42:56,113 TO THE PARTICULAR INTERVENTION 7057 04:42:56,113 --> 04:43:00,184 YOU ARE GOING TO BE 7058 04:43:00,184 --> 04:43:00,651 IMPLEMENTING IN THESE 7059 04:43:00,651 --> 04:43:08,725 COMMUNITIES. 7060 04:43:08,725 --> 04:43:12,830 YOU DON'T GO INTO THE 7061 04:43:12,830 --> 04:43:14,331 COMMUNITIES BLINDED, IT GUIDES 7062 04:43:14,331 --> 04:43:17,167 YOU ON THINGS YOU ARE GOING TO 7063 04:43:17,167 --> 04:43:17,868 APPROACH THE COMMUNITIES 7064 04:43:17,868 --> 04:43:20,704 BECAUSE A LOT OF OUR WORKERS 7065 04:43:20,704 --> 04:43:22,406 ARE IN THE COMMUNITY, IN 7066 04:43:22,406 --> 04:43:24,474 NIGERIA YOU KNOW WE HAVE MORE 7067 04:43:24,474 --> 04:43:26,410 THAN 200 ETHNIC GROUPS AND MORE 7068 04:43:26,410 --> 04:43:29,980 THAN 200 HLAING WANLS WITH SIX 7069 04:43:29,980 --> 04:43:32,049 REGIONS. WE WORK ACROSS ALL THE 7070 04:43:32,049 --> 04:43:34,585 REGIONS. SO WHAT WORKS FOR ONE 7071 04:43:34,585 --> 04:43:36,587 REGION, DOESN'T USUALLY WORK 7072 04:43:36,587 --> 04:43:37,020 FOR ANOTHER REGION. 7073 04:43:37,020 --> 04:43:39,122 SO WE HAVE A LOT OF 7074 04:43:39,122 --> 04:43:41,925 CO-CREATIVE, WE HAVE A LOT OF 7075 04:43:41,925 --> 04:43:43,193 STAKEHOLDER ENGAGEMENTS, A LOT 7076 04:43:43,193 --> 04:43:45,295 OF DISCUSSIONS BACK AND FORTH. 7077 04:43:45,295 --> 04:43:47,965 FOR INSTANCE, LIKE THE BABY 7078 04:43:47,965 --> 04:43:52,002 SHOWER WE FOUND THAT WAS 7079 04:43:52,002 --> 04:43:53,770 POSSIBLE THROUGH PHASE OF ONE 7080 04:43:53,770 --> 04:43:56,340 OUR STUDIES BUT THE BABY SHOWER 7081 04:43:56,340 --> 04:44:01,445 WAS BASICALLY DESIGNED FOR THE 7082 04:44:01,445 --> 04:44:01,912 CHURCH, THE CHRISTIAN 7083 04:44:01,912 --> 04:44:03,313 COMMUNITIES. 7084 04:44:03,313 --> 04:44:06,850 WE FOUND OUT WE COULD ADAPT IT 7085 04:44:06,850 --> 04:44:09,353 FOR THE MUSLIM COMMUNITIES. 7086 04:44:09,353 --> 04:44:11,989 WE BROUGHT TOGETHER COMMUNITY 7087 04:44:11,989 --> 04:44:14,591 LEADERS AND RELIGION LEADERS, 7088 04:44:14,591 --> 04:44:17,327 AND WE ADAPTED BABY SHOWER FOR 7089 04:44:17,327 --> 04:44:18,528 THE MUSLIM COMMUNITY AND WAS 7090 04:44:18,528 --> 04:44:22,099 ABLE TO USE IT. 7091 04:44:22,099 --> 04:44:24,301 FOR FOR IMPLEMENTATION 7092 04:44:24,301 --> 04:44:27,004 PRINCIPLES, LOT OF CO-CREATION 7093 04:44:27,004 --> 04:44:28,038 STRATEGIES, PLANNING, IF YOU 7094 04:44:28,038 --> 04:44:31,441 FOLLOW THE STAGES OF THOSE 7095 04:44:31,441 --> 04:44:33,610 PHASES, YOU SEE IT KIND OF 7096 04:44:33,610 --> 04:44:39,249 GUIDES YOUR INTERVENTION, IT 7097 04:44:39,249 --> 04:44:42,386 HELPS YOU PAY ATTENTION TO THE 7098 04:44:42,386 --> 04:44:45,656 NITTY-GRITTY DETAILS THAT 7099 04:44:45,656 --> 04:44:48,091 NORMALLY YOU MIGHT OVERLOOK, 7100 04:44:48,091 --> 04:44:51,295 FOR INSTANCE, TO CREATE A 7101 04:44:51,295 --> 04:44:53,830 COMMUNITY ADVICE REPORT, IF YOU 7102 04:44:53,830 --> 04:44:56,433 DO NOT DO THE EXPLORATION PHASE 7103 04:44:56,433 --> 04:44:58,368 YOU WILL NOT KNOW IN SOME 7104 04:44:58,368 --> 04:44:59,836 COMMUNITIES YOU NEED TO CREATE 7105 04:44:59,836 --> 04:45:01,571 A CBA. 7106 04:45:01,571 --> 04:45:03,774 BECAUSE WHAT IS ACCEPTED IN ONE 7107 04:45:03,774 --> 04:45:05,943 COMMUNITY IS USUALLY NOT 7108 04:45:05,943 --> 04:45:07,844 ACCEPTED IN THAT COMMUNITY. 7109 04:45:07,844 --> 04:45:10,881 SOME COMMUNITIES THAT HAVE 7110 04:45:10,881 --> 04:45:12,783 CBA'S CREATED FROM TRADITIONAL 7111 04:45:12,783 --> 04:45:15,185 LEADER, RELIGION LEADER, THE 7112 04:45:15,185 --> 04:45:16,653 COMMUNITY LEADER, THE KING, THE 7113 04:45:16,653 --> 04:45:18,155 HEALTH WORKER. 7114 04:45:18,155 --> 04:45:20,023 WHY IN SOME OTHER COMMUNITIES 7115 04:45:20,023 --> 04:45:21,124 JUST GOING INTO THE COMMUNITY 7116 04:45:21,124 --> 04:45:23,193 IS FINE. 7117 04:45:23,193 --> 04:45:24,428 EVERYBODY LISTENS TO THE 7118 04:45:24,428 --> 04:45:25,729 COMMUNITY LEADER. 7119 04:45:25,729 --> 04:45:28,231 THEY DON'T WANT ANY OTHER 7120 04:45:28,231 --> 04:45:31,401 PERSON INTERFERING WITH THAT. 7121 04:45:31,401 --> 04:45:31,935 IMPLEMENTATION FRAMEWORK 7122 04:45:31,935 --> 04:45:35,238 ACTUALLY HELPED US IN OUR 7123 04:45:35,238 --> 04:45:38,976 INTERVENTION TO ACTUALLY TAILOR 7124 04:45:38,976 --> 04:45:39,810 OUR INTERVENTIONS WITH CONTEXT 7125 04:45:39,810 --> 04:45:41,278 SPECIFIC. 7126 04:45:41,278 --> 04:45:44,748 WE MAY BE ONE COUNTRY, ONE 7127 04:45:44,748 --> 04:45:47,818 ETHNIC GROUP WITH DIFFERENT 7128 04:45:47,818 --> 04:45:48,885 ETHNICITY, DIFFERENT LANGUAGES 7129 04:45:48,885 --> 04:45:50,620 AND DIFFERENT BELIEF SYSTEM AND 7130 04:45:50,620 --> 04:45:54,091 CULTURAL PRACTICES. 7131 04:45:54,091 --> 04:45:55,158 >> ABSOLUTELY, NGOZI, I THINK 7132 04:45:55,158 --> 04:45:57,427 YOU HIT THE NAIL ON THE HEAD. 7133 04:45:57,427 --> 04:45:58,762 AS YOU SAID, FRAMEWORKS DEFINE 7134 04:45:58,762 --> 04:46:00,197 HOW WE CONDUCT THE RESEARCH. 7135 04:46:00,197 --> 04:46:02,766 BUT IT'S A BIT OF A RESEARCH 7136 04:46:02,766 --> 04:46:07,371 GAP WHERE CENTERING THE 7137 04:46:07,371 --> 04:46:08,305 COMMUNITIES IN THOSE FRAMEWORKS 7138 04:46:08,305 --> 04:46:11,575 HASN'T BEEN DONE AS INTENSELY 7139 04:46:11,575 --> 04:46:13,643 AS SOME PROJECTS SO REALLY 7140 04:46:13,643 --> 04:46:15,812 CENTERING THOSE COMMUNITIES AND 7141 04:46:15,812 --> 04:46:17,581 THE IMPLEMENTATION FRAMEWORKS 7142 04:46:17,581 --> 04:46:18,982 AROUND HEALTH EQUITY IS WHAT'S 7143 04:46:18,982 --> 04:46:20,517 REALLY NEEDED TO HAPPEN. 7144 04:46:20,517 --> 04:46:22,219 YOU ARE WORKING TOWARDS A GOAL 7145 04:46:22,219 --> 04:46:23,754 THAT WILL ACTUALLY BENEFIT THE 7146 04:46:23,754 --> 04:46:25,155 COMMUNITY AND NOT JUST RESULT 7147 04:46:25,155 --> 04:46:27,290 IN PAPERS SO THAT OUR RESEARCH 7148 04:46:27,290 --> 04:46:29,393 REALLY GOES FROM THE BENCH TO 7149 04:46:29,393 --> 04:46:30,794 THE BOOKSHELF BUT RESULTS IN 7150 04:46:30,794 --> 04:46:31,928 IMPACT TO THE COMMUNITIES. 7151 04:46:31,928 --> 04:46:34,031 WE HAVE ANOTHER QUESTION IN THE 7152 04:46:34,031 --> 04:46:34,231 CHAT. 7153 04:46:34,231 --> 04:46:35,766 I THINK IT'S ADDRESSED LARGELY 7154 04:46:35,766 --> 04:46:39,169 TO THE PANELISTS SO ANYONE IS 7155 04:46:39,169 --> 04:46:39,536 FREE TO RESPOND. 7156 04:46:39,536 --> 04:46:40,937 HOW COULD REGULATORY BODIES 7157 04:46:40,937 --> 04:46:43,040 ENSURE ETHICAL CONCERNS ARE 7158 04:46:43,040 --> 04:46:44,574 ADDRESSED WHILE PROMOTING 7159 04:46:44,574 --> 04:46:46,309 INNOVATION AND PATIENT DATA 7160 04:46:46,309 --> 04:46:46,610 MANAGEMENT. 7161 04:46:46,610 --> 04:46:52,849 EXCELLENT QUESTION. 7162 04:46:52,849 --> 04:46:58,021 ANYONE CAN JUMP IN. 7163 04:46:58,021 --> 04:47:01,925 >> THE QUESTION IS, HELLO, YOU 7164 04:47:01,925 --> 04:47:03,527 ARE LOOKING AT REGULATING 7165 04:47:03,527 --> 04:47:04,027 BODIES. 7166 04:47:04,027 --> 04:47:05,429 >> CORRECT. 7167 04:47:05,429 --> 04:47:09,132 >> YOU HAVE A LOT OF RESEARCH 7168 04:47:09,132 --> 04:47:17,307 GOING ON IN COMMUNITIES. 7169 04:47:17,307 --> 04:47:18,909 IT'S IMPORTANT SOCIETIES ARE 7170 04:47:18,909 --> 04:47:20,977 AWARE WE HAVE HUMAN RIGHTS 7171 04:47:20,977 --> 04:47:24,347 ISSUES. IN ORDER FOR YOU TO 7172 04:47:24,347 --> 04:47:28,151 ACCESS, THE VULNERABLE 7173 04:47:28,151 --> 04:47:30,787 POPULATIONS ARE OFTEN MISUSED 7174 04:47:30,787 --> 04:47:31,221 AND OVER RESEARCHED. 7175 04:47:31,221 --> 04:47:33,356 SO IN TERMS OF ETHICAL, IT'S 7176 04:47:33,356 --> 04:47:35,025 IMPORTANT THAT AN ETHICAL 7177 04:47:35,025 --> 04:47:36,526 APPROVALS ARE GRANTED FOR 7178 04:47:36,526 --> 04:47:37,561 RESEARCH STUDIES. 7179 04:47:37,561 --> 04:47:41,164 AND ALSO IN TERMS OF, LET'S SAY 7180 04:47:41,164 --> 04:47:42,532 YOU HAVE NEW INNOVATIONS YOU 7181 04:47:42,532 --> 04:47:44,835 WANT DO HAVE TESTED, I THINK 7182 04:47:44,835 --> 04:47:46,403 THE PHARMACY, THE 7183 04:47:46,403 --> 04:47:47,671 PHARMACEUTICAL AND BOARD SHOULD 7184 04:47:47,671 --> 04:47:49,439 COME ON BOARD TO ENSURE THEY 7185 04:47:49,439 --> 04:47:51,108 ARE SAFE AND THEY ARE OF GOOD 7186 04:47:51,108 --> 04:47:52,542 QUALITY. 7187 04:47:52,542 --> 04:48:00,884 THEN I THINK WE NEED TO HAVE 7188 04:48:00,884 --> 04:48:01,985 RESEARCH STUDIES CONDUCTED, SO 7189 04:48:01,985 --> 04:48:03,487 WE KNOW WHERE WE ARE AND HOW 7190 04:48:03,487 --> 04:48:07,190 SAFE THINGS ARE. 7191 04:48:07,190 --> 04:48:10,127 I THINK IT'S WRONG TO START OFF 7192 04:48:10,127 --> 04:48:11,728 A NEW PRODUCT WITHOUT INFORMING 7193 04:48:11,728 --> 04:48:16,466 SOCIETY ABOUT IT. 7194 04:48:16,466 --> 04:48:17,767 WE HAVE INSTITUTION AND RHODE 7195 04:48:17,767 --> 04:48:20,270 ISLAND VIEW BOARDS AND ALSO 7196 04:48:20,270 --> 04:48:22,806 ETHICAL REVIEW BODIES SO ISSUES 7197 04:48:22,806 --> 04:48:26,009 LIKE THINGS LIKE MATERIAL AND 7198 04:48:26,009 --> 04:48:26,443 TRANSFER AGREEMENT. 7199 04:48:26,443 --> 04:48:27,544 ALL OF THESE ARE BUILT INTO 7200 04:48:27,544 --> 04:48:29,746 MOST OF THE RESEARCH 7201 04:48:29,746 --> 04:48:31,548 APPLICATIONS NOWADAYS SO PEOPLE 7202 04:48:31,548 --> 04:48:33,583 AREN'T TAKING ADVANTAGE. 7203 04:48:33,583 --> 04:48:37,320 SO IT'S VERY IMPORTANT. 7204 04:48:37,320 --> 04:48:38,188 ESPECIALLY FOR LOW-MIDDLE 7205 04:48:38,188 --> 04:48:40,423 INCOME COUNTRIES WE HAVE LOW 7206 04:48:40,423 --> 04:48:41,525 LEVELS OF EDUCATION, SO WOMEN 7207 04:48:41,525 --> 04:48:43,293 AND CHILDREN THEY ARE NOT AWARE 7208 04:48:43,293 --> 04:48:45,128 OF SOME OF THEIR RIGHTS SO IT'S 7209 04:48:45,128 --> 04:48:46,663 IMPORTANT THEY ARE PROTECT AT 7210 04:48:46,663 --> 04:48:47,164 SOME POINT. 7211 04:48:47,164 --> 04:48:52,769 SO I THINK THE ETHICAL AND 7212 04:48:52,769 --> 04:48:53,970 COMMUNITIES THEY HAVE ROLES TO 7213 04:48:53,970 --> 04:48:58,408 PLAY IN TERMS OF INNOVATING. 7214 04:48:58,408 --> 04:48:59,910 PEOPLE TRUST THEIR SYSTEM. 7215 04:48:59,910 --> 04:49:02,379 PEOPLE TRUST THE SERVICE 7216 04:49:02,379 --> 04:49:03,747 PROVIDERS. SO AS HEALTHCARE 7217 04:49:03,747 --> 04:49:05,815 PROVIDERS I THINK WE ARE IN A 7218 04:49:05,815 --> 04:49:06,917 POSITION TO ENSURE THAT 7219 04:49:06,917 --> 04:49:08,385 WHATEVER, YOU KNOW, IS TESTED 7220 04:49:08,385 --> 04:49:11,221 OUT THERE IS BASED ON EVIDENCE 7221 04:49:11,221 --> 04:49:13,924 AND PROVEN TO BE SAFE, OF GOOD 7222 04:49:13,924 --> 04:49:15,425 QUALITY AND DOES NOT ENDANGER 7223 04:49:15,425 --> 04:49:16,826 THE LIFE OF THE MOTHER AND THE 7224 04:49:16,826 --> 04:49:17,661 BABY. 7225 04:49:17,661 --> 04:49:24,834 I THINK THAT'S MY TAKE ON THAT. 7226 04:49:24,834 --> 04:49:26,703 >> THANKS SO MUCH. 7227 04:49:26,703 --> 04:49:29,406 I SEE YOUR HAND IS UP, ZALEHA. 7228 04:49:29,406 --> 04:49:31,474 WOULD YOU LIKE TO JOIN IN? 7229 04:49:31,474 --> 04:49:32,976 >> I AGREE WITH JOAN. 7230 04:49:32,976 --> 04:49:35,579 IF WE START THE IMPLEMENTATION 7231 04:49:35,579 --> 04:49:37,514 OF THE INNOVATION, AS A 7232 04:49:37,514 --> 04:49:39,182 RESEARCH PROJECT, YOU ARE VERY 7233 04:49:39,182 --> 04:49:49,659 MUCH, YOU KNOW, WITHIN THE 7234 04:49:50,360 --> 04:49:51,394 BOUNDARIES OF GOOD ETHICS 7235 04:49:51,394 --> 04:49:54,898 BECAUSE IT WILL HAVE TO BE 7236 04:49:54,898 --> 04:49:57,267 SUBJECT TO THE ETHICS OF THE 7237 04:49:57,267 --> 04:49:58,735 INSTITUTION WHERE YOU CONDUCT 7238 04:49:58,735 --> 04:50:00,070 THE RESEARCH. 7239 04:50:00,070 --> 04:50:02,505 FOR THE DRONE PROJECT WE WERE 7240 04:50:02,505 --> 04:50:05,475 SUBJECTED TO RIGOROUS REVIEW BY 7241 04:50:05,475 --> 04:50:06,576 THE INSTITUTIONAL REVIEW BOARD 7242 04:50:06,576 --> 04:50:08,144 OF THE MINISTRY OF HEALTH. 7243 04:50:08,144 --> 04:50:12,349 AND THEY WENT TO THE EXTENT OF 7244 04:50:12,349 --> 04:50:14,317 ASKING US WHETHER THERE WAS 7245 04:50:14,317 --> 04:50:15,085 INSURANCE COVERAGE, FOR 7246 04:50:15,085 --> 04:50:17,087 EXAMPLE, IF THE DRONE WERE TO 7247 04:50:17,087 --> 04:50:19,456 FALL ON SOMEBODY'S HEAD, FOR 7248 04:50:19,456 --> 04:50:19,823 EXAMPLE. 7249 04:50:19,823 --> 04:50:23,426 WE WERE FORTUNATE THAT WE WERE 7250 04:50:23,426 --> 04:50:32,602 WORKING WITH ROBUST, VERY GOOD 7251 04:50:32,602 --> 04:50:34,638 INDUSTRY WITH A LOT OF 7252 04:50:34,638 --> 04:50:37,540 EXPERIENCE AS DRONE OPERATOR 7253 04:50:37,540 --> 04:50:40,543 AND THEY ACTUALLY HAD INSURANCE 7254 04:50:40,543 --> 04:50:43,113 COVERAGE ALREADY TAKEN FOR SUCH 7255 04:50:43,113 --> 04:50:43,947 EVENTUALITIES SO WE WERE QUITE 7256 04:50:43,947 --> 04:50:47,150 SAFE THERE. 7257 04:50:47,150 --> 04:50:48,885 >> THANK YOU, ZALEHA, THAT WAS 7258 04:50:48,885 --> 04:50:51,221 A WONDERFUL RESPONSE. 7259 04:50:51,221 --> 04:50:55,158 AND NGOZI, I THOUGHT YOU MIGHT 7260 04:50:55,158 --> 04:50:55,859 HAVE SOMETHING. 7261 04:50:55,859 --> 04:50:57,694 YOU WANT TO WEIGH IN? 7262 04:50:57,694 --> 04:51:01,197 >> YES, YOU KNOW IN NIGERIA, WE 7263 04:51:01,197 --> 04:51:01,998 HAD SOME ETHICAL MISHAPS IN THE 7264 04:51:01,998 --> 04:51:03,199 PAST. 7265 04:51:03,199 --> 04:51:06,336 BECAUSE THAT, OUR ETHICAL 7266 04:51:06,336 --> 04:51:10,573 REVIEW BOARDS IN THE COUNTRY 7267 04:51:10,573 --> 04:51:12,676 NOW PAY MORE ATTENTION TO THE 7268 04:51:12,676 --> 04:51:13,643 ETHICS OF OF RESEARCH GOING ON 7269 04:51:13,643 --> 04:51:17,347 THERE. 7270 04:51:17,347 --> 04:51:22,852 BUT ONE CRITICAL PART IS EQUITY. 7271 04:51:22,852 --> 04:51:26,323 ONE WAY TO ENSURE EQUITY IN 7272 04:51:26,323 --> 04:51:27,390 PROCESS OF RESEARCH IS ALSO 7273 04:51:27,390 --> 04:51:28,291 CONCEPT. 7274 04:51:28,291 --> 04:51:30,560 SO WHAT WE NOTICED IN MOST OF 7275 04:51:30,560 --> 04:51:31,828 OUR COMMUNITIES, YOU KNOW, 7276 04:51:31,828 --> 04:51:33,663 PEOPLE, YOU CAN TRANSLATE, YOU 7277 04:51:33,663 --> 04:51:37,233 KNOW, THE INFORMED CONSENT. 7278 04:51:37,233 --> 04:51:38,802 IN THAT PERSON'S LANGUAGE. 7279 04:51:38,802 --> 04:51:40,603 OR YOU GIVE THE PERSON 7280 04:51:40,603 --> 04:51:41,805 TRANSLATING THE PAPER AND SAY 7281 04:51:41,805 --> 04:51:44,708 OKAY YOU CAN READ THIS. 7282 04:51:44,708 --> 04:51:46,543 SOME PEOPLE CAN SPEAK THE 7283 04:51:46,543 --> 04:51:50,914 LANGUAGE BUT CANNOT READ THE 7284 04:51:50,914 --> 04:51:51,181 LANGUAGE. 7285 04:51:51,181 --> 04:51:52,849 WHAT DO WE DO IN INTERVENTION 7286 04:51:52,849 --> 04:51:54,851 TO ENSURE THE WOMAN OR PERSON 7287 04:51:54,851 --> 04:51:57,520 WE ARE RECRUITING TO OUR 7288 04:51:57,520 --> 04:51:59,189 STUDIES ARE FULLY AWARE OF 7289 04:51:59,189 --> 04:52:00,190 EVERY ASPECT WHAT THEY ARE 7290 04:52:00,190 --> 04:52:01,424 SIGNING UP FOR. 7291 04:52:01,424 --> 04:52:03,426 NOT ONLY DO WE GET A GENERAL 7292 04:52:03,426 --> 04:52:07,564 CONSENT, WE DO THE INFORMED 7293 04:52:07,564 --> 04:52:09,599 CONSENT, TAKE IT, TRANSLATE IT, 7294 04:52:09,599 --> 04:52:11,801 TAKE IT HOME AND READ OR GIVE 7295 04:52:11,801 --> 04:52:13,636 IT TO SOMEONE TO READ. 7296 04:52:13,636 --> 04:52:15,972 WE ALSO SHOW A VIDEO IN YOUR 7297 04:52:15,972 --> 04:52:26,516 LANGUAGE OF THE CONSENT PROCESS. 7298 04:52:28,518 --> 04:52:30,320 SOME PEOPLE DON'T KNOW HOW TO 7299 04:52:30,320 --> 04:52:32,355 READ, THEY WILL NOT TELL YOU, 7300 04:52:32,355 --> 04:52:34,157 MOST PEOPLE ARE VISUAL IN 7301 04:52:34,157 --> 04:52:36,192 NATURE, THEY UNDERSTAND THE 7302 04:52:36,192 --> 04:52:37,927 ANIMATION, THE LANGUAGE AND 7303 04:52:37,927 --> 04:52:39,129 PROCESS AND CAN PLAY IT OVER 7304 04:52:39,129 --> 04:52:40,897 AND OVER AGAIN. 7305 04:52:40,897 --> 04:52:43,166 MOST TIMES WE EVEN DO WHAT THEY 7306 04:52:43,166 --> 04:52:45,468 CALL A ROLE PLAY. 7307 04:52:45,468 --> 04:52:47,437 DO YOU UNDERSTAND, YES, OKAY. 7308 04:52:47,437 --> 04:52:49,572 TELL ME WHAT IS SAID. 7309 04:52:49,572 --> 04:52:51,674 SO THE WOMEN WILL TELL YOU, 7310 04:52:51,674 --> 04:52:53,643 EXACTLY WHAT THEY THINK. 7311 04:52:53,643 --> 04:52:55,111 SO IF THERE'S ANY 7312 04:52:55,111 --> 04:52:55,912 MISINFORMATION WE CORRECT IT AT 7313 04:52:55,912 --> 04:52:57,247 THAT POINT. 7314 04:52:57,247 --> 04:53:00,850 SO WE MAKE SURE THAT EVERYBODY 7315 04:53:00,850 --> 04:53:02,652 IS EDUCATED, NOT JUST THINK 7316 04:53:02,652 --> 04:53:06,256 THEY CAN READ OR THOSE DO NOT 7317 04:53:06,256 --> 04:53:07,457 UNDERSTAND WHAT AN INFORMED 7318 04:53:07,457 --> 04:53:08,558 CONSENT IS. 7319 04:53:08,558 --> 04:53:09,292 IT'S IMPORTANT PEOPLE 7320 04:53:09,292 --> 04:53:10,760 UNDERSTAND WHAT THEY ARE 7321 04:53:10,760 --> 04:53:13,229 GETTING INTO, NOT JUST BY PEER 7322 04:53:13,229 --> 04:53:14,264 PRESSURE, THEY NEED TO 7323 04:53:14,264 --> 04:53:14,998 UNDERSTAND, EVEN THE GOOD AND 7324 04:53:14,998 --> 04:53:16,266 BAD. 7325 04:53:16,266 --> 04:53:17,867 WE TELL THEM BOTH WAYS. 7326 04:53:17,867 --> 04:53:19,836 THIS IS THE DOWN SIDE GETTING 7327 04:53:19,836 --> 04:53:21,538 INVOLVED IN THIS STUDY AND THIS 7328 04:53:21,538 --> 04:53:23,139 IS ALSO THE BENEFITS. 7329 04:53:23,139 --> 04:53:25,675 SO THEY ARE REALLY, REALLY 7330 04:53:25,675 --> 04:53:25,875 AWARE. 7331 04:53:25,875 --> 04:53:28,745 WE MAKE THE INFORMED CONSENT 7332 04:53:28,745 --> 04:53:35,485 VERY EQUITABLE. 7333 04:53:35,485 --> 04:53:37,020 SO THEY CAN UNDERSTAND WHAT 7334 04:53:37,020 --> 04:53:39,289 THEY ARE GETTING INTO AND GIVE 7335 04:53:39,289 --> 04:53:40,056 FULL CONSENT. 7336 04:53:40,056 --> 04:53:42,192 >> INNOVATIVE WAY TO 7337 04:53:42,192 --> 04:53:43,193 COMMUNICATE THE ASPECTS 7338 04:53:43,193 --> 04:53:45,261 INFORMED CONSENT THROUGH 7339 04:53:45,261 --> 04:53:47,163 VIDEOS. I THINK THE CULTURAL 7340 04:53:47,163 --> 04:53:48,898 APPROPRIATENESS HOW WE GET 7341 04:53:48,898 --> 04:53:50,600 CONSENT IS ALSO SOMETIMES 7342 04:53:50,600 --> 04:53:52,535 OVERLOOKED AND THAT LEADS TO 7343 04:53:52,535 --> 04:53:54,237 ETHICAL AND OTHER CONCERNS 7344 04:53:54,237 --> 04:53:54,504 COMING UP. 7345 04:53:54,504 --> 04:53:55,171 I THINK WE SHOULD START TO WRAP 7346 04:53:55,171 --> 04:53:55,872 UP. 7347 04:53:55,872 --> 04:53:58,074 I WILL WRAP UP BY MY LAST 7348 04:53:58,074 --> 04:54:00,143 QUESTION AND I WANT EACH OF THE 7349 04:54:00,143 --> 04:54:01,578 PANELISTS TO WEIGH IN ON THIS. 7350 04:54:01,578 --> 04:54:03,646 EACH OF YOU HAVE A CHANCE TO 7351 04:54:03,646 --> 04:54:06,516 WEIGH IN ON THIS LAST QUESTION 7352 04:54:06,516 --> 04:54:09,085 BEFORE I HAND IT OVER TO THE 7353 04:54:09,085 --> 04:54:10,720 CO-LEADS TO WRAP UP AND PROVIDE 7354 04:54:10,720 --> 04:54:11,588 A SUMMARY. 7355 04:54:11,588 --> 04:54:13,523 LOOKING FORWARD, WHAT ARE YOUR 7356 04:54:13,523 --> 04:54:15,959 HOPES AND EXPECTATIONS FOR THE 7357 04:54:15,959 --> 04:54:16,926 FUTURE OF MATERNAL HEALTHCARE 7358 04:54:16,926 --> 04:54:21,164 DELIVERY AND HOW CAN INNOVATION 7359 04:54:21,164 --> 04:54:22,665 AND IMPLEMENTATION SCIENCE 7360 04:54:22,665 --> 04:54:23,566 CONTRIBUTE TO ACHIEVING THESE 7361 04:54:23,566 --> 04:54:24,000 GOALS. 7362 04:54:24,000 --> 04:54:25,568 IT'S A LARGE QUESTION. 7363 04:54:25,568 --> 04:54:27,036 GIVE US YOUR SHORT IMMEDIATE 7364 04:54:27,036 --> 04:54:28,271 THOUGHTS THAT COME TO MIND. 7365 04:54:28,271 --> 04:54:32,509 I WILL START WITH ZALEHA. 7366 04:54:32,509 --> 04:54:35,011 >> THANK YOU, MALIHA. 7367 04:54:35,011 --> 04:54:35,678 MORE THAN TECHNOLOGICAL 7368 04:54:35,678 --> 04:54:37,714 INNOVATION, I THINK 7369 04:54:37,714 --> 04:54:39,048 TRANSPARENCY AND AUDIT ARE MOST 7370 04:54:39,048 --> 04:54:45,955 IMPORTANT IN TERMS OF 7371 04:54:45,955 --> 04:54:46,556 SAFEGUARDING MATERNAL HEALTH. 7372 04:54:46,556 --> 04:54:49,893 I'M A MEMBER OF THE MALAYSIAN 7373 04:54:49,893 --> 04:54:51,094 CONFEDERATION INQUIRY INTO 7374 04:54:51,094 --> 04:54:53,696 MATERNAL DEATHS. 7375 04:54:53,696 --> 04:54:56,065 ALONG WITH OTHER EFFECTIVE 7376 04:54:56,065 --> 04:54:59,302 MEASURES SUCH AS ENSURING 7377 04:54:59,302 --> 04:55:02,405 NEARLY 100% PROFESSIONAL CHILD 7378 04:55:02,405 --> 04:55:04,440 BIRTH ATTENDANCE AND ADEQUATE 7379 04:55:04,440 --> 04:55:08,678 PRENATAL CARE, I THINK CMD WAS 7380 04:55:08,678 --> 04:55:10,847 VERY EFFECTIVE TOOL. 7381 04:55:10,847 --> 04:55:14,250 I THINK BEING ABLE TO SINGLE 7382 04:55:14,250 --> 04:55:16,553 OUT FACTORS FROM EACH AND EVERY 7383 04:55:16,553 --> 04:55:20,256 CASE THAT WAS AUDITED HELPS TO 7384 04:55:20,256 --> 04:55:24,527 CLEARLY HIGHLIGHT. 7385 04:55:24,527 --> 04:55:25,962 MANY ESSENTIAL IMPROVEMENTS 7386 04:55:25,962 --> 04:55:28,865 HAVE BEEN MAIDEN HANSING 7387 04:55:28,865 --> 04:55:29,332 HEALTHCARE EQUITY AND 7388 04:55:29,332 --> 04:55:38,608 ACCESSIBILITY, THOSE ARE THE 7389 04:55:38,608 --> 04:55:39,342 TWO KEYWORDS. CONFIDENTIAL 7390 04:55:39,342 --> 04:55:42,612 INQUIRIES HAVE A REQUIREMENT OF 7391 04:55:42,612 --> 04:55:44,814 COMMITMENT FROM THE BODIES 7392 04:55:44,814 --> 04:55:46,416 INVOLVED, THE STAKEHOLDERS 7393 04:55:46,416 --> 04:55:47,317 INVOLVED IN HIGH-LEVEL PLANNING 7394 04:55:47,317 --> 04:55:49,586 AND POLICY. 7395 04:55:49,586 --> 04:55:50,987 SO CONFIDENTIAL INQUIRIES HAVE 7396 04:55:50,987 --> 04:55:53,957 A POTENTIAL TO MAKE GREATEST 7397 04:55:53,957 --> 04:55:56,526 IMPACT ON MATERNAL DUE TO 7398 04:55:56,526 --> 04:55:59,128 LINKAGE TO POLICY MAKING AS 7399 04:55:59,128 --> 04:56:04,500 WELL AS PERCEIVED PRESTIGE AND 7400 04:56:04,500 --> 04:56:06,169 REPRESENTATIVES. INNOVATION 7401 04:56:06,169 --> 04:56:06,936 WHETHER TECHNOLOGICAL OR 7402 04:56:06,936 --> 04:56:11,307 OTHERWISE IS IMPORTANT TO 7403 04:56:11,307 --> 04:56:13,142 ADDRESS PROBLEMS DIFFERENTLY. 7404 04:56:13,142 --> 04:56:20,383 IT PROVIDES A USEFUL TOOL THAT 7405 04:56:20,383 --> 04:56:25,955 CAN BE APPLIED THE DIFFERENCE 7406 04:56:25,955 --> 04:56:28,791 BETWEEN KNOWING AND DOING. 7407 04:56:28,791 --> 04:56:35,231 >> THANK YOU, ZALEHA. 7408 04:56:35,231 --> 04:56:37,800 SARAH, CAN WE GO TO YOU NEXT. 7409 04:56:37,800 --> 04:56:43,272 >> SURE ONE OF THE REASON UZ I 7410 04:56:43,272 --> 04:56:51,414 ACTUALLY JOINED, -- THAT'S 7411 04:56:51,414 --> 04:56:51,748 THE POSITIVE. 7412 04:56:51,748 --> 04:56:54,384 TO YOUR QUESTION ABOUT 7413 04:56:54,384 --> 04:56:55,084 INNOVATION AND IMPLEMENTATION 7414 04:56:55,084 --> 04:56:57,320 SCIENCE, MAYBE I WILL TAKE, 7415 04:56:57,320 --> 04:57:01,090 MAYBE NOT AS POSITIVE, BUT IT'S 7416 04:57:01,090 --> 04:57:01,491 A CAUTIONARY TALE. 7417 04:57:01,491 --> 04:57:03,226 WE CANNOT BE TOO ACADEMIC, 7418 04:57:03,226 --> 04:57:03,426 RIGHT? 7419 04:57:03,426 --> 04:57:05,828 WE TALK A LOT ABOUT RESEARCH. 7420 04:57:05,828 --> 04:57:07,430 OFTEN TIMES RESEARCH DOESN'T 7421 04:57:07,430 --> 04:57:07,930 TRANSLATE, RIGHT? 7422 04:57:07,930 --> 04:57:09,832 I THINK IT'S THAT WE NEED TO 7423 04:57:09,832 --> 04:57:12,201 CONSIDER AND FOCUS N THE 7424 04:57:12,201 --> 04:57:15,138 BUSINESS CASE AND COST 7425 04:57:15,138 --> 04:57:17,507 EFFECTIVENESS OF INNOVATIVE 7426 04:57:17,507 --> 04:57:19,208 IDEAS. I THINK IMPLEMENTATION 7427 04:57:19,208 --> 04:57:22,145 SCIENCE, THERE'S A LOT OF WORK 7428 04:57:22,145 --> 04:57:24,847 THAT HAS TO GO INTO THE 7429 04:57:24,847 --> 04:57:27,050 FEASIBILITY AND SUSTAINABILITY 7430 04:57:27,050 --> 04:57:27,383 OF SOMETHING. 7431 04:57:27,383 --> 04:57:29,619 SOMETIMES THE REASON IT'S NOT 7432 04:57:29,619 --> 04:57:30,787 SUSTAINABLE, IT'S NOT 7433 04:57:30,787 --> 04:57:31,421 IMPLEMENTATION SCIENCE, IT'S 7434 04:57:31,421 --> 04:57:33,890 MORE REGULATORY. 7435 04:57:33,890 --> 04:57:35,058 I THINK ZALEHA MENTIONED THIS, 7436 04:57:35,058 --> 04:57:38,461 YOU HAVE A REGULATORY PROBLEM 7437 04:57:38,461 --> 04:57:40,897 OR CAN'T FIND FUNDING. 7438 04:57:40,897 --> 04:57:46,202 ALMOST AS MUCH EFFORT NEEDS. 7439 04:57:46,202 --> 04:57:48,104 SOMEBODY WHO CARES ABOUT THE 7440 04:57:48,104 --> 04:57:50,273 PROBLEM WILLING TO PAY FOR IT 7441 04:57:50,273 --> 04:57:51,674 BECAUSE EVERYTHING TAKES MONEY. 7442 04:57:51,674 --> 04:57:54,343 I THINK THAT IS SOMETIMES, IN A 7443 04:57:54,343 --> 04:58:00,183 GENERAL SENSE, IF WE GET TOO 7444 04:58:00,183 --> 04:58:04,053 ACADEMIC, WE ARE ABLE TO GET 7445 04:58:04,053 --> 04:58:08,858 FUNDING FOR THE ONE STUDY BUT 7446 04:58:08,858 --> 04:58:10,426 IT'S NOT SUSTAINABLE BECAUSE 7447 04:58:10,426 --> 04:58:13,162 THE BUSINESS CASE OR THE ROI 7448 04:58:13,162 --> 04:58:15,298 WAS THERE NOT AT THE VERY 7449 04:58:15,298 --> 04:58:16,132 BEGINNING. 7450 04:58:16,132 --> 04:58:18,534 SO I THINK IMPLEMENTATION 7451 04:58:18,534 --> 04:58:19,769 SCIENCE, ALSO PRACTICAL WORLD 7452 04:58:19,769 --> 04:58:22,772 WE CAN GET PEOPLE TOO REALLY 7453 04:58:22,772 --> 04:58:24,307 SUPPORT CARE ABOUT ISSUES IN 7454 04:58:24,307 --> 04:58:25,041 MATERNAL HEALTH. 7455 04:58:25,041 --> 04:58:27,877 >> ABSOLUTELY. 7456 04:58:27,877 --> 04:58:30,279 JOAN, WOULD YOU LIKE TO GO NEXT? 7457 04:58:30,279 --> 04:58:33,082 >> YES, PERSPECTIVE OF A 7458 04:58:33,082 --> 04:58:35,184 MIDWIFE AND MIDWIFE EDUCATOR, I 7459 04:58:35,184 --> 04:58:37,220 BELIEVE WE SHOULD TRY AT ALL 7460 04:58:37,220 --> 04:58:39,288 COST TO REMOVE GEOGRAPHICAL 7461 04:58:39,288 --> 04:58:39,655 BARRIERS. 7462 04:58:39,655 --> 04:58:42,925 NO WOMAN SHOULD BE OUT OF REACH. 7463 04:58:42,925 --> 04:58:46,162 IT DOESN'T MEAN THAT IF SHE IS 7464 04:58:46,162 --> 04:58:49,632 FAR AWAY SHE SHOULD RECEIVE 7465 04:58:49,632 --> 04:58:50,032 POOR QUALITY CARE. 7466 04:58:50,032 --> 04:58:54,036 WE NEED TO GET OUT AND REMOTE 7467 04:58:54,036 --> 04:58:56,672 RURAL AREAS. ONE OF OUR 7468 04:58:56,672 --> 04:58:58,674 COLLEAGUES TALKED ABOUT THE 7469 04:58:58,674 --> 04:58:59,976 DRONE. 7470 04:58:59,976 --> 04:59:02,979 TO GET BLOOD TRANSFUSION OR TO 7471 04:59:02,979 --> 04:59:07,617 COLLEAGUES ON THE OTHER SIDE. 7472 04:59:07,617 --> 04:59:11,687 SOME COUNTRIES HAVE MADE 7473 04:59:11,687 --> 04:59:13,923 MATERNAL FLAGSHIP. 7474 04:59:13,923 --> 04:59:17,160 IT'S IMPORTANT WE INVEST IN 7475 04:59:17,160 --> 04:59:20,496 MORE, MOST AREN'T GIVE 7476 04:59:20,496 --> 04:59:21,097 ESPECIALLY, IT'S HIGHLY 7477 04:59:21,097 --> 04:59:23,833 IMPORTANT WE TRY TO HAVE 7478 04:59:23,833 --> 04:59:25,434 RESOURCE MOBILIZATION DRIVE-IN 7479 04:59:25,434 --> 04:59:27,970 TERN ALLEY AS NATURAL LEVEL TO 7480 04:59:27,970 --> 04:59:30,873 BE ABLE TO SUPPORT SOME WOMEN, 7481 04:59:30,873 --> 04:59:31,674 ISSUES OF SUSTAINABILITY NEEDS 7482 04:59:31,674 --> 04:59:33,442 TO BE ADDRESSED. 7483 04:59:33,442 --> 04:59:34,877 WHEN YOU ENGAGE COMMUNITIES 7484 04:59:34,877 --> 04:59:36,245 INTO THEIR OWN PROBLEMS, WHEN 7485 04:59:36,245 --> 04:59:39,182 YOU MAKE THEM TO FEEL THEY ARE 7486 04:59:39,182 --> 04:59:40,716 EQUALLY IMPORTANT, THEY GIVE 7487 04:59:40,716 --> 04:59:41,484 THEIR BEST. 7488 04:59:41,484 --> 04:59:43,019 COMMUNITIES ARE NOT IN 7489 04:59:43,019 --> 04:59:46,322 ISOLATION, WE ARE PART 7490 04:59:46,322 --> 04:59:46,622 COMMUNITIES. 7491 04:59:46,622 --> 04:59:48,257 COMMUNITIES HAVE GREAT 7492 04:59:48,257 --> 04:59:51,561 POTENTIAL GUESSING SOME OF THE 7493 04:59:51,561 --> 04:59:56,399 QUESTIONS THEY, I THINK WE NEED 7494 04:59:56,399 --> 04:59:59,535 TO ADOPT MORE DISCIPLINARY 7495 04:59:59,535 --> 05:00:01,003 PERSPECTIVE. 7496 05:00:01,003 --> 05:00:02,205 ENGINEERS, THOSE WHO TAKE CARE 7497 05:00:02,205 --> 05:00:04,674 OF THE RULES. 7498 05:00:04,674 --> 05:00:11,447 NOT ONLY THE MEDICAL APPROACH. 7499 05:00:11,447 --> 05:00:15,384 TO BRING ONBOARD OTHER 7500 05:00:15,384 --> 05:00:15,685 COLLEAGUES. 7501 05:00:15,685 --> 05:00:17,553 I BELIEVE THAT LOW AND MIDDLE 7502 05:00:17,553 --> 05:00:19,355 INCOME COUNTRIES SHOULD NOT 7503 05:00:19,355 --> 05:00:19,755 SUFFER THE BRUNT. 7504 05:00:19,755 --> 05:00:21,691 WE NEED TO ENSURE THAT WOMEN 7505 05:00:21,691 --> 05:00:23,125 HAVE EQUAL ACCESS TO SOME OF 7506 05:00:23,125 --> 05:00:24,493 THE SERVICES THAT ARE VERY MUCH 7507 05:00:24,493 --> 05:00:26,095 NEEDED. 7508 05:00:26,095 --> 05:00:30,733 WE NEED TO ALSO INVEST IN 7509 05:00:30,733 --> 05:00:31,801 INTERVENTIONS THAT TARGET NOT 7510 05:00:31,801 --> 05:00:33,436 ONLY THE MOTHER BUT ALSO THE 7511 05:00:33,436 --> 05:00:35,338 UNBORN CHILD AND ALSO THE 7512 05:00:35,338 --> 05:00:36,138 NEWBORN BABY. 7513 05:00:36,138 --> 05:00:40,676 I THINK WE ALSO NEED TO EXPLORE 7514 05:00:40,676 --> 05:00:44,347 COST-EFFECTIVE METHODS, EXAMPLE 7515 05:00:44,347 --> 05:00:46,816 FOR PREECLAMPSIA, DOCTOR WAS 7516 05:00:46,816 --> 05:00:47,650 UTILIZING. 7517 05:00:47,650 --> 05:00:50,953 THE DOCTOR WAS ASKING THE 7518 05:00:50,953 --> 05:00:55,691 WOMEN, SO THERE ARE HOME GROWN 7519 05:00:55,691 --> 05:00:57,560 SOLUTIONS TO SOME PROBLEMS. 7520 05:00:57,560 --> 05:01:00,396 WE NEED TO MEET EACH OTHER, THE 7521 05:01:00,396 --> 05:01:03,766 LOW MIDDLE INCOME, AT SOME 7522 05:01:03,766 --> 05:01:13,509 POINT, I THINK BY AT LARGE, 7523 05:01:13,509 --> 05:01:16,178 MATERNAL AND CHILDISH SHOE, 7524 05:01:16,178 --> 05:01:18,447 WHAT ARE THE PROBLEMS? 7525 05:01:18,447 --> 05:01:19,415 ISSUES OF POVERTY NEEDS TO BE 7526 05:01:19,415 --> 05:01:21,684 ADDRESSED. 7527 05:01:21,684 --> 05:01:23,286 GENDER EQUALITY ISSUES NEEDS TO 7528 05:01:23,286 --> 05:01:24,020 ALSO BE ADDRESSED. 7529 05:01:24,020 --> 05:01:26,722 WE NEED TO LOOK AT 23R5R, AND 7530 05:01:26,722 --> 05:01:27,990 THE PERSONNEL THEMSELVES AND 7531 05:01:27,990 --> 05:01:31,327 LOOK AT OUR POLICIES. 7532 05:01:31,327 --> 05:01:33,362 OUR S.O.P.'S, OUR PROTOCOL AND 7533 05:01:33,362 --> 05:01:36,499 STANDARDS WE ARE USING. 7534 05:01:36,499 --> 05:01:44,173 THERE WE NEED TO EVALUATE THE 7535 05:01:44,173 --> 05:01:45,875 SERVICES GIVEN EVALUATE THE 7536 05:01:45,875 --> 05:01:47,576 PERSONNEL WORKING WITHIN SUCH 7537 05:01:47,576 --> 05:01:50,746 PROGRAMS AND GO BACK TO THE 7538 05:01:50,746 --> 05:01:54,650 WOMEN THEMSELVES. 7539 05:01:54,650 --> 05:01:57,019 WOMEN NEED TO KNOW THEY ARE 7540 05:01:57,019 --> 05:01:58,721 INVOLVED IN PREGNANCY, WE NEED 7541 05:01:58,721 --> 05:02:01,390 TO EMPOWER WOMEN THROUGH 7542 05:02:01,390 --> 05:02:03,059 CULTURE, EDUCATION AND NEED TO 7543 05:02:03,059 --> 05:02:07,430 ALSO EMPOWER WOMEN TO KNOW THEY 7544 05:02:07,430 --> 05:02:09,231 SHOULD SEEK EARLY IN HOSPITAL. 7545 05:02:09,231 --> 05:02:11,167 I THINK THAT'S MY TAKE ON THAT. 7546 05:02:11,167 --> 05:02:13,836 >> THANK YOU, JOAN, THAT WAS 7547 05:02:13,836 --> 05:02:15,838 VERY COMPREHENSIVE, APPRECIATE 7548 05:02:15,838 --> 05:02:16,839 YOUR THOUGHTS. NGOZI, WOULD YOU 7549 05:02:16,839 --> 05:02:19,542 LIKE TO CLOSE OUT WITH SOME 7550 05:02:19,542 --> 05:02:21,644 STATEMENTS AND YOUR THOUGHTS? 7551 05:02:21,644 --> 05:02:25,081 >> YES, FROM OUR EXPERIENCE IN 7552 05:02:25,081 --> 05:02:27,049 CARRYING OUT INTERVENTIONS IN 7553 05:02:27,049 --> 05:02:31,721 COMMUNITIES, ESPECIALLY IN THE 7554 05:02:31,721 --> 05:02:33,756 LMIC'S, WE LACK INFRASTRUCTURE. 7555 05:02:33,756 --> 05:02:39,428 SO A LOT OF MONEY GOES INTO 7556 05:02:39,428 --> 05:02:44,266 BUILDING. 7557 05:02:44,266 --> 05:02:46,869 THAT'S THE FOUNDATION OF 7558 05:02:46,869 --> 05:02:48,104 THEY'VINGER. 7559 05:02:48,104 --> 05:02:49,972 -EVERYTHING. 7560 05:02:49,972 --> 05:02:51,874 IF WE DEPLOY TECHNOLOGY IN THE 7561 05:02:51,874 --> 05:02:58,147 RURAL AREA, WE NEED TO BUILD 7562 05:02:58,147 --> 05:02:59,682 INFRASTRUCTURE IN RURAL AREAS. 7563 05:02:59,682 --> 05:03:02,284 FOR EXAMPLE, WITH NEED TO 7564 05:03:02,284 --> 05:03:04,620 PROVIDE TABLETS FOR DOCTORS AND 7565 05:03:04,620 --> 05:03:06,322 TAR LET'S FOR THE COMMUNITY 7566 05:03:06,322 --> 05:03:07,223 RESEARCHERS TO BE ABLE TO LINK 7567 05:03:07,223 --> 05:03:09,859 THAT. 7568 05:03:09,859 --> 05:03:12,995 KNOW AND WE NEED -- WE HAVE A 7569 05:03:12,995 --> 05:03:18,067 LOT TO LEARN FROM THE HIGH 7570 05:03:18,067 --> 05:03:20,536 INCOME AND MIDDLE INCOME 7571 05:03:20,536 --> 05:03:21,370 COMMUNITIES. 7572 05:03:21,370 --> 05:03:24,473 I LOOK AT WHAT SARAH SAID ABOUT 7573 05:03:24,473 --> 05:03:27,009 COST EFFECTIVENESS AND 7574 05:03:27,009 --> 05:03:27,376 SUSTAINABILITY. 7575 05:03:27,376 --> 05:03:29,111 WE HAVE INTERVENTIONS NOT COST 7576 05:03:29,111 --> 05:03:34,517 EFFECTIVE FOR THE LMIC. 7577 05:03:34,517 --> 05:03:38,921 JUST IMPORTING INNOVATIONS 7578 05:03:38,921 --> 05:03:40,356 AFTER THAT, WHAT NEXT? 7579 05:03:40,356 --> 05:03:42,425 THAT'S ONE OF THE REASONS, 7580 05:03:42,425 --> 05:03:44,460 DOING A LOT OF RESEARCH, 7581 05:03:44,460 --> 05:03:45,961 COLLECTING THAT. 7582 05:03:45,961 --> 05:03:47,797 I WAS ASKING MYSELF, WHAT NEXT, 7583 05:03:47,797 --> 05:03:49,765 WHERE ARE YOU COLLECTING THIS, 7584 05:03:49,765 --> 05:03:52,168 AND PEOPLE IN THE XHUPITY ARE 7585 05:03:52,168 --> 05:03:53,769 ASKING YOU, WHAT IS NEXTER. 7586 05:03:53,769 --> 05:03:55,604 IT NEEDS TO BE SUSTAINABLE. 7587 05:03:55,604 --> 05:04:00,443 WE NEED TO LOOK AT 7588 05:04:00,443 --> 05:04:02,344 CONTENT-SPECIFIC SUSTAINABLE 7589 05:04:02,344 --> 05:04:03,546 INNOVATIONS FOR MATERNAL-CHILD 7590 05:04:03,546 --> 05:04:04,914 HEALTH OUTCOMES. 7591 05:04:04,914 --> 05:04:07,716 WE CANNOT JUST SAY KEEP DOING 7592 05:04:07,716 --> 05:04:09,485 THIS, THIS WORKS HERE AND THERE. 7593 05:04:09,485 --> 05:04:11,353 HAVE WE TRIED IT HERE. 7594 05:04:11,353 --> 05:04:19,295 IT'S NOT WHETHER IT WORKS IS IT 7595 05:04:19,295 --> 05:04:23,099 SUSTAINABILITY THIEFRJ YOU. 7596 05:04:23,099 --> 05:04:28,137 >> VERY WELL SAID. 7597 05:04:28,137 --> 05:04:30,473 I THINK IT'S A CROSS-CUTTING 7598 05:04:30,473 --> 05:04:32,775 THEME WE HAVE BEEN HEARING 7599 05:04:32,775 --> 05:04:35,544 ABOUT LOTS OF PANELS CONTEXT 7600 05:04:35,544 --> 05:04:39,215 MATTERS. THANK YOU, NGOZI WITH 7601 05:04:39,215 --> 05:04:42,384 THAT NOTE AND I WANT TO THANK 7602 05:04:42,384 --> 05:04:43,452 ALL OF OUR ESTEEMED PANELISTS 7603 05:04:43,452 --> 05:04:44,720 FOR JOINING US TODAY. 7604 05:04:44,720 --> 05:04:46,489 WAND THAT I WILL HAND IT OVER 7605 05:04:46,489 --> 05:04:47,490 TO THE CO-LEADS OF THIS 7606 05:04:47,490 --> 05:04:49,725 WORKSHOP. 7607 05:04:49,725 --> 05:04:53,395 KAREN AND I THINK VERONICA WILL 7608 05:04:53,395 --> 05:04:54,497 BE CLOSING US ALL OUT WITH A 7609 05:04:54,497 --> 05:04:55,531 SUMMARY. 7610 05:04:55,531 --> 05:05:00,069 GO AHEAD, V. 7611 05:05:00,069 --> 05:05:02,905 >> THANK YOU, DR. ILIAS. 7612 05:05:02,905 --> 05:05:09,979 THANK YOU EVERYONE FOR YOUR 7613 05:05:09,979 --> 05:05:11,313 THOUGHTFUL AND IMPACTFUL 7614 05:05:11,313 --> 05:05:13,249 ENGAGING PRESENTATIONS AND 7615 05:05:13,249 --> 05:05:13,549 DISCUSSIONS. 7616 05:05:13,549 --> 05:05:15,518 AS WE CONCLUDE OUR TWO-DAY 7617 05:05:15,518 --> 05:05:17,720 WORKSHOP ON THE GLOBAL 7618 05:05:17,720 --> 05:05:19,121 IMPLEMENTATION SCIENCE 7619 05:05:19,121 --> 05:05:22,091 APPROACHES ON IMPROVE MATERNAL 7620 05:05:22,091 --> 05:05:24,627 HEALTH, HEART, LUNG BLOOD AND 7621 05:05:24,627 --> 05:05:28,731 SLEEP HEALTH OUTCOMES, WE WANT 7622 05:05:28,731 --> 05:05:31,367 TO GO TO VALUABLE INSIGHTS 7623 05:05:31,367 --> 05:05:32,801 SHARED ON BOTH DAYS. 7624 05:05:32,801 --> 05:05:35,838 >> THANK YOU, THIS WORKSHOP 7625 05:05:35,838 --> 05:05:38,607 DEDICATED SPECIFIC PANELS TO 7626 05:05:38,607 --> 05:05:43,612 MAJOR HEALTH DOMAINS, 7627 05:05:43,612 --> 05:05:46,015 CARDIOVASCULAR HEALTH, 7628 05:05:46,015 --> 05:05:47,650 HEMATOLOGY, BLOOD TRANSFUSIONS, 7629 05:05:47,650 --> 05:05:51,086 SLEEP AND LUNG HEALTH. 7630 05:05:51,086 --> 05:05:53,389 THIS ALLOWED US TO DIVE DEEP 7631 05:05:53,389 --> 05:05:59,061 AND ADDRESS UNIQUE CHALLENGES 7632 05:05:59,061 --> 05:06:00,462 AND INNOVATIVE APPROACHES. 7633 05:06:00,462 --> 05:06:02,865 WE WILL START WITH SOME KEY 7634 05:06:02,865 --> 05:06:04,900 PANEL HIGHLIGHTS AND CONCLUDE 7635 05:06:04,900 --> 05:06:05,935 WITH CROSS-CUTTING THEMES THAT 7636 05:06:05,935 --> 05:06:06,969 CAME FROM THE DISCUSSIONS. 7637 05:06:06,969 --> 05:06:09,305 I WILL START WITH KEY 7638 05:06:09,305 --> 05:06:10,873 TAKE-AWAYS FROM DAY ONE. 7639 05:06:10,873 --> 05:06:12,575 THERE WERE MANY FANTASTIC 7640 05:06:12,575 --> 05:06:14,310 POIBTS THAT WERE BROUGHT UP AND 7641 05:06:14,310 --> 05:06:17,313 WE ATTEMPTED TO SYNTHESIZE TO 7642 05:06:17,313 --> 05:06:18,647 CONCLUDE THE WORKSHOP. 7643 05:06:18,647 --> 05:06:26,055 I WILL TRY TO DO DAY ONE'S 7644 05:06:26,055 --> 05:06:27,489 FULLY DISCUSSION, NEXT SLIDE, 7645 05:06:27,489 --> 05:06:28,157 PLEASE. 7646 05:06:28,157 --> 05:06:38,500 WE WILL START WITH 7647 05:06:39,335 --> 05:06:43,239 CARDIOVASCULAR TAKE AWAYS, 7648 05:06:43,239 --> 05:06:44,940 WHERE THE SURVEILLANCE SYSTEMS 7649 05:06:44,940 --> 05:06:46,175 EXIST THEY SHOULD BE OPTIMIZED 7650 05:06:46,175 --> 05:06:48,978 IN PAY WAY THAT ALLOW FOR 7651 05:06:48,978 --> 05:06:50,512 MAXIMUM LEVERAGING, SUCH AS 7652 05:06:50,512 --> 05:06:51,513 ELECTRONIC HEALTH RECORDS. 7653 05:06:51,513 --> 05:06:55,084 WE ALSO NEED TO REIMAGINE 7654 05:06:55,084 --> 05:06:57,519 MATERNAL CARDIOVASCULAR HEALTH 7655 05:06:57,519 --> 05:07:00,556 FROM A BROADER WOMEN'S HEALTH 7656 05:07:00,556 --> 05:07:01,624 PERSPECTIVE AND EXAMPLES 7657 05:07:01,624 --> 05:07:05,628 BROUGHT UP EARLY DETECTION OF 7658 05:07:05,628 --> 05:07:07,563 HEART DISEASE, ENSURING 7659 05:07:07,563 --> 05:07:09,231 CONTINUITY OF PRIMARY CARE, 7660 05:07:09,231 --> 05:07:12,034 POSTPARTUM AND BEYOND. 7661 05:07:12,034 --> 05:07:14,703 ADDITIONALLY THERE WAS A HUGE 7662 05:07:14,703 --> 05:07:16,438 OPPORTUNITY TO LEAPFROG 7663 05:07:16,438 --> 05:07:18,340 PROGRESS USING NEW TECHNOLOGIES. 7664 05:07:18,340 --> 05:07:21,277 EXAMPLES INCLUDE POINT OF CARE 7665 05:07:21,277 --> 05:07:24,013 TESTING AND HEALTH INNOVATIONS 7666 05:07:24,013 --> 05:07:28,584 AND STRATEGIC USE OF A.I., 7667 05:07:28,584 --> 05:07:30,519 ESPECIALLY IN LMICKS. GLAOEL 7668 05:07:30,519 --> 05:07:34,490 COLLABORATION AND CONSORTIA FOR 7669 05:07:34,490 --> 05:07:37,192 IMPLEMENTATION SCIENCE 7670 05:07:37,192 --> 05:07:37,626 RESEARCH, ALLOW FOR 7671 05:07:37,626 --> 05:07:38,894 BIDIRECTIONAL LEARNING. 7672 05:07:38,894 --> 05:07:41,196 NEXT SLIDE, PLEASE. 7673 05:07:41,196 --> 05:07:47,569 FOR THE PANEL 2, HEMATOLOGY AND 7674 05:07:47,569 --> 05:07:51,473 BLOOD PANEL, DISCUSSIONS 7675 05:07:51,473 --> 05:07:51,740 INCLUDED: 7676 05:07:51,740 --> 05:08:02,017 [READING SLIDE] 7677 05:09:33,342 --> 05:09:35,411 >> THANK YOU. 7678 05:09:35,411 --> 05:09:37,413 FROM THE LUNG PANEL WE LEARNED 7679 05:09:37,413 --> 05:09:42,684 THERE ARE EXPOSURES THAT RISK 7680 05:09:42,684 --> 05:09:45,687 IMPAIRED LUNG HEALTH THROUGH 7681 05:09:45,687 --> 05:09:49,892 LIFE INNOVATIVE COMMUNITY TO 7682 05:09:49,892 --> 05:09:51,326 PROTECT HIGH-RISK POPULATIONS 7683 05:09:51,326 --> 05:09:52,961 AND OPTIMIZE COMMUNITY 7684 05:09:52,961 --> 05:09:56,498 STRATEGIES TO PROTECT HIGH-RISK 7685 05:09:56,498 --> 05:09:57,132 POPULATION PRENATAL RESPIRATORY 7686 05:09:57,132 --> 05:09:57,699 HEALTH. 7687 05:09:57,699 --> 05:10:01,103 WE ALSO SAW EMPHASIS OF 7688 05:10:01,103 --> 05:10:03,305 PREGNANT PEOPLE WITH CYSTIC 7689 05:10:03,305 --> 05:10:05,274 FIBROSIS, NEED FOR MORE 7690 05:10:05,274 --> 05:10:07,810 LARGE-SCALE STUDIES TO DEVELOP 7691 05:10:07,810 --> 05:10:09,411 EVIDENCE-BASED GUIDELINES FOR 7692 05:10:09,411 --> 05:10:11,346 MANAGING PREGNANCY WITH CF AND 7693 05:10:11,346 --> 05:10:15,484 RARE LUNG DISEASES. NEXT SLIDE, 7694 05:10:15,484 --> 05:10:21,690 PLEASE. 7695 05:10:21,690 --> 05:10:27,229 IN THE SLEEP PANEL WE SAW: 7696 05:10:27,229 --> 05:10:28,530 ANOTHER WAS KEY QUESTIONS 7697 05:10:28,530 --> 05:10:31,166 REMAINING ABOUT THE IMPACT OF 7698 05:10:31,166 --> 05:10:33,669 SLEEP HEALTH DISPARITY AND 7699 05:10:33,669 --> 05:10:35,771 INTERVENTIONS OF PRENATAL, 7700 05:10:35,771 --> 05:10:37,372 PERINATAL AND POSTPARTUM 7701 05:10:37,372 --> 05:10:37,639 OUTCOMES. 7702 05:10:37,639 --> 05:10:40,008 WE ALSO SAW THE IMPLEMENTATION 7703 05:10:40,008 --> 05:10:41,844 SCIENCE FRAMEWORKS CAN HELP 7704 05:10:41,844 --> 05:10:44,847 IDENTIFY GAPS BETWEEN RESEARCH 7705 05:10:44,847 --> 05:10:46,081 AND PRACTICE OFFERING 7706 05:10:46,081 --> 05:10:48,650 OPPORTUNITIES TO ENHANCE 7707 05:10:48,650 --> 05:10:50,285 MATERNAL HEALTH THROUGH 7708 05:10:50,285 --> 05:10:51,286 IMPROVED SLEEP INTERVENTIONS. 7709 05:10:51,286 --> 05:10:53,956 NEXT SLIDE, PLEASE. 7710 05:10:53,956 --> 05:10:55,958 FROM THE INNOVATIVE CARE 7711 05:10:55,958 --> 05:10:58,160 DELIVERY PANELS, WE HIGHLIGHTED 7712 05:10:58,160 --> 05:11:00,429 SIGNIFICANT REDUCTIONS IN 7713 05:11:00,429 --> 05:11:05,167 MATERNAL AND INFANT MORTALITIES 7714 05:11:05,167 --> 05:11:09,304 IN LMIC'S LIKE SIERRA LEONE 7715 05:11:09,304 --> 05:11:12,441 THROUGH TARGETED INTERVENTIONS 7716 05:11:12,441 --> 05:11:14,676 LIKE ANTENATAL CARE, EMERGENCY 7717 05:11:14,676 --> 05:11:17,679 OBSTETRIC CARE AND 7718 05:11:17,679 --> 05:11:20,382 ESTABLISHMENT OF MATERNAL DEATH 7719 05:11:20,382 --> 05:11:21,917 SURVEILLANCE AND RESPONSE 7720 05:11:21,917 --> 05:11:24,419 COMMITTEES. WE SAW TRAINING OF 7721 05:11:24,419 --> 05:11:26,054 MIDWIFES, DOCTORS AND COMMUNITY 7722 05:11:26,054 --> 05:11:29,157 HEALTH OFFICERS AND COMMUNITY 7723 05:11:29,157 --> 05:11:34,630 HEALTH WORKERS IS IMPORTANT FOR 7724 05:11:34,630 --> 05:11:35,297 PROGRAMS. 7725 05:11:35,297 --> 05:11:36,031 ACCEPTANCE OF HEALTHCARE 7726 05:11:36,031 --> 05:11:38,500 TECHNOLOGIES LIKE DRONES ARE 7727 05:11:38,500 --> 05:11:39,601 ESSENTIALLY WITH NAVIGATING 7728 05:11:39,601 --> 05:11:41,670 REGULATIONS AND ENSURING BLOOD 7729 05:11:41,670 --> 05:11:42,771 QUALITY IN VARYING CLIMATES. 7730 05:11:42,771 --> 05:11:50,445 NEXT SLIDE, PLEASE. 7731 05:11:50,445 --> 05:11:52,080 TO HIGHLIGHT SOME COMMON 7732 05:11:52,080 --> 05:11:53,282 OBSERVATIONS AND KEY POINTS 7733 05:11:53,282 --> 05:11:55,984 FROM BOTH DAYS WE LEARNED 7734 05:11:55,984 --> 05:11:58,186 FACTORS LIKE AGE, RACE, 7735 05:11:58,186 --> 05:11:59,454 ETHNICITY AND ECONOMIC STATUS 7736 05:11:59,454 --> 05:12:01,557 CAN INCREASE RISK FOR PREGNANT 7737 05:12:01,557 --> 05:12:01,857 INDIVIDUALS. 7738 05:12:01,857 --> 05:12:04,660 WE SAW THERE'S A LACK OF SOCIAL 7739 05:12:04,660 --> 05:12:06,528 SUPPORT, TRANSPORTATION, 7740 05:12:06,528 --> 05:12:07,396 MEDICAL COVERAGE, FOOD 7741 05:12:07,396 --> 05:12:09,431 INSECURITY AND POOR ACCESS TO 7742 05:12:09,431 --> 05:12:11,767 AFFORDABLE HOUSING ARE MAJOR 7743 05:12:11,767 --> 05:12:13,769 CONTRIBUTORS TO MATERNAL HEALTH 7744 05:12:13,769 --> 05:12:15,037 INEQUITIES AND DISCUSSED 7745 05:12:15,037 --> 05:12:16,772 IMPORTANCE OF INTEGRATED CARE 7746 05:12:16,772 --> 05:12:18,507 APPROACHES. 7747 05:12:18,507 --> 05:12:21,009 THESE INCLUDE SELF-MANAGEMENT 7748 05:12:21,009 --> 05:12:24,112 SUPPORT, REGULAR CLINICAL, 7749 05:12:24,112 --> 05:12:26,048 BEHAVIORAL AND SOCIAL 7750 05:12:26,048 --> 05:12:26,615 CHECK-INNS ASSISTANCE WITH 7751 05:12:26,615 --> 05:12:28,183 NAVIGATING CLINICAL AND SOCIAL 7752 05:12:28,183 --> 05:12:29,918 SERVICES. SUCH APPROACHES CAN 7753 05:12:29,918 --> 05:12:31,286 SIGNIFICANTLY REDUCE RISKS AND 7754 05:12:31,286 --> 05:12:33,288 IMPROVE OUTCOMES. 7755 05:12:33,288 --> 05:12:35,591 IT'S IMPORTANT TO INCLUDE 7756 05:12:35,591 --> 05:12:36,959 PREGNANT INDIVIDUALS IN 7757 05:12:36,959 --> 05:12:38,727 RESEARCH STUDIES TO ENSURE THE 7758 05:12:38,727 --> 05:12:40,662 FINDINGS ARE RELEVANT AND 7759 05:12:40,662 --> 05:12:41,530 APPLICABLE. 7760 05:12:41,530 --> 05:12:44,333 IN SCALING UP THESE 7761 05:12:44,333 --> 05:12:44,967 EVIDENCE-BASED INTERVENTIONS 7762 05:12:44,967 --> 05:12:47,603 THROUGH IMPLEMENTATION RESEARCH 7763 05:12:47,603 --> 05:12:50,005 IS ESSENTIAL FOR ACHIEVING A 7764 05:12:50,005 --> 05:12:51,974 BROADER IMPACT AND ENHANCING 7765 05:12:51,974 --> 05:12:52,841 MATERNAL HEALTH ON A LARGER 7766 05:12:52,841 --> 05:12:54,109 SCALE. 7767 05:12:54,109 --> 05:12:58,013 NEXT SLIDE, PLEASE. 7768 05:12:58,013 --> 05:13:00,148 SO TO ROUND US OUT, THE PAST 7769 05:13:00,148 --> 05:13:02,784 TWO DAYS WE SAW MANY 7770 05:13:02,784 --> 05:13:04,319 CROSS-CUTTING THEMES THAT HAVE 7771 05:13:04,319 --> 05:13:05,387 EMERGED FROM OUR SESSION, MOST 7772 05:13:05,387 --> 05:13:07,222 OF WHICH HAVE BEEN DISCUSSED 7773 05:13:07,222 --> 05:13:08,457 THROUGHOUT THE PANELS, 7774 05:13:08,457 --> 05:13:09,891 ESPECIALLY THE LAST PANEL. 7775 05:13:09,891 --> 05:13:12,060 THE FIRST WAS EQUITY AND 7776 05:13:12,060 --> 05:13:12,928 INCLUSION IN MATERNAL HEALTH 7777 05:13:12,928 --> 05:13:15,931 THAT HAVE BEEN AT THE FOREFRONT. 7778 05:13:15,931 --> 05:13:18,834 EMPHASIS WAS PLACED ON 7779 05:13:18,834 --> 05:13:29,077 ADDRESSING BIRTH EQUITY SYSTEMIC 7780 05:13:29,077 --> 05:13:31,279 DISPARITIES ENSURING INCLUSIVE 7781 05:13:31,279 --> 05:13:32,381 HEALTHCARE PRACTICES AND 7782 05:13:32,381 --> 05:13:35,450 SESSIONS THAT INCLUDED WI 7783 05:13:35,450 --> 05:13:36,518 DISCUSSED BIRTH EQUITY, 7784 05:13:36,518 --> 05:13:39,087 CRITICAL NEED TO CONFRONT AND 7785 05:13:39,087 --> 05:13:41,923 ADDRESS SYSTEMIC INE QUAILTS TO 7786 05:13:41,923 --> 05:13:43,558 IMPROVE MATERNAL HEALTH 7787 05:13:43,558 --> 05:13:43,825 OUTCOMES. 7788 05:13:43,825 --> 05:13:47,029 DISCUSSIONS ALSO HIGHLIGHTED 7789 05:13:47,029 --> 05:13:48,597 IMPORTANCE OF 7790 05:13:48,597 --> 05:13:49,164 INTERDISCIPLINARY, 7791 05:13:49,164 --> 05:13:49,931 MULTI-DISCIPLINARY AND 7792 05:13:49,931 --> 05:13:50,766 MULTI-SECTOR COLLABORATIONS 7793 05:13:50,766 --> 05:13:54,269 WITH EXPERTS FROM FIELDS SUCH 7794 05:13:54,269 --> 05:13:58,473 AS OBSTETRICS, GYNECOLOGY, 7795 05:13:58,473 --> 05:13:59,174 EPIDEMIOLOGY, PUBLIC HEALTH 7796 05:13:59,174 --> 05:14:00,976 CAME TOGETHER TO STRESS THE 7797 05:14:00,976 --> 05:14:04,179 NEED FOR INTEGRATED APPROACHES. 7798 05:14:04,179 --> 05:14:05,981 PANELS LIKE MATERNAL HEALTH 7799 05:14:05,981 --> 05:14:07,482 XHUPITY IMPLEMENTATION PROGRAM 7800 05:14:07,482 --> 05:14:10,819 AND OTHERS SHOWCASE HOW DIVERSE 7801 05:14:10,819 --> 05:14:11,887 EXPERTISE AND MULTI-SECTOR 7802 05:14:11,887 --> 05:14:16,992 ENGAGEMENT ARE CRUCIAL FOR 7803 05:14:16,992 --> 05:14:20,028 OVERCOMING IMPLEMENTATION 7804 05:14:20,028 --> 05:14:23,031 CHALLENGES AND MULTI-SECTOR 7805 05:14:23,031 --> 05:14:24,800 ENGAGEMENT ARE CRUCIAL, 7806 05:14:24,800 --> 05:14:26,968 ENGAGEMENT AND EMPOWERMENT WAS 7807 05:14:26,968 --> 05:14:28,303 ANOTHER RECURRENT THEME, THE 7808 05:14:28,303 --> 05:14:30,772 ROLE OF COMMUNITY INVOLVEMENT 7809 05:14:30,772 --> 05:14:32,674 AND ENHANCING MATERNAL HEALTH 7810 05:14:32,674 --> 05:14:36,278 OUTCOMES ACROSS THE CONTINUUM 7811 05:14:36,278 --> 05:14:39,414 WAS EMPHASIZED AND REINFORCING 7812 05:14:39,414 --> 05:14:41,249 EFFECTIVE SOLUTIONS OFTEN 7813 05:14:41,249 --> 05:14:42,484 REQUIRE ACTIVE COMMUNITY 7814 05:14:42,484 --> 05:14:44,519 PARTICIPATION AND INPUT. 7815 05:14:44,519 --> 05:14:46,888 IN TERMS OF INNOVATIVE 7816 05:14:46,888 --> 05:14:48,423 SOLUTIONS, SEVERAL SESSIONS 7817 05:14:48,423 --> 05:14:50,058 HIGHLIGHTED ADVANCEMENTS THEY 7818 05:14:50,058 --> 05:14:51,293 MADE IN MATERNAL HEALTHCARE 7819 05:14:51,293 --> 05:14:52,360 DELIVERY. 7820 05:14:52,360 --> 05:14:57,566 MOST RECEPTLY THE FINAL PANEL 7821 05:14:57,566 --> 05:15:00,469 ON THE INNOVATIVE METHODS SUCH 7822 05:15:00,469 --> 05:15:02,637 AS TELEHEALTH, DRONE DELIVERY, 7823 05:15:02,637 --> 05:15:04,439 ILLUSTRATING HOW TECHNOLOGY CAN 7824 05:15:04,439 --> 05:15:06,274 SIGNIFICANTLY TRANSFORM AND 7825 05:15:06,274 --> 05:15:07,342 ENHANCE MATERNAL HEALTH 7826 05:15:07,342 --> 05:15:08,710 SERVICES. OUR DISCUSSION ALSO 7827 05:15:08,710 --> 05:15:10,312 HIGHLIGHTED THE BALANCE OF 7828 05:15:10,312 --> 05:15:13,014 GLOBAL AND LOCAL AND 7829 05:15:13,014 --> 05:15:15,751 IMPLEMENTATION SCIENCE 7830 05:15:15,751 --> 05:15:18,186 APPROACHES IN ADDRESSING HLBS 7831 05:15:18,186 --> 05:15:19,221 ISSUES. THESE PRESENTATIONS 7832 05:15:19,221 --> 05:15:22,290 INCLUDING THOSE ON GLOBAL 7833 05:15:22,290 --> 05:15:24,426 SUCCESSES TO ADOPT 7834 05:15:24,426 --> 05:15:26,561 EVIDENCE-BASED PRACTICES AND 7835 05:15:26,561 --> 05:15:28,663 ADDRESSING MATERNAL MORTALITY 7836 05:15:28,663 --> 05:15:32,200 IN LMIC'S EMPHASIZE THE VALUE 7837 05:15:32,200 --> 05:15:33,335 OF ADAPTING SUCCESSES TO LOCAL 7838 05:15:33,335 --> 05:15:35,403 CONTEXT. 7839 05:15:35,403 --> 05:15:37,205 ENSURING EVIDENCE-BASED 7840 05:15:37,205 --> 05:15:37,739 PRACTICES ARE EFFECTIVELY 7841 05:15:37,739 --> 05:15:39,274 TAILORED TO MEET THEIR LOCAL 7842 05:15:39,274 --> 05:15:40,542 NEEDS. 7843 05:15:40,542 --> 05:15:43,278 RECIPROCAL LEARNING AND 7844 05:15:43,278 --> 05:15:44,279 CAPACITY BUILDING IS ANOTHER 7845 05:15:44,279 --> 05:15:47,949 EMERGING THEME. 7846 05:15:47,949 --> 05:15:49,284 BY FOSTERING BIDIRECTIONAL 7847 05:15:49,284 --> 05:15:51,887 KNOWLEDGE EXCHANGE WE EMPOWER 7848 05:15:51,887 --> 05:15:52,788 COMMUNITIES AND HEALTH 7849 05:15:52,788 --> 05:15:54,923 PROFESSIONALS WORLDWIDE. 7850 05:15:54,923 --> 05:15:56,324 ENHANCING CAPABILITIES AND 7851 05:15:56,324 --> 05:15:57,125 STRENGTHENING HEALTHCARE 7852 05:15:57,125 --> 05:15:59,661 SYSTEMS, THIS APPROACH AIMS TO 7853 05:15:59,661 --> 05:16:00,662 IMPROVE MATERNAL HEALTH 7854 05:16:00,662 --> 05:16:02,631 OUTCOMES IN AREAS LIKE HEART, 7855 05:16:02,631 --> 05:16:05,300 LUNG, BLOOD AND SLEEP HEALTH 7856 05:16:05,300 --> 05:16:08,069 OUTCOMES AND CREATE A MORE 7857 05:16:08,069 --> 05:16:09,538 EQUITABLE AND EFFECTIVE GLOBAL 7858 05:16:09,538 --> 05:16:10,639 HEALTHCARE LANDSCAPE. 7859 05:16:10,639 --> 05:16:13,408 THE IMPORTANCE OF REACH WAS 7860 05:16:13,408 --> 05:16:14,709 EMPHASIZED ENSURING MATERNAL 7861 05:16:14,709 --> 05:16:16,711 HEALTH INTERVENTIONS HAVE BROAD 7862 05:16:16,711 --> 05:16:18,547 EQUITABLE REACH AND LONG-TERM 7863 05:16:18,547 --> 05:16:20,248 SUSTAINABILITY IS VITAL FOR 7864 05:16:20,248 --> 05:16:23,185 MAKING A LASTING IMPACT ON 7865 05:16:23,185 --> 05:16:23,718 MATERNAL HEALTH OUTCOMES 7866 05:16:23,718 --> 05:16:24,753 GLOBALLY. 7867 05:16:24,753 --> 05:16:30,759 IN CONCLUSION PARTNERSHIPS WERE 7868 05:16:30,759 --> 05:16:31,059 HIGHLIGHTED. 7869 05:16:31,059 --> 05:16:34,429 BY COMBINING DIVERSE EXPERTISES 7870 05:16:34,429 --> 05:16:37,265 RESOURCES AND PERSPECTIVES, 7871 05:16:37,265 --> 05:16:39,134 PARTNERSHIPS CREATE INNOVATIVE, 7872 05:16:39,134 --> 05:16:40,235 EFFECTIVE AND SUSTAINABLE 7873 05:16:40,235 --> 05:16:43,205 SOLUTIONS THAT REACH BORDER 7874 05:16:43,205 --> 05:16:45,841 POPULATIONS AND TACKLE SYSTEMIC 7875 05:16:45,841 --> 05:16:46,141 DISPARITIES. 7876 05:16:46,141 --> 05:16:47,909 SO AS WE MOVE FORWARD, LET US 7877 05:16:47,909 --> 05:16:48,910 CARRY THESE INSIGHTS AND 7878 05:16:48,910 --> 05:16:50,545 COMMITMENTS WITH US. 7879 05:16:50,545 --> 05:16:52,247 TOGETHER WE CAN MAKE 7880 05:16:52,247 --> 05:16:58,653 SIGNIFICANT STRIDES AND IMPROVE 7881 05:16:58,653 --> 05:17:03,091 MATERNAL, HEART, LUNG, BLOOD 7882 05:17:03,091 --> 05:17:05,727 AND SLEEP HEALTH OUTCOMES BOTH 7883 05:17:05,727 --> 05:17:06,261 DOMESTICALLY AND GLOBALLY. 7884 05:17:06,261 --> 05:17:12,000 NEXT SLIDE. 7885 05:17:12,000 --> 05:17:14,769 WE WANT TO TAKE THIS 7886 05:17:14,769 --> 05:17:16,204 OPPORTUNITY TO EXTEND MY 7887 05:17:16,204 --> 05:17:21,009 DEEPEST GRAT TAOUT TO ALL OUR 7888 05:17:21,009 --> 05:17:22,010 KEYNOTE SPEAKERSS, PANELISTS, 7889 05:17:22,010 --> 05:17:24,913 MODERATORS AND ATTEND 7890 05:17:24,913 --> 05:17:31,620 EES, THE BREADTH AND DEPTH HAVE 7891 05:17:31,620 --> 05:17:33,488 TRULY ENRICHED OUR 7892 05:17:33,488 --> 05:17:34,522 UNDERSTANDING OF MATERNAL 7893 05:17:34,522 --> 05:17:36,258 HEALTH CRISIS AND POTENTIAL 7894 05:17:36,258 --> 05:17:37,993 SOLUTIONS WE CAN EXPLORE 7895 05:17:37,993 --> 05:17:39,427 THROUGH IMPLEMENTATION SCIENCE. 7896 05:17:39,427 --> 05:17:41,596 THE SPECIAL THANK YOU GOES OUT 7897 05:17:41,596 --> 05:17:47,269 TO MY CO-CHAIR DR. KAREN AND 7898 05:17:47,269 --> 05:17:50,972 NHLBI PLANNING TEAM LISTED HERE 7899 05:17:50,972 --> 05:17:51,840 FOR THEIR EXCEPTIONAL 7900 05:17:51,840 --> 05:17:52,707 COLLABORATION DEDICATION AND 7901 05:17:52,707 --> 05:17:55,543 ORGANIZING THIS WORKSHOP WITH 7902 05:17:55,543 --> 05:17:57,746 ME. 7903 05:17:57,746 --> 05:18:00,215 GRATITUDE TO THE AV TEAM, 7904 05:18:00,215 --> 05:18:00,916 BRITTNEY, ENTIRE WORKSHOP 7905 05:18:00,916 --> 05:18:02,484 SUPPORT TEAM FOR YOUR BEHIND 7906 05:18:02,484 --> 05:18:04,653 THE SCENES WORK FOR EXECUTION 7907 05:18:04,653 --> 05:18:06,855 OF THIS WORKSHOP AND SCIENCE 7908 05:18:06,855 --> 05:18:08,290 WRITER FOR CAPTURING THE 7909 05:18:08,290 --> 05:18:09,925 DISCUSSIONS AND INSIGHTS OVER 7910 05:18:09,925 --> 05:18:11,426 THE PAST TWO DAYS. 7911 05:18:11,426 --> 05:18:13,295 LAST BUT NOT LEAST I WOULD LIKE 7912 05:18:13,295 --> 05:18:23,772 TO THANK OUR LEADERSHIP AND 7913 05:18:54,769 --> 05:18:56,805 THANK YOU ONCE AGAIN FOR YOUR 7914 05:18:56,805 --> 05:18:58,039 PARTICIPATION AND ENGAGEMENT 7915 05:18:58,039 --> 05:19:00,008 FOR THIS VITAL CAUSE, I WISH 7916 05:19:00,008 --> 05:19:01,843 EVERYONE A WONDERFUL EVENING 7917 05:19:01,843 --> 05:19:03,845 AND EARLY MORNING AND I LOOK 7918 05:19:03,845 --> 05:19:05,313 FORWARD TO STAYING CONNECTED AS 7919 05:19:05,313 --> 05:19:07,949 WE CONTINUE TO STRIVE FOR 7920 05:19:07,949 --> 05:19:09,784 IMPROVED GLOBAL MATERNAL HEALTH. 7921 05:19:09,784 --> 05:19:10,719 AND WITH THAT, I OFFICIALLY 7922 05:19:10,719 --> 05:19:11,152 CLOSE THE WORKSHOP. 7923 05:19:11,152 --> 05:19:15,757 THANK YOU. 7924 05:19:15,757 --> 05:19:25,967 AND GOODBYE.