Conservative management as an alternative to hysterectomy for placenta accreta spectrum.

保守治疗作为植入性胎盘谱子宫切除术的替代方案。

• 批准号: 10661713
• 负责人: Brett David Einerson
• 金额: $ 17.17万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-12 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10661713
• 关键词: Address; Award; Benefits and Risks; Caring; Clinical; Clinical Treatment; Clinical Trials; Clinical Trials Design; Cohort Studies; Complex; Control Groups; Counseling; Data; Decision Aid; Decision Making; Discipline of obstetrics; Disease; Economic Burden; Economics; Eligibility Determination; Enrollment; Foundations; Frustration; Funding; Future; Goals; Health; Healthcare Systems; Hemorrhage; Hysterectomy; In Situ; Incidence; Infertility; International; Interview; Knowledge; Leadership; Left; Maternal-fetal medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Monitor; Morbidity - disease rate; Necrosis; Needs Assessment; Neonatal; Operative Surgical Procedures; Outcome; Patient Care; Patient Outcomes Assessments; Patients; Physicians; Placenta; Placenta Accreta; Positioning Attribute; Pregnancy; Principal Investigator; Process; Qualitative Methods; Qualitative Research; Quality of life; Randomized; Repeat Surgery; Research; Research Design; Research Ethics; Research Personnel; Risk; Safety; Scientist; Silver; Structure; Therapeutic; Time; United States National Institutes of Health; Universities; Utah; Uterus; Woman; Work; alternative treatment; barrier to care; career; career development; cost; cost comparison; cost effective; cost effective treatment; design; economic evaluation; evidence base; follow-up; health economics; improved; mortality; novel; patient oriented; pilot trial; preference; pregnancy disorder; premature; randomized, clinical trials; severe maternal morbidity; shared decision making; skills; standard care; treatment comparison; trial comparing; trophoblast

PROJECT SUMMARY/ABSTRACT This is an application for a K23 award for Dr. Brett Einerson, a Maternal-Fetal Medicine (MFM) physician at the University of Utah. Dr. Einerson is a promising young investigator in placenta accreta spectrum (PAS) research. His long-term career goal is to become an independent investigator and national leader of PAS studies that evaluate treatments for PAS, including in situ conservative management (CM). This K23 award will provide Dr. Einerson with the protected time and mentored support to accomplish the following career goals: 1] develop expertise in clinical trial design and management; 2] acquire proficiency in interview study design and qualitative assessment; 3] obtain advanced skills in health economic evaluation; and 4] develop and strengthen research leadership and management skills. To achieve these goals, Dr. Einerson assembled a mentoring team comprising a primary mentor, Dr. Robert Silver, a MFM physician and international leader in PAS research, and two co-mentors: Dr. Erin Rothwell, a NIH-funded scientist and expert in shared decision-making, qualitative research, and research ethics, and Dr. Richard Nelson, a federally-funded health economist. Dr. Einerson also has four advisors with expertise in clinical trials, CM, and multicenter research leadership. PAS is an extremely morbid and increasingly common pregnancy condition that often results in massive obstetric hemorrhage. The standard treatment in the US is hysterectomy, but this treatment is complex, morbid, and costly. A promising alternative for PAS treatment is CM, a strategy in which the placenta is left in the uterus. Unfortunately, there are insufficient data available to compare outcomes of these two treatments because past studies are limited by non-randomized study designs, minimal inclusion of patient values in making treatment decisions, and nominal consideration of economic barriers to care. A large clinical trial comparing PAS treatments is needed. Dr. Einerson's research will provide essential data to prepare for a randomized clinical trial and will provide the evidence base for enhanced shared decision-making regarding treatments for PAS. He will (Aim 1) evaluate the feasibility of randomizing patients to CM for PAS; (Aim 2) identify the information needs, outcome priorities, and shared decision-making preferences for PAS; and (Aim 3) quantify the cost of PAS treatments. In Aim 1, Dr. Einerson will design and implement a pilot trial of PAS patients randomized to CM or hysterectomy to evaluate feasibility of a larger trial. In Aim 2, Dr. Einerson will conduct interviews with patients, clinicians, and partners to assess the information needs and values of those who are part of making treatment decisions for PAS. In Aim 3, Dr. Einerson will compare the cost of PAS treatments using advanced economic analytics. The expected outcome will lay the groundwork for a large clinical trial of CM versus hysterectomy for PAS and help to establish the data necessary for shared decision-making and value-based care in PAS. Completing these goals and aims will prepare Dr. Einerson for a successful transition into an independent clinical trialist.

项目总结/文摘

项目成果

Conservative management for placenta accreta spectrum: questions and barriers remain but are surmountable.

侵入性胎盘的保守治疗：问题和障碍仍然存在，但可以克服。

• DOI: 10.1016/j.ajogmf.2023.100859
• 发表时间: 2023
• 期刊: American journal of obstetrics & gynecology MFM
• 影响因子: 6.3
• 作者: Einerson,BrettD

Trends in Unplanned Peripartum Hysterectomy in the United States, 2009-2020.

2009-2020 年美国计划外围产期子宫切除术的趋势。

• DOI: 10.1097/aog.0000000000004673
• 发表时间: 2022-03-01
• 期刊: Obstetrics and gynecology
• 影响因子: 7.2
• 作者: Givens M;Einerson BD;Allshouse AA;Bruno AM;Hammad I;Debbink MP;Branch DW;Silver RM
• 通讯作者: Silver RM

Placenta Accreta Spectrum.

植入性胎盘光谱。

• DOI: 10.1097/aog.0000000000005229
• 发表时间: 2023
• 期刊: Obstetrics and gynecology
• 影响因子: 7.2
• 作者: Einerson,BrettD;Gilner,JenniferB;Zuckerwise,LisaC
• 通讯作者: Zuckerwise,LisaC