Alternative Interventions Research Articles

Effects of virtual reality guided meditation in older adults: the protocol of a pilot randomized controlled trial.

Virtual reality (VR) based meditation has been shown to help increase relaxation and decrease anxiety and depression in younger adults. However, this has not been studied in Randomized Controlled Trials (RCT) in the older adult population. The aim of this RCT is to assess the feasibility and acceptability of a VR-guided meditation intervention for community-dwelling older adults and its effect on stress and mental health. We will recruit 30 participants aged ≥ 60 years, whose perceived stress score (PSS) is > 14 (moderate stress), and randomize them 1:1 to the intervention or control waitlist group. The intervention will involve exposure to eight 15-min VR-guided meditation sessions distributed twice weekly for 4-weeks. Two modalities will be offered: in-home and at the hospital. Baseline and post-intervention assessments will evaluate perceived stress, anxiety, depression, sleep quality, quality of life, and mindfulness skills. Analyses will employ mixed methods repeated ANOVA tests. Qualitative analyses through semi-structured interviews and participant observation will be used to assess participants' experiences. Study outcomes include: (A) feasibility and acceptability compared to a waitlist control (B) stress, using the Perceived Stress Scale (PSS); (C) anxiety, and depression, using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9); (D) insomnia, quality of life and mindfulness skills, using the Athens Insomnia Scale (AIS), Quality of Life Questionnaire (EQ-5D-5L) and Five Facets Mindfulness Questionnaire Short Forms (FFMQ-SF), respectively. We will also measure immersive tendencies, sickness and sense of presence using the Simulator Sickness Questionnaire (SSQ) and the Presence Questionnaire (PQ). Virtual reality-guided meditation could be an acceptable, feasible, safe, and cost-effective novel alternative health intervention for improving older adults' mental health.Clinical trial registration: NCT05315609 at https://clinicaltrials.gov.

Opening Treatment Windows for Treatment-Resistant Schizophrenia: Improving Emotion Regulation Strategies Using the Unified Protocol in a Case Study in Spain

Approximately 30%-50% of people with schizophrenia worldwide have treatment-resistant schizophrenia (TRS). Currently available standard psychopharmacological and psychological treatments have proven insufficient to achieve full recovery in these patients. Alternative psychological interventions focused on improving emotion regulation, such as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), could potentially improve treatment outcomes in this difficult to treat population. The aim of the present case study is to demonstrate how the UP can be adapted for the treatment of TRS. We decided to use UP to treat this particular patient due to the presence of intense unpleasant emotions, aversive reactions, and emotional avoidance strategies. After completing the full treatment protocol, the patient showed significant decreases in scores on the Difficulties in Emotion Regulation Scale (DERS), including total and emotional rejection, life interference, and emotional lack of control. A significant reduction was also observed in anxiety (OASIS) and depressive symptoms (ODSIS). The intervention had a positive impact on auditory hallucinations, with decreased severity, less intense anxiety, and less interference in life. The treatment led to greater control over voices and the patient reported feeling more confident in her relationship with those voices. These results provide preliminary support for the use of UP for the treatment of TRS.

Effect of Tai Chi on knee pain and muscle strength in middle-aged and older adults with knee osteoarthritis: a randomized controlled trial protocol

BackgroundKnee osteoarthritis (KOA) is a common public health problem and a leading cause of long-term pain, decreased muscle strength, and even disability. Tai Chi has been proved effective and highly recommended for KOA management worldwide. However, little is known about its benefits on quadriceps strength which is closely associated with relieving knee pain. This trial is designed to evaluate the efficacy and safety of Tai Chi on knee pain and muscle strength in middle-aged and older adults with KOA.MethodsA total of 100 participants will be randomly divided into a Tai Chi group (TC group) (1x/week for 12 weeks) and a control group with a health education and stretching program (1x/week for 12 weeks) with a follow-up period of 6 weeks. The primary outcome is the change of Western Ontario and McMaster Universities (WOMAC) pain subscale at week 12 compared with baseline. Secondary outcomes include WOMAC stiffness and function subscales, data from isokinetic dynamometry, gait analysis with electromyography (EMG), and a 36-item short form health survey (SF-36). The daily dose of pain-relieving medication will also be recorded. All adverse effects will be assessed by the Treatment Emergent Symptom Scale (TESS).DiscussionWe expect this randomized trial to evaluate the effectiveness of Tai Chi on relieving pain and increasing quadriceps strength in KOA patients. This protocol, if proven effective, will contribute to providing a promising alternative intervention for middle-aged and older adults with KOA.Trials registration numberThis trial has been registered in the China Clinical Trials Registry (registration number: ChiCTR2300069339).

Impact of vitamin B12 on the reproductive health of women with sickle cell disease: a narrative review.

Sickle cell disease (SCD) poses an increased risk of infertility, pregnancy complications and maternal and perinatal mortality among women of reproductive age. This risk is particularly higher for women in sub-Saharan Africa, where the disease burden is highest and access to comprehensive health care is limited, as well as in other countries with a high SCD prevalence due to migration. Disease modifying treatments for SCD could directly and indirectly harm the ovaries, potentially compromising quality and quantity of existing oocytes. Therefore, it is essential to explore alternative interventions, such as nutritional modifications that are less harmful and cost-effective in order to improve reproductive outcomes, and enhance the overall well-being of both mother and child in this population. Maintaining optimal levels of B12 may possibly provide benefits to the ovaries and pregnancy by decreasing homocysteine levels, increasing nitric oxide (NO) bioavailability, and promoting antioxidant and anti-inflammatory activities. Individuals living with SCD are more susceptible to vitamin B12 (B12) deficiency. However, there is a lack of clinical data investigating the relationship between systemic levels of B12, its supplementation, and reproductive outcome measures in SCD women. Therefore, this review aims to examine the current evidence regarding the impact of SCD on female reproductive health and the role of B12 in the reproductive biology of women living with SCD.

Effectiveness of Self Management Technique Intervention in Reducing Addictive Behavior towards Online Games in Adolescents: A Literature Study

Generally, the handling of online game addiction in adolescents is still dominated by conventional counseling interventions, even though along with the rapid development of science there are many alternative interventions that can be applied in handling internet addiction in adolescents. One of them is intervention with self management techniques in recent years began to be widely used for handling online game addiction. Therefore, this study intends to examine and map the use of self management technique interventions in reducing adolescent online game addiction behavior. Through a literature study, the researcher tries to compile, analyze, and present the study material systematically in accordance with the research objectives. The results of the study of the ten articles analyzed, the researcher concluded that efforts to improve self-management in adolescents are effective to suppress and prevent addiction from getting worse, as well as self-management interventions proven effective in reducing online game addiction, and have a positive impact on adolescent mental health. Therefore, school counselors need to learn and practice self-management-based interventions in an effort to deal with online game addiction gradually.

A pragmatic clinical trial assessing the effect of a targeted notification and clinical support pathway on the diagnostic evaluation and treatment of individuals with left ventricular hypertrophy (NOTIFY-LVH)

Electronic health records contain vast amounts of cardiovascular data, including potential clues suggesting unrecognized conditions. One important example is the identification of left ventricular hypertrophy (LVH) on echocardiography. If the underlying causes are untreated, individuals are at increased risk of developing clinically significant pathology. As the most common cause of LVH, hypertension accounts for more cardiovascular deaths than any other modifiable risk factor. Contemporary healthcare systems have suboptimal mechanisms for detecting and effectively implementing hypertension treatment before downstream consequences develop. Thus, there is an urgent need to validate alternative intervention strategies for individuals with preexisting-but potentially unrecognized-LVH. Through a randomized pragmatic trial within a large integrated healthcare system, we will study the impact of a centralized clinical support pathway on the diagnosis and treatment of hypertension and other LVH-associated diseases in individuals with echocardiographic evidence of concentric LVH. Approximately 600 individuals who are not treated for hypertension and who do not have a known cardiomyopathy will be randomized. The intervention will be directed by population health coordinators who will notify longitudinal clinicians and offer to assist with the diagnostic evaluation of LVH. Our hypothesis is that an intervention that alerts clinicians to the presence of LVH will increase the detection and treatment of hypertension and the diagnosis of alternative causes of thickened myocardium. The primary outcome is the initiation of an antihypertensive medication. Secondary outcomes include new hypertension diagnoses and new cardiomyopathy diagnoses. The trial began in March 2023 and outcomes will be assessed 12 months from the start of follow-up. The NOTIFY-LVH trial will assess the efficacy of a centralized intervention to improve the detection and treatment of hypertension and LVH-associated diseases. Additionally, it will serve as a proof-of-concept for how to effectively utilize previously collected electronic health data to improve the recognition and management of a broad range of chronic cardiovascular conditions. NCT05713916.

Effect of Balloon Pulmonary Valvuloplasty on Growth of Pulmonary Annulus in Infants with Tetralogy of Fallot.

Percutaneous balloon pulmonary valvuloplasty (PBPV) is an alternative intervention in infants with Tetralogy of Fallot (TOF). It can not only improve hypoxia but also promote pulmonary annulus (PA) growth. In this study, we evaluated the effect of PBPV on PA growth in infants with TOF. To eliminate the effect of the systemic to pulmonary shunt (SPS) that may promote PA growth, we divided TOF infants into 2 groups: group A, patients who underwent PBPV with or without other SPS, and group B, patients who attempted SPS but without PBPV. Sixty patients were included, 28 patients in group A and 32 patients in group B. Age at the time of intervention in group A (range, 0.4-5.4; median 1.4months) was lower than that in group B (range, 2.3-7.7; median 4.8months), p-value 0.02. The body weight in group A (range, 3-5.5; median 3.7kg) was also lower than that in group B (range 4.1-6.4; median 5.9kg), p-value 0.02. Echocardiographic data at the mean follow-up period of 37.2months (3-88months) in group A and 39.6months (6-95months) in group B demonstrated an increase in mean PA diameter from 5.0 ± 1.3mm to 10.2 ± 2.9mm, p-value < 0.001 in group A; and from 6.2 ± 2mm to 9.5 ± 2.9mm, p-value < 0.001 in group B. The median PA z-score increased from -3.4SD (-3.9 to -2.6SD) to -1.8SD (-2.5 to -0.8SD), with the p-value of 0.002 in group A; and increased from -2.9SD (-4.5 to -1.3SD) to -2.7SD (-3.6 to -1.4SD), with the p-value of 0.73 in group B. By using the PA z-score as the absolute value, there was a statistically significant increase in the PA z-score during follow-up in group A, but not in group B. Balloon pulmonary valvuloplasty in infants with TOF can facilitate the growth of the pulmonic annulus even after eliminating the effect of the systemic to pulmonary shunt.

In Situ Neutralization and Detoxification of LPS to Attenuate Hyperinflammation.

Hyperinflammation elicited by lipopolysaccharide (LPS) that derives from multidrug-resistant Gram-negative pathogens, leads to a sharp increase in mortality globally. However, monotherapies aiming to neutralize LPS often fail to improve the prognosis. Here, an all-in-one drug delivery strategy equipped with bactericidal activity, LPS neutralization, and detoxification is shown to recognize, kill pathogens, and attenuate hyperinflammation by abolishing the activation of LPS-triggered acute inflammatory responses. First, bactericidal colistin results in rapid bacterial killing, and the released LPS is subsequently sequestered. The neutralized LPS is further cleared by acyloxyacyl hydrolase to remove secondary fatty chains and detoxify LPS in situ. Last, such a system shows high efficacy in two mouse infection models challenged with Pseudomonas aeruginosa. This approach integrates direct antibacterial activity with in situ LPS neutralizing and detoxifying properties, shedding light on the development of alternative interventions to treat sepsis-associated infections.

Internet-Mobile-Based Acceptance and Commitment Therapy (ACT) Against Diabetes Mellitus Distress: A Systematic Review

An intervention that can be used by nurses who treat DM patients is acceptance and commitment therapy (ACT). ACT is a therapy that has the goal of helping individuals to be able to accept unpleasant self-experiences and be willing to commit to behaving and acting in accordance with values so as to achieve a more valuable life. Diabetes can also cause stress which is usually called diabetes distress. One strategy that can be used at this time is the use of the internet–mobile–based interventions. Systematic review is based on Preferred Reporting Items for Systematic Review and Meta-Analyzed (PRISMA). The databases used are Scopus, Proquest, Science Direct, and Pubmed which are limited to publications for the last 5 years from 2018 to 2022, full-text articles, and use English. The keywords used in the search for articles are "Diabetes Mellitus" AND "Acceptance and Commitment Therapy" AND "mobile" AND "Distress". This systematic review uses 10 articles that meet the inclusion criteria. The initial literature search yielded 56 articles. There are 10 articles selected for review. conclusions: The results of this systematic review provide evidence for policymakers to consider alternative interventions using this method to reduce distress in patients with diabetes mellitus.

The efficacy of individual humanistic-experiential therapies for the treatment of depression: A systematic review and meta-analysis of randomized controlled trials

ABSTRACT Objective: Conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy of individual humanistic-experiential therapies (HEPs) for depression. Method: Database searches (Scopus, Medline, and PsycINFO) identified RCTs comparing any HEP intervention with a treatment-as-usual (TAU) control or active alternative intervention for the treatment of depression. Included studies were assessed using the Risk of Bias 2 tool and narratively synthesized. Post-treatment and follow-up effect sizes were aggregated using random-effects meta-analysis and moderators of treatment effect were explored (PROSPERO: CRD42021240485). Results: Seventeen RCTs, synthesized across four meta-analyzes, indicated HEP depression outcomes were significantly better than TAU controls at post-treatment (g = 0.41, 95% CI [0.18, 0.65], n = 735), but not significantly different at follow-up (g = 0.14, 95% CI [−0.30, 0.58], n = 631). HEP depression outcomes were comparable to active treatments at post-treatment (g = −0.09, 95% CI [−0.26, 0.08], n = 2131), but significantly favored non-HEP alternative interventions at follow-up (g = −0.21, 95% CI [−0.35, −0.07], n = 1196). Conclusion: Relative to usual care, HEPs are effective in the short-term and comparable to non-HEP alternative interventions at post-treatment, but not at follow-up. However, imprecision, inconsistency, and risk of bias concerns were identified as limitations of the evidence included. Future large-scale trials of HEPs with equipoise between comparator conditions are required.

Tetraspanin CD9-derived peptides inhibit Pseudomonas aeruginosa corneal infection and aid in wound healing of corneal epithelial cells

Pseudomonas aeruginosa is a leading cause of corneal infection both within India and globally, often causing a loss of vision. Increasing antimicrobial resistance among the bacteria is making its treatment more difficult. Preventing initial bacterial adherence to the host membrane has been explored here to reduce infection of the cornea. Synthetic peptides derived from human tetraspanin CD9 have been shown to reduce infection in corneal cells both in vitro, ex vivo and in vivo. We found constitutive expression of CD9 in immortalized human corneal epithelial cells by flow cytometry and immunocytochemistry. The synthetic peptides derived from CD9 significantly reduced bacterial adherence to cultured corneal epithelial cells and ex vivo human cadaveric corneas as determined by colony forming units. The peptides also significantly reduced bacterial burden in a murine model of Pseudomonas keratitis and lowered the cellular infiltration in the corneal stroma. Additionally, the peptides aided corneal wound healing in uninfected C57BL/6 mice compared to control mice. These potential therapeutics had no effect on cell viability or proliferation of corneal epithelial cells and have the potential to be developed as an alternative therapeutic intervention.

Using systems-thinking approaches to evaluate impacts to essential services in fragile contexts: a case study on Venezuela

ABSTRACT The global risk landscape is evolving, leading to more protracted and complex crises. The eventual degradation of critical infrastructure in such contexts often results in insufficient access to essential services and heightened risks of public health crises. To navigate complex protracted crises, engineering decision-makers can use systems-thinking approaches to develop a better understanding of the systems they are working in. This paper presents a qualitative systems mapping approach and applies it to a case study in Venezuela to assess how electricity and water services are being impacted by the ongoing political and economic crisis. The analysis uses the systems map to explore the current state of the sectors, as well as the root causes, cascading effects, and coping mechanisms causing or resulting from the current state. The insights drawn from the case analysis demonstrates how systems mapping can reveal alternative interventions that are rooted in a holistic understanding of a problem rather than opting for conventional, sector-based solutions that do not necessarily reflect the specific contextual challenges. For example, in this case, it became apparent that engineering decision-makers need to not only address issues of electricity continuity, but also consider power quality to ensure the electricity supply is usable. This work is part of a Special Issue on Systems Perspectives: Clarity through Examples (see Dias 2023).

Impact of pharmacist alternative therapy interventions in a pediatric Medicaid population

Impact of pharmacist alternative therapy interventions in a pediatric Medicaid population

The Phenomenon of Hatred in Adolescents: A Systemic-Relational Study and Alternative Intervention Strategies

&lt;p class="06IsiAbstrak"&gt;&lt;span class="Longtext"&gt;&lt;span&gt;The prevalence of hatred among adolescents, spanning schools, families, communities, and cyberspace, is a significant issue that requires further research, especially among Indonesian youth in the school environment. This qualitative study investigates hatred in adolescents using a systemic relational paradigm and alternative intervention strategies. Through in-depth interviews with five participants and a focus on three hate themes, it was found that all participants had experienced hatred, leading to distancing themselves from and severing connections with their haters. Some participants reported long-term trauma and feelings of anger and threat. They committed to reducing hatred and redirecting their focus to positive aspects, acknowledging the harmful effects of nurturing hatred. Relational hatred arises from family conflicts, particularly those involving parents, and social conflicts that induce trauma, emphasizing the crucial role of the family and social environment in prevention and intervention efforts. Addressing the phenomenon of hatred among adolescents is crucial to protecting both haters and those who are hated, providing an opportunity for counsellors and other supportive figures to implement suitable interventions.&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

Associations of social interactions during the COVID-19 pandemic with cognitive function among the South Korean older adults

BackgroundWe aimed to demonstrate the associations between social interactions within social distancing norms during the coronavirus disease 2019 (COVID-19) pandemic and cognitive function among South Korean older adults.MethodsData from the 2017 and 2020 Survey of Living Conditions and Welfare Needs of Korean Older Persons were used. There were 18,813 participants (7,539 males; 11,274 females). T-test and multiple logistic regression analyses verified whether the mean difference in older adults’ cognitive function before and during the COVID-19 pandemic was statistically significant. We also examined the associations between social interactions and cognitive function. The key results were presented as odds ratios (ORs) and 95% confidence intervals (CI).ResultsAll participants were more likely to experience cognitive impairment during the COVID-19 pandemic than before (males: OR 1.56, 95% CI 1.3–1.78; females: OR 1.26, 95% CI: 1.14–1.40). Cognitive impairment increased linearly with the decreased frequency of face-to-face contact with non-cohabiting children. Possible cognitive impairment was greater for females who had not visited senior welfare centers for the past year (OR 1.43, 95% CI 1.21–1.69).ConclusionKorean older adults’ cognitive function declined during the COVID-19 pandemic and was associated with reduced social interactions because of social distancing measures. Alternative interventions should be promoted for safely restoring social networks, considering the adverse effects of long-term social distancing on older adults’ mental health and cognitive function.

The Effectiveness of a Mobile Phone–Based Physical Activity Program for Treating Depression, Stress, Psychological Well-Being, and Quality of Life Among Adults: Quantitative Study

BackgroundDepression is a substantial global health problem, affecting &gt;300 million people and resulting in 12.7% of all deaths. Depression causes various physical and cognitive problems, leading to a 5-year to 10-year decrease in life expectancy compared with the general population. Physical activity is known to be an effective, evidence-based treatment for depression. However, people generally have difficulties with participating in physical activity owing to limitations in time and accessibility.ObjectiveTo address this issue, this study aimed to contribute to the development of alternative and innovative intervention methods for depression and stress management in adults. More specifically, we attempted to investigate the effectiveness of a mobile phone–based physical activity program on depression, perceived stress, psychological well-being, and quality of life among adults in South Korea.MethodsParticipants were recruited and randomly assigned to the mobile phone intervention or waitlist group. Self-report questionnaires were used to assess variables before and after treatment. The treatment group used the program around 3 times per week at home for 4 weeks, with each session lasting about 30 minutes. To evaluate the program’s impact, a 2 (condition) × 2 (time) repeated-measures ANOVA was conducted, considering pretreatment and posttreatment measures along with group as independent variables. For a more detailed analysis, paired-samples 2-tailed t tests were used to compare pretreatment and posttreatment measurements within each group. Independent-samples 2-tailed t tests were conducted to assess intergroup differences in pretreatment measurements.ResultsThe study included a total of 68 adults aged between 18 and 65 years, who were recruited both through web-based and offline methods. Of these 68 individuals, 41 (60%) were randomly assigned to the treatment group and 27 (40%) to the waitlist group. The attrition rate was 10.2% after 4 weeks. The findings indicated that there is a significant main effect of time (F1,60=15.63; P=.003; ηp2=0.21) in participants’ depression scores, indicating that there were changes in depression level across time. No significant changes were observed in perceived stress (P=.25), psychological well-being (P=.35), or quality of life (P=.07). Furthermore, depression scores significantly decreased in the treatment group (from 7.08 to 4.64; P=.03; Cohen d=0.50) but not in the waitlist group (from 6.72 to 5.08; P=.20; Cohen d=0.36). Perceived stress score of the treatment group also significantly decreased (from 2.95 to 2.72; P=.04; Cohen d=0.46) but not in the waitlist group (from 2.82 to 2.74; P=.55; Cohen d=0.15).ConclusionsThis study provided experimental evidence that mobile phone–based physical activity program affects depression significantly. By exploring the potential of mobile phone–based physical activity programs as a treatment option, this study sought to improve accessibility and encourage participation in physical activity, ultimately promoting better mental health outcomes for individuals with depression and stress.

Assessing socioeconomic impact of pathogen tested and conventional practice sweet potato production in the highlands of Papua New Guinea

Sweet potato (Ipomoea batatas) is a major staple food crop in Papua New Guinea (PNG), grown extensively in the high-altitude Highlands as a subsistence food crop by smallholder farmers and it is developing into commercial production for cash income. However, pests and diseases attack remain a major challenge. Most of the PNG farmers do not practice an active pests and diseases management, which has a significant impact on the yield and farmers' income. Few farmers have opted to use cultural practices, though these methods are ineffective and expensive. An alternative intervention technology through Pathogen Tested (PT) seeds as a part of Integrated Pest and Disease Management (IPDM) technology was trialed in three different zones in the Highlands of PNG and compared with the Conventional Practice (CP). The study was done using farmer participatory research approach (FPR). Pre-designed structured questionnaires were administered to collect data for yield, costs, income, and farmer's perception. The Benefit Cost Ratio (BCR) analysis was used to compare the costs, benefits, and net incomes. T-test statistics was used to compare the mean yield. The farmer perception was summarized using descriptive statistics. Results revealed that marketable sweet potato yield was significantly (P < 0.01) improved with implementation of the PT practice compared to the CP. The improvement in storage root yield had subsequent result in the net income doubled for the farmers. The yield and quality of storage roots had significant influence on the farmers' perception towards adoption of the IPDM technology.

Ultrasound versus videos: A comparative study on the effectiveness of musculoskeletal anatomy education and student cognition.

Ultrasound imaging is a dynamic imaging technique that uses high-frequency sound waves to capture live images of the structures beneath the skin. In addition to its growing use in diagnosis and interventions, ultrasound imaging has the potential to reinforce concepts in the undergraduate medical curriculum. However, research assessing the impact of ultrasound on anatomy learning and student cognition is scarce. The purpose of this study was to compare the impact of ultrasound-based instruction versus narrated videos on students' understanding of anatomical relationships, as well as the role of intrinsic motivation, self-efficacy beliefs, and students' attitudes in this process. A booster course on anterior leg and wrist anatomy was offered to second-year medical students. A randomized controlled trial with a cross-over design allocated students to either an ultrasound-based teaching condition (cohort A) or a narrated anatomy video condition (cohort B). Next, participants were crossed to the alternative intervention. At the start of the study (T0), baseline anatomy knowledge, intrinsic motivation, self-efficacy beliefs, and spatial ability were measured. After the first intervention (T1) and at the end of the study (T2), both cohorts were administered an anatomy test, an intrinsic motivation scale, and a self-efficacy scale. In addition, each student was asked to fill out a perception survey after the ultrasound intervention. Finally, building on the cross-over design, the most optimal sequence of interventions was examined. A total of 181 students participated (cohort A: n = 82, cohort B: n = 99). Both cohorts performed comparably on the baseline anatomy knowledge test, spatial ability test, intrinsic motivation, and self-efficacy scale. At T1, cohort B outperformed cohort A on the anatomy test (p = 0.019), although only a small effect size could be detected (Cohen's d = 0.34). Intrinsic motivation and self-efficacy of both cohorts were similar at T1. At T2, the anatomy test, intrinsic motivation, and self-efficacy scale did not reflect an effect after studying either sequence of the interventions. Students reported favorably about the ultrasound experience, but also mentioned a steep learning curve. Medical students found the hands-on ultrasound sessions to be valuable, increasing their interest in musculoskeletal anatomy and ultrasound imaging. However, the addition of ultrasound did not result in superior spatial anatomy understanding compared to watching anatomy videos. In addition, ultrasound teaching did not have a major effect on student cognition. Ultrasound-based teaching of musculoskeletal anatomy is regarded as difficult to learn, and therefore it is hypothesized that too high levels of cognitive load might explain the presented results.

O-101 Add-ons in the ART lab

Abstract Study question Which laboratory based add-ons are effective and safe to use in ART treatment? Summary answer In total, more than thirty recommendations were formulated on the use of add-ons, with about a third being laboratory based tests or interventions What is known already Treatment add-ons are defined as not essential for the treatment, but optional additional treatments that are sometimes offered on top of routine fertility treatment. There are a wide range of treatment add-ons available, including diagnostic tests, drugs, equipment, holistic or alternative therapies, laboratory and surgical interventions, all claiming to potentiate the effect of the treatment and/or to lessen side effects, improve pregnancy or live birth rate, reduce the risk of miscarriage or shorten the time to pregnancy. Add-ons and can be at extra cost (or not), and evidence on efficacy and safety is often missing. Presumably they can be both beneficial or non-beneficial, as there may be absence of evidence to either. Study design, size, duration The ESHRE working group for good practice recommendations on add-ons in ART has produced recommendations useful for professionals, patients and policy makers. More than 30 add-ons were identified, and evaluated for efficiency and safety, and wherever possible also for cost. The literature was identified in a systematic search, reviewed and critically appraised. In the absence of any clear scientific evidence, judgement was based on the professional experience and consensus of the multidisciplinary development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by independent international reviewers. Participants/materials, setting, methods Interventions were characterized in three sections: 1) Diagnosis and diagnostic tests, 2) Laboratory tests and intervention, and 3) Clinical management. Outcomes were efficacy (pregnancy or live birth rate), risk of miscarriage, time to pregnancy, cost, and safety/risk aspects. Some examples of add-ons in the group of laboratory tests and interventions are oocyte and sperm activation, mitochondria load and transfer, sperm selection, assisted hatching, genetic testing and addition of hyaluronic acid to media. Main results and the role of chance The guideline development group formulated more than 30 recommendations. This lecture will focus on the rationale and the recommendations of the laboratory add-ons currently used in fertility clinics. We will discuss the potential beneficial effects on the IVF treatment, its efficacy, and its safety. While most add-ons are not recommended for the general population of ART patients, where specific patient populations might benefit, indications were formulated. The guideline has been in stakeholder review and is prepared for submission in 2023. Limitations, reason for caution Of the recommendations, none are based on high quality evidence and only a few are based on moderate quality evidence. Hence 90% of the recommendations are supported only by low quality RCTs, observational data, professional experience, or consensus of the development group. Wider implications of the findings These recommendations aim to provide guidance to health care professionals and laboratory experts in the field of reproductive medicine, to help towards safe and efficient ART treatments for patients where they can participate in informed decision making with realistic expectations and be fully informed about their chances to pregnancy and live birth. Study funding and competing interest(s) All costs relating to the development process were covered from ESHRE funds. There was no external funding of the development process or manuscript production.

O-102 Add-ons in the ART clinic

Abstract Study question Which add-ons are effective and safe to use in the ART clinic? Summary answer More than thirty recommendations were formulated on the use of add-ons in diagnosis and diagnostic tests, laboratory tests and intervention, and clinical management. What is known already Treatment add-ons are not essential for the treatment but optional additional treatments that are sometimes offered on top of routine fertility treatment. There are a wide range of treatment add-ons on offer including tests, drugs, equipment, holistic or alternative therapies, laboratory and surgical interventions, but consistently, they aim to potentiate the effect of treatment or to lessen side effects herein improve pregnancy or live birth rate, reduce the risk of miscarriage or shorten the time to pregnancy. Evidence on whether some treatment add-ons are effective and safe is often missing or absent. Add-ons can be proven or evidence-based (or not) and can be at extra cost (or not), presumable they can be both beneficial and non-beneficial, as there may be absence of evidence to either. Study design, size, duration The ESHRE working group for good practice recommendations on add-ons in ART has produced recommendations useful for professionals, patients and policy makers and identified more than 30 add-ons and evaluated each one of them for efficiency and safety and wherever possible also costs. The literature was identified in a systematic search, was reviewed and critically appraised. In the absence of any clear scientific evidence, judgement was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by independent international reviewers. Participants/materials, setting, methods Interventions were characterized in three sections: 1) Diagnosis and diagnostic tests, 2) Laboratory tests and intervention, and 3) Clinical management. Outcomes were efficacy (pregnancy or live birth rate), risk of miscarriage, time to pregnancy, costs, and safety/risk aspects. This lecture will focus on the recommendations relevant for the ART clinic including endometrial receptivity tests, assisted hatching, freeze-all (elective), ICSI (elective), uterine flushing and endometrial scratching. Main results and the role of chance The multidisciplinary development group formulated more than 30 recommendations. This lecture provides a summary of the recommendations of the add-ons currently used in fertility clinics. First it is described how an add-on is hypothesized to have beneficial effects on the IVF treatment, its efficacy, and its safety. While most add-ons are not recommended for the general population of ART patients, indications were formulated where specific patient populations might benefit. The guideline has been in stakeholder review and is prepared for submission in 2023. Limitations, reason for caution Of the recommendations, none are based on high quality evidence and only a few are based on moderate quality evidence. Hence 90% of the recommendations are supported only by low quality RCTs, observational data, professional experience, or consensus of the development group. Wider implications of the findings These recommendations provide guidance to health care professionals and laboratory experts in the field of reproductive medicine, and will help towards safe and efficient ART treatment, where patients can participate in informed decision making with realistic expectations and are fully informed about their changes to pregnancy and live birth. Study funding and competing interest(s) All costs relating to the development process were covered from ESHRE funds. There was no external funding of the development process or manuscript production. The authors have stated their conflicts of interest if any.