BACKGROUND: IVIg is a pooled donor immunoglobulin preparation, used for auto-immune and inflammatory diseases. In assisted reproduction it receives considerable scepticism. Clinical data is expanding, but individual studies may be perceived as weak, meaning an updated appraisal of evidence in implantation failure is needed.
OBJECTIVE: To assess the efficacy of IVIg in Recurrent Implantation Failure (RIF) following assisted reproductive technology.
METHODS: Systematic review and meta-analysis of randomized controlled trials and observational studies comparing IVIg therapy against placebo in a defined RIF population.
METHODS: A comprehensive literature search, identifying studies involving RIF following ART, using pre-conception IVIg. Primary outcomes were clinical pregnancy (CPR), live birth (LBR), implantation (IR), and miscarriage rates (MR). The selection process yielded twelve studies, including 1023 cases and 2276 controls.
RESULTS: A significant increase in CPR (OR=5.14, 95 % CI: 2.33-11.30, p<0.001) and LBR (OR=4.60, 95 % CI:2.44-8.68, p<0.001) is demonstrated in IVIG-treated patients, with an improvement in IR (OR=2.35, 95 % CI: 1.04-5.29, p=0.039) and reduction in MR (OR=0.60, 95 % CI: 0.37-0.97, p=0.036). Substantial heterogeneity was identified across studies, which was addressed through subgroup analyses, assessing if the variability in may be attributed to study-specific factors.
CONCLUSIONS: IVIg may enhance implantation, clinical pregnancy, and live birth rates in RIF patients, underscoring benefit for specific populations. Positive immunological risk factors may predict potential candidates, but it could also be of use in unexplained RIF with high-grade embryos. These findings highlight the importance of personalized therapeutic strategies to improve ART outcomes for complex cases.

BACKGROUND: Drawing tasks are an elementary component of psychological assessment in the evaluation of mental health. With the rise of digitalization not only in psychology but healthcare in general, digital drawing tools (dDTs) have also been developed for this purpose. This scoping review aims at summarizing the state of the art of dDTs available to assess mental health conditions in people above preschool age.
METHODS: PubMed, PsycInfo, PsycArticles, CINAHL, and Psychology and Behavioral Sciences Collection were searched for dDTs from 2000 onwards. The focus was on dDTs, which not only evaluate the final drawing, but also process data.
RESULTS: After applying the search and selection strategy, a total of 37 articles, comprising unique dDTs, remained for data extraction. Around 75 % of these articles were published after 2014 and most of them target adults (86.5 %). In addition, dDTs were mainly used in two areas: tremor detection and assessment of cognitive states, utilizing, for example, the Spiral Drawing Test and the Clock Drawing Test.
CONCLUSIONS: Early detection of mental diseases is an increasingly important field in healthcare. Through the integration of digital and art-based solutions, this area could expand into an interdisciplinary science. This review shows that the first steps in this direction have already been taken and that the possibilities for further research, e.g., on the optimized application of dDTs, are still open.

This is a review essay based primarily on the 2021 Routledge Handbook of Art, Science, and Technology Studies, edited by Hannah Star Rogers, Megan K. Halpern, Dehlia Hannah, and Kathryn de Ridder-Vignone. It focuses particularly on the use of art for public engagement with science and technology and it also draws upon the following books: Dialogues Between Artistic Research and Science and Technology Studies (2023), edited by Henk Borgdorff, Peter Peters, and Trevor Pinch, Making Art Work: How Cold War Engineers and Artists Forged a New Creative Culture (2020) by Patrick McCray, and Art, Science, and the Politics of Knowledge (2022), by Hannah Star Rogers.

OBJECTIVE: To evaluate the association between first trimester (≤ 12 weeks gestation) subchorionic hemorrhage (SCH), and maternal and neonatal outcomes in women who conceived with the help of assisted reproductive technique (ART).
METHODS: PubMed, Embase, Web of Science, and Scopus databases were searched for observational studies that specifically focused on women who achieved pregnancy via ART and investigated the relationship between early pregnancy (within 12 weeks of gestation) SCH and maternal and neonatal outcomes. Only studies with singleton pregnancies and reporting data on the comparator group (women without SCH) were included. Primary outcomes of interest included incidences of early (within 20 weeks of gestation) pregnancy loss, preterm delivery, caesarean section, and live birth rates. Pooled effect sizes were reported as odds ratio (OR) with 95% confidence intervals (CI).
RESULTS: Nine studies were included. All studies had a cohort design. In all studies, the primary assisted reproduction technique used was in-vitro fertilization (IVF). Compared to pregnancies without SCH, women with diagnosed early pregnancy SCH have a similar risk of preterm birth (< 37 weeks) (OR 1.01, 95% CI 0.83, 1.22), low birth weight (< 2500 g) (OR 1.01, 95% CI 0.59, 1.73) and fetal growth restriction (OR 1.57, 95% CI 0.62, 4.02). The gestational age (in weeks) (weighted mean difference (WMD) - 0.06, 95% CI - 0.18, 0.06) and the birth weight (in grams) (WMD - 16.5, 95% CI - 62.9, 29.8) were also similar in the two groups. The odds of early pregnancy loss (OR 1.39, 95% CI 0.97, 2.01), live birth (OR 0.77, 95% CI 0.55, 1.08) and caesarean delivery (OR 0.97, 95% CI 0.81, 1.16) were statistically similar in both groups. The risk of maternal adverse outcomes such as gestational diabetes (OR 0.98, 95% CI 0.74, 1.29), hypertensive disorder (OR 0.95, 95% CI 0.63, 1.43), premature rupture of membranes (PROM) (OR 1.36, 95% CI 0.90, 2.05) and placental abruption (OR 2.44, 95% CI 0.57, 10.5) was also similar in both the groups. There was no evidence of publication bias.
CONCLUSIONS: The findings suggest that SCH may not significantly increase the risk of adverse maternal and perinatal outcomes in pregnancies conceived through ART, particularly IVF.
BACKGROUND: PROSPERO registration number CRD42024533996.

OBJECTIVE: While graphics are commonly used by clinicians to communicate information to patients, the impact of using visual media on surgical patients is not understood. This review seeks to understand the current landscape of research analyzing impact of using visual aids to communicate with patients undergoing surgery, as well as gaps in the present literature.
METHODS: A comprehensive literature search was performed across 4 databases. Search terms included: visual aids, diagrams, graphics, surgery, patient education, informed consent, and decision making. Inclusion criteria were (i) full-text, peer-reviewed articles in English; (ii) evaluation of a nonelectronic visual aid(s); and (iii) surgical patient population.
RESULTS: There were 1402 articles identified; 21 met study criteria. Fifteen were randomized control trials and 6 were prospective cohort studies. Visual media assessed comprised of diagrams as informed consent adjuncts (n = 6), graphics for shared decision-making conversations (n = 3), other preoperative educational graphics (n = 8), and postoperative educational materials (n = 4). There was statistically significant improvement in patient comprehension, with an increase in objective knowledge recall (7.8%-29.6%) using illustrated educational materials (n = 10 of 15). Other studies noted increased satisfaction (n = 4 of 6), improvement in shared decision-making (n = 2 of 4), and reduction in patient anxiety (n = 3 of 6). For behavioral outcomes, visual aids improved postoperative medication compliance (n = 2) and lowered postoperative analgesia requirements (n = 2).
CONCLUSIONS: The use of visual aids to enhance the surgical patient experience is promising in improving knowledge retention, satisfaction, and reducing anxiety. Future studies ought to consider visual aid format, and readability, as well as patient language, race, and healthcare literacy.

This study adopted a scoping review methodology to analyze international literature on the barriers impacting Muslim couples\' access to equitable assisted reproductive technologies (ART). A total of 27 studies were included for review. Results show that Muslim communities face several barriers when accessing ART. These include cultural and religious barriers that impacted which aspects of ART couples were open to adopting, diminished quality of care due to low cultural/religious capacity of practitioners, as well as gendered norms which intersect with experiences of ART treatments. Further research, based in western countries, should be conducted to better understand how these contexts can support Muslim patients accessing ART.

BACKGROUND: Laser-assisted hatching (LAH) stands as the predominant technique for removing the zona pellucida (ZP) in embryos, primarily consisting of two methods: drilling laser-assisted hatching (D-LAH) and thinning laser-assisted hatching (T-LAH). Presently, both methods have limitations, and their comparative efficacy for embryo implantation and clinical pregnancy remains uncertain.
OBJECTIVE: Evaluate the impact of D-LAH and T-LAH on clinical pregnancy rates within assisted reproductive technology (ART).
METHODS: We systematically searched electronic databases including PubMed, Web of Science, and Cochrane Library until July 20, 2022. This study encompassed observational studies and randomized controlled trials (RCTs). A 95% confidence interval (CI) was utilized for assessing the risk ratio (RR) of pregnancy outcomes. The level of heterogeneity was measured using I2 statistics, considering a value exceeding 50% as indicative of substantial heterogeneity.
RESULTS: The meta-analysis scrutinized 9 studies involving 2405 clinical pregnancies from D-LAH and 2239 from T-LAH. Findings suggested no considerable variation in the clinical pregnancy rates between the two techniques (RR = 0.93, 95% CI: 0.79-1.10, I2 = 71%, P = 0.41). Subgroup analyses also revealed no substantial differences. However, D-LAH exhibited a notably higher occurrence of singleton pregnancies compared to T-LAH (RR = 2.28, 95% CI: 1.08-4.82, I2 = 89%, P = 0.03). There were no noteworthy distinctions observed in other secondary outcomes encompassing implantation rate, multiple pregnancies, ongoing pregnancy, miscarriage, premature birth, and live birth.
CONCLUSIONS: Both the primary findings and subgroup analyses showed no marked variance in clinical pregnancy rates between D-LAH and T-LAH. Therefore, patients with varying conditions should select their preferred LAH technique after assessing their individual situation. However, due to the restricted number of studies involved, accurately gauging the influence of these laser techniques on clinical outcomes is challenging, necessitating further RCTs and high-quality studies to enhance the success rate of ART.
BACKGROUND: PROSPERO: CRD42022347066.

To identify, critically appraise and synthesise evidence of the use and effectiveness of the arts for enhancing pre-registration/prelicensure healthcare students\' empathy skills.
A systematic review of mixed methods literature.
A search of six electronic databases was conducted.
Articles describing English language, peer-reviewed, primary research studies reporting empathy as an outcome of an arts-based intervention with pre-registration/prelicensure healthcare students (years 1-7) and published between 2000 and 2024 were eligible for inclusion. The JBI Manual for Evidence Synthesis guided the review and a convergent segregated methodology was used to synthesise the results. Methodological rigour of included studies was examined using the Mixed Methods Appraisal Tool.
Twenty studies from 12 countries described the use of the arts to develop empathy, with visual arts being the most common approach (n = 8). Other modalities included film, drama, digital stories, literature, creative writing, music, poetry, photography and dance. Studies included nursing, medicine and dental, pharmacy and/or health sciences students. Ten studies used quantitative methods, three qualitative, and seven used mixed methods designs. Of the studies that presented pre-post outcome measures, nine reported significant gains in empathy scores at post-test and two reported non-significant gains in empathy. In eight studies, empathy scores demonstrated a significant intervention effect with effect sizes ranging from moderate (d = 0.52) to large (d = 1.19). Findings from qualitative studies revealed that arts pedagogies support students to better understand the perspectives of people with a lived experience of suffering but that these approaches are sometimes perceived negatively by students.
Arts interventions generally have a positive effect on healthcare students\' empathy levels and enable a nuanced conceptual understanding of empathy. Arts modalities used as a stimulus for active learning and supported with facilitated group-based discussion and/or reflection, tend to be most effective.

OBJECTIVE: Which assited reproductive technology (ART) interventions in high-income countries are cost-effective and which are not?
CONCLUSIONS: Among all ART interventions assessed in economic evaluations, most high-cost interventions, including preimplantation genetic testing for aneuploidy (PGT-A) for a general population and ICSI for unexplained infertility, are unlikely to be cost-effective owing to minimal or no increase in effectiveness.
BACKGROUND: Approaches to reduce costs in order to increase access have been identified as a research priority for future infertility research. There has been an increasing number of ART interventions implemented in routine clinical practice globally, before robust assessments of evidence on economic evaluations. The extent of clinical effectiveness of some studied comparisons has been evaluated in high-quality research, allowing more informative decision making around cost-effectiveness.
METHODS: We performed a systematic review and searched seven databases (MEDLINE, PUBMED, EMBASE, COCHRANE, ECONLIT, SCOPUS, and CINAHL) for studies examining ART interventions for infertility together with an economic evaluation component (cost-effectiveness, cost-benefit, cost-utility, or cost-minimization assessment), in high-income countries, published since January 2011. The last search was 22 June 2022.
METHODS: Two independent reviewers assessed publications and included those fulfilling the eligibility criteria. Studies were examined to assess the cost-effectiveness of the studied intervention, as well as the reporting quality of the study. The chosen outcome measure and payer perspective were also noted. Completeness of reporting was assessed against the Consolidated Health Economic Evaluation Reporting Standard. Results are presented and summarized based on the intervention studied.
RESULTS: The review included 40 studies which were conducted in 11 high-income countries. Most studies (n = 34) included a cost-effectiveness analysis. ART interventions included medication or strategies for controlled ovarian stimulation (n = 15), IVF (n = 9), PGT-A (n = 7), single embryo transfer (n = 5), ICSI (n = 3), and freeze-all embryo transfer (n = 1). Live birth was the mostly commonly reported primary outcome (n = 27), and quality-adjusted life years was reported in three studies. The health funder perspective was used in 85% (n = 34) of studies. None of the included studies measured patient preference for treatment. It remains uncertain whether PGT-A improves pregnancy rates compared to IVF cycles managed without PGT-A, and therefore cost-effectiveness could not be demonstrated for this intervention. Similarly, ICSI in non-male factor infertility appears not to be clinically effective compared to standard fertilization in an IVF cycle and is therefore not cost-effective. Interventions such as use of biosimilars or HMG for ovarian stimulation are cheaper but compromise clinical effectiveness.
CONCLUSIONS: Lack of both preference-based and standardized outcomes limits the comparability of results across studies. The selection of efficacy evidence offered for some interventions for economic evaluations is not always based on high-quality randomized trials and systematic reviews. In addition, there is insufficient knowledge of the willingness to pay thresholds of individuals and state funders for treatment of infertility. There is variable quality of reporting scores, which might increase uncertainty around the cost-effectiveness results.
CONCLUSIONS: Investment in strategies to help infertile people who utilize ART is justifiable at both personal and population levels. This systematic review may assist ART funders decide how to best invest to maximize the likelihood of delivery of a healthy child.
BACKGROUND: There was no funding for this study. E.C. and R.W. receive salary support from the National Health and Medical Research Council (NHMRC) through their fellowship scheme (EC GNT1159536, RW 2021/GNT2009767). M.D.-T. reports consulting fees from King Fahad Medical School. All other authors have no competing interests to declare.
BACKGROUND: Prospero CRD42021261537.

This article was migrated. The article was marked as recommended. Introduction: Medicine\'s increasing technologic complexities can constrain medical learners\' development of patient-centered communication skills, and adversely impact patient outcomes. Although humanities-based clinical education interventions encourage reflective practice and promote the practice of holistic patient care, it remains unclear which educational interventions are the most effective. Methods : A search was conducted in PubMed, utilising the terms \'humanities\', \'humanism\', \'art\', \'medicine\', \'narrative medicine\', and \'medical education\' to identify relevant English-language articles. Discussion with experts yielded further titles, such that 156 articles were reviewed and summarised, with particular focus on those describing novel curricular interventions. Results: 108/156 (69%) of the articles were commentaries or reflections; 48/156 (31%) reported on curricular interventions. Of the latter, the majority incorporated literature or ethics, typically delivered in small-group format. Only ten interventions included impact assessment measures beyond learner satisfaction. Five of these used qualitative evaluations; three, quantitative scales; and two, both. Discussion: Humanities-based curricular interventions with a focus on literature or ethics were more common than those involving the visual or performing arts. Among the studies that evaluated these curricular interventions, the majority employed qualitative measures. Collaborative teaching between clinicians, arts educators and patients may be considered in order to bridge the gap between science and humanities.