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Time-lapse imaging systems for embryo incubation and assessment to improve reproductive outcomes in women undergoing in vitro fertilisation: study protocol for an individual participant data meta-analysis of randomised controlled trials

Por: Bhide · P. · Chan · D. Y. L. · Ahlström · A. · del Campo · L. · Kieslinger · D. · Lundin · K. · Park · H. · Fauque · P. · Kahraman · S. · Khan · K. S. · Kovacs · P. · Lambalk · C. B. · Thangaratinam · S. · Vergouw · C. G. · van Wely · M. · Zamora · J.
Introduction

Time-lapse imaging (TLI) systems for embryo incubation and assessment are hypothesised to improve the success rates of in vitro fertilisation (IVF) treatment by providing undisturbed culture conditions for embryos and/or providing more information on embryo development (morphokinetic parameters) to improve predictive accuracy for embryo selection. Despite numerous aggregate meta-analyses showing uncertainty of benefit, IVF clinics globally continue to invest significant resources into this technology with little translation of evidence into guidelines or policy frameworks. This may be attributed to heterogeneity in participant populations and/or variations in the use of TLI, as highlighted in the aggregate meta-analyses.

Methods and analysis

Our research proposal for evidence synthesis using individual participant data meta-analysis will provide greater power than aggregate meta-analysis to detect differential treatment effects for effectiveness (live birth, clinical pregnancy) and safety (pregnancy loss, multiple births, congenital malformations) outcomes across three comparisons (overall effect, undisturbed culture and morphokinetic parameters). We will also analyse if there are specific subgroups of women who may benefit from the intervention and if variations in use of the intervention show any benefits. We have incorporated the results of the literature search used for the latest Cochrane review (7 January 2019) into this review and will include all the trials included therein. We will further update the literature search to include new evidence by searching the electronic databases MEDLINE, EMBASE, CINAHL and CENTRAL from 07/01/2019 to date, outcomes for all ongoing trials reported in the 2019 Cochrane review, trial registers for newer ongoing/completed trials and the citation lists of all the newly identified trials for any relevant references. The search strategy will include a combination of subject headings and text words relating to or describing the participants and the intervention, with no language restrictions. Two authors will independently screen the titles and abstracts, and full text of articles retrieved from the search, to finalise a list of trials suitable for inclusion in the review. We will include randomised controlled trials that assess TLI systems for either undisturbed culture and/or use of morphokinetic parameters for embryo selection in women having IVF/ICSI treatment using their own oocytes.

Ethics and dissemination

Ethical approval is not required for this study. We plan to disseminate the findings of the research to all stakeholders, including the National Institute for Health and Care Excellence and other international guideline development groups, through publication in peer-reviewed journals, presentation at conferences, newsletters, meetings and websites of the funders, fertility charities and patient support groups.

PROSPERO registration number

CRD42024564332.

School health professionals understanding of culture: a scoping review

Por: Wahlström · E. · Landerdahl Stridsberg · S. · Larsson · C. · Stier · J.
Introduction

Culture underpins social interaction between school health professionals and children. Both practice and research suggest that cultural variations, migration and intercultural interactions pose potential challenges in encounters between school health professionals and children and may relate to the health professionals’ understanding of their own culture as a factor in such encounters. Still, for the school health services (SHS), reviews collating existing research on school health professionals’ understanding of culture are lacking.

Objectives

This review aims to identify, describe and analyse existing research on school health professionals’ (ie, school nurses, school social workers, school doctors and school psychologists) understanding of culture.

Design

A scoping review of peer-reviewed and published scientific articles on school health professionals’ understanding of culture.

Inclusion criteria

Articles published between 2013 and 2024 on culture, SHS and school nurses, school doctors, school social workers or school psychologists.

Methods and analysis

Searches were conducted in October 2023 and September 2024 in 10 databases. Two reviewers independently screened the article titles, abstracts and full texts for inclusion. Extracted data were analysed using descriptive statistics and qualitative content analysis. The qualitative content analysis focused on content related to theoretical considerations, key findings and conceptualisations of culture.

Results

From 1784 screened articles, 100 articles were screened in full text and 21 articles fulfilled the eligibility criteria. After identifying two additional articles through manual searches, a total of 23 articles were included in the review. The findings show that the articles primarily applied a quantitative study design, focused on school psychologists and school nurses and were conducted in the USA and Nordic-Baltic area. Self-understanding was mainly studied using validated instruments, leaving the conceptualisation of culture to the researchers. Still, only about half of all the articles described the theoretical conceptualisation of culture. Studies of intercultural interaction focused on the challenges of encountering ‘diverse’ children and raised concerns about barriers and hindrances to the encounters.

Conclusions

This review shows that SHS professionals’ understanding of culture has mainly been studied within two SHS professions, within a narrow geographical sphere and without a theoretical stance on culture. Thus, more qualitative research, a clearer theoretical conceptualisation of culture and more research on SHS professionals’ practice and self-understanding are needed.

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