P-266 Sharing time-lapse embryo videos with patients: recommendations to prevent patients’ unnecessary distress

Study question

How do patients receive time-lapse videos of their own embryos and how do they react to them?

Summary answer

Videos are received in various ways and often watched by patients at home. A lack of professional support in interpreting them can cause unnecessary distress.

What is known already

Time-lapse imaging technology (TLIT) allows to take recurrent pictures of embryos during their first days of development and produce short videos of embryo’s growth in the lab. Many TLIT studies have focused on the potential benefits associated with non-invasive embryo selection, but very few have explored how these videos are shared with patients and how patients react to them. A few recent survey-based studies suggest that watching videos of their own embryos may have positive effects on patients’ IVF experience (Picou et al., 2021) and even increase pregnancy rates (Garcia-Faura et al., 2021).

Study design, size, duration

We interviewed 34 women who had experience of IVF treatment and 8 partners. Participants were aged between 29 and 47, and they were recruited from across England. 22 participants were recruited by NHS fertility clinics and 20 were recruited through advertisement on relevant social media groups and communities. All interviews were conducted between 2018 and 2019. The interviews are part of a larger study exploring the perspectives of both fertility patients and professionals.

Participants/materials, setting, methods

Semi-structured qualitative interviews were undertaken in different locations. On average, interviews undertaken at NHS clinics lasted 40 minutes, whereas interviews over the phone or at the participant’s home were often longer at around an hour. All interviews were recorded, professionally transcribed, and anonymised. Qualitative thematic analysis was used to explore how and when participants received TLIT videos and how they managed personal attachments to them.

Main results and the role of chance

Participants described different experiences in how and when they saw TLIT videos of their embryos. Participants reported a variety of practices around sharing videos, including receiving the video via their online patient portal or an email link, purchasing or being given the video on a USB at the clinic, or having the USB posted to them at home. Due to these sharing methods, TLIT videos were often received by patients once they had left the clinic, and seen after the transfer and outside of consultations, often at home.

Analysis of the interviews shows that, for IVF patients undergoing fertility treatment, receiving videos of their own embryos can cause confusion and potential distress. Participants often described shifting emotions about the embryo videos, especially when they felt unprepared for receiving them. Participants discussed the difficulty they experienced in interpreting or contextualising this imagery outside of the clinic and expressed their concerns about how to interpret embryo development. Associations made between embryo videos and a potential future baby made the videos emotionally difficult to manage, especially when patients received them prior to being able to test for pregnancy.

Limitations, reasons for caution

The study sample size is small and the findings cannot be generalised to the broader patient population.

It is important to emphasise that not all fertility clinics in the UK have adopted TLIT. Furthermore, many clinics adopting TLIT have chosen not to share the videos with their patients.

Wider implications of the findings

To support patients in how to interpret TLIT videos and avoid unnecessary distress, when sharing TLIT videos with patients clinics may pay attention to the following: how (through what medium); where (ideally providing professional support to interpret videos shared outside consultations); and when during the treatment process.

Trial registration number

not applicable

Comparison of Clostridioides difficile Stool Toxin Concentrations in Adults With Symptomatic Infection and Asymptomatic Carriage Using an Ultrasensitive Quantitative Immunoassay

Background

We used an ultrasensitive, quantitative single molecule array (Simoa) immunoassay to test whether concentrations of Clostridioides (formerly Clostridium) difficile toxins A and/or B in the stool of adult inpatients with C. difficile infection (CDI) were higher than in asymptomatic carriers of toxinogenic C. difficile.

Methods

Patients enrolled as CDI-NAAT had clinically significant diarrhea and a positive nucleic acid amplification test (NAAT), per US guidelines, and received CDI treatment. Potential carriers had recently received antibiotics and did not have diarrhea; positive NAAT confirmed carriage. Baseline stool samples were tested by Simoa for toxin A and B.

Results

Stool toxin concentrations in both CDI-NAAT (n = 122) and carrier-NAAT (n = 44) cohorts spanned 5 logs (0 pg/mL to >100000 pg/mL). Seventy-nine of 122 (65%) CDI-NAAT and 34 of 44 (77%) carrier-NAAT had toxin A + B concentration ≥20 pg/mL (clinical cutoff). Median toxin A, toxin B, toxin A + B, and NAAT cycle threshold (Ct) values in CDI-NAAT and carrier-NAAT cohorts were similar (toxin A, 50.6 vs 60.0 pg/mL, P = .958; toxin B, 89.5 vs 42.3 pg/mL, P = .788; toxin A + B, 197.2 vs 137.3 pg/mL, P = .766; Ct, 28.1 vs 28.6, P = .354). However, when CDI/carrier cohorts were limited to those with detectable toxin, respective medians were significantly different (A: 874.0 vs 129.7, P = .021; B: 1317.0 vs 81.7, P = .003, A + B, 4180.7 vs 349.6, P = .004; Ct, 25.8 vs 27.7, P = .015).

Conclusions

Toxin concentration did not differentiate an individual with CDI from one with asymptomatic carriage. Median stool toxin concentrations in groups with CDI vs carriage differed, but only when groups were defined by detectable stool toxin (vs positive NAAT).

Fluoxetine effects on molecular, cellular and behavioral endophenotypes of depression are driven by the living environment

Selective serotonin reuptake inhibitors (SSRIs) represent the most common treatment for major depression. However, their efficacy is variable and incomplete. In order to elucidate the cause of such incomplete efficacy, we explored the hypothesis positing that SSRIs may not affect mood per se but, by enhancing neural plasticity, render the individual more susceptible to the influence of the environment. Consequently, SSRI administration in a favorable environment promotes a reduction of symptoms, whereas in a stressful environment leads to a worse prognosis. To test such hypothesis, we exposed C57BL/6 mice to chronic stress in order to induce a depression-like phenotype and, subsequently, to fluoxetine treatment (21 days), while being exposed to either an enriched or a stressful condition. We measured the most commonly investigated molecular, cellular and behavioral endophenotypes of depression and SSRI outcome, including depression-like behavior, neurogenesis, brain-derived neurotrophic factor levels, hypothalamic-pituitary-adrenal axis activity and long-term potentiation. Results showed that, in line with our hypothesis, the endophenotypes investigated were affected by the treatment according to the quality of the living environment. In particular, mice treated with fluoxetine in an enriched condition overall improved their depression-like phenotype compared with controls, whereas those treated in a stressful condition showed a distinct worsening. Our findings suggest that the effects of SSRI on the depression- like phenotype is not determined by the drug per se but is induced by the drug and driven by the environment. These findings may be helpful to explain variable effects of SSRI found in clinical practice and to device strategies aimed at enhancing their efficacy by means of controlling environmental conditions.

Medication is an additional source of phosphate intake in chronic kidney disease patients

BACKGROUND AND AIMS

Hyperphosphatemia increases the risk of cardiovascular morbidity but the use of medicines as a source of phosphate has not been investigated yet. This study aims to explore the use of absorbable phosphate-containing drugs in CKD patients.

METHODS AND RESULTS

Incident CKD patients were identified within the Arianna database (containing data from 158,510 persons in Caserta (Southern Italy) registered with 123 general practitioners) from 2005 to 2011. Drugs prescribed to these patients were classified as phosphate-containing based on the summary of product characteristics (SPC), PubChem and Micromedex. The number and duration of prescriptions for these drugs as well as the overall intake of phosphate were estimated. Out of 1989 CKD patients, 1381 (70%) were prescribed 266 medicinal products containing absorbable phosphate over a median follow-up of 6 years (interquartile range (IQR) = 5.2-6.0). Most patients were prescribed ATC A (650; 47.1%) and C (660; 47.8%) phosphate-containing drug products targeting the gastrointestinal and cardiovascular system for a median of 232 (IQR: 56-656) and 224 (IQR: 56-784) days respectively.

CONCLUSIONS

Several medications, especially chronically prescribed ones, contain absorbable phosphate. This study's findings confirm the relevance of medicines as a phosphate source for the first time.

[Intrahepatic cholangiocarcinoma: case report]

The primitive tumors of the liver are relatively rare in the Western countries (around the 0.7% of all the neoplasms) while they present more elevated incidence in Africa and in the South Asian East. While the hepatocellular carcinoma rises up in the 50-70% of the cases in livers cirrosis, this correlation is not valid for the form of carcinoma to departure from the learned intra and extra biliar. The etiology of the intrahepatic colangiocarcinoma (CC) stays unknown. They have stayed observe, on the other hand, of the conditions sometimes correlated to the development of the CC (Carolí morbs, ulcerative colitis, asbestosis). The CC usually rises up from the epithelial cells of surface that delimit the biliary ducts, although different studies suggest that these tumors can also originate from the learned smaller biliary ducts, from the hepatic cysts of the policistic illness and from the complexes of von Meyenburg. The low incidence of the CC, the clinical atypical debut, the not facility of a precise diagnosis have aroused our interest so that the present job wants to be a modest scientific contribution to this type of pathology.

[Intrahepatic biliary cystadenoma: case report]

According to the OMS classification of the epithelial benign neoplasm of the liver, the adenomas represent the most important group. In literature an increase of their incidence in the last years is reported especially in the female sex, in relationship to the diffusion of the use of hormonal contraceptives. The biliar cistoadenoma (BCA) represents a not frequent neoplasm of the liver that has origin on the inside of the liver, and less frequently from the extrahepatic biliar system. The surgical interest is underlined by the potentiality of the malignant evolution of the lesion and by its high tendency to the relapse. The real difficulty is represented by differential diagnosis from the other cystic lesions of the liver and by the need of its radical excision and therefore of real hepatectomy.

Open-label comparison of the antiemetic efficacy of single intravenous doses of dolasetron mesylate in pediatric cancer patients receiving moderately to highly emetogenic chemotherapy

BACKGROUND

Nausea and vomiting are among the most unpleasant adverse side effects of cancer therapy.

PROCEDURE

An open-label dose-escalation study was conducted to assess the appropriate intravenous dose of dolasetron for pediatric patients undergoing chemotherapy. Patients received dolasetron in single intravenous doses of 0.6 (n = 10), 1.2 (n = 12), 1.8 (n = 12), or 2.4 (n = 12) mg/kg 30 min before receiving emetogenic chemotherapy. Pharmacokinetic parameters were evaluated at each dose level and efficacy was evaluated over the first 24 hr following the administration of dolasetron.

RESULTS

A complete response was achieved in 10% of patients given 0.6 mg/kg, 25% of patients given 1. 2 mg/kg, 67% of patients given 1.8 mg/kg, and 33% of patients given 2.4 mg/kg. Peak plasma concentrations (Cmax) were observed between 0. 33 and 0.75 hr following dolasetron infusion. Cmax and area under plasma concentration-time (AUC) increased with larger doses of dolasetron, while terminal disposition half-life (t1/2) and apparent clearance (Clapp) were not significantly changed with respect to dose. For 1.8-mg/kg dolasetron, the t1/2 was 4.98 hr and the maximum plasma concentration (tmax) 0.47 hr. Adverse events were mild to moderate. No serious events occurred. Conclusions. This study suggests that a single intravenous dose of 1.8 mg/kg is the optimum single intravenous dose for controlling chemotherapy-induced emesis in pediatric patients.

Safety, tolerability, antiemetic efficacy, and pharmacokinetics of oral dolasetron mesylate in pediatric cancer patients receiving moderately to highly emetogenic chemotherapy

PURPOSE

The safety, antiemetic efficacy, and pharmacokinetics of single oral doses of dolasetron, a new highly selective 5-HT3 receptor antagonist, were evaluated in children with cancer undergoing treatment with moderately to highly emetogenic chemotherapy.

PATIENTS AND METHODS

A total of 32 children, ages 3 to 18 years, were enrolled in a nonrandomized, multicenter, open-label, dose-escalation study. Three oral dose levels (0.6, 1.2, or 1.8 mg/kg) were studied. Safety, efficacy, and pharmacokinetic parameters were assessed over 24 hours at each dosage level.

RESULTS

The most effective dose was 1.8 mg/kg; 60% of the patients achieved a complete or major response (< or =2 emetic episodes in 24 hours). A complete response was achieved in 3 of 9 patients (33%) who received 0.6 mg/kg, 4 of 13 (31%) patients who received 1.2 mg/kg, and 5 of 10 (50%) patients who received 1.8 mg/kg of dolasetron. Overall, dolasetron was well tolerated. Adverse events were mild and similar to those reported in adults. Peak plasma concentrations (Cmax) of dolasetron's active reduced metabolite, MDL 74,156, were dose proportional and occurred, on the average, within 1 hour of oral administration. The half-life (t1/2) in plasma was approximately 6 hours for all dose levels, and the mean clearance (CLapp) was unrelated to dose.

CONCLUSIONS

Oral dolasetron is safe and effective in reducing chemotherapy-induced nausea and vomiting, particularly at the 1.8-mg/kg dose level. These results support further evaluation of oral dolasetron in larger randomized clinical trials in the pediatric cancer population.

Bioavailability of metformin in tablet form using a new high pressure liquid chromatography assay method

Twenty-four young healthy volunteers received a single dose of metformin 500 mg (Glucophage, Nordic Laboratories, Canada) in tablet form. Plasma concentrations were determined by HPLC in samples collected prior to and 0.33, 0.66, 1, 1.33, 1.66, 2, 2.5, 3, 4, 5, 6, 7, 8, 10, 12, 15, 18, 24, and 30 h after dosing. Mean (+/- SD) Cmax was 682.1 (160.6) ng ml-1 at a mean (+/- SD) tmax of 2.4 (0.93) h. Overall elimination was monoexponential with a mean (+/- SD) half-life of 3.16 (0.47) h. We conclude that metformin is rapidly absorbed from this formulation and is also rapidly eliminated. Extrapolation to steady state predicts that equilibrium will be reached within 24 h.

Continuities and discontinuities in the development of 64 very small premature infants to 4 years of age

The psychiatric, psychological, school and overall family functioning of 64 very small premature infants was assessed from birth up to 48 mnths of age. Results indicated that 43% of infants scored in the abnormal range on a behaviour rating scale filled in by the mothers and 24% on a teacher rating scale at age 4. However, only 11% of the children received a psychiatric diagnosis. Traditional attachment ratings at 1 yr were not related to psychiatric status at age 4, but family functioning was. Disturbed children had also suffered more perinatal difficulties.

Impact of delayed development in premature infants on mother-infant interaction: a prospective investigation

We examined events that precede a diagnosis of developmental delay by comparing 16 very low birth weight premature infants whose condition was diagnosed as developmental delay at 18 months corrected age with 16 matched developmentally normal infants. All infants were observed with their mothers during maternal visits to the nursery and during home visits 1, 3, 6, and 9 months after discharge. The mothers' reactions to their infants were rated at these times. All the children were followed up at a neonatal clinic, and detailed clinic records were used to document the time when a physician first suspected a delay and when this delay was first mentioned to the mother. The results indicate that parents had usually been told of their child's handicap by the time the child was 6 to 9 months old; yet mothers of the delayed children changed the interaction with their children as early as 1 month after discharge from hospital. These mothers initially touched, smiled at, and talked to their developmentally delayed infants significantly more often, but by 9 months they did so much less often than mothers of nondelayed children. The degree of change in mothers' behavior was related to their psychosocial background, with better-adjusted mothers showing the most change. We conclude that mothers' statements about their infants are usually valid and that physicians may share their potential concerns about infants more freely.

Maternal behavior and attachment in low-birth-weight twins and singletons

Early mother-infant interaction and later security of attachment were assessed for 17 pairs of twins, 5 singleton survivors of twin pairs, and 20 singletons, all low-birth-weight preterm infants. Mother and infant behavior during home observations at 6 weeks and 3, 6, and 9 months was rated on scales developed by Ainsworth and Egeland and Brunquell. A, B, and C patterns of behavior in the Strange Situation conformed to the frequencies predicted from prior full-term samples and were not affected by twinship. However, the proportion of B1 and B4 dyads in the B group significantly exceeded that predicted from normative data. Mothers in B2 and B3 dyads were rated more sensitive and responsive than all others at all 4 observations. Contrary to our expectations that mothers in A and C dyads would receive the lowest ratings, this occurred only at 6 weeks. At later observations mothers in B1 and B4 dyads consistently received the lowest ratings. The discussion focuses on possible reasons for this unexpected finding.

Maternal caretaking and play with full-term and premature infants

The contribution of past psychological experiences of the mother and medical complications of the infant to differences in caretaking of pre- and full-term infants are examined. Twenty full- and 20 pre-term matched mother-infant dyads were studied during a feed and play 1, 2 and 3 months after the expected date of birth. Full-term infants were more active than pre-terms at 4 weeks only. Mother of pre-terms showed differences in their interactions at all times. Interactions were related to maternal experiences in full-term infants only. Degree of neonatal illness was correlated with behavioral disorganization of premature infants, leading to differences in caretaking style.

Autonomy in mothers with careers

We analyzed questionnaires filled out by 23 mothers with careers and rated them as to degrees of autonomy; 26% received a '1' (least autonomous) rating, 39% a '2', 22% a '3' and 4% (1 person) received a '4' (most autonomous). Psychoanalyst Dr. Elizabeth Zetzel (1) stated "The healthy woman should be able to combine successful marriage and motherhood with some sort of personal career." It would seem that the woman who is most effective at doing so is one who is highly autonomous and, therefore, feels free to construct a non-traditional role for herself. Unfortunately, in our study, these women were very much in the minority. In keeping with our hypothesis, the mere fact that a woman is combining a career and family is not a guaranteed indicator that she is highly autonomous.