The association of in vitro fertilization/intracytoplasmic sperm injection results with anxiety levels and stress biomarkers: An observational, case-control study✰.

INTRODUCTION: Anxiety has been considered to exert a negative influence on fecundity. However, it remains unclear whether it is a cause or a consequence and whether it is associated with the treatment outcome. This observational case control study evaluated the levels of state anxiety and various stress biomarkers and assessed their association with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. MATERIALS AND METHODS: We allocated 109 infertile nulliparous women aged 25-45 years in their first IVF/ICSI fresh treatment cycle into two groups according to the final outcome: group A (PTP = pregnancy-test positive, n = 49) and group B (PTN = pregnancy-test negative, n = 60). State anxiety levels were measured with the Spielberger Trait Anxiety Inventory (STAI) questionnaire (Marteau and Bekker modification) on the days of oocyte retrieval (OR) and embryo transfer (ET). Serum stress biomarkers (cortisol, adrenaline, noradrenaline, α-amylase, and prolactin) were measured at the same time points. Blood samples were collected at 9 am. RESULTS: Most women in both groups showed comparable mild-to-moderate degrees of state anxiety on the days of OR and ET (p = 0.183 and p = 0.760, respectively). The stress biomarker measurements did not differ between the two groups, except for noradrenaline that was higher in group B (p = 0.015) and associated with significant cardiovascular changes. DISCUSSION: Women in both groups showed comparable levels of state anxiety, which were unlikely to influence the chance of pregnancy. Noradrenaline levels were higher in the non-pregnant group, with significant cardiovascular changes. Other stress biomarkers did not reflect the different treatment outcomes between the groups.

First experiences with patient safety initiatives in Greek rural primary care. Action research by the LINNEAUS collaboration on patient safety in primary care.

BACKGROUND: Accreditation of primary care organizations within Greece is still in its infancy. Our task in Greece was to attempt to introduce a patient safety initiative in a local area, focusing on developing minimum standards for accreditation, assess whether a pragmatic approach would engage physicians, and provide evidence of improvement. OBJECTIVE: To use monitoring of clinical performance as the basis for the launch of an accreditation system for primary care in Greece and to report on the process and lessons learnt. METHODS: An established set of clinical indicators for patient safety was introduced in five Greek primary health centres. A web-based platform, for reporting practitioners' scores on the selected indicators, was used to record the activity of the practitioners. RESULTS: There was considerable variation in the use of clinical indicators by individual GPs. Following the intervention, the reporting on the indicators had increased while the scores on indicators only increased slightly. However, GPs engaged with the process and recognized its relevance to improving patient safety. CONCLUSION: We successfully piloted a means of engaging with GPs to improve patient safety using established indicators even where there was limited infrastructure to support such initiatives.