Communication between community mental health services and primary care

2011 ◽  
Vol 28 (3) ◽  
pp. 134-137
Author(s):  
Vincent IO Agyapong ◽  
Olorunfemi Ahmodu ◽  
Allys Guerandel
Keyword(s):  
Primary Care ◽  
Odds Ratio ◽  
Bipolar Affective Disorder ◽  
Community Mental Health Services ◽  
Psychiatric Services ◽  
P Value ◽  
Primary Care Teams ◽  
Psychiatric Outpatient Clinic ◽  
The Mean ◽  
Clinical Records

AbstractObjectives: This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication.Methods: A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months.Results: A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, ‘changes made to the patents medication in the last six months’ was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00.Conclusion: A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.

scholarly journals Improving team coordination in primary-care settings via multifaceted team-based feedback: a non-randomised controlled trial study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0185
Author(s):  
Sylvia J Hysong ◽  
Amber B Amspoker ◽  
Ashley M Hughes ◽  
Houston F Lester ◽  
Erica K Svojse ◽  
...  
Keyword(s):  
Primary Care ◽  
Implementation Fidelity ◽  
Audit And Feedback ◽  
Patient Portal ◽  
Health Administration ◽  
Team Coordination ◽  
Intervention Teams ◽  
Primary Care Teams ◽  
Low Exposure ◽  
Clinical Records

BackgroundCoordination is critical to successful team-based health care. Most clinicians, however, are not trained in effective coordination or teamwork. Audit and feedback (A&F) could improve team coordination, if designed with teams in mind.AimThe effectiveness of a multifaceted, A&F-plus-debrief intervention was tested to establish whether it improved coordination in primary care teams compared with controls.Design & settingCase-control trial within US Veterans Health Administration medical centres.MethodThirty-four primary care teams selected from four geographically distinct hospitals were compared with 34 administratively matched control teams. Intervention-arm teams received monthly A&F reports about key coordination behaviours and structured debriefings over 7 months. Control teams were followed exclusively via their clinical records. Outcome measures included a coordination composite and its component indicators (appointments starting on time, timely recall scheduling, emergency department utilisation, and electronic patient portal enrolment). Predictors included intervention arm, extent of exposure to intervention, and degree of multiple team membership (MTM).ResultsIntervention teams did not significantly improve over control teams, even after adjusting for MTM. Follow-up analyses indicated cross-team variability in intervention fidelity; although all intervention teams received feedback reports, not all teams attended all debriefings. Compared with their respective baselines, teams with high debriefing exposure improved significantly. Teams with high debriefing exposure improved significantly more than teams with low exposure. Low exposure teams significantly increased patient portal enrolment.ConclusionTeam-based A&F, including adequate reflection time, can improve coordination; however, the effect is dose dependent. Consistency of debriefing appears more critical than proportion of team members attending a debriefing for ensuring implementation fidelity and effectiveness.

scholarly journals A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial (Preprint)

2017 ◽  
Author(s):  
Graciela Rojas ◽  
Viviana Guajardo ◽  
Pablo Martínez ◽  
Ariel Castro ◽  
Rosemarie Fritsch ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Rural Areas ◽  
Care Program ◽  
Open Label ◽  
Rural Primary Care ◽  
Primary Care Teams ◽  
Clinical Records

BACKGROUND In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. OBJECTIVE The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. METHODS In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. RESULTS Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). CONCLUSIONS Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. CLINICALTRIAL Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ)

PENTINGNYA STATUS ANEMIA DALAM KEHAMILAN DENGAN PERDARAHAN POSTPARTUM PRIMER

2021 ◽  
Vol 3 (4) ◽  
pp. 359
Author(s):  
Nadia Taqiyya ◽  
Djohar Nuswantoro ◽  
Muhammad Ardian C.L
Keyword(s):  
Standard Deviation ◽  
Postpartum Hemorrhage ◽  
Odds Ratio ◽  
Case Control ◽  
T Test ◽  
P Value ◽  
Chi Square ◽  
The Mean ◽  
Anemia In Pregnancy ◽  
In Pregnancy

Abstrak Latar belakang : Kejadian perdarahan postpartum merupakan penyebab kematian ibu tertinggi ketiga di Kota Surabaya Provinsi Jawa Timur. Hal tersebut diiringi oleh kejadian anemia pada ibu hamil di Indonesia yang meningkat pada tahun 2018 sebesar 48.9% daripada tahun 2013 sebesar 37.1%. Penelitian ini bertujuan untuk menganalisis hubungan anemia dalam kehamilan dengan perdarahan postpartum primer di Rumah Sakit DKT Gubeng Pojok Kota Surabaya. Metode : penelitian ini menggunakan metode analitik observasional dengan rancangan penelitian case control design. Jumlah sampel sebanyak 60 ibu bersalin secara pervaginam yang sesuai dengan kriteria eksklusi dan inklusi. Variabel bebas anemia dalam kehamilan adalah sedangkan variabel terikat adalah perdarahan postpartum primer. Hasil : Sebagian besar ibu bersalin secara pervaginam 60% mengalami anemia dalam kehamilan dengan analisis uji chi square menunjukkan p value = 0.000 (p < 0.05), Odds Ratio sebesar 21.35, dan berdasarkan hasil uji T test didapatkan rata-rata kadar Hb pada kelompok anemia sebesar 9.058 g% dengan standar deviasi 0.9782 dan rata-rata kadar Hb pada kelompok non-anemia sebesar 12.063 g% dengan standar deviasi 1.13792 yang menunjukkan bahwa terdapat perbedaan yang signifikan. Kesimpulan : Terdapat hubungan yang signifikan antara anemia dalam kehamilan dengan kejadian perdarahan postpartum primer sehingga bidan sebagai tenaga kesehatan di lini utama harus memperhatikan  kadar Hb pada masa kehamilan.Abstract Background : Primary postpartum hemorrhage was the third-highest cause of maternal death in the city of Surabaya, East Java Province. This was accompanied by the incidence of anemia in a pregnant women in Indonesia which increased in 2018 by 48.9% compared to 2013 at 37.1%. This study aimed to analyze the relationship anemia in pregnancy with primary postpartum hemorrhage in DKT Gubeng Pojok hospitals in Surabaya city East Java. Method : This study used analytic observational methods with a case-control study research design. The number of samples was 60 vaginal delivery mothers who were under the criteria of exclusion and inclusion. A sampling of this study used purposive sampling with independent variable is anemia in pregnancy and dependent variable is primary postpartum hemorrhage. Result : Most of mothers that gave birth pervaginally  60% had anemia in pregnancy with analysis chi-square test showing  p-value =0.000 (p<0.05) , Odds Ratio of 21.35, and based on the results of the T-test it was found that the mean Hb level in the anemic group was 9.058 g% with standard deviation of 0.9782 and the mean Hb level in the non-anemic group was 12.063 g% with standard deviation of 1.13792 indicating that there were significant differences. Conclusion : There is a significant relationship between anemia in pregnancy with the incidence of primary postpartum hemorrhage , so that midwives as health workers in the mainline must pay attention to Hb levels during pregnancy.

scholarly journals Equilibration and Increase of Hemoglobin Concentration after One Unit Whole Blood Transfusion among Patients Not Actively Bleeding

2015 ◽  
Vol 23 (2) ◽  
pp. 161-166
Author(s):  
Md Mazharul Hoque ◽  
Sheikh Daud Adnan ◽  
Shanaz Karim ◽  
Mohd Abdullah Al Mamun ◽  
Subir Nandy ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Whole Blood ◽  
Blood Donation ◽  
Haemoglobin Concentration ◽  
Rational Approach ◽  
P Value ◽  
Medical College ◽  
Significant Difference ◽  
The Mean ◽  
Clinical Records

Background: Transfusion is a specialized modality of patient management and lifesaving intervention. The decision to transfuse should be individualized, based on a rational approach and taking into account the hemoglobin value in addition to physiologic variables. The purpose of this study was to determine the amount of increase in haemoglobin levels and the rapidity of equilibration after single unit fresh whole blood transfusion in medical inpatients not actively bleeding among the Bangladeshi population.Methods: The present cross sectional study was conducted at the Department of Transfusion Medicine, Dhaka Medical College, Dhaka during the periods of July 2012 to June 2013. Total 100 purposively selected admitted patients in the Department of Medicine of Dhaka Medical College Hospital (DMCH) undergone blood transfusion were included in the study. Demographic characteristics were obtained from the clinical records and by face to face interview. Haemoglobin concentration was measured before transfusion, after 6 hours and 24 hours of transfusion using standard laboratory method. Data were analyzed using SPSS version 16 (SPPS Incorporation, Chicago, IL, USA). Comparison between mean values of haemoglobin was compared with student’s t-test and two-sided P value of 0.05 or less was considered significant.Results: The mean ±SD of the age of the respondents was 24.17±4.96 years with a range of 19 to 45 years and 90.0% were male and 10.0% were female. Previous blood donation history present in 72.0% respondents and absent in 28.0% respondents. Mean±SD of Hb level before, 6 hours and 24 hours after transfusion were 7.64±1.05, 8.03±1.07 and 8.78±1.19 gm/dl respectively. In the present study the mean increase of Hb 6 hours and 24 hours after transfusion were 0.39 gm/dl and 1.14 gm/dl respectively. Comparison between mean Hb level of before transfusion with 6 hours and 24 hours after transfusion revealed a statistically significant difference. Comparison between mean Hb level at 6 hours and 24 hours after transfusion also revealed a statistically significant difference.Conclusion: The study revealed slightly more one gram increase of Hb at 24 hours after transfusion of one unit of whole blood among patients not actively bleeding. There is significant difference between Hb level at 6 hours and 24 hours after transfusion.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 161-166

scholarly journals Patient Discomfort and Resident Confidence After Knee Intra-articular Injection Simulation Training: A Randomized Control Trial Study

2018 ◽  
Vol 11 ◽  
pp. 117954411878290 ◽  
Author(s):  
Adae O Amoako ◽  
George GA Pujalte ◽  
Neha Kaushik ◽  
Timothy Riley
Keyword(s):  
Primary Care ◽  
Simulation Training ◽  
Intervention Group ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Control Group ◽  
P Value ◽  
Care Providers ◽  
Patient Discomfort ◽  
The Mean

Teaching primary care providers how to perform musculoskeletal procedures has become increasingly important as more and more patients with orthopedic conditions present in primary care clinics. This study aims to evaluate whether targeted simulation model training in residency can increase residents’ comfort level in performing intra-articular knee injections and decrease the pain of the procedure, as reported by patients injected. Residents were randomized into intervention and control groups. The comfort level of the residents as well as the pain levels from the procedures, as reported by patients, was recorded. The mean comfort level for the intervention group was 1.2, compared with that in the control group, which was 2.13; P value was .047. The mean pain level in the intervention group was 1.8, whereas in the control group was 3.63; P value was .156. Simulation training may boost residents’ comfort level, but not necessarily decrease patient discomfort during intra-articular knee injections.

Multidisciplinary review to identify patients who could be managed in primary care

2011 ◽  
Vol 28 (3) ◽  
pp. 138-140 ◽  
Author(s):  
Vincent IO Agyapong ◽  
Olorunfemi Ahmodu ◽  
Allys Guerandel
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Service ◽  
Health Service ◽  
Multidisciplinary Team ◽  
Psychiatric Clinic ◽  
Community Mental Health Service ◽  
Primary Care Teams ◽  
Specialist Services ◽  
Clinical Records

AbstractObjectives: Primary care teams have the potential to deliver much of the care currently provided by specialist services. The aim of this review was to determine from patients' clinical records and multidisciplinary team discussions, those that may be suitable for discharge back into primary care.Methods: A retrospective review of the clinical notes of all patients attending a psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to determine the appropriateness of continuing to provide psychiatric services in a specialised psychiatric clinic rather than in a primary care setting, taking into account the patients demographic and clinical variables.Results: It was recommended that 60% of all the patients needed to continue attending the local mental health service, 35.2% could be discharged back into primary care for continuing management whilst the remaining 4.8% could be managed jointly between primary care and the community mental health service. The bulk of the patients recommended for discharge into primary care had a diagnosis of anxiety disorder or depression and all of them had been stable on their treatment for more than six months.Conclusion: Regular multidisciplinary team review has a potential to identify patients who could be discharged back into primary care.

scholarly journals Prevalence of comorbidities associated with type 2 diabetes in patients attending a disease management program, Medellín, Colombia 2014 - 2019: a descriptive study.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 389
Author(s):  
Uriel Palacios-Barahona ◽  
Jaime Ordoñez Molina ◽  
Nelson Alvis Guzmán ◽  
José Fernando Botero Arango
Keyword(s):  
Type 2 Diabetes ◽  
Disease Management ◽  
Disease Management Program ◽  
Prevalence Ratio ◽  
Descriptive Study ◽  
Management Program ◽  
P Value ◽  
The Mean ◽  
Clinical Records

Background: Type 2 diabetes is a significant cause of morbidity and mortality worldwide. The prevalence has increased due to population aging, obesity, and longer life expectancy. Likewise, the development of complications related to the disease has contributed to a more significant disease burden and is the leading cause of death in people with diabetes.  Methods: A descriptive study of patients in a disease management program in Medellín, Colombia, from June 10, 2014 to March 30, 2019 was carried out. Sociodemographic and clinical data were collected from clinical records. Descriptive analysis was performed using absolute and relative frequencies and the prevalences presented by sex. The Chi-square test was used to calculate the prevalence ratio with a 95 % confidence interval, with a p-value < 0.05 being considered statistically significant. Results: There were 1,018 patients with type 2 diabetes analyzed. The mean age was 66.0 years (SD: 12.93), the mean duration with diabetes was 12.9 years (SD:9.3), 55 % of patients were women, and 60.6 % of patients had no metabolic control. The main comorbidities were dyslipidemia in 67.9 %, obesity in 61.4 %, and hypertension in 59 % of patients. Differences were observed in the prevalence ratio (PR) of women versus men for dyslipidemia (PR 0.68 [CI: 0.52 - 0.89]), coronary artery disease (PR 0.41 [CI: 0.28 - 0,61]) and obesity (PR 0.23 [CI: 0.17 - 0.30]). Conclusions: Patients with type 2 diabetes have a high prevalence of comorbidities: dyslipidemia, obesity and arterial hypertension. A lower prevalence of comorbidities was observed in women than men for dyslipidemia, coronary heart disease, and obesity.

scholarly journals Comparing Primary Care Interprofessional and Non-interprofessional Teams on Access to Care and Health Services Utilization in Ontario, Canada: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Wissam Haj-Ali ◽  
Brian Hutchison ◽  
Rahim Moineddin ◽  
Walter Wodchis ◽  
Rick Glazier
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Access To Care ◽  
Health Services Utilization ◽  
P Value ◽  
Emergency Department Use ◽  
Services Utilization ◽  
Interprofessional Teams ◽  
Primary Care Teams ◽  
After Hours

Abstract Background: Many countries, including Canada, have introduced primary care reforms to improve health system functioning and value. The purpose of this study was to examine the association between receiving care from interprofessional primary care teams and access to care and health services utilization. Methods: We conducted a retrospective cohort study linking population-based administrative databases to Ontario’s Health Care Experience Survey (HCES) between 2012 and 2018. We adjusted for physician group characteristics as well as individual physician and patient characteristics while assessing the relationship between receiving care from interprofessional teams and the outcomes of interest.Results: As of March 31st, 2015, there were 465 physician groups with HCES respondents of which 177 (38.0%) were interprofessional teams and 288 (62.0%) were non-interprofessional teams in the same blended capitation reimbursement model. In this period, there were 4,518 physicians with HCES respondents, of whom 2,131 (47.2%) were in interprofessional teams and 2,387 (52.8%) were in non-interprofessional teams. There were 10,102 HCES respondents included in this study, of whom 42.4% were in interprofessional teams and 42.3% were in non-interprofessional teams. After adjustment, we found that being in an interprofessional team was associated with an increase in the odds of patients reporting same/next day access to care by 12.0% (OR=1.12 CI=1.00 to 1.24 p-value 0.0436) and a decrease in the odds of patients reporting walk-in clinic use by 16% (OR=0.84 CI=0.75 to 0.94 p-value 0.0019). After adjustment, there were no significant differences in patient-reported after-hours access to care and emergency department use.Conclusions: Ontario has invested heavily in interprofessional primary care teams. As compared to patients in non-interprofessional teams, patients in interprofessional teams self-reported more timely access to care and less walk-in clinic use but no significant difference in self-reported access to after-hours care or in emergency department use. For jurisdictions aiming to expand physician voluntary participation in interprofessional teams, our study results inform expectations around access to care and health services utilization.

scholarly journals Non-dispensing pharmacist integrated in the primary care team: effect on the quality of physician’s prescribing, a non-randomised comparative study

2020 ◽  
Vol 42 (5) ◽  
pp. 1293-1303
Author(s):  
Vivianne M. Sloeserwij ◽  
Dorien L. M. Zwart ◽  
Ankie C. M. Hazen ◽  
Judith M. Poldervaart ◽  
Anne J. Leendertse ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Intervention Group ◽  
P Value ◽  
Control Groups ◽  
Clinical Pharmacists ◽  
Prescribing Quality ◽  
Primary Care Teams ◽  
Quality Of Prescribing

Abstract Background Especially in elderly with polypharmacy, medication can do harm. Clinical pharmacists integrated in primary care teams might improve quality of pharmaceutical care. Objective To assess the effect of non-dispensing clinical pharmacists integrated in primary care teams on general practitioners’ prescribing quality. Setting This study was conducted in 25 primary care practices in the Netherlands. Methods Non-randomised, controlled, multi-centre, complex intervention study with pre-post comparison. First, we identified potential prescribing quality indicators from the literature and assessed their feasibility, validity, acceptability, reliability and sensitivity to change. Also, an expert panel assessed the indicators’ health impact. Next, using the final set of indicators, we measured the quality of prescribing in practices where non-dispensing pharmacists were integrated in the team (intervention group) compared to usual care (two control groups). Data were extracted anonymously from the healthcare records. Comparisons were made using mixed models correcting for potential confounders. Main outcome measure Quality of prescribing, measured with prescribing quality indicators. Results Of 388 eligible indicators reported in the literature we selected 8. In addition, two more indicators relevant for Dutch general practice were formulated by an expert panel. Scores on all 10 indicators improved in the intervention group after introduction of the non-dispensing pharmacist. However, when compared to control groups, prescribing quality improved solely on the indicator measuring monitoring of the renal function in patients using antihypertensive medication: relative risk of a monitored renal function in the intervention group compared to usual care: 1.03 (95% CI 1.01–1.05, p-value 0.010) and compared to usual care plus: 1.04 (1.01–1.06, p-value 0.004). Conclusion This study did not demonstrate a consistent effect of the introduction of non-dispensing clinical pharmacists in the primary care team on the quality of physician’s prescribing. This study is part of the POINT-study, which was registered at The Netherlands National Trial Register with trial registration number NTR‐4389.

scholarly journals The human factor: does the operator performing the embryo transfer significantly impact the cycle outcome?

2020 ◽  
Vol 35 (2) ◽  
pp. 275-282 ◽  
Author(s):  
F Cirillo ◽  
P Patrizio ◽  
M Baccini ◽  
E Morenghi ◽  
C Ronchetti ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Uterine Cavity ◽  
P Value ◽  
Ongoing Pregnancy Rate ◽  
The Mean ◽  
The Relationship

Abstract STUDY QUESTION Is Ongoing Pregnancy Rate (OPR) operator-dependent, and can experience improve embryo transfer efficiency? SUMMARY ANSWER OPR is influenced by the operators who perform the embryo transfer (ET), and experience does not assure proficiency for everyone. WHAT IS KNOWN ALREADY ET remains the critical step in assisted reproduction. Although many other factors such as embryo quality and uterine receptivity impact embryo implantation, the proper ET technique is clearly an operator-dependent variable and as such it should be objectively standardized. STUDY DESIGN, SIZE, DURATION Retrospective comparative analysis including all fresh ETs performed between January 1996 and December 2016 at the Humanitas Fertility Center after IVF—ICSI cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS IVF/ICSI fresh ETs performed by 32 operators, 19 824 cycles in all, were analyzed. All transfers consisting of freehand insertion of a preloaded soft catheter into the uterine cavity under transabdominal ultrasound guidance were considered. Two different statistical analyses were performed. First, a logistic regression model with a random intercept for the operator was used to estimate the heterogeneity of the rate of success among operators, accounting for woman age, FSH, number of oocytes retrieved, fertilization rate, year of the procedure, number and stage of transferred embryos and operator’s experience. Second, the relationship between experience and pregnancy rate was estimated separately for each operator by logistic regression, and operator-specific results were combined and compared in a random-effects meta-analysis. In both analyses, the operator’s experience at time t was measured in terms of number of embryo transfers performed before t. MAIN RESULTS AND THE ROLE OF CHANCE The heterogeneity among operators was highly significant (P value &lt;0.001) and explained 44.5% of the total variability. The odds ratio of success of the worst operator in respect to the mean was equal to 0.84. For the best operator, the odds ratio of success was equal to 1.13 in respect to the mean. Based on the meta-analysis of the relationship between operator’s experience and success rate, it resulted that, on average, the operators’ performance did not improve with additional transfers. LIMITATIONS, REASONS FOR CAUTION At our center, operators become independent for ET’s after performing between 30 and 50 transfers under supervision. It is also possible that other relevant factors, such as embryologists on duty for the ET, have not been included in the present analysis and this may represent a potential bias. Among these, it should be mentioned that the embryologists on duty for the ET were not taken into consideration. WIDER IMPLICATIONS OF THE FINDINGS Continued performance analysis and the use of a digital simulator could help operators to test their expertise over time and either correct poor performance or avoid doing transfers. STUDY FUNDING/COMPETING INTEREST(S) None. TRIAL REGISTRATION NUMBER NCT03561129.

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