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Endometriosis patients face a significant economic burden. In addition to the directly attributable costs of the diagnosis and therapy of endometriosis, such as drug treatment and multimodal pain therapy, various indirect follow-up costs can be expected, e.g., due to incapacity for work and reduced work performance. As already reported in previous publications, endometriosis is associated with considerable costs for the health care system and society as well as for the affected women and their families. In order to measure the extent of the costs associated with endometriosis patients, 250 patients with an average age of 32.80 years were recruited via social media and interviewed about their self-financed costs as part of an online survey. The assessed direct costs comprise inpatient treatments, outpatient or pain therapy, fertility treatments, hormone therapies, prescribed and privately paid medications and aids, other therapeutic procedures, and directly attributable travel costs for endometriosis treatments. This resulted in an average cost of € 2059.55 per year. Indirect costs were calculated based on loss of income, day-to-day support, care costs, costs due to follow-up illnesses and other costs. On average, the indirect costs were € 2174.25. The average costs resulting from the survey totalled € 4233.81 per year with a standard deviation of € 8240.31. An increase of out-of-pocket costs can be assumed. This may result from an improved range of services for alternative treatment methods and an increased awareness of the need for personal investment in health. However, further health economic studies are needed to validate the results., Competing Interests: Conflict of Interest All authors declare the following: Payment/services info: The Endo Health GmbH (formerly UG) received funding from the European Regional Development Fund (ERDF) from the state of Saxony, Germany. Financial relationships: Nadine Rohloff declares employment and stock/stock options from Endo Health GmbH. CEO, Shareholder. Nadine Rohloff and Nicole R Heinze declare personal fees from DGE (German Nutrition Society). Nicole R Heinze and Teres Götz declare employment from Endo Health GmbH. Consulting fees. Intellectual property info: The Endo-App is a medical device and a registered trademark. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Introduction: Endometriosis can significantly impair the quality of life of those affected. Multimodal self-help measures are recommended but are often difficult to access. Smartphone apps have been shown to improve the quality of life for other conditions with chronic pain. The aim of this study was to examine the impact of the Endo-App (Endo Health GmbH, Chemnitz, Germany) on both disease-related quality of life and symptoms of endometriosis affecting it., Methods: In the present randomized, controlled pilot study, the impact of utilizing the Endo-App on the quality of life among a sample of 122 women affected by endometriosis is assessed. To measure the changes over a 12-week period, the study incorporates the validated Endometriosis Health Profile (EHP-5 and EHP-30) questionnaire from Oxford University, among other assessment tools., Results: The use of the Endo-App leads to significant changes in the following areas after 12 weeks compared to the control group: pain disability, pain self-efficacy, fatigue, depressive symptoms, and Endometriosis Health Profile scores. The EHP-5 score from T0 to T12 is reduced by -16.76 (p-value of the Mann-Whitney U test (p U ) = 0.008), and the EHP-30 score by -15.48 (p U = 0.004). The results remain significant in sensitivity analyses. The effect size of Cohen's d was in the medium range., Conclusion: In summary, the Endo-App improves both physical and psychological symptoms and the patient's self-efficacy. The Endo-App contributes to improving endometriosis care in Germany and enables women suffering from endometriosis to significantly increase their quality of life., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of the State Chamber of Physicians of Saxony, Germany issued approval EK-BR-113/21-1. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: The Endo Health GmbH (formerly UG) received funding from the European Regional Development Fund (ERDF) from the state of Saxony, Germany. Financial relationships: Nadine Rohloff declare(s) employment and stock/stock options from Endo Health GmbH. CEO, Shareholder. Sebastian D Schäfer declare(s) non-financial support from Adboard AGE, Adboard EEL, Adboard SEF, WES Ambassador, Board AGEM. Nadine Rohloff declare(s) personal fees from DGE (German Nutrition Society). Reimbursement for lectures. Nicole R Heinze declare(s) employment from Medical School Hannover. Employment since 03/2024. Sebastian D Schäfer declare(s) Support for attending meetings and/or travel from Theramex. Teresa Götz, Sarah S Kortekamp, Nicole R Heinze, Charlotte Weber declare(s) employment from Endo Health GmbH. Sebastian D Schäfer declare(s) personal fees from Roche. Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events. Sebastian D Schäfer declare(s) personal fees from Endo Health GmbH, Gedeon Richter GmbH, Baxter Medical GmbH, PlantTec Medical GmbH. Participation on a Data Safety Monitoring Board or Advisory Board, Consulting fees. Sebastian D Schäfer declare(s) personal fees from Eisai Pharma. Consulting fees . Intellectual property info: The Endo-App is a medical device and a registered trademark. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rohloff et al.)

Background: Surgical site infections (SSIs) are highly prevalent in abdominal surgery despite evidence-based prevention measures. Since guidelines are not self-implementing and SSI-preventive compliance is often insufficient, implementation interventions have been developed to promote compliance. This systematic review aims to identify implementation interventions used in abdominal surgery to prevent SSIs and determine associations with SSI reductions., Methods: Literature was searched in April 2018 (Medline/PubMed and Web of Science Core Collection). Implementation interventions were classified using the implementation subcategories of the EPOC Taxonomy (Cochrane Review Group Effective Practice and Organisation of Care, EPOC). Additionally, an effectiveness analysis was conducted on the association between the number of implementation interventions, specific compositions thereof, and absolute and relative SSI risk reductions., Results: Forty studies were included. Implementation interventions used most frequently ("top five") were audit and feedback (80% of studies), organizational culture (70%), monitoring the performance of healthcare delivery (65%), reminders (53%), and educational meetings (45%). Twenty-nine studies (72.5%) used a multimodal strategy (≥3 interventions). An effectiveness analysis revealed significant absolute and relative SSI risk reductions. E.g., numerically, the largest absolute risk reduction of 10.8% pertained to thirteen studies using 3-5 interventions (p < .001); however, this was from a higher baseline rate than those with fewer or more interventions. The largest relative risk reduction was 52.4% for studies employing the top five interventions, compared to 43.1% for those not including these. Furthermore, neither the differences in risk reduction between studies with different numbers of implementation interventions (bundle size) nor between studies including the top five interventions (vs. not) were significant., Conclusion: In SSI prevention in abdominal surgery, mostly standard bundles of implementation interventions are applied. While an effectiveness analysis of differences in SSI risk reduction by number and type of interventions did not render conclusive results, use of standard interventions such as audit and feedback, organizational culture, monitoring, reminders, and education at least does not seem to represent preventive malpractice. Further research should determine implementation interventions, or bundles thereof, which are most effective in promoting compliance with SSI-preventive measures in abdominal surgery.