Evidence-based medicine in ART

Sir, The treatment of infertility through assisted reproduction technology (ART) is currently helping hundreds of thousands of people each year to achieve parenthood. This branch of medicine is also undergoing substan tial technological development. While the technology is implemented quickly, solid clinical data become available slowly, resulting in a growing gap between current ART practices and evidence-based standards

¿Es mejor que los bebés duerman solos o acompañados?

El colecho es la circunstancia en la que el bebé duerme en la misma superficie que la madre, lo que favorece la lactancia materna. El copecho, por otro lado, se refiere a amamantar durante el colecho. Hoy en día existe mucha controversia sobre los peligros que conlleva dormir con el bebé. Entre ellos, una posible asfixia, aplastamiento o muerte súbita

El sesgo de género en la asistencia sanitaria: definición, causas y consecuencias en los pacientes

Objectives. The aim of this bibliographic review is to provide information on the origin and consequences of gender bias, analyzing the limitations that it produces in clinical practice and proposing multiple points that must be addressed in the future so that the current panorama can be modified. Material and methods. A bibliographic search is performed on the Pubmed, Google Scholar and Dialnet databases, where 241 non-duplicate records are obtained. Following the application of the exclusion criteria, they are reduced to 37 articles, from which other 21 relevant items are identified by snowball sampling. Results. The content of the 33 articles that have been relevant to the research is briefly commented. Discussion. The gender bias in health care is caused by its presence in the production and dissemination of knowledge, leading to a bias in the diagnostic and therapeutic effort. This has consequences related to medical knowledge, clinical management and the provision of health care that have an impact on the health of women, but also of men. The highlighting study limitation is that the impact of gender bias in health professionals, both in their training and in their work practice, and in specific pathologies is not addressed. Conclusions. Currently, there are limitations related to gender bias in the field of research, dissemination of knowledge and clinical practice. Therefore, this will continue to be an important search field in the coming years, since the integration of gender medicine is a key item consider within personalized medicine and patient-centered care to achieve a holistic approach of patients and diseases.Objetivo. El objetivo de esta revisión bibliográfica es aportar información sobre el origen y las consecuencias del sesgo de género en la actualidad, analizando las limitaciones que produce en la práctica clínica y proponiendo múltiples puntos que se deben abordar en un futuro para modificar el panorama actual. Material y método. Se ha realizado una búsqueda bibliográfica en bases de datos como Pubmed, Google Scholar y Dialnet, donde se han obtenido 241 registros no duplicados. Después de aplicar los criterios de exclusión, se reducen a 37, a partir de los cuales se identifican otros 21 artículos relevantes en bola de nieve. Resultados. Se comenta brevemente el contenido de los 33 artículos que han sido relevantes para la investigación. Discusión. El sesgo de género en la asistencia sanitaria es causado por su presencia en la producción y la difusión del conocimiento, dando lugar a un sesgo en el esfuerzo diagnóstico y terapéutico. Este hecho tiene consecuencias relacionadas con el conocimiento médico, el manejo clínico y la prestación de la asistencia sanitaria que repercuten en la salud de las mujeres, pero también de los hombres. Como limitaciones del estudio, cabe destacar que no se abordan la repercusión del sesgo de género en el colectivo sanitario, tanto en su formación como en su práctica laboral, ni en patologías concretas. Conclusiones. Actualmente, se encuentran limitaciones relacionadas con el sesgo de género en el ámbito de la investigación, la difusión de conocimientos y la práctica clínica. Por ello, este continuará siendo un campo de investigación importante durante los próximos años, ya que la integración de la medicina de género es un elemento clave a tener en cuenta dentro de la medicina personalizada y la atención centrada en el paciente para alcanzar un enfoque holístico de los pacientes y las enfermedades

Reproductive outcomes in lesbian couples undergoing reception of oocytes from partner versus autologous in vitro fertilization/intracytoplasmic sperm injection

Introduction: The utilization of assisted reproductive technology (ART) by the lesbian, gay, bisexual, transgender, inter sex, and queer community, and specifically lesbian couples, has substantially increased over the past decade.1,2 Depend ing on their reproductive history, age, and preference, same sex female couples may elect to undergo donor intrauterine insemination (IUI) or in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) using autologous oocytes and donor sperm. Couples may also opt for co-in vitro fertiliza tion (co-IVF), also known as reciprocal IVF or Reception of Oocytes from Partner (ROPA). This is a reproductive in tervention in which one woman in the couple contributes her oocytes, which are fertilized with donor sperm to generate embryos that are transferred to the uterus of the second woman, who will carry the pregnancy and deliver the child. Lesbian couples in Spain have had legal access to treatment with donor sperm since 1977, after the establish ment of the first sperm bank, whereas ART in Spain was first regulated in 1988.3 However, at that time, the partner of the woman undergoing the treatment had no legal rights toward the child. Some years later, the legalization of same-sex marriage in Spain (Law 13/2005)4 and legislation allowing the utilization of embryos generated by ART by a woman or by her partner (Law 14/2006),5 ultimately made it possible for both women in a lesbian couple to participate in the pregnancy plan

El sesgo de género en la asistencia sanitaria: definición, causas y consecuencias en los pacientes

OBJECTIVES: The aim of this bibliographic review is to provide information on the origin and consequences of gender bias, analyzing the limitations that it produces in clinical practice and proposing multiple points that must be addressed in the future so that the current panorama can be modified. MATERIAL AND METHODS: A bibliographic search is performed on the Pubmed , Google Scholar and Dialnet databases, where 241 non-duplicate records are obtained. Following the application of the exclusion criteria, they are reduced to 37 articles, from which other 21 relevant items are identified by snowball sampling. RESULTS. The content of the 33 articles that have been relevant to the research is briefly commented. DISCUSSION: The gender bias in health care is caused by its presence in the production and dissemination of knowledge, leading to a bias in the diagnostic and therapeutic effort. This has consequences related to medical knowledge, clinical management and the provision of health care that have an impact on the health of women, but also of men. The highlighting study limitation is that the impact of gender bias in health professionals, both in their training and in their work practice, and in specific pathologies is not addressed. CONCLUSIONS: Currently, there are limitations related to gender bias in the field of research, dissemination of knowledge and clinical practice. Therefore, this will continue to be an important search field in the coming years, since the integration of gender medicine is a key item consider within personalized medicine and patient-centered care to achieve a holistic approach of patients and diseases

¿Es posible dar el pecho sin embarazo previo? Protocolos para la inducción a la lactancia materna

Introduction: Induced lactation is a method by which a non-pregnant mother can breastfeed her baby. New family models such as homosexual couples, surrogate gestation and adoption are the typical cases in which you can choose to carry out this process. The existing methods for induction are pharmacological and non- pharmacological, both included in specific protocols. Objectives: To delve into the mechanism that allows lactation induction, the types of existing protocols, detailing what techniques were used and determining what are the success factors for successful induction. Material and methods: Bibliographic research in the following databases: Pubmed, Web of Science, Cinahl. The search is expanded in the Journal of Human Lactation and Musas. Sixteen case articles related to lactation induction were selected. Results: Most mothers manage to establish lactation thanks to personal motivation, emotional support, breast stimulation and sucking. Conclusions: There is a need to inform health professionals and consultants so that they can promote and advise on induced lactation when needed. More studies are necessary to be able to standardize inductive methods and to be able to individualize them according to the case, objectives, and expectations, since, based on these, the success of the induction will be determined

¿Es posible dar el pecho sin embarazo previo? Protocolos para la inducción a la lactancia materna

Introduction. Induced lactation is a method by which a non-pregnant mother can breastfeed her baby. New family models such as homosexual couples, surrogate gestation and adoption are the typical cases in which you can choose to carry out this process. The existing methods for induction are pharmacological and non-pharmacological, both included in specific protocols. Objectives. To delve into the mechanism that allows lactation induction, the types of existing protocols, detailing what techniques were used and determining what are the success factors for successful induction. Material and methods. Bibliographic research in the following databases: Pubmed, Web of Science, Cinahl. The search is expanded in the Journal of Human Lactation and Musas. Sixteen case articles related to lactation induction were selected. Results. Most mothers manage to establish lactation thanks to personal motivation, emotional support, breast stimulation and sucking. Conclusions. There is a need to inform health professionals and consultants so that they can promote and advise on induced lactation when needed. More studies are necessary to be able to standardize inductive methods and to be able to individualize them according to the case, objectives, and expectations, since, based on these, the success of the induction will be determined.Introducción. La lactancia inducida es un método a través del cual una madre no gestante puede dar el pecho a su bebé. Los nuevos modelos de familia formados por parejas homosexuales, gestación por sustitución y adopción son los casos típicos en los que se puede optar por llevar a cabo este proceso. Los métodos existentes para la inducción son farmacológicos y no farmacológicos, ambos recogidos en unos protocolos específicos. Objetivos. Profundizar sobre el mecanismo que permite la inducción de la lactancia, los tipos de protocolos existentes, detallando qué técnicas se usaron y determinando cuáles son los factores de éxito para una inducción satisfactoria. Material y métodos. Búsqueda bibliográfica en las siguientes bases de datos: Pubmed, Web of Science, Cinahl. Se amplía la búsqueda en Journal of Human Lactation y la revista Musas. Fueron seleccionados 16 artículos de casos relacionados con la inducción a la lactancia. Resultados. La mayoría de las madres consiguen instaurar la lactancia gracias a la motivación personal, el apoyo emocional y la estimulación y succión del pecho. Conclusiones. Surge la necesidad de informar a los sanitarios y consultores para que promuevan y asesoren sobre la lactancia inducida. Son necesarios más estudios para poder estandarizar los métodos inductivos y poderlos individualizar en función del caso, objetivos y expectativas, ya que, en función de estos, se determinará el éxito de la inducción

Integració de coneixements: “Donant sentit al que estudia un futur Podòleg”

Memòria final del projecte d'innovació: 2015 PID-UB/017 Integració de coneixements: “Donant sentit al que estudia un futur Podòleg”Al grau de Podologia existeix una certa reticència per part dels estudiants a veure la necessitat d’estudiar conceptes bàsics de matèries de primer que per a ells resulten molt allunyats de la seva futura pràctica professional. L’actual model d’assignatures independents i no coordinades temporalment dificulta la connexió dels coneixements de les diferents matèries de primer. Per aquest motiu ens vam proposar el professorat de Fisiologia, Bioquímica i Biofísica portar a terme el projecte d’integració de coneixements. Aquest projecte s’emmarca en les directrius de l’ESEE i te en compte les noves tendències per promoure curriculums més integrats i interdisciplinaris en el camp de les ciències de la salut (Rosell et al 2002, Vicedo et al. 2009). Aquest projecte s’ha portat a terme durant el primer quadrimestre del curs 2015-16 i s’han elaborat treballs d’integració de coneixements entorn a temes generals i d’altres més específics del camp de la Podologia amb l’objectiu aconseguir una major coordinació entre les diferents disciplines participants i a la vegada proporcionar contextos significatius d’aprenentatge. La iniciativa va tenir una gran acollida per part dels estudiants i es van formar 6 grups de treball d’entre 7-10 participants. Aquesta memòria recull l’experiència realitzada i analitza la incidència positiva del treball d’integració en els resultats de l’assignatura valorats mitjançant enquestes i preguntes específiques d’integració a la prova d’avaluació final

Preservation of fertility in patients with cancer (Review)

Survival rates in oncological patients have been steadily increasing in recent years due to the greater effectiveness of novel oncological treatments, such as radio‑ and chemotherapy. However, these treatments impair the reproductive ability of patients, and may cause premature ovarian failure in females and azoospermia in males. Fertility preservation in both female and male oncological patients is nowadays possible and should be integrated as part of the oncological healthcare. The main objective of this review was to describe the different existing options of fertility preservation in patients undergoing gonadotoxic cancer treatments, as well as the differences in success rates that may appear in the different techniques evaluated. Emerging techniques are promising, such as the cryopreservation in orthotopic models of ovarian or testicle tissues, artificial ovaries, or in vitro culture prior to the autotransplantation of cryopreserved tissues. However, oocyte vitrification for female patients and sperm banking for male patients are considered the first line fertility preservation option at the present time for cancer patients undergoing treatment. Certainly, new fertility preservation techniques will continue to develop in the following years. However, despite the growing advances in the subject, optimal counselling from healthcare professionals should always be present

Full-term pregnancy in breast cancer survivor with fertility preservation: A case report and review of literature

A 43-year-old woman with an associated history of gynecological pathology and breast cancer with only one cryopreserved embryo wished to be a mother. Several factors that influenced the success of the pregnancy in this case were analyzed. Favorable factors included: triple positive breast cancer [positive hormone receptors and positive human epidermal growth factor receptor 2], which is more hormosensitive and chemosensitive; absence of metastasis; correct endometrium preparation; and the patient's optimistic attitude and strict health habits. In contrast, the factors against success were: breast cancer; adjuvant breast cancer therapy gonadotoxicity; the age of the patient (> 40-year-old); endometriosis; ovarian cyst; hydrosalpinx; submucosal fibroids and the respective associated surgery done for the above-mentioned pathology (all resolved prior to the embryo transfer); and a low quantity of ovules (low ovarian reserve) after ovarian stimulation. This is a very special clinical case of a patient with theoretically low pregnancy success probability due to the consecutive accumulation of gynecological and oncological pathologies, who nonetheless became pregnant and delivered a full-term infant and was able to provide adequate breastfeeding