A need for definition: a matter of life and death for human embryos

A recent IMJ commentaryon brain stem death criteria summarised ethical and technical issues concerning “end of life decisions”, and we concur that physicians should have competence in eliciting the proper sequence of brain stem signs in clinical practice. However, a truly comprehensive dialogue on the definition of death should address another question that confronts IVF clinics in Ireland each day—when does a human embryo die? Despite the enormous social and political energy focused on “right to life” issues over recent decades, the death of a human embryo remains a sadly forgotten topic. As Dr Murphy indicated1, the introduction of brain stem death criteria in 1967 recognised permanent loss of consciousness and spontaneous breathing after the inactivation of essential human neural elements. But our IVF clinics and allied research facilities are responsible for human life well before any discrete neurological system has developed. For practitioners and scientists engaged in the care of these tiniest of “patients”, a relevant definition of death should not be neglected

Disparities and relative risk ratio of preterm birth in six Central and Eastern European centers

Aim To identify characteristic risk factors of preterm birth in Central and Eastern Europe and explore the differences from other developed countries. Method Data on 33 794 term and 3867 preterm births (<37 wks.) were extracted in a retrospective study between January 1, 2007 and December 31, 2009. The study took place in 6 centers in 5 countries: Czech Republic, Hungary (two centers), Romania, Slovakia, and Ukraine. Data on historical risk factors, pregnancy complications, and special testing were gathered. Preterm birth frequencies and relevant risk factors were analyzed using Statistical Analysis System (SAS) software. Results All the factors selected for study (history of smoking, diabetes, chronic hypertension, current diabetes, preeclampsia, progesterone use, current smoking, body mass index, iron use and anemia during pregnancy), except the history of diabetes were predictive of preterm birth across all participating European centers. Preterm birth was at least 2.4 times more likely with smoking (history or current), three times more likely with preeclampsia, 2.9 times more likely with hypertension after adjusting for other covariates. It had inverse relationship with the significant predictor body mass index, with adjusted risk ratio of 0.8 to 1.0 in three sites. Iron use and anemia, though significant predictors of preterm birth, indicated mixed patterns for relative risk ratio. Conclusion Smoking, preeclampsia, hypertension and body mass index seem to be the foremost risk factors of preterm birth. Implications of these factors could be beneficial for design and implementation of interventions and improve the birth outcome

Fertility patients and their prescriptions: a two-year audit of patient-pharmacist interactions in a reproductive endocrinology practice

BACKGROUND: This study assessed pharmacy performance and satisfaction as reported by patients during ovulation induction therapy. MATERIALS AND METHODS: Patients (n = 1269) receiving gonadotropin prescriptions for intrauterine insemination or in vitro fertilisation-embryo transfer in 2007-2008 were prospectively interviewed by nurses and/or completed a structured questionnaire to evaluate pharmacy performance. "Community" (n = 12) and "specialty" (n = 2) pharmacy status (C vs. S) was defined by each pharmacy, and all pharmacies were selected by patients before cycle start. Patient comments about their pharmacy were classified into five types: i) Dispensing error-gonadotropin, ii) Dispensing error-non gonadotropin, iii) Mistake in prescribed medical equipment/supplies, iv) Counselling/communication inaccuracy, and v) Inventory problem or other. RESULTS: 391 pharmacy concerns were reported from 150 fertility patients during the study period. The majority (75.9%) of patients selected a S pharmacy to fill their prescriptions, and this pharmacy type was identified in 2.8% of adverse pharmacy encounters (p CONCLUSION: Fertility patients reported a disproportionate and significantly higher number of adverse pharmacy encounters from C pharmacies compared to S pharmacies. Although no licensing mechanism in Ireland currently recognises special training or certification in any area of pharmacy practice, informal self-designations by pharmacies remain a useful discriminator. Level of familiarity with fertility medicines and availability of inventory are important characteristics to be considered when counselling fertility patients about pharmacy choice. Those who select a C pharmacy should be advised to allow extra time for inventory verification, order confirmation, and additional counselling. Additional study is needed to determine if a minimum volume of fertility-related prescriptions is necessary to assure competence in this particular field of pharmacy practice.</p