Wound healing in US medical school curricula.

Approximately 6.5 million Americans suffer from nonhealing wounds. As physicians are increasingly expected to manage chronic wounds, the degree to which formalized wound care education exists as a clinical rotation is unclear. For the first time, the prevalence and characteristics of formal wound electives offered by US medical schools are documented. Online surveys were distributed to 134 US medical schools and to the 74 medical students who completed the wound healing elective at the University of Miami regarding their experiences. School response rate was 41% (n = 55). We found that out of 55 schools, only 7 schools offered a formal wound healing elective. The University of Miami was the only school to include a surgical component. Students' response rate was 39% (n = 29). After completing the elective, 20 students (69%) felt confident in their knowledge of surgical and medical wound management. A majority of students (76%, n = 22) felt that the elective was an important part of the medical school curriculum. In conclusion, we found very few schools offer a formal wound elective and recommend medical schools in formalizing this education through clinical electives. Education should be team-based and multidisciplinary; evidence exists that this is the best approach to managing chronic wounds. Basic tenets of wound care, both medical and surgical, should be emphasized.

Taking a closer look at the key performance indicators in an assisted reproductive technology laboratory: a guide for reproductive professionals.

Over the years, laboratories performing assisted reproductive technologies have been tasked with a growing number of procedures of increased complexity. New technologies, including hardware and software innovations, are constantly evolving, and evaluated as potential tools to improve laboratory and clinical outcomes. The assisted reproductive technology (ART) laboratory plays a crucial role in fertility treatments and, therefore, it is often under intense scrutiny with regards to performance and success rates. As the reproductive medicine field strives to deliver improved clinical outcomes to patients, in-vitro fertilization (IVF) clinics - including the ART laboratories - are required to monitor their performance and seek improvement in the many different aspects related to patient care. Key performance indicators (KPIs) and benchmarking are important tools to support performance monitoring and quality improvement processes. The concept and potential benefits of KPI utilization is generally accepted. However, its adoption poses some challenges that may discourage ART practices from pursuing it as part of their quality management systems (QMS). Properly selecting and using KPIs will allow laboratories to successfully manage their performance and set up realistic target goals to consistently deliver high rates. Existing literature can guide reproductive medicine professionals to embark on their journey to successfully select, implement, and manage KPI and benchmarking as part of their ART programs. This article discusses the concept and essentials of KPI and benchmarking applied to the ART laboratory, as well as potential challenges and how to overcome them.

An expert commentary on essential equipment, supplies and culture media in the assisted reproductive technology laboratory.

The assisted reproductive technology (ART) laboratory is a complex system designed to sustain the fertilization, survival, and culture of the preimplantation embryo to the blastocyst stage. ART outcomes depend on numerous factors, among which are the equipment, supplies and culture media used. The number and type of incubators also may affect ART results. While large incubators may be more suitable for media equilibration, bench-top incubators may provide better embryo culture conditions in separate or smaller chambers and may be coupled with time-lapse systems that allow continuous embryo monitoring. Microscopes are essential for observation, assessment, and micromanipulation. Workstations provide a controlled environment for gamete and embryo handling and their quantity should be adjusted according to the number of ART cycles treated in order to provide a steady and efficient workflow. Continuous maintenance, quality control and monitoring of equipment are essential and quality control devices such as the thermometer, and pH-meter are necessary to maintain optimal culture conditions. Tracking, appropriate delivery and storage conditions, and quality control of all consumables are recommended so that adequate quantity and quality are available for use. Embryo culture media have evolved: preimplantation embryos are cultured either by sequential media or single-step media that can be used for interrupted or uninterrupted culture. There is currently no sufficient evidence that any individual commercially-available culture system is better than others in terms of embryo viability. In this review, we aim to analyze the various parameters that should be taken into account when choosing the essential equipment, consumables and culture media systems that will create optimal culture conditions and provide the most effective patient treatment.

Optimizing embryological aspects of oocyte retrieval, oocyte denudation, and embryo loading for transfer.

Oocyte retrieval, oocyte denudation, and embryo transfer are crucial processes during assisted reproduction technology (ART). Air quality in the ART laboratory, temperature, pH of the media used and the time interval between oocyte retrieval and insemination are all critical factors. Anesthesia is required for oocyte retrieval, however, evidence regarding the potential impact of different methods (general anesthesia, conscious sedation, and local anesthesia) on the clinical outcomes is unclear. The optimal timing of oocyte denudation following retrieval has not been established. Regarding the mechanical denudation process, there is a lack of evidence to demonstrate the safest minimum inner diameter of denuding pipettes used to complete the removal of granulosa cells surrounding the oocytes. During embryo transfer, many clinics worldwide flush the catheter before embryo loading, in an attempt to potentially rinse off any toxic agents; however, there is insufficient evidence to show that flushing the embryo transfer catheter before loading increases the success of ART outcome. Considering the serious gaps in knowledge in ART practice, the aim of this review is to provide an updated overview of the current knowledge regarding the various steps and techniques involved in oocyte retrieval, oocyte denudation, and embryo loading for transfer.

Oocyte quality and embryo selection strategies: a review for the embryologists, by the embryologists.

With the advance of assisted reproduction techniques, and the trend towards blastocyst culture and single embryo transfer, gamete and embryo assessment have gained greater importance in ART treatment. Embryo quality depends mainly on gamete quality and culture conditions. Oocyte maturity identification is necessary in order to plan fertilization timing. Mature oocytes at the metaphase II stage show a higher fertilization rate compared to immature oocytes. Morphology assessment is a critical yet challenging task that may serve as a good prognostic tool for future development and implantation potential if done effectively. Various grading systems have been suggested to assess embryos at pronuclear, cleavage, and blastocyst stages. By identifying the embryo with the highest implantation potential, it is possible to reduce the number of embryos transferred without compromising the chances of a successful pregnancy. Apart from the conventional morphology assessment, there are several invasive or non-invasive methods for embryo selection such as preimplantation genetic testing, morphokinetics, proteomics, metabolomics, oxygen consumption, and measurement of oxidative stress in culture medium. Morphokinetics is a method based on time-lapse technology and continuous monitoring of embryos. In this review, we aimed to describe and compare the most effective and widely used methods for gamete and embryo assessment as well as embryo selection.

Feasibility of a randomized hypertension screening initiative in the perioperative setting.

OBJECTIVES: This study sought to assess feasibility of a randomized trial of blood pressure intervention (home blood pressure monitoring vs. counseling) in the preoperative clinic and the baseline rates of primary care follow-up after such interventions. METHODS: A prospective randomized feasibility study was performed at Yale New Haven Hospital Preadmission Testing Clinic. A sample of 100 adults, with elevated blood pressure, were recruited during their preadmission visit, and randomized 1:1 to receive brief BP counseling and an educational brochure versus additionally receiving a home BP monitor (HBPM) with a mailed report of their home readings. At 60-day post-surgery telephone follow-up, investigators asked whether participants had primary-care follow-up; had new/adjusted hypertension treatment; and felt satisfied with the study. RESULTS: There were 51 patients in the counseling group and 49 in the HBPM group. Of 46 patients in the HBPM group who returned their monitors, 36 (78%) were hypertensive at home. At 60 days post-surgery, 31 (61%) patients in the counseling group and 30 (61%) in the HBPM group were reached by telephone with the remaining followed by EHR. Thirty-six (71%) patients in the counseling group and 36 (73%) in the HBPM group had seen their primary care provider. Seventeen of 36 (47%) in the counseling group and 18 of 31 (58%) in the HBPM group received new or adjusted hypertension medications. Sixty-one participants answered questions regarding their satisfaction with the study with 52 (85%) reporting that they felt moderately to very satisfied. CONCLUSIONS: This feasibility study suggests that interventional blood pressure trials in the preoperative clinic are feasible, but telephone follow-up leads to significant gaps in outcome ascertainment. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03634813 . Registered 16 of August 2018.