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A major challenge for healthcare in Ireland today is achieving an appropriate balance between the protection of personal health information, and the use and sharing of such information, to improve care and to provide a more seamless experience for patients receiving care across multiple healthcare settings. Ireland is at an early stage of eHealth adoption. There is a lack of clarity in relation to an appropriate model for the collection, use and sharing of personal health information. As we start to introduce new digital technologies, it is essential that a robust consent model is in place to protect people’s rights in relation to health information. Drawing on international evidence, it is important to engage with the public around the introduction of new technologies, such as a national electronic health record. Engagement will ensure that new technologies are implemented in a way that is acceptable to the public; involving people in important decisions about their health information and ensuring that their rights are upheld. To advance this, HIQA, in partnership with the Department of Health and the HSE, conducted the first National Public Engagement on Health Information in Ireland to ask the public their views on how their health information should be collected, used and shared in Ireland. People were asked to share their views through a national survey and focus groups. Building on the findings from the National Public Engagement, HIQA has worked collaboratively with key stakeholders to develop recommendations on a consent model for health and social care. Guidance is also being developed to define the consent model for the various uses of health information. There is an additional need for comprehensive national policy and legislation in relation to health information in Ireland. [ABSTRACT FROM AUTHOR]

The Joint Theater Trauma Registry is a standardized, retrospective data collection system for all echelons of combat casualty care. Military-specific data elements include expanded demographic data to include military branch, service, rank, military occupation, and personal protective equipment. Varying data from each echelon are entered into the Joint Theater Trauma Registry, version 3. The Joint Theater Trauma Registry, version 3 at the echelon 4 medical treatment facility requires routine collection of 367 data elements for each casualty, but casualties sustaining burns, deaths, or those with performance improvement issues may have more than 450 data elements recorded. Trauma registries are powerful tools for process improvement. Collaboration between civilian and military trauma programs may foster improvements in registry design and data collection for both groups. [ABSTRACT FROM AUTHOR]

Hepatocyte growth factor (HGF) is a structurally unique growth factor with potent motogenic (motility inducing) effects. Studies in the murine male genital tract have suggested important associations between HGF and the acquisition of sperm motility during epididymal maturation. The aim of this study was, therefore, to determine the concentration of HGF in human semen and assess its correlation, if any, with sperm motility and other semen parameters. Semen samples were collected by masturbation and analysed using standard procedures. HGF concentrations were measured in duplicate using an enzyme-linked immunoassay technique. Total protein estimations were also made in a subset of samples. The 95 subjects were divided into three groups for analysis: normozoospermic, subnormal semen and azoospermic. HGF was detected in all samples (median 0.456, 25th centile 0.388, 75th centile 0.556 ng/ml). No significant correlations were found between semen HGF concentrations and sperm concentration, motility, total sperm count or total motile count. There were no significant differences in mean HGF concentrations between the three subgroups. In conclusion HGF is present in human semen in significant quantities. The data do not suggest HGF concentrations are correlated with parameters of sperm motility. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine why oocytes remain unfertilized or develop three pronuclei after intracytoplasmic sperm injection (ICSI). Unfertilized and abnormally fertilized oocytes were fixed in glutaraldehyde, stained with Hoechst 33342 and examined by fluorescence microscopy to identify oocyte, sperm and polar body DNA. One-pronuclear oocytes were considered to be unfertilized. A total of 285 unfertilized oocytes were examined (104 ICSI cycles). Overall, 83% of these oocytes were not activated (still at metaphase II) while 17% had activated and formed a single (female) pronucleus. About 66% of the unfertilized, metaphase II oocytes contained a swollen sperm head, indicating that the oocyte was correctly injected but had failed to activate and complete the second meiotic division. Premature chromosome condensation of the sperm DNA was evident in 6% of these metaphase II oocytes (4% of the unfertilized oocytes). The swollen sperm head was located among the oocyte chromosomes in 5% of the metaphase II oocytes. Other causes of failed fertilization in the metaphase II oocytes were the failure of sperm head decondensation (11%) and ejection of the spermatozoon from the oocyte (23%). A similar pattern was observed in one-pronuclear oocytes (52%, swollen sperm head; 28%, intact, undecondensed sperm head; 20%, ejection of the spermatozoon), which indicates that asynchronous pronuclear development does not explain the presence of one-pronuclear oocytes. A total of 41 three-pronuclear oocytes were examined and all had a single polar body, which indicates that the retention of the second polar body leads to the formation of the third pronucleus. In conclusion, this study demonstrates that: (i) the major cause of fertilization failure after ICSI is failure of oocyte activation; (ii) ejection of the spermatozoon into the perivitelline space is not a major cause of fertilization failure; and (iii) sperm head decondensation and oocyte activation after ICSI can occur independently. [ABSTRACT FROM AUTHOR]

In this report, we present the results of our first 100 consecutive cycles of intracytoplasmic sperm injection (ICSI). Overall, fertilization occurred in 98% of cycles and embryos were transferred in 94% (2.6 embryos per cycle). About 50% of patients had embryos frozen. The overall fertilization rate was 71%, of which 4% were abnormally fertilized (three pronuclei). A total of 30 clinical pregnancies were established (32% per transfer), resulting in 18 singleton, six twin and one triplet ongoing pregnancies. The implantation rate per embryo was 15%. There were no significant differences in the fertilization or pregnancy rates between patients who had only occasional motile spermatozoa in the ejaculate, semen that was too poor for routine in-vitro fertilization (IVF), or who had failed routine IVF and/or subzonal sperm injection (SUZI). A group of 18 patients were treated with both ICSI and routine IVF on their first cycle because of the high likelihood of failed fertilization due to poor sperm morphology < 20% normal). In this group, ICSI oocytes had a fertilization rate of 76% compared to only 15% for the routine IVF (control) oocytes, and six patients conceived after transfer of ICSI embryos (33%), indicating that ICSI can be used successfully on 50% of the oocytes if fertilization failure is expected. Similarly, patients who had failed to become pregnant with SUZI achieved excellent results after ICSI. There were no significant differences between ICSI and routine IVF in the proportions of grade 1, 2 or 3 embryos on day 3 post-oocyte recovery.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

The usefulness of sub-zonal injection (SZI) for the treatment of severe male factor infertility has been restricted by low and unpredictable fertilization rates and the high risk of polyspermy after the injection of multiple spermatozoa. In this prospective study, we have evaluated whether sperm morphology and the percentage of acrosome-reacted spermatozoa at the time of injection can be used to predict SZI fertilization outcomes. Populations of motile spermatozoa equivalent to those injected were collected from the medium/oil interface immediately after SZI of each cohort of oocytes. Morphology was assessed using the World Health Organization 1987 criteria and the acrosomal status of spermatozoa was determined after staining with rhodamine-conjugated Pisum sativum agglutinin. A fertilization index (FI) was calculated to express the actual fertilizing potential of the spermatozoa injected. In all, 67 patients underwent 72 SZI cycles. The overall fertilization and polyspermy rates were 36 and 47% respectively, and a clinical pregnancy rate per transfer of 22% was achieved. Linear regression analysis demonstrated a statistically significant relationship between morphology and the FI (r = 0.506, P < 0.0001). Patients with < or = 10% normal morphology always had a FI < or = 10%, and this was reflected by low fertilization and polyspermy rates and the high number (32%) of cycles with complete failure of fertilization in this group. In patients with > 10% normal morphology, there were two patterns: low (< or = 10% FI) or high (> or = 10% FI) fertility. This was evident in the fertilization (23 and 85%, respectively), and polyspermy (25 and 68%, respectively) rates of these two patient sub-groups.(ABSTRACT TRUNCATED AT 250 WORDS) [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the efficacy of enriching X-bearing human spermatozoa using 12-step (25-80%) discontinuous Percoll gradients. X- and Y-bearing spermatozoa were simultaneously identified in neat semen (controls) and in 80% Percoll fractions from the same samples using double-label fluorescence in-situ hybridization and chromosome-specific DNA probes. Hybridization and labelling efficiencies of 95-99% were obtained in all samples. The mean ratio of X- to Y-bearing spermatozoa in the controls was 49.0:48.2, whereas there was a significant enrichment (P < 0.0001) of X-bearing spermatozoa in the Percoll fractions (mean X:Y ratio was 55.1:41.1 or 1.35). The ratio varied from 1.1-1.5 in individual Percoll samples. There were no significant differences in the proportions of aneuploid spermatozoa (XX, YY, XY) between the control and Percoll fractions. We conclude that 12-step discontinuous Percoll gradients enrich X-bearing spermatozoa, but the degree of enrichment is insufficient for use in preconceptional sex selection. [ABSTRACT FROM AUTHOR]