Building practice-informed indigenous health curricula: A systematic review of pharmacy services for indigenous peoples.

BACKGROUND: An increased need is recognized to improve Indigenous cultural safety curriculum. This review aimed to inform curriculum development by identifying and categorizing challenges and opportunities that underlie existing practices. This entails policies, pharmacy services, and health workers' perspectives associated with pharmacy services for Indigenous peoples of Australia, Canada, New Zealand, and the United States. METHODS: Four academic databases were screened including PubMed, Embase, CINAHL, and Web of Science. This search was complemented by grey literature database searches. Thematic analysis by NVivo, version 12 (QSR International) was utilized to analyze qualitative data, and a narrative strategy guided common theme consolidation. This approach was prefaced and supplemented using Endnote X9 (Clarivate) and SUMARI 2019 (JBI) and according to the Joanna Briggs Institute's guidelines. An Indigenous Curriculum Advisory Committee at the University of British Columbia Pharmaceutical Sciences was queried for suggestions, potential cross-cultural interpretation, and guidance for explicit content in the context of pharmacy service delivery in Indigenous communities. RESULTS: Fourteen studies were included and classified into three categories: (1) Indigenous patients', pharmacists', and health care providers' perspectives, (2) policies and practices, (3) pharmacy-based programs. Thematic analysis portrayed several themes with overlapping presentation of challenges and opportunities. It is important to utilize evidence-based strategies for improving the effectiveness of culturally-safe pharmacy services for Indigenous populations and for optimizing education and practice-informed curriculum development. IMPLICATIONS: This information can inform pharmacists, educators, and faculty members in understanding and delivering optimal care and education engaging Indigenous insights and perspectives at systems and curricular levels.

An Indigenous health elective - Perspectives of pharmacy undergraduate students and alumni.

BACKGROUND AND PURPOSE: Health professional programs, including pharmacy, have increased Indigenization efforts through cultural safety learning. The objective of this paper is to describe student and alumni interest, impact, and perceptions for improvement of an undergraduate elective course on Indigenous health. EDUCATIONAL ACTIVITY AND SETTING: A three-credit elective course was developed with an Indigenous advisory committee and a two-phase mixed-methods design incorporating pre- and post-course surveys and interviews for pharmacy students was implemented from 2013 to 2016. In 2019, all previous students enrolled in the course, now alumni and practicing pharmacists were invited to participate in an online survey and follow-up interview. FINDINGS: A total of 87 students and 21 alumni participated. The course appeared to have considerable impact on students' interest in course topics, specifically Canadian history of colonialism and impact on health. The course generated an increased interest in both Indigenous-oriented practicums and future practice setting. Self-perceived efficacy in providing care to Indigenous patients increased post-course and was sustained in alumni. Three major themes emerged: course should be mandatory and/or more widely available to all students, incorporate more experiential learning (such as educational field trips), and understanding of Indigenous history and impact on health care was a key learning outcome. SUMMARY: A lecture-based elective course increased interest in Indigenous health topics, changed current perspectives on Indigenous health needs, and improved self-perceived efficacy in providing care. Students and alumni felt course content should be more widely available and highlighted the importance of increased experiential learning opportunities.

Usability assessment of an open-source simulated electronic medical record in pharmacy education.

BACKGROUND AND PURPOSE: The growth of electronic medical records (EMRs) has been a critical component of evolving pharmacy practice, catalyzed by foundational initiatives such as the HITECH Act in 2009. The objective of this study was to evaluate the usability and student perceptions of a novel, open-source, educational EMR (EdEMR) for integration in the PharmD program at the University of British Columbia (UBC). EDUCATIONAL ACTIVITY AND SETTING: Participants were PharmD students at UBC and had to complete a series of survey questions and EdEMR tasks including a Systems Usability Scale (SUS) evaluation. Task completion time, mouse clicks, SUS score, and 5-point Likert scale rankings of student opinions on the use of the EdEMR were collected. FINDINGS: Seven students successfully completed the study. Participants self-ranked themselves as novice EMR users who used EMRs a few times a week. The mean time to complete the tasks was 6 min, 42 seconds and was approximately double that of benchmark times (mean benchmark = 2 min, 20 seconds). The EdEMR scored within the upper quartile of SUS scores (mean = 83), indicating good usability. Participants identified that the EMR would most optimally be used for distance learning and case-based learning. SUMMARY: The EdEMR showed good usability as demonstrated by the successfully completed tasks and SUS score. Participants were receptive to the EdEMR's application as an online learning tool and for case-based learning. The EdEMR is an enticing, open-source tool currently available to all pharmacy programs and could further support online and remote teaching.

Assessing Indigenous Cultural Safety Learning using Modified Reflexive Visual Arts.

Objective: Assessing Indigenous cultural safety learning in pharmacy students using modified reflexive visual arts Innovation: Traditional quantitative assessment methods are often ineffective and impractical for the evaluation of Indigenous cultural safety learning. Existing qualitative assessment methods have shown potential in small-class and experiential environments, but evidence to guide the scalability and use in a large lecture format is sparse. An innovative, visual arts-based qualitative assessment of cultural safety learning was developed and deployed to 223 first-year pharmacy students. The assessment was deployed in a pre- and post-term style in a foundational pharmacy module that included content on Indigenous health and cultural safety. The pre-term assessment included two activities for students: 1) a visual art self-reflection requiring students to use any visual art medium to depict what they think it means to practice as a pharmacist with cultural safety, accompanied by a brief written description and (2) an in-class session with a brief lecture component, small and large group sharing of reflections, debrief of experiences, and student peer review of the visual reflections. The post-term portion included a similar self-reflection activity and an in-class session that now asked students in their small groups to: 1) compare their pre/post reflections, and 2) collectively create a new summative visual that depicts the entire group's thoughts. Surveys and a focus group were used as an additional source of data. Critical Analysis: Survey responses (n=215) indicated that feedback for the assessment was highly positive, with 77% of students recommending the activity for future first-year pharmacy students. Students also validated the utility of the assessment, with 70% strongly or somewhat agreeing that the activity was valuable for their learning, 80% strongly or somewhat agreeing that the activity stimulated their thinking, and 81% strongly or somewhat agreeing the activity accurately reflected their true feelings on practicing cross-culturally.

Family physician perceptions of barriers and enablers to integrating a co-located clinical pharmacist in a medical clinic: A qualitative study.

OBJECTIVE: Pharmacists from The University of British Columbia Pharmacists Clinic provide comprehensive medication management services once to twice a month through the co-location model at multiple general practice clinics beginning from 2014 and consistently since 2016. For some of the clinics, this was the first experience with a co-located allied health professional. The objective of this study was to examine the perspectives of physicians who had a relatively long-standing relationship with a co-located pharmacist to identify barriers and facilitators to integrating a clinical pharmacist. METHODS: A qualitative research methodology was used to gain the perspectives of physicians. Data were collected through convenience sampling and one-on-one semistructured interviews. In-person or telephone interviews were conducted from August 12, 2019, to September 10, 2019, and audio was recorded with the participants' consent. The recorded interviews were transcribed, and a thematic analysis with an inductive approach was used to analyze the data. RESULTS: Eight physicians from 4 general practice clinics were interviewed. Analysis of the interviews identified 6 themes that contained barriers or enablers to the integration of a co-located pharmacist: (1) electronic medical record (EMR) use, (2) identifying patients and the referral process, (3) workload and logistics, (4) patients' willingness, (5) impact of in-person communication, and (6) shifting physicians' perspectives. The enablers included the use of an EMR to proactively identify patient referrals, a dedicated pharmacist workspace, a physician champion, and intentional scheduling of in-person physician-pharmacist case conferences. The barriers included identifying patients for referral, the lack of EMR interoperability, pharmacist availability, physician colleagues who were less committed to team-based care, and financial implications despite externally funded pharmacists. CONCLUSION: The physician participants perceived several barriers and enablers to the integration of a pharmacist into their practice. The themes identified can be used to inform physicians and pharmacists on the integration process for team-based primary care.

Creating a pharmacy elective course in Indigenous health.

BACKGROUND AND PURPOSE: There is a critical need for greater Indigenous health education and cultural safety training for pharmacists. The objective of this paper is to describe the creation, development, and impact of Canada's first offering of an undergraduate elective course specific to pharmaceutical care in Indigenous health. EDUCATIONAL ACTIVITY AND SETTING: A three-credit elective course was developed and offered to bachelor of science pharmacy students at the University of British Columbia. A variety of pedagogical approaches including reflection, educational trips, video conferencing with Indigenous communities, and Indigenous community-based projects were used. Evaluation of student learning impact included quantitative and qualitative post-course survey data, student enrollment, and student work. FINDINGS: From course inception in 2012 to 2017, 101 students participated. Survey respondents rated an average of 4.7 out of 5 on the five core elements of the curriculum design and pedagogical practice (i.e. learning objectives, instructional methods, assessments, organization, and workload). Thematic analysis identified three themes: 1) the qualities of the course instructors, 2) the unique curriculum design and pedagogical practices, and 3) significant personal and professional impact on students. SUMMARY: This course is one of few opportunities for pharmacy students to learn about cultural safety as it relates to the pharmaceutical care of Indigenous peoples. Extensive engagement with stakeholders and utilization of various teaching and assessment techniques were beyond the expected requirements of course offerings. Students highly rated this course as having personal and professional impact. This course plays a critical role in the overall Indigenization of pharmacy curricula.

Compatibility of the ForenSeq™ DNA Signature Prep Kit with laser microdissected cells: An exploration of issues that arise with samples containing low cell numbers.

Massively parallel sequencing is rapidly emerging as a valuable tool in forensic DNA analyses. As part of our validation of this technology, we established its compatibility with a laser microdissection cell collection method including a one-tube DNA extraction process. We also used the laser microdissector to explore the number of cells required to generate informative DNA sequence profiles and establish the limitations of the technology. Using the ForenSeq™ DNA Signature Prep Kit (Primer Mix B) and a MiSeq FGx™ sequencer, we successfully demonstrated the compatibility of MPS with a laser microdissection one-tube extraction method, with minor alterations made to the manufacturer's recommended library preparation protocol, including the addition of magnesium chloride to counteract the effect of dithiothreitol on amplification efficacy. This work highlighted several quality issues that may be encountered when preparing sequencing libraries from low quantity DNA samples, particularly that libraries prepared from low cell numbers showed high levels of adapter dimer compared to those prepared from more cells. To remediate this, we replaced the bead normalisation step with a qPCR normalisation method, whereby sequencing libraries are diluted based on their molarity as determined after library purification. The work presented here focuses on the results from the autosomal and Y STR markers as these could be directly compared to results obtained from traditional capillary electrophoresis techniques. Full autosomal STR DNA sequence profiles (27 loci) could be obtained from 50 epithelial cells and 100 spermatozoa (sperm cells). The limit of detection for the ForenSeq™ system was determined to be 25 epithelial and 25 sperm cells for both autosomal and Y STRs. Cells were dissected from both single source samples and mixtures of semen and saliva. There was no apparent difference in sensitivity, presence of contamination or PCR artefacts between libraries prepared from single source samples and libraries prepared from mixed source samples.

Exploring Canadian pharmacy students' e-health literacy: a mixed method study.

BACKGROUND: While much has been described about technology use by digital natives in general, understanding of pharmacy student's knowledge and understanding of technology is lacking. OBJECTIVE: This study explores the current state of pharmacy students' self-rated digital health literacy in British Columbia, Canada, and seeks to identify future opportunities for technology training in pharmacy education and in practice. METHODS: A mixed methods design using surveys and semi-structured interviews was conducted. An online, validated survey (eHEALS) was conducted among currently enrolled 2nd to 4th year pharmacy students at the University of British Columbia. An additional interview was offered to consenting participants to further explore the use of technology in daily lives, pharmacy practicums, and implications on future pharmacy curricula. Both quantitative and qualitative thematic analysis was done of all data. RESULTS: A total of 30 pharmacy students completed the eHEALS survey and 5 completed interviews. Most participants were 2nd year students (50%), were 25 years and younger (80%), and female (87%). Ranking of digital health literacy was lower than expected with participants stating they know what (87%), where (87%) and how to find (77%) health resources on the Internet. Even less students (77%) rated that they have the skills to evaluate the health resources that they find on the Internet and only 53% felt confident in using information from the Internet to make health decisions. Most students mentioned that they had limited technology related training at school and would like more training opportunities throughout their program and connect what they have learned at school to their practice. CONCLUSIONS: These results expose significant and surprising gaps in student understanding of technology despite modifications seen in the entry-to-practice PharmD curriculum. Regional differences and digital health literacy of practicing pharmacists are areas that require better understanding and hold significant impact as practice evolves.

Exploring Canadian pharmacy students' e-health literacy: a mixed method study

BACKGROUND: While much has been described about technology use by digital natives in general, understanding of pharmacy student's knowledge and understanding of technology is lacking. OBJECTIVE: This study explores the current state of pharmacy students' self-rated digital health literacy in British Columbia, Canada, and seeks to identify future opportunities for technology training in pharmacy education and in practice. METHODS: A mixed methods design using surveys and semi-structured interviews was conducted. An online, validated survey (eHEALS) was conducted among currently enrolled 2nd to 4th year pharmacy students at the University of British Columbia. An additional interview was offered to consenting participants to further explore the use of technology in daily lives, pharmacy practicums, and implications on future pharmacy curricula. Both quantitative and qualitative thematic analysis was done of all data. RESULTS: A total of 30 pharmacy students completed the eHEALS survey and 5 completed interviews. Most participants were 2nd year students (50%), were 25 years and younger (80%), and female (87%). Ranking of digital health literacy was lower than expected with participants stating they know what (87%), where (87%) and how to find (77%) health resources on the Internet. Even less students (77%) rated that they have the skills to evaluate the health resources that they find on the Internet and only 53% felt confident in using information from the Internet to make health decisions. Most students mentioned that they had limited technology related training at school and would like more training opportunities throughout their program and connect what they have learned at school to their practice. CONCLUSIONS: These results expose significant and surprising gaps in student understanding of technology despite modifications seen in the entry-to-practice PharmD curriculum. Regional differences and digital health literacy of practicing pharmacists are areas that require better understanding and hold significant impact as practice evolves

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Navigating Allyship through Indigenization, Decolonization, and Reconciliation: Perspectives from Non-Indigenous Pharmacy Educators.

As pharmacy schools across Canada and North America work towards authentic and meaningful curriculum and learning opportunities in Indigenous health and cultural safety, the conversation of "why" we need to do this has become clearer, but the task of "how" we do this remains challenging. This curricular transformation can be increasingly more complex to navigate as a non-Indigenous ally and pharmacy educator. Defining your role as an ally is deeply personal and critically important, as it can transform based on the collaborative work undertaken with Indigenous partners and communities. The purpose of this article is to share perspectives gained over years of experience and practical applications of allyship through the lens of three key separate, but interconnected concepts - indigenization, decolonization, and reconciliation.

Development of an Interprofessional Educational Electronic Health Record.

This paper identifies issues relating to academic health record systems and outlines a project currently underway to develop an open source educational clinical information system to better support interprofessional health education.

Cardiovascular Risk Reduction in the Workplace With CAMMPUS (Cardiovascular Assessment and Medication Management by Pharmacists at the UBC Site).

BACKGROUND: Cardiovascular (CV) disease is a leading cause of death despite being largely preventable. Employers increasingly offer preventive health programs in the workplace, and pharmacists are well suited to provide these programs. OBJECTIVE: To evaluate the impact of a pharmacist-led service on CV risk in University of British Columbia (UBC) employees. METHODS: This was a prospective observational pre-and-post design study, with participants as their own controls. Employees >18 years of age in the UBC health plan with a Framingham Risk Score (FRS) ≥10% or ≥1 medication-modifiable CV risk factor were included. Participants received a baseline assessment, individualized consultation for 12 months, and a final assessment by a pharmacist at the UBC Pharmacists Clinic. The primary end point was FRS reduction. RESULTS: Baseline assessment of 512 participants between September 2015 and October 2016 yielded 207 (40%) participants, of whom 178 (86%) completed the 12-month intervention. Participants were 54% female and 55% Caucasian, with an average age of 51 (SD = 9.1) years. FRS at baseline was <10 in 45.8%, 10 to 19.9 in 37.9%, and ≥20 in 16.4% of participants. Over 12 months, significant reductions in average FRS (from 11.7 [SD = 7.7] to 10.7 [SD = 7.3]; P = 0.0017) and other parameters were observed. Significant improvements in quality of life (EQ5D change of 0.031 [95% CI = 0.001, 0.062] P = 0.023) and medication adherence (MMAS-8 change of 0.42 [ P = 0.019]) were also noted. CONCLUSIONS AND RELEVANCE: UBC employees had improvements in health markers, self-reported quality of life, and medication adherence after receiving a 12-month pharmacist-led intervention. Pharmacists are encouraged to provide CV risk reduction services in workplaces.

Comparison of a Web-Based Teaching Tool and Traditional Didactic Learning for In Vitro Fertilization Patients: A Preliminary Randomized Controlled Trial.

OBJECTIVE: The objective of this prospective RCT was to compare the efficacy of a web-based teaching tool to traditional didactic teaching in IVF patients. METHODS: Forty women undergoing their first IVF cycle were randomly allocated to an interactive web-based teaching session or a nurse-led didactic teaching session. The primary outcome measure was participant knowledge regarding the IVF process, risks, and logistics assessed before and after the respective teaching session. Secondary outcomes included patient stress, assessed before and after the respective teaching session, and patient satisfaction, assessed following the respective teaching session and on the day of embryo transfer (following implementation of the teaching protocol). RESULTS: Both groups demonstrated similar and significant improvements in knowledge and stress after exposure to their respective teaching sessions. The web-based group was significantly more satisfied than the didactic teaching group. Web-based teaching was also shown to be equally effective for participants of high versus low income and education status for knowledge, stress, and satisfaction. CONCLUSION: This study provides preliminary support for the use of web-based teaching as an equally effective tool for increasing knowledge and reducing stress compared to traditional didactic teaching in IVF patients, with the added benefit of increased patient satisfaction.

The diagnosis and management of ovarian hyperstimulation syndrome: No. 268, November 2011.

OBJECTIVE: To review the clinical aspects of ovarian hyperstimulation syndrome and provide recommendations on its diagnosis and clinical management. OUTCOMES: These guidelines will assist in the early recognition and management of ovarian hyperstimulation. Early recognition and prompt systematic supportive care will help avert poor outcomes. EVIDENCE: Medline, Embase, and the Cochrane database were searched for relevant articles, using the key words "ovarian hyperstimulation syndrome" and "gonadotropins," and guidelines created by other professional societies were reviewed. VALUES: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table 1).

Elective single embryo transfer following in vitro fertilization.

OBJECTIVE: To review the effect of elective single embryo transfer (eSET) compared with double embryo transfer (DET) following in vitro fertilization (IVF), and to provide guidelines on the use of eSET in order to optimize live birth rates and minimize twin pregnancies. OPTIONS: Rates of live birth, clinical pregnancy, and multiple pregnancy following eSET and DET are compared. OUTCOMES: Live birth, clinical pregnancy, and multiple pregnancy rates, and cost-effectiveness. EVIDENCE: Published literature was retrieved through searches of PubMed, Medline, and The Cochrane Library in 2009, using appropriate controlled vocabulary (e.g., elective single embryo transfer) and key words (e.g., embryo transfer, in vitro fertilization, intracytoplasmic sperm injection, assisted reproductive technologies, blastocyst, and multiple pregnancy). Results were restricted to English language systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to November 2009. Additional references were identified through searches of bibliographies of identified articles and international medical specialty societies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES: Available evidence was reviewed by the Joint Society of Obstetricians and Gynaecologist of Canada-Canadian Fertility and Andrology Society Clinical Practice Guidelines Committee and the Reproductive Endocrinology and Infertility Committee of the Society of Obstetricians and Gynaecologists of Canada, and was qualified using the evaluation of evidence criteria outlined in the report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: This guideline is intended to minimize the occurrence of twin gestations while maintaining acceptable overall live birth rates following IVF-ET. SUMMARY STATEMENTS 1. Indiscriminate application of eSET in populations with less than optimal prognosis for live birth will result in a significant reduction in effectiveness compared with DET. (I) 2. In women aged 38 years and over, eSET may result in a significant reduction in live birth rate compared with DET. (II-2) 3. Selective application of eSET in a small group of good-prognosis patients may be effective in reducing the overall multiple rate of an entire IVF population. (II-3) 4. Given the high costs of treatment, uptake of eSET would be enhanced by public funding of IVF treatment. (II-2) Recommendations 1. Patients should be informed of the reductions in both multiple pregnancy rate and overall live birth rate after a single fresh eSET when compared with DET in good-prognosis patients. (I-A) 2. Because the cumulative live birth rate after fresh eSET followed by transfer of a single frozen-thawed embryo is similar but not equivalent to the rate after fresh DET in good-prognosis patients, the eSET strategy should be used in order to avoid multiple pregnancy. (I-A) 3. Women aged 35 years or less, in their first or second IVF attempt, with at least 2 good quality embryos available for transfer should be considered good-prognosis patients. (I-A) 4. In order to maximize cumulative live birth rates following eSET, effective cryopreservation programs should be in place. (I-A) 5. In order to maintain the reduction in the rate of multiples achieved by fresh eSET, eSET should be performed in subsequent frozen-thawed embryo transfer cycles. (II-2A) 6. Because blastocyst stage embryo transfer generally increases the chance of implantation and live birth compared with cleavage stage embryo transfer, eSET should be performed in good-prognosis patients who have good quality blastocysts available. (I-A) 7. In women aged 36 to 37 years, eSET should be considered in good-prognosis patients with good quality embryos, particularly when blastocysts are available for transfer. (II-2A) 8. In oocyte donor-recipient cycles when the donor has good prognosis and when good quality embryos are available, eSET should be performed. (II-2B) 9. In women with medical or obstetrical contraindications to twin pregnancy, eSET should be performed. (III-B) 10. In order to achieve successful uptake of eSET, it is essential to provide patient and physician education regarding the risks of twin pregnancy and regarding the similar cumulative live birth rate following an eSET strategy and DET. (III-C) 11. When considering both direct health care and societal costs, it should be noted that live birth following eSET is significantly less expensive than DET in good-prognosis patients. (I-A) Therefore, from a cost-effectiveness perspective, eSET is indicated in good-prognosis patients. (III-A).

Incidence and complications of multiple gestation in Canada: proceedings of an expert meeting.

This paper reports the proceedings of a consensus meeting on the incidence and complications of multiple gestation in Canada. In addition to background presentations about current and possible future practice in Canada, the expert panel also developed a set of consensus points. The need for infertility to be understood, and funded, as a healthcare problem was emphasized, along with recognition of the emotional impact of infertility. It was agreed that the goal of assisted reproduction treatment is the delivery of a single healthy infant and that even though many positive outcomes have resulted from twin or even triplet pregnancies, the potential risks associated with multiple pregnancy require that every effort be made to achieve this goal. The evidence shows that treatments other than IVF (such as superovulation and clomiphene citrate) contribute significantly to the incidence of multiple pregnancy. There is an urgent need for studies to understand better the usage and application of these other fertility technologies within Canada, as well as the non-financial barriers to treatment. The final consensus of the expert panel was that with adequate funding and good access to treatment, it will be possible to achieve the goal of reducing IVF-related multiple pregnancy rates in Canada by 50%.

Guidelines for the number of embryos to transfer following in vitro fertilization.

OBJECTIVE: To review the effect of the number of embryos transferred on the outcome of in vitro fertilization (IVF), to provide guidelines on the number of embryos to transfer in IVF-embryo transfer (ET) in order to optimize healthy live births and minimize multiple pregnancies. OPTIONS: Rates of live birth, clinical pregnancy, and multiple pregnancy or birth by number of embryos transferred are compared. OUTCOMES: Clinical pregnancy, multiple pregnancy, and live birth rates. EVIDENCE: The Cochrane Library and MEDLINE were searched for English language articles from 1990 to April 2006. Search terms included embryo transfer (ET), assisted reproduction, in vitro fertilization (IVF), ntracytoplasmic sperm injection (ICSI), multiple pregnancy, and multiple gestation. Additional references were identified through hand searches of bibliographies of identified articles. VALUES: Available evidence was reviewed by the Reproductive Endocrinology and Infertility Committee and the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada and the Board of the Canadian Fertility and Andrology Society, and was qualified using the Evaluation of Evidence Guidelines developed by the Canadian Task Force on the Periodic Health Exam. BENEFITS, HARMS, AND COSTS: This guideline is intended to minimize the occurrence of multifetal gestation, particularly high-order multiples (HOM), while maintaining acceptable overall pregnancy and live birth rates following IVF-ET.

What is the most relevant standard of success in assisted reproduction? The singleton, term gestation, live birth rate per cycle initiated: the BESST endpoint for assisted reproduction.

Assisted reproduction programmes do not report success consistently. Rates vary with the definition used. Success must reflect delivery of healthy babies, and the burden of treatment to couples. We report the singleton, term gestation, live birth rate of a baby per assisted reproductive technology cycle initiated for a large IVF programme. We defined assisted reproductive technology cycles as those initiated with the intention of oocyte collection. We examined cycles conducted through Monash IVF in 2001. All women with positive pregnancy tests had first trimester ultrasonography. Obstetric outcomes were recorded. All babies had neonatal examinations conducted by paediatricians. A total of 644 positive pregnancy tests were recorded in 2600 cycles; 509 showed fetal heart motion. Of 448 deliveries, 328 were singleton and 120 were multiple. There were 290 singleton deliveries at term gestation. In 2001, a couple had an 11.1% chance of delivering a singleton, term gestation, live baby per assisted reproductive technology cycle begun. We suggest that delivery of a single, term gestation, live baby per cycle initiated is the most relevant standard of success. This statistic was 11.1% at Monash IVF. We encourage programmes to report this BESST (Birth Emphasizing a Successful Singleton at Term) outcome.