ABSTRACT
To review the cumulative outcome of pre-implantation genetic diagnosis (PGD) cycles performed for prevention of sickle cell disease (SCD). Couples referred for PGD for SCD between April 2012 and October 2017 were included. Ovarian stimulation was performed using a short gonadotrophin-releasing hormone (GnRH) antagonist protocol and follicle-stimulating hormone injections. The GnRH agonist was used to trigger oocyte maturation. Oocytes were fertilised using intracytoplasmic sperm injection. Trophectoderm biopsy was performed on day 5 or 6 followed by vitrification. Genetic testing was done using pre-implantation genetic haplotyping. A total of 60 couples started 70 fresh PGD cycles (mean 1·2 cycles/couple) and underwent a total of 74 frozen-embryo-transfer (FET) cycles (mean 1·3 FET/couple). The mean (SD) female age was 33 (4·4) years and the mean (SD) anti-müllerian hormone level was 22·9 (2·8) pmol/l. The cumulative live-birth rate was 54%/PGD cycle started and 63%/couple embarking on PGD. The rate of multiple births was 8%. The cumulative outcome of PGD treatment for prevention of SCD transmission is high and PGD treatment should be offered to all at-risk couples.
Subject(s)
Anemia, Sickle Cell/diagnosis , Preimplantation Diagnosis , Adult , Anemia, Sickle Cell/embryology , Cryopreservation , Female , Humans , Live Birth , Oocytes , Ovulation Induction , Pregnancy , Sperm Injections, IntracytoplasmicSubject(s)
Cerebrospinal Fluid Leak/diagnosis , Headache/diagnosis , Postoperative Complications/diagnosis , Vaginal Discharge/diagnosis , Ventriculoperitoneal Shunt/adverse effects , Adult , Cerebrospinal Fluid Leak/etiology , Diagnosis, Differential , Female , Headache/etiology , Humans , Postoperative Complications/etiology , Vaginal Discharge/etiologyABSTRACT
OBJECTIVE: The study aimed to explore contemporary collaborative experiences of nurse practitioners (NPs) in providing care with general practitioners (GPs) and allied health care professionals. DESIGN: A qualitative descriptive, exploratory design was considered the most appropriate to achieve the study objectives. This allowed the researcher at first hand to gain a thorough understanding of the nurse participants' experiences. SETTING: The study was conducted in urban, rural and remote clinics and hospitals throughout New South Wales, Australia, where the NPs were authorised to care for the community. PARTICIPANTS: Nine authorised NPs were the key participants in the study. RESULTS: Analysis identified one main theme of Collaboration and three sub themes that were named as Total Collaboration, Partial Collaboration and Non Collaboration. CONCLUSION: In this study, most NPs reported dissatisfaction from working in ineffective collaborative relationships with medical and allied health care professionals. Total collaboration did not automatically occur and was identified as the exception. Sustainable collaborative partnerships should be developed with all heath care providers by acknowledging each others unique, valuable contribution. Despite this challenging and complex situation, NSW NPs remained determined to provide advanced nursing care for patients and to establish and maintain effective collaboration with all health care professionals.
