Patterns of ovarian morphology in polycystic ovary syndrome: a study utilising magnetic resonance imaging.

OBJECTIVE: To evaluate and compare MRI-based ovarian morphology in groups of women with polycystic ovary syndrome (PCOS) and controls. METHODS: All PCOS cases (n = 44) had oligo-amenorrhoea and hyperandrogenism irrespective of ovarian morphology, and fulfilled NIH/Rotterdam diagnostic criteria for PCOS. All control women (n = 40) had normal menses and normoandrogenaemia. All subjects were of white British/Irish origin and pre-menopausal. Group comparisons were based on independent-sample t tests. Polycystic ovarian morphology was defined by at least 12 follicles 2-9 mm in diameter and/or an ovarian volume greater than 10 cm(3). RESULTS: Ovarian morphology differed significantly in PCOS cases and controls (follicle number geometric mean [SD range] 18.6 [9.9, 35.0] vs 6.6 [3.1, 14.2], unadjusted P = 1.3 x 10(-16); calculated ovarian volume 8.8 cm(3) [5.0, 15.5] vs 5.1 cm(3) [2.5, 10.3], unadjusted P = 3.0 x 10(-7); peripheral follicle location in 55% vs 18% of ovaries, P = 7.9 x 10(-6); visible central ovarian stroma in 61% vs 24% of ovaries, P = 2.3 x 10(-5)). Follicle number and calculated ovarian volume were not concordant with clinical/biochemical assignment of PCOS/control status in 36 (23%) and 52 (34%) of ovaries, respectively. CONCLUSION: Ovarian morphology overlaps in PCOS cases and controls, emphasising the importance of considering clinical/biochemical presentation together with imaging ovarian morphology in the diagnosis of PCOS.

Emotional boundary work in advanced fertility nursing roles.

In this article we examine the nature of intimacy and knowing in the nurse-patient relationship in the context of advanced nursing roles in fertility care. We suggest that psychoanalytical approaches to emotions may contribute to an increased understanding of how emotions are managed in advanced nursing roles. These roles include nurses undertaking tasks that were formerly performed by doctors. Rather than limiting the potential for intimacy between nurses and fertility patients, we argue that such roles allow nurses to provide increased continuity of care. This facilitates the management of emotions where a feeling of closeness is created while at the same time maintaining a distance or safe boundary with which both nurses and patients are comfortable. We argue that this distanced or 'bounded' relationship can be understood as a defence against the anxiety of emotions raised in the nurse-fertility patient relationship.

Nothing out of the ordinary: advanced fertility nursing practice.

This paper discusses data from a case study of fertility nursing practice. An ethnographic case study approach using participant observation and nine semi-structured interviews with staff and patients was undertaken. The data were analysed thematically and these themes are discussed in this paper. We present the meaning a small group of nurses working in a fertility unit in the UK attach to new roles and the ways in which changes in practice may be influenced. The nurses in this study believed that nature of the task demanded changes to practice and they identified personal, interpersonal and socio-cultural factors which influenced these changes. These new roles facilitated greater continuity of care for patients. This paper discusses the effects of these new roles on knowing and intimacy in nurse - patient relationships. The data suggests that new nursing roles, which are based on "traditional" nursing and "new" technical skills, are fragile and may not be shared across a professional community.

The extended role of the nurse: practical realities.

This article provides an overview of the development of the extended role of fertility nurses. The key factors discussed are the historical development of the nurses' role in the Oxford Fertility Unit at John Radcliffe Hospital and the relevant issues that influence this process and how this is reflected in other units nationally. Each practitioner is accountable for his or her actions and must be aware of the legal implications of practice within the process of role extension. Appropriate training and standards of competence are required for both professional indemnification, provided by the Royal College of Nursing (RCN), and vicarious liability, provided by the individual's employer. There is great variation in nurses' scope of practice, job titles, salaries and standards of training, particularly in the fertility specialism. The United Kingdom Central Council for Nurses, Midwives and Health Visitors (UKCC) is currently piloting a new standard for nurses to attain a 'higher level of practice'. The aim is to provide a generic standard of practice for nurses undertaking an extended role and to overcome many of the inconsistencies experienced by nurses across the UK. Central to any role extension is the delivery of safe care to all patients. Many fertility nurses face new challenges within their practice but require the support of the multidisciplinary team to ensure good standards of patient care.

Fertility nurses doing embryo transfers -- what is the impact of training?

It has been demonstrated that embryo transfer during IVF treatment can be performed competently and successfully by nurses (Barber et al., 1996). The present study has examined the success of nurses in training using the standardized protocol of this Unit. Initially, three nurses (two experienced (training completed) and one inexperienced (training ongoing)) each performed 80 transfers, which were standardized to three embryos replaced per transfer. The study aimed to establish whether a standardized procedure was undertaken by the nurses and to assess the influence of one inexperienced nurse performing the procedure. A further study (study 2) was performed to assess the influence of three inexperienced nurses against three experienced nurses undertaking the same procedures. In study 1, the pregnancy rates were 27.5%, 38.8% and 40.0% and there was no significant difference in the clinical pregnancy rates. In study 2, the pregnancy rates were 18.7%, 20.0% and 20.0% for the inexperienced nurses, and 26.3%, 30.0% and 32.5% for the experienced nurses. There was no significant difference in the clinical pregnancy rates within the inexperienced group or the experienced group. When the results of the three inexperienced nurses were grouped and were compared with those of the three experienced nurses, the pregnancy rates were 19.5% and 29.5%, respectively (P < 0.02). It has been shown that good clinical pregnancy rates can be achieved when nurses perform embryo transfer. There is no significant effect on clinical results when one nurse is in training; however, because of the expected learning curve, when three nurses train together a more significant effect is observed.

Use of competencies in training fertility nurses in clinical practice.

In this article, the value of clinical competencies in the role development of fertility nurses is discussed using the example of the Oxford Fertility Programme. Clinical competencies are incorporated into the training programme within the Oxford Fertility Unit to enable new staff to demonstrate their clinical ability and undergo assessment while learning new and expanded skills. New staff are required to explore both the theoretical and practical foundations that underpin clinical practice. Competencies are used in a structured programme in which staff have to provide evidence of the appropriate knowledge to perform new and expanded procedures. New staff work with a senior nurse, who is their lecturer and who assesses both their clinical and theoretical development. The new staff are also assigned a preceptor with whom they work on a daily basis to consolidate the practice explored with the lecturer. The Scope of Professional Practice produced by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC, 1992) places the emphasis on professional development for individual practitioners. Within the Oxford Fertility Unit, the nurses work collectively and as autonomous practitioners, which enables them to provide a specialized and personal service to their patients. Professional profiles are an integral element of an individual's professional development and are used in the training programme. They provide an accurate record of a nurse's abilities and knowledge and how he or she relates them to practice.