Background and Purpose: Nurse practitioners (NPs) are expected to fill gaps in providing primary care in the United States and need vital skills to meet the growing need for primary care providers. One necessary skill is managing “on-call” clinical questions/concerns by patients across the life span. To date, there are no published studies that address “on-call” simulations for family NP (FNP) students across the life span. Methods: This quasi-experimental, mixed-methods design used a confidence scale and Krippendorff's method for content analysis of discussion pages to determine the effectiveness and confidence of simulated “on-call” scenarios for FNP students during each of their clinical courses. Conclusions: There was a significant increase in the confidence level of students as measured by the confidence questionnaire (t = 3.07 [33]; p < .001), at the end of the FNP didactic and clinical courses. Krippendorff content analysis revealed three themes: self-reliance; thinking on your feet; and uncertainty of management. Implications for Practice: “On-call” processing is a skill that is needed in graduate FNP programs so that these providers are fully prepared to meet any challenge they may encounter.
OBJECTIVE: A growing number of patients are referred for fertility preservation treatment (FPT) prior to gonadotoxic therapy. FPT options include embryo, oocyte and ovarian tissue cryopreservation (OTC). Our objective was to identify factors associated with FPT and fertility outcomes in women facing gonadotoxic therapies. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We performed an analysis of 451 females ages 6-42 years old seen for FPT consultation at an academic fertility center from 2001-2017. Patients were categorized by diagnosis: breast cancer, gynecologic (Gyn) cancer, benign Gyn, leukemia/lymphoma, non-malignant anemia, other cancer and other non-cancer. We calculated proportions for patient diagnosis, demographics, type of FPT, planned treatment, and assisted reproductive technology (ART) outcomes. Pearson chisquared and Fisher's exact tests were performed to test for associations. RESULTS: Our cohort of 451 patients had a mean age of 29.1 + 7.6 years, of which 54.8% (n¼247) underwent FPT. Regarding type of FPT, 21.7% (n¼98) chose embryo cryopreservation, 19.5% (n¼88) oocyte cryopreservation, 2.8% (n¼13) half oocyte/half embryo cryopreservation, 15.7% (n¼39) ovarian tissue cryopreservation (OTC) and 5.3% (n¼13) underwent oophoropexy or trachelectomy. Factors associated with choosing FPT included parity (p¼0.005), prior chemotherapy (p¼0.001), planned chemotherapy (p<0.001) and planned radiation (p¼0.001). No significant differences were seen when comparing age, race or education status. There was a significant difference among diagnosis category and type of fertility preservation chosen (p<0.001). The prevalence of various diagnoses included breast cancer 27.9% (126/451), Gyn cancer 22.4% (101/451), leukemia/lymphoma 20.4% (92/451), other cancer 18.2% (82/451) and 9.1% (41/451) benign Gyn/other non-cancer. During the study period, 62 women had a total of 79 conceptions; 39 women had a total of 55 live born babies. After ART, 38 women underwent embryo transfer, with a clinical pregnancy rate of 30.3% (27/89) and a live birth rate of 23.6% (21/89) per transfer. ART outcomes were significantly different by age group, age difference between FPT visit and age of diagnosis (p<0.001), number of oocytes retrieved and number of embryos frozen (p<0.05). CONCLUSIONS: Among patients referred for FPT prior to gonadotoxic treatment, more than half decided to move forward with FPT. Significant factors for choosing FPT included diagnosis, parity, prior and planned chemotherapy and radiation. Further work is needed to use these factors to help improve access for FPT.
OBJECTIVE: A growing number of patients are referred for fertility preservation treatment (FPT) prior to gonadotoxic therapy. FPT options include embryo, oocyte and ovarian tissue cryopreservation (OTC). Our objective was to identify factors associated with FPT and fertility outcomes in women facing gonadotoxic therapies. DESIGN: Retrospective analysis. MATERIALS AND METHODS: We performed an analysis of 451 females ages 6-42 years old seen for FPT consultation at an academic fertility center from 2001-2017. Patients were categorized by diagnosis: breast cancer, gynecologic (Gyn) cancer, benign Gyn, leukemia/lymphoma, non-malignant anemia, other cancer and other non-cancer. We calculated proportions for patient diagnosis, demographics, type of FPT, planned treatment, and assisted reproductive technology (ART) outcomes. Pearson chisquared and Fisher's exact tests were performed to test for associations. RESULTS: Our cohort of 451 patients had a mean age of 29.1 + 7.6 years, of which 54.8% (n¼247) underwent FPT. Regarding type of FPT, 21.7% (n¼98) chose embryo cryopreservation, 19.5% (n¼88) oocyte cryopreservation, 2.8% (n¼13) half oocyte/half embryo cryopreservation, 15.7% (n¼39) ovarian tissue cryopreservation (OTC) and 5.3% (n¼13) underwent oophoropexy or trachelectomy. Factors associated with choosing FPT included parity (p¼0.005), prior chemotherapy (p¼0.001), planned chemotherapy (p<0.001) and planned radiation (p¼0.001). No significant differences were seen when comparing age, race or education status. There was a significant difference among diagnosis category and type of fertility preservation chosen (p<0.001). The prevalence of various diagnoses included breast cancer 27.9% (126/451), Gyn cancer 22.4% (101/451), leukemia/lymphoma 20.4% (92/451), other cancer 18.2% (82/451) and 9.1% (41/451) benign Gyn/other non-cancer. During the study period, 62 women had a total of 79 conceptions; 39 women had a total of 55 live born babies. After ART, 38 women underwent embryo transfer, with a clinical pregnancy rate of 30.3% (27/89) and a live birth rate of 23.6% (21/89) per transfer. ART outcomes were significantly different by age group, age difference between FPT visit and age of diagnosis (p<0.001), number of oocytes retrieved and number of embryos frozen (p<0.05). CONCLUSIONS: Among patients referred for FPT prior to gonadotoxic treatment, more than half decided to move forward with FPT. Significant factors for choosing FPT included diagnosis, parity, prior and planned chemotherapy and radiation. Further work is needed to use these factors to help improve access for FPT.
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