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Gynecologic health care of women with disabilities
Citations from the Literature nancy rate was similar in the three protocol groups, 53% at 44 to 48 hours, 59% at 64 to 72 hours, and 41% by sequential transfer. There probably is no advantage in delaying the transfer or dividing the embryos into two sequential transfers. It seems that sequential transfer is not associated with any harmful effect.
Follicular stimulation for high tech pregnancies: Are we playing it safe? Fishel S; Jackson P
Department of Obstetrics and Gynaecology, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH; United Kingdom BR. MED. J/298/6694 (309-311)/1989/ The techniques for in vitro fertilisation have changed and improved at a great rate. The finding that the incidence of pregnancy increases in proportion to the number of conceptuses replaced, up to at least three, generated widespread interest in the use of follicular stimulants in the hope of obtaining many follicles and many conceptuses (or, as in the case of some units, oocytes for anonymous donation). Improvements in the efficiency of freezing techniques led to the more general use of these potent follicular stimulants, with the aim of having a stock of frozen conceptuses preserved for the couple. Almost invariably the minimum ‘blanket’ follicle stimulation is now provided by gonadotrophins (menotrophin), with or without an antioestrogen (clomiphene or tamoxifen). Women with ovulatory problems require more potent follicular stimulants. An outline of the development of such follicle stimulant treatments is shown in the box.
CLINICAL GYNECOLOGY Heuristic determination of relevant diagnostic procedures in a medical expert system for gynecology Small SL; Muechler EK
Department of Computer Science and the Decision Systems Laboratory, University of Pittsburgh, Pittsburgh, PA; USA American Journal of Obstetrics and Gynecology /161/l (1724) /1989/ Many professions including medicine have standard operating procedures for the performance of their tasks. In the construction of expert systems, knowledge engineers have exploited this fact in devising heuristic rules that mimic the standard practice among such personnel (i.e., experts). This article suggests that the expert system designer should not stop at the level of the standard operating procedure heuristic but should instead investigate the reasons that the standard procedures have become standard. Because the experts in a field often do not understand the reasons for the standard operating procedures of their profession, this effort not only rewards the system designer but the expert as well. Because medical training does not always emphasize the logical reasoning underlying certain standard operating procedures, the ability to perform this reasoning is especially important in medicine. Further, a medical expert system for consultation or education would make a valuable impact by incorporating such knowledge and inference rules. This article investigates the development of a computerized medical expert system that applies the principles of artificial intelligence by limiting the number of questions and tests to find the solution for an ill-defined complex problem. Finally, we describe a logic program that tests the basic ideas.
Gynecologic health care of women with disabilities Beckmann CRB; Gittler M; Barzansky BM; Beckmann CA
Department of Obstetrics and Gynecology, Illinois, Chicago, IL; USA
The importance of ultrasonography in infertile women with ‘forgotten’ intrauterine contraceptive devices Ron-El R; Weinraub Z; Langer R; Bukovsky I; Caspi E
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, 70300; Israel American Journal of Obstetrics and Gynecology/l61/1 (21 l212)/1989/ Seven cases in which an unknown intrauterine contraceptive device in situ was the cause of infertility were referred to our Infertility Clinic after each patient had been told by her physician that she no longer had an intrauterine contraceptive device. In some cases, there were lapses in the infertility workup that might explain how the cause of infertility of an intrauterine contraceptive device in situ was missed. In other cases, a thorough investigation was made and infertility treatment was started without the existence of an intrauterine contraceptive device in situ being diagnosed.
203
University of
Obstetrics and Gynecology /74/l (75-79) /1989/ Information about their gynecologic health care was obtained from 55 women with acquired and congenital disabilities, 42% of whom were disabled after menarche. Although 91% of the entire group had received breast and pelvic examinations and Papanicolaou smears since their disability, only 18.8% had received counseling about sexuality and 64.6% had received information about contraception. However, those disabled after menarche were significantly less likely (P = ,001) to be satisfied with the counseling or method they received. Women with paralysis, impaired motor function, or obvious physical deformity were rarely offered contraceptive information or methods. These findings may be related in part to the characteristics of the patient group. However, we suggest that special attention needs to be directed to those disabled after menarche with respect to issues such as sexuality and contraception. This can be accomplished in part through improved education of health professionals regarding the various aspects of gynecologic health care for the disabled.
In1 J Gynecol Obstet 31
Follicular stimulation for high tech pregnancies: Are we playing it safe? Fishel S; Jackson P
Department of Obstetrics and Gynaecology, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH; United Kingdom BR. MED. J/298/6694 (309-311)/1989/ The techniques for in vitro fertilisation have changed and improved at a great rate. The finding that the incidence of pregnancy increases in proportion to the number of conceptuses replaced, up to at least three, generated widespread interest in the use of follicular stimulants in the hope of obtaining many follicles and many conceptuses (or, as in the case of some units, oocytes for anonymous donation). Improvements in the efficiency of freezing techniques led to the more general use of these potent follicular stimulants, with the aim of having a stock of frozen conceptuses preserved for the couple. Almost invariably the minimum ‘blanket’ follicle stimulation is now provided by gonadotrophins (menotrophin), with or without an antioestrogen (clomiphene or tamoxifen). Women with ovulatory problems require more potent follicular stimulants. An outline of the development of such follicle stimulant treatments is shown in the box.
CLINICAL GYNECOLOGY Heuristic determination of relevant diagnostic procedures in a medical expert system for gynecology Small SL; Muechler EK
Department of Computer Science and the Decision Systems Laboratory, University of Pittsburgh, Pittsburgh, PA; USA American Journal of Obstetrics and Gynecology /161/l (1724) /1989/ Many professions including medicine have standard operating procedures for the performance of their tasks. In the construction of expert systems, knowledge engineers have exploited this fact in devising heuristic rules that mimic the standard practice among such personnel (i.e., experts). This article suggests that the expert system designer should not stop at the level of the standard operating procedure heuristic but should instead investigate the reasons that the standard procedures have become standard. Because the experts in a field often do not understand the reasons for the standard operating procedures of their profession, this effort not only rewards the system designer but the expert as well. Because medical training does not always emphasize the logical reasoning underlying certain standard operating procedures, the ability to perform this reasoning is especially important in medicine. Further, a medical expert system for consultation or education would make a valuable impact by incorporating such knowledge and inference rules. This article investigates the development of a computerized medical expert system that applies the principles of artificial intelligence by limiting the number of questions and tests to find the solution for an ill-defined complex problem. Finally, we describe a logic program that tests the basic ideas.
Gynecologic health care of women with disabilities Beckmann CRB; Gittler M; Barzansky BM; Beckmann CA
Department of Obstetrics and Gynecology, Illinois, Chicago, IL; USA
The importance of ultrasonography in infertile women with ‘forgotten’ intrauterine contraceptive devices Ron-El R; Weinraub Z; Langer R; Bukovsky I; Caspi E
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, 70300; Israel American Journal of Obstetrics and Gynecology/l61/1 (21 l212)/1989/ Seven cases in which an unknown intrauterine contraceptive device in situ was the cause of infertility were referred to our Infertility Clinic after each patient had been told by her physician that she no longer had an intrauterine contraceptive device. In some cases, there were lapses in the infertility workup that might explain how the cause of infertility of an intrauterine contraceptive device in situ was missed. In other cases, a thorough investigation was made and infertility treatment was started without the existence of an intrauterine contraceptive device in situ being diagnosed.
203
University of
Obstetrics and Gynecology /74/l (75-79) /1989/ Information about their gynecologic health care was obtained from 55 women with acquired and congenital disabilities, 42% of whom were disabled after menarche. Although 91% of the entire group had received breast and pelvic examinations and Papanicolaou smears since their disability, only 18.8% had received counseling about sexuality and 64.6% had received information about contraception. However, those disabled after menarche were significantly less likely (P = ,001) to be satisfied with the counseling or method they received. Women with paralysis, impaired motor function, or obvious physical deformity were rarely offered contraceptive information or methods. These findings may be related in part to the characteristics of the patient group. However, we suggest that special attention needs to be directed to those disabled after menarche with respect to issues such as sexuality and contraception. This can be accomplished in part through improved education of health professionals regarding the various aspects of gynecologic health care for the disabled.
In1 J Gynecol Obstet 31