A.M. van Ginneken

Fertility and Ovarian Function in High-Dose Estrogen-Treated Tall Women

BACKGROUND/OBJECTIVE High-dose estrogen treatment to reduce final height of tall girls has been shown to interfere with fertility. Ovarian function has not been studied. We therefore evaluated fertility and ovarian function in tall women who did or did not receive such treatment in adolescence. METHODS This was a retrospective cohort study of 413 tall women aged 23-48 yr, of whom 239 women had been treated. A separate group of 126 fertile, normoovulatory volunteers aged 22-47 yr served as controls. RESULTS Fertility was assessed in 285 tall women (157 treated, 128 untreated) who had attempted to conceive. After adjustment for age, treated women were at increased risk of experiencing subfertility [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.38-3.81] and receiving infertility treatments (OR 3.44, 95% CI 1.76-6.73). Moreover, fecundity was notably affected because treated women had significantly reduced odds of achieving at least one live birth (OR 0.26, 95% CI 0.13-0.52). Remarkably, duration of treatment was correlated with time to pregnancy (r = 0.23, P = 0.008). Ovarian function was assessed in 174 tall women (119 treated, 55 untreated). Thirty-nine women (23%) exhibited a hypergonadotropic profile. After adjusting for age category, treated women had significantly higher odds of being diagnosed with imminent ovarian failure (OR 2.83, 95% CI 1.04-7.68). Serum FSH levels in these women were significantly increased, whereas antral follicle counts and serum anti-Müllerian hormone levels were decreased. CONCLUSION High-dose estrogen-treated tall women are at risk of subfertility in later life. Their fecundity is significantly reduced. Treated women exhibit signs of accelerated ovarian aging with concomitant follicle pool depletion, which may be the basis of the observed subfertility.

Integration and communication for the continuity of cardiac care (I4C)

The project I4C (Integration and Communication for the Continuity of Cardiac Care) is carried out for the advancement of cardiac care, from prevention to follow-up. The goals of I4C are: (1) integrated access to patient data, wherever they are stored; (2) support of evidence-based care; (3) consistent recording of patient data (eg, patient history, electrocardiograms IECGs] or cine-angios) in a multimedia patient record; and (4) a documented reference data set for research. In several clinics, workstations are being installed to serve the four goals. Integration with other information systems in clinical care is realized by encapsulation. A computer-based patient record (ORCA) has been developed to support the collection, consultation, and sharing of patient data. In I4C, ORCA is intended for use in a research setting as well as routine patient care. The functionality of ORCA covers the collection of patient history data in a highly structured manner, the recording of drug prescriptions, an overview of laboratory test results, and viewers for ECGs and angiographic images. At present, structured data entry and consultation is supported in six European languages.

Supporting patient care and medical research at a heart failure outpatient clinic using a medical workstation with a computerized patient record

Heart failure is a complex clinical syndrome and a major cause of disability and death. Reliable criteria for the diagnosis and the classification of the seventy of heart failure are important for treatment and prognosis. At the outpatient clinic of the Thoraxcentre, a group of 250 patients with heart failure are being studied to evaluate determinants of diagnosis and classification of heart failure. Because of the amount and complexity of data involved it is important for patient care as well as clinical research that these data are stored in an unambiguous and accessible way. For this reason collection and storage of patient data are performed by means of a computerized patient record, which is running as a service on a medical workstation. During patient visits structured data are entered into the computerized patient record, which has been tailored to the specific domain of heart failure. Connection of the workstation with the departmental information system and systems that store signals and images provides direct access to these data. The computerized patient record and the medical workstation were introduced in the heart failure outpatient clinic in March 1995.

Computer-assisted Acquisition Of Formalized Knowledge In Pathology And Its Significance For Diagnostic Support

Diagnostic support in pathology based on findings requires a formal representation of knowledge. A tool is introduced for the acquisition of formalized descriptive knowledge directly from the expert. The nature of ovarian pathology was explored at the meta level. The resulting meta knowledge defining the proper terminology, structure and scope for the domain was incorporated in the tool. Via a menu-driven interface the expert is guided in the process of formalizing knowledge. The knowledge cquisition (KA) tool also serves as a versatile instrument for further analysis of the KA process.