1 דר' רות הנדזל אוניברסיטת חיפה ruthhan@barak-online.net רפואה...

11

דר' רות הנדזל אוניברסיטת חיפהדר' רות הנדזל אוניברסיטת חיפה

ruthhan@barak-online.netruthhan@barak-online.net

רפואה מבוססת מידע:רפואה מבוססת מידע:מקורות ברשת מקורות ברשת

העומדים לרשות העומדים לרשות הגניקולוגהגניקולוג

22

מתודולוגיה לבדיקת צרכי מידעמתודולוגיה לבדיקת צרכי מידע

( קבוצות מיקוד( קבוצות מיקודFocus Group InterviewsFocus Group Interviews))שאלוניםשאלונים( ניתוח תוכן על פי נושאים( ניתוח תוכן על פי נושאיםContent AnalysisContent Analysis ) )תצפיותתצפיותTransaction Log AnalysisTransaction Log AnalysisDeep Log AnalysisDeep Log Analysis

33

Megabyte (MB)Megabyte (MB)

1,000,000 bytes OR 101,000,000 bytes OR 1066 bytes bytes1 Megabyte: A small novel OR a 3.5 inch floppy 1 Megabyte: A small novel OR a 3.5 inch floppy disk.disk.2 Megabytes: A high-resolution photograph.2 Megabytes: A high-resolution photograph.5 Megabytes: The complete works of 5 Megabytes: The complete works of Shakespeare. Shakespeare. 10 Megabytes: A minute of high-fidelity sound.10 Megabytes: A minute of high-fidelity sound.100 Megabytes: 1 meter of shelved books. 100 Megabytes: 1 meter of shelved books. 500 Megabytes: A CD-ROM.500 Megabytes: A CD-ROM.

44

Terabyte (TB)Terabyte (TB)

1,000,000,000,000 bytes OR 101,000,000,000,000 bytes OR 101212 bytes bytes 1 Terabyte: 50000 trees made into paper 1 Terabyte: 50000 trees made into paper and printed. and printed. 2 Terabytes: An academic research library. 2 Terabytes: An academic research library.

10 Terabytes: The print collections of the 10 Terabytes: The print collections of the U.S. Library of Congress. U.S. Library of Congress. 400 Terabytes: National Climactic Data 400 Terabytes: National Climactic Data Center )NOAA( database.Center )NOAA( database.

55

מספר כתבי העת היוצאים לאור מספר כתבי העת היוצאים לאור בעולםבעולם

מספר כתבי העת היוצאים לאור בעולם - מספר כתבי העת היוצאים לאור בעולם -208,000208,000

20,94920,949 בכל תחומי הרפואה - בכל תחומי הרפואה -

637637 בגניקולוגיה ובמיילדות - בגניקולוגיה ובמיילדות -

6

7

8

9

10

1111

TDNet ManagerTDNet Manager

Finding Journals Finding Journals

in Gynecology & Obstetrics in Gynecology & Obstetrics

12

13

14

15

16

17

UpToDate 14.2 New Search Table of Contents My UpToDate Help Search results for: Menopause Adult Medicine, Obstetrics and Gynecology    )63 titles( Most Relevant Topics• Clinical manifestations and diagnosis of menopause • Ovarian development and failure )menopause( in normal women • Androgen production and therapy in women • Cross-cultural considerations in menopausal women • Menopausal hot flashes • Postmenopausal hormone therapy and the risk of breast cancer • Postmenopausal hormone therapy: Benefits and risks • Recommendations for postmenopausal hormone therapy • Treatment of menopausal symptoms in women not taking systemic estrogen • Use of selective estrogen receptor modulators in postmenopausal women • Determinants and management of cardiovascular risk in women • Management of spontaneous premature ovarian failure • Menstrual function; menopause; and oral contraceptives in women with

systemic lupus erythematosus

18

©2006 UpToDate® Clinical manifestations and diagnosis of menopauseRobert F Casper, MDUpToDate performs a continuous review of over 350 journals and other

resources. Updates are added as important new information is published. The literature review for version 14.2 is current through April 2006; this topic was last changed on May 17, 2006. The next version of UpToDate )14.3( will be released in October 2006.

INTRODUCTION — Menopause occurs secondary to a genetically programmed loss of ovarian follicles )show figure 1(. Defined as the cessation of menstrual periods, menopause occurs at a mean age of 51.4 years in normal women [1,2].

This topic will review the clinical features and diagnosis of perimenopause and menopause. The basic aspects of ovarian development, factors that affect age at menopause, and the physiology of the menopausal transition and menopause are discussed separately. The use of hormone therapy for menopausal symptoms is also reviewed separately. )See "Ovarian development and failure )menopause( in normal women" and see "Postmenopausal hormone therapy: Benefits and risks"(.

DEFINITIONS — The nomenclature for the different phases of reproductive senescence has been inconsistent and confusing. In an attempt to define the stages of reproductive aging and its clinical and biochemical markers, the Stages of Reproductive Aging Workshop was held in 2001 to develop a useful staging system and to revise the nomenclature )show figure 2( [3]. This system provides useful clinical definitions of the menopausal transition, perimenopause, menopause, and postmenopause as follows:

19

EPIDEMIOLOGY — Although the average age at menopause is approximately 51 years, for 5 percent of women, it occurs after age 55 )late menopause(, and for another 5 percent, between ages 40 to 45 years )early menopause( [4,5]. Menopause occurring prior to age 40 years is considered to be premature ovarian failure. )See "Pathogenesis and causes of spontaneous premature ovarian failure"(.

• Unlike the age of menarche, which is affected by nutritional status and general health, the age of menopause has not changed since ancient times. Genetic variation in the estrogen receptor gene may be one determinant of the age of menopause. In a study of 900 postmenopausal women in the Netherlands; the mean age at menopause varied by 1.1 year among women with different alleles at the same locus of the estrogen receptor gene [6].

• The age of menopause is reduced by about two years in women who smoke [1,7-9]. There is also a tendency for women who have never had children and for those with more regular cycles to have an earlier age of menopause [10]. Other factors that may be important include: A family history of early menopause [11] A history of type 1 diabetes mellitus [12] galactose consumption [4,13] The presence of a variant of form galactose-1-phosphate uridyl transferase [4,14] Shorter cycle length during adolescence )which is also a predictor of higher basal FSH( [9].

• ENDOCRINOLOGY — Menstrual cycle and hormone patterns begin to change many years prior to menopause. In the late reproductive years, prior to the menopausal transition, menstrual cycles are ovulatory, but follicular phase length begins to shorten [15]. In the early menopausal transition, women begin to

20

Early Transition Hormone Patterns

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

תו תקן לאתר רפואי

43

44

45

46

47

48

49

5050

של המקורות המוצגים של המקורות המוצגים URLURLלקבלת כתובות ה-לקבלת כתובות ה-בהרצאה, אפשר לפנות למרצה בכתובת:בהרצאה, אפשר לפנות למרצה בכתובת:

דר' רות הנדזל אוניברסיטת חיפהדר' רות הנדזל אוניברסיטת חיפה

ruthhan@barak-online.netruthhan@barak-online.net