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Re: [Gnumed-devel] pregnancy and ace-inhibitor

From: Jim Busser
Subject: Re: [Gnumed-devel] pregnancy and ace-inhibitor
Date: Sun, 28 Feb 2010 08:06:46 -0800

On 2010-02-28, at 12:41 AM, Sebastian Hilbert wrote:

> Does GNUmed have a mean to display an ongoing pregnancy yet ? 
> I propose a feature to track that information.

I suggest we remind if we already some way to identify (store and keep 
query-able) the presence or absence of chronic (or even short term) states.

Pregnancy would seem on a continuum of

        fertile (no protection status)
        fertile (on contraception)
        fertile (unprotected)
        fertile (attempting pregnancy)
        infertile (e.g. primary; post-surgical)

I took out lactating, on account that lactating women can become fertile, so 
those states are not mutually exclusive. Lactation is a state pertinent to drug 
(contra) indications though I do not know if it is yet supported in French INN 

I don't know whether the above would be better handled by a special variable / 
table, or whether inside some larger archetypal system within GM.

From the point of view of drug interactions, the schema would be simplified by 
managing female fertility state, and separately lactating state, in the problem 
list despite that they are not diseases.

If we would contemplate it more closely, the draft list above combines 
biological with behavioral with medication states... the patient who was taking 
an oral contraceptive may lapse in their prescription, and so despite that they 
were coded in an EMR as fertile (on contraception) they may actually not be. 
Maybe this entire ATC class of medications when first initiated or discontinued 
could result in a prompt in GM to reconsider the manually-managed fertility 

We did also previously on the list acknowledge other states (risks) as may 
include being sexually active (even if infertile, certain sexual activity is 
relevant to infectious diseases) and occupations were also potential risk 
factors. Smoking and alcohol, as well. So fertility state could join these in 
some structure other than the problem list. ??

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