ABSTRACT
Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.
ABSTRACT
Objective@#This study aimed to characterize a validated model for predicting oocyte retrieval in controlled ovarian stimulation (COS) and to construct model-based nomograms for assistance in clinical decision-making regarding the gonadotropin protocol and dose. @*Methods@#This observational, retrospective, cohort study included 636 women with primary unexplained infertility and a normal menstrual cycle who were attempting assisted reproductive therapy for the first time. The enrolled women were split into an index group (n=497) for model building and a validation group (n=139). The primary outcome was absolute oocyte count. The dose-response relationship was tested using modified Poisson, negative binomial, hybrid Poisson-Emax, and linear models. The validation group was similarly analyzed, and its results were compared to that of the index group. @*Results@#The Poisson model with the log-link function demonstrated superior predictive performance and precision (Akaike information criterion, 2,704; λ=8.27; relative standard error (λ)=2.02%). The covariate analysis included women’s age (p<0.001), antral follicle count (p<0.001), basal follicle-stimulating hormone level (p<0.001), gonadotropin dose (p=0.042), and protocol type (p=0.002 and p<0.001 for short and antagonist protocols, respectively). The estimates from 500 bootstrap samples were close to those of the original model. The validation group (n=139) showed model assessment metrics comparable to the index model. Based on the fitted model, a static nomogram was built to improve visualization. In addition, a dynamic electronic tool was created for convenience of use. @*Conclusion@#Based on our validated model, nomograms were constructed to help clinicians individualize the stimulation protocol and gonadotropin doses in COS cycles.
ABSTRACT
This work was performed to assess whether a pharmaceutical care program improves outcomes and optimizes quality of life in Egyptian patients with bronchial asthma or chronic obstructive nissup severce with bronchial asthma or COPD were selected from the out-patient chest clinics, El-Demerdash hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt; from January 2003 to August 2004. Participants were divided into 175 patients for whom the program was implemented and the remaining 175 patients were considered as control; received the hospital usual care. Patients at the out-patient chest clinics were invited to participate in the pharmaceutical care program. The program consisted of scheduled meetings between the pharmacist and patients to assess drug therapy, plan goals, and intervene through counseling and/or consultation with other health professionals. Three primary parameters were measured monthly. First: health-related quality of life [HRQOL]. Second: clinical outcomes including change in peak expiratory flow rate [PEFR], physical findings, numbers of visits to clinics' and emergency department [ED] and hospitalization. Third: the costs. Results showed great statistically significant improvements in HRQOL and the clinical outcome for patients in the intervention group; either asthmatics or patients with COPD, compared with control groups. The monthly average costs were statistically significantly higher for the control group in comparison with either asthmatics or patients with COPD in the intervention group. In results from this study provide evidence that through providing structured, co-operative, patient-oriented pharmaceutical care, pharmacists can help patients with reactive airway disease achieve desired health outcomes, optimize health related quality of life in realistic economic parameters. Recommendation: Pharmaceutical care would have maximum impact if its effect on patients' outcomes could be demonstrated in community pharmacies by well trained pharmacist. Community pharmacies have the capacity to rapidly implement programs system-wide. However, for programs to be integrated into these pharmacies, a rigorous change in pharmacy education in Egypt will be necessary
Subject(s)
Humans , Male , Female , Pulmonary Disease, Chronic Obstructive/drug therapy , Quality of Life , Drug Costs , Treatment Outcome , Pharmaceutic Aids , Respiratory Function TestsABSTRACT
Thirty patients with theophylline overdose were selected to study the pharmacokinetics of theophylline during continuous hemodialysis with and without filtration, charcoal hemoperfusion and intestinal dialysis using multiple-dose activated charcoal [MDAC]. Patients were classified into three equal groups; each comprised 10 patients. Group-1 started the enhanced elimination by continuous hemodialysis with filtration, Group-2 by charcoal hemoperfusion and Group-3 by continuous hemodialysis alone. The extracorporeal procedures in the three groups were initiated 2 hours post-admission and terminated when patient's vomiting had settled where MDAC was started. Serum theophylline concentrations peaked at 2 hours, for both hemofiltration and hemoperfusion groups, which is the time of initiating the extracorporeal procedures. For hemodialysis group, drug concentration peaked at 3 hours [1 hour post-initiating hemodialysis]. Following the peak, serum levels of patients in hemofiltration group showed significant greater decrease compared with patients in either charcoal hemoperfusion or hemodialysis groups. Also, charcoal hemoperfusion produced the same effects compared with hemodialysis alone. With respect to the pharmacokinetic parameters, there was a significant shorter half-life and a greater clearance for theophylline as a result of continuous hemodialysis with filtration [1.27 +/- 0.214 hours and 0.273 +/- 0.046 L/h/kg, respectively] versus charcoal hemoperfusion [1.86 +/- 0.335 hours and 0.186 +/- 0.034 Mg, respectively], continuous hemodialysis [3.73 +/- 1.087 hours and 0.093 +/- 0.031 L/h/kg, respectively] or gastrointestinal dialysis by MDAC [5.58 +/- 1.36 hours and 0.0621 +/- 0.0163 L/h/kg, respectively]. In conclusion, immediate continuous dialysis with filtration is an effective, rapid, and safe treatment of the life-threatening toxicity of theophyiline overdose. In combination with oral activated charcoal, hemofiltration is considered as a realistic and practical alternative to charcoal hemoperfusion
Subject(s)
Humans , Male , Female , Renal Dialysis/statistics & numerical data , Hemoperfusion/statistics & numerical data , Enzyme-Linked Immunosorbent Assay/methods , Sorbitol/adverse effects , Treatment Outcome , Hospitals, UniversityABSTRACT
Thirty patients with theophylline overdose were selected to study the toxicokinetics of theophylline during intestinal dialysis using multiple-dose activated charcoal [MDAC] and during continuous hemodialysis. Patients were classified according to serum theophylline level [STL] into two groups. Group [I]: comprised 20 patients with a mean STL of 43.29 +/- 15, 02. Treatment in this group was started using MDAC. Group [II]: comprised 10 patients with a mean STL of 81.32 +/- 31.07. Treatment in this group was started using continuous hemodialysis up to vomiting control, then continued using MDAC in the same regimen as group [I]. The enhanced elimination procedures in the two groups were initiated 2 hours post-admission. STL peaked at 3 hours, for both groups [1 hour after initiating the enhanced procedure]. Greater variation in STL among patients in each time interval in the hemodialysis group was clear compared to MDAC group. Following the peak, serum theophylline concentrations, in each treatment group, declined in a biphasic linear fashion. Non significant difference was observed in the pharmacokinetic parameters of theophylline as a result of MDAC; either from the start or following hemodialysis. Elimination rate constant [Ke], elimination half life [t1/2] and total body clearance of theophylline were 0.168 +/- 0.033 hour[-] 1, 4.125 +/- 1.56 hour, and 0.0841 + 0.028 L/kg/ hr, respectively as a result of MDAC modality from the start and 0.186 +/- 0.048 hour[-1], 3.73 +/- 1.087 hour, and 0.093 + 0.031 L/kgl hour, respectively following. hemodialysis. Compared with MDAC, hemodialysis did not significantly increase Elimination rate constant [Ke] of theophylline and consequently did not shorten its elimination half life [t1/2] or increase its clearance significantly. In conclusion, hemodialysis showed no advantages over MDAC in enhancing theophylline elimination in overdose except that it could be used in patients with protracted vomiting