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81.
Marleen?J?NahuisEmail author Nienke?S?Weiss Fulco?van der Veen Ben?Willem?J?Mol Peter?G?Hompes Jur?Oosterhuis Nils?B?Lambalk Jesper?MJ?Smeenk Carolien?AM?Koks Ron?JT?van Golde Joop?SE?Laven Ben?J?Cohlen Kathrin?Fleischer Angelique?J?Goverde Marie?H?Gerards Nicole?F?Klijn Lizka?CM?Nekrui Ilse?AJ?van Rooij Diederik?A?Hoozemans Madelon?van Wely 《BMC women's health》2013,13(1):42
Background
Clomiphene citrate (CC) is first line treatment in women with World Health Organization (WHO) type II anovulation and polycystic ovary syndrome (PCOS). Whereas 60% to 85% of these women will ovulate on CC, only about one half will have conceived after six cycles. If women do not conceive, treatment can be continued with gonadotropins or intra-uterine insemination (IUI). At present, it is unclear for how many cycles ovulation induction with CC should be repeated, and when to switch to ovulation induction with gonadotropins and/or IUI.Methods/Design
We started a multicenter randomised controlled trial in the Netherlands comparing six cycles of CC plus intercourse or six cycles of gonadotrophins plus intercourse or six cycles of CC plus IUI or six cycles of gonadotrophins plus IUI.Women with WHO type II anovulation who ovulate but did not conceive after six ovulatory cycles of CC with a maximum of 150 mg daily for five days will be included.Our primary outcome is birth of a healthy child resulting from a pregnancy that was established in the first eight months after randomisation. Secondary outcomes are clinical pregnancy, miscarriage, multiple pregnancy and treatment costs. The analysis will be performed according to the intention to treat principle. Two comparisons will be made, one in which CC is compared to gonadotrophins and one in which the addition of IUI is compared to ovulation induction only. Assuming a live birth rate of 40% after CC, 55% after addition of IUI and 55% after ovulation induction with gonadotrophins, with an alpha of 5% and a power of 80%, we need to recruit 200 women per arm (800 women in total).An independent Data and Safety Monitoring Committee has criticized the data of the first 150 women and concluded that a sample size re-estimation should be performed after including 320 patients (i.e. 80 per arm).Discussion
The trial will provide evidence on the most effective, safest and most cost effective treatment in women with WHO type II anovulation who do not conceive after six ovulatory cycles with CC with a maximum of 150 mg daily for five days. This evidence could imply the need for changing our guidelines, which may cause a shift in large practice variation to evidence based primary treatment for these women.Trial registration number
Netherlands Trial register NTR144982.
83.
AJ Phillips 《Clinical & experimental optometry》1989,72(2):32-34
A patient with severe ocular albinism was fitted with a prosthetic soft contact lens which improved both photophobic symptoms and facial cosmesis. 相似文献
84.
85.
86.
Anxiety in patients undergoing MR imaging 总被引:6,自引:0,他引:6
To determine and quantify the major sources of anxiety for patients undergoing magnetic resonance (MR) imaging and to suggest means by which to eliminate or diminish their negative effects, the authors studied anxiety in 46 subjects. Of these, 20 randomly selected subjects who successfully completed the examination participated in exit interviews. Six subjects who terminated the examination before completion also completed exit interviews. Pre-imaging and postimaging questionnaires (state-trait anxiety inventory) were administered to measure anxiety in the 20 other subjects. Anxiety was associated with the constrictive dimensions of the magnet bore, examination duration, coil noise, and temperature within the bore. Preparation at the point of referral was consistently absent, incomplete, or misleading. Patients used identifiable strategies to cope with the examination: blinding, breathing relaxation techniques, visualization of pleasant images, and performance of mental exercises. 相似文献
87.
Di Chiro G; Girton ME; Frank JA; Dietz MJ; Gansow OA; Wright DC; Dwyer AJ 《Radiology》1986,160(1):221-222
Canine cerebrospinal fluid rhinorrhea, which occurs frequently in purebred beagles, was demonstrated in two dogs on magnetic resonance images after cisternal introduction of gadolinium-DTPA dimeglumine. 相似文献
88.
STEWART AJ; ALLEN JD; ADGEY AAJ 《QJM : monthly journal of the Association of Physicians》1992,85(1):761-769
SUMMARY In 56 patients, frequency analysis of the electrocardiogramof ventricular fibrillation exhibited power spectra with a distinctdominant frequency. The greatest success for resuscitation fromventricular fibrillation is recorded when ventricular fibrillationdevelops after the patient comes under coronary care. Of the41 patients in whom the onset and first 8 s of ventricular fibrillationwere artefact-free the mean dominant frequency of primary ventricularfibrillation (no cardiogenic shock or cardiac failure) in 21patients was 6.2±0.2 Hz, significantly higher than themean dominant frequency of the first 8 s of secondary ventricularfibrillation (cardiogenic shock or heart failure) (4.0±0.2Hz, 20 patients, p =0.0001). In these patients the peak-to-troughamplitude (ECG) of the first 8 s of ventricular fibrillationwas similar in both primary and secondary ventricular fibrillationas was the mean duration of ventricular fibrillation prior tothe first DC shock. There was a significantly lower successrate for resuscitation from secondary ventricular fibrillation(6 of 20 patients) compared with resuscitation from primaryventricular fibrillation (18 of 21 patients, x2 17.8, p=0.001).Of the remaining 15 patients who were collapsed between 3 and20 min before the arrival of the mobile coronary care unit,the dominant frequency of the first 8 s of ventricular fibrillationfell with increased duration of collapse (from 5.5 Hz at 3 minto a mean of 2.1 Hz at 20 min). Four of these 15 patients whosurvived the initial arrest had a mean dominant frequency of5.2±0.3 Hz, which was significantly higher than the meandominant frequency (3.1±0.3 Hz, p<0.01) of the 11patients who were not resuscitated. This study shows that low frequency ventricular fibrillationis indicative of a poor chance of successful resuscitation.Alteration of the frequency may increase resuscitation success. 相似文献
89.
90.
Impact of an infection consultation service for bacteraemia on clinical management and use of resources 总被引:2,自引:0,他引:2
Nathwani D; Davey P; France AJ; Phillips G; Orange G; Parratt D 《QJM : monthly journal of the Association of Physicians》1996,89(10):789-797
Since 1993, the infection consultation service for bacteraemia has seen 310
patients in the Medical and Surgical Directorates at Ninewells Hospital and
Kings Cross Hospital. A random sample of 100 was audited. Case-notes were
incomplete for five patients, leaving 95 fully-audited patients. Clinical
outcome measures were death from infection, and readmission within 2 weeks
of discharge. Initial treatment was inconsistent with antibiotic policy in
46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these
patients: increased in intensity in 19 (41%) and decreased in 18 (39%).
Changes were also made in 30 (61%) of the 49 patients whose initial
treatment was consistent with sepsis policy-increased in seven (14%) and
decreased in 23 (47%). Median daily antibiotic costs were lowered in
patients whose initial treatment was consistent with sepsis policy (pounds
10.10 vs. pounds 7.28, p = 0.0274). However, in the other patients, savings
were balanced by increases (p = 0.7696). Consultation required one
consultant session per week (3.5 h) and the audit required an additional 16
consultant sessions. Seven patients died, but only one death was directly
related to infection. Six patients were readmitted to hospital within 2
weeks, in three due to recurrence of infection. Changes to treatment were
recommended in the majority of patients, regardless of whether initial
treatment complied with the sepsis policy. The service primarily
redistributed resources rather than reducing costs. A fully audited service
requires considerable consultant time, but we believe such time is well
spent.
相似文献