Determination of Adrenal Response After Oral Administration of Multiple Doses of Methylprednisolone

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97189/1/j.1552-4604.1979.tb01627.x.pd

Rectal and oral absorption of methylprednisolone acetate

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/117227/1/cpt1979262232.pd

Novel method of estimating volume of distribution of a drug obeying Michaelis-Menten elimination kinetics

The novel method of estimating the volume of distribution involves (a) administering an appropriate bolus intravenous dose of the drug, (b) starting a constant-rate intravenous infusion of the drug at the same time, (c) maintaining the infusion for a given number of hours, (a) measuring the drug concentration over the entire time course, (e) computer-fitting the post-infusion data to obtain estimates of V m and K m , (f) estimating the total area under the concentration-time curve from zero time to infinity, and (g) iteratively solving a cubic equation to obtain the estimate of the volume of distribution. The method was applied to ethanol in the cat and yielded an average value of 635ml/kg (63.5% of body weight) with a coefficient of variation of 23.0%. This is equivalent to total body water in the cat.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45074/1/10928_2005_Article_BF01312262.pd

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified