Kornimate/medical-research-clean huggingface dataset:
experimental prospective study on the effectiveness and efficiency of the implementation of clinical pathways

Conditions: Congestive Heart Failure

Summary: the purpose of this study is to determine whether the use of clinical pathways improves the quality of the hospital care of decompensated heart failure patients.

in europe approximately 5% of all acute medical admissions relate to heart failure and in the united states heart failure is responsible for almost 1 million hospitalizations annually. almost three quarters of these admissions are unplanned and worsening heart failure is responsible for half of these admissions. the acute decompensated heart failure national registry (adhere) showed that the hospital treatment of heart failure frequently does not follow published guidelines or conform to the joint commission on accreditation of healthcare organizations (jcaho) core performance measures, potentially contributing to the high morbidity, mortality and economic cost of this disorder. adhere findings also suggested that the wide variations in conformity may reflect differences in training, guideline familiarity, and implementation of tools and systems to ensure that recommended care is provided and documented. consequently the development of educational and quality improvement programs has the potential to considerably reduce the current variability in care, enhance guideline adherence, and improve outcomes for patients. clinical pathways has become a popular tool to achieve such goals. clinical pathways are a methodology for the mutual decision making and organization of care for a well-defined group of patients during a well-defined period with the aim to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. they are also developed by multi-professional teams. despite enthusiasm and diffusion, the widespread acceptance of clinical pathways remain questionable because very little prospective controlled data demonstrated their effectiveness. the experimental prospective study on the effectiveness and efficiency of the implementation of clinical pathways was designed in order to conduct a rigorous evaluation of a clinical pathway in hospital treatment of decompensated heart failure.

Eligibility criteria:
inclusion criteria: * principal diagnosis of heart failure (all icd-9 codes included in 428.xx code) exclusion criteria: * current acute myocardial infarction (ami) * current unstable angina

Keywords: critical pathways congestive heart failure randomized controlled trial effectiveness
efficacy and safety of non-resorbable uveoscleral implant versus absorbable collagen matrix in non-perforating deep sclerectomy

Conditions: Glaucoma

Summary: the aim of the study is to evaluate and compare the hypotensive efficacy at 24 months between non-perforating deep sclerectomy surgery with non-resorbable uveoscleral implant associated with absorbable collagen matrix versus non-perforating deep sclerectomy surgery with isolated absorbable collagen matrix implant.

the aim of this study is to evaluate and compare the hypotensive efficacy at 24 months between two implants in glaucoma surgery. non-perforating deep sclerectomy surgery with non-resorbable uveoscleral implant associated with absorbable collagen matrix versus non-perforating deep sclerectomy surgery with isolated absorbable collagen matrix implant.

Eligibility criteria:
inclusion criteria: * patients older than 18 years of age * primary or secondary open-angle glaucoma * high intraocular pressure (greater than or equal to 18mmhg) despite using maximum medical treatment * intolerance to medication. exclusion criteria: * patients with previous glaucoma surgery * previous ocular surgery in the last 6 months * previous history of laser trabeculoplasty in the last 12 months * moderate or severe diabetic retinopathy * active or recurrent eye disease (uveitis) * plateau iris * ocular neovascularization * aphakia * neovascular angle-closure glaucoma * previous history of intraocular or extraocular malignant neoplasm * pregnancy or lactation period, axial length\> 26mm and \<20mm * unwillingness for participating
median effective dose of remifentanil for the prevention of pain caused by the injection of rocuronium

Conditions: Rocuronium; Injection Pain

Summary: as a medium-and long-term non-depolarizing muscle relaxant, rocuronium has the advantages of quick effect, no histamine release and accumulation and no obvious cardiovascular adverse reactions, so it has been widely used in clinical anesthesia induction. however, when given intravenously, rocuronium can cause adverse reactions such as injection pain and limb retraction, which can lead to needle prolapse, extravasation of injection drugs, swelling of injection site, serious induction delay, and cardiovascular adverse events in severe cases. remifentanil is a synthetic opioid drug hydrolyzed by esterase. compared with other opioid drugs, remifentanil has the advantages of quick effect, short half-life and short time of hemodynamic changes, so it is an ideal analgesic in clinical anesthesia. in this study, in order to provide clinical references, sequential method was used to find the median effective dose (ed50) by means of pre-intravenous injection of remifentanil to suppress pain in rocuronium injection.


Eligibility criteria:
inclusion criteria: 1. ages ranged from 18 to 80. 2. asa # or # level. exclusion criteria: * allergy or contraindication to remifentanil or rocuronium; required for central venipuncture catheterization; * abnormal liver or kidney function; * heavy drinking and long-term use of sedatives, analgesics or anti-anxiety drugs; * hearing and language impairment; * peripheral vascular disease; * severe cardiovascular disease or neurological disorders; * failure of one-time peripheral venipuncture; * infection of hand or wrist skin.
a tailored interactive website for promoting condom use among young adults

Conditions: HIV Infections; Sexually Transmitted Diseases

Summary: this study will develop and evaluate the effectiveness of tailored web-based messages in promoting condom use among young adults.

adolescents and young adults are at the greatest risk for acquiring a sexually transmitted disease (std). approximately 3 million people between the ages of 18 and 24 become infected with an std each year. education about the risks and consequences of unprotected sex is a powerful tool that can be used to prevent or reduce the risk of infection. the program in this study will deliver messages to educate participants about condom use and the risk of std infection. the study will evaluate the effectiveness of a tailored interactive online risk reduction program versus a standard online risk reduction program in reducing the risk of std infection in young adults. participants in this open-label study will be recruited from one of two clinics in the denver, colorado area: denver metropolitan health clinic or planned parenthood of the rocky mountains. participants will be randomly assigned to receive internet-based messages from either the youthnet program or the control program while filling out a risk assessment survey. participants in the youthnet program will be asked their gender and ethnicity so they may be assigned to a role model of the same gender and ethnicity via a computer program. this role model will appear online 5 times during the survey to deliver interactive messages that will be tailored to hiv/std risk reduction and will specifically address attitudes about condom usage. the control program will deliver 5 general, non-tailored messages containing information on reproductive health not specific to condoms or stds. participants will be assessed at baseline and a follow-up session 3 months after enrollment. frequency of condom use and attitudes toward condom use will be assessed using behavioral scales.

Eligibility criteria:
inclusion criteria: * client of denver metropolitan health clinic or planned parenthood * english-speaking * access to a computer and an existing e-mail account * will be in denver for at least 4 months exclusion criteria: * not a resident of the denver metropolitan area * no existing e-mail address * no access to a computer

Keywords: internet interactive computer program hiv prevention
evaluating use of deferasirox as compared to deferoxamine in treating cardiac iron overload

Conditions: Transfusional Iron Overload; Transfusional Hemosiderosis

Summary: this is a clinical research study in patients who have iron overload in the heart due to chronic blood transfusions. the study will have 2 treatment groups and will compare the safety and efficacy of chelation therapy with a medicine called deferasirox (icl670) with another medicine called deferoxamine (dfo). the study is aimed at finding out which of the two medicines is the best for treating iron overload in the heart. patients will be treated for 12 months (core study phase). patients who complete the core study phase will be offered to continue their study treatment in a 12 months extension phase. during the core and extension, the effects of treatment on iron overload in the heart and the liver will be evaluated using specific magnetic resonance imaging (mri) assessments.


Eligibility criteria:
inclusion criteria: * male or female patients, aged 10 years and above, with β-thalassemia major or dba or sideroblastic anemia on chronic transfusion therapy, having given written consent to participate in the study. * patients with cardiac iron as measured by a myocardial t2\* value that is ≥ 6ms but not ≥ 20 ms. * patients with a lifetime history of at least 50 units of red cell transfusions, and must be receiving at least ≥10 units/yr of red blood cells transfusions. * patients with a left ventricular ejection fraction (lvef) ≥ 56 % as determined by cardiovascular magnetic resonance (cmr). * patients with liver iron content (lic) value ≥ 3 mg fe / g dw, as determined by liver mri. exclusion criteria: * patients with clinical symptoms of cardiac dysfunction. * patients unable to undergo study assessments including mri * patients participating in another clinical trial or receiving an investigational drug. other protocol-defined inclusion/exclusion criteria may apply.

Keywords: iron overload cardiac iron haemosiderosis myocardial t2* left ventricular ejection fraction lvef cardiac dysfunction thalassaemia diamond blackfan anemia dba sideroblastic anemia myelodysplastic syndromes mds (low and int-1 risk as per the ipss for mds) liver mri deferasirox deferoxamine icl670 dfo cardiovascular magnetic resonance imaging
systematic laryngoscopic evaluation of upper airways in ventilated als patients in portugal and in norway

Conditions: Amyotrophic Lateral Sclerosis

Summary: the study examines if titration of non-invasive mechanical ventilation (niv) settings during ongoing laryngoscopic visualization can improve the compliance of niv in subjects with amyotrophic lateral sclerosis (als). the study is a multicentre study between norwegian national advisory unit on long-term mechanical ventilation at the thoracic department, haukeland university hospital, bergen, norway and centro hospital tras-os-montes e alto douro, vila real, portugal.

als, amyotrophic lateral sclerosis, is a rare and fatal disease causing gradual loss of motor neurons and thus loss of function in all skeletal muscle, eventually also in the breathing muscles, leading to respiratory failure and ultimately death. there is no causal treatment. the treatment provided aims to improve life quality as long as possible. non-invasive ventilation (niv) compensates for respiratory failure as breathing deteriorates. als patients with bulbar innervated muscle dysfunction (mouth, tongue, jaw, throat, larynx) have poor compliance to the use of niv. it is not completely understood why bulbar als patients fails niv, although the upper airways have been a suggested cause also of this treatment failure. the investigators in the norwegian study group has previously examined laryngeal response patterns (using transnasal fiberoptic laryngoscopy ) during mechanically assisted cough in als. the studies revealed that transnasal fiberoptic laryngoscopy was safely performed with ongoing mechanically assisted cough, and it appeared a feasible tool to visualize the laryngeal responses to mechanical cough therapy. the further hypothesis is that the use of transnasal fiberoptic laryngoscopy during ongoing niv titration could improve the compliance of niv treatment in als. since als is a relatively rare disease and it is difficult to perform large clinical studies, a project group has been established and agreed to a common protocol of a population-based multicenter-study including two hospitals, in bergen in norway and vila real in portugal. aims of the study are: to investigate the feasibility of video-recorded transnasal fiberoptic laryngoscopic evaluation of the upper airways applied during niv titration, and to describe the upper airway responses to niv treatment in patients with als. to explore whether the endoscopic view of the upper airways will influence the titration of niv settings in als patients. to explore whether niv titration with endoscopic evaluation will influence niv compliance and ventilation effectiveness in als patients.

Eligibility criteria:
inclusion criteria: * patients diagnosed amyotrophic lateral sclerosis (als) due to el escorial criteria * must have already established non-invasive ventilation (niv) exclusion criteria: * ages under 18 years * unstable ischemic heart disease * oncological disease * ventilatory support dependency (more than 16h per day)

Keywords: noninvasive ventilation laryngoscopy
asthma inpatient research on education

Conditions: Asthmatic Attack

Summary: children with asthma are admitted for asthma attacks very frequently in the u.s. the families and children are given basic education about asthma but studies are needed to improve this education so that it makes a meaningful difference in health outcomes and asthma care. this study compares two inpatient education models for children hospitalized with asthma.

the current standard is to review an asthma action plan with families and to review inhaler medication administration. in this study, investigators will be assigning families to either a control (current standard education) or and intervention group. in the intervention group, participants will receive interactive education based on learning theories that are thought to enhance long term memory. participants in the interactive group will build their own action plan using colored templates and pictures. participants will also learn to use their inhaler using teach-back methodologies. investigators will then compare the two groups in terms of er visits, hospitalizations, family confidence in managing asthma, asthma knowledge, and quality of life.

Eligibility criteria:
inclusion criteria: * diagnosis of asthma exclusion criteria: * active cardiac disease * speaks language other than english or spanish
impact of rapid art initiation on retention in care in the southern us

Conditions: HIV-1-infection

Summary: impact of rapid art initiation on retention in care in the southern us specific goals and aims: the major goal for this study is to determine if rapid start of antiretroviral (art) therapy increases retention in hiv medical care. the investigators hypothesize that there will be an increase in retention in care with rapid start, by removing barriers that would normally delay enrollment in a treatment program and enforce the importance of linkage to care and art initiation from diagnosis. in order to test this hypothesis, the investigators have the following specific aims for their proposed study: 1. study retention in care after rapid art start in comparison to standard of care. 2. analyze risk factors for decreased retention in care, with focus on high-risk populations. 3. analyze potential demographic and geographic determinants of retention in care. 4. generate retention in care data in a southern us state. the investigators hypothesize the introduction of rapid start art, as well as the introduction of care navigators, will lead to improved clinical outcomes, including retention in care at one year, viral suppression at one year, time to viral suppression, and time to first missed appointment. in the event rapid start art fails to have a positive impact on clinical outcomes, the results of this study will still positively contribute to the knowledge gap, since there is a scarcity of data in the southern united states, specifically in high-risk populations, such as racial and ethnic minorities, youth, and patients co-infected with hepatitis c.


Eligibility criteria:
inclusion criteria: * prospective arms: human subjects ≥18 years old, newly diagnosed with hiv who are establishing care at the 550 clinic. * retrospective arm: human subjects ≥18 years old, newly diagnosed with hiv who established care at the 550 clinic and were treated with art between 2012-2019. exclusion criteria: * pregnancy * prior hiv diagnosis or exposure to art * medical necessity for therapy with art agent other than bictegravir/emtricitabine/tenofovir alafenamide (bic/f/taf), such as drug allergy, drug-drug interactions, creatinine clearance \<30.
participant centered active surveillance for adverse event following measles immunization in gedeo zone, ethiopia, 2022. a multi-center open-label randomized control trial

Conditions: Measles

Summary: introduction participant centered active adverse event following immunization (aefi) surveillance can offer real time vaccine safety data and help in signal detection. evidence showed that it is still difficult to get aefi from passive reporting in ethiopia. vast novel method of enhanced aefi surveillance has been practiced globally. however, those methods had serious limitations including the requirement of high resource and expertise. hence, there is a need to find the most flexible low cost and integrated aefi surveillance system. to the best of our knowledge, there has no published research in ethiopia which compare participant diary, sms, and telephone interview for the purpose of active aefi surveillance. objective: to assess participant centered active adverse event surveillance following measles immunization at gedeo zone health facilities, ethiopia. method: an open randomized trial will be employed from october 1, 2022- december 1, 2023, at gedio zone health facilities. all parents, care givers/guardians whose child receive vaccine during the study period in the study site will be included in the study. a total of 391participants will be randomized to sms, telephone interview or diary card group using random number generator on excel. every participant will be contacted on day seven to request them whether they experience any aefi. differences in proportions will compared using chi-square tests. a 0.05 level of significance will be used for all analyses. independent sample t-tests will be used to compare the mean time (in days) required to collect complete aefi data by sms, telephone interview and diary card. multinominal logistic regression analyses will be used assess the factors associated with effective use of tailored sms, telephone interview and diary card for the aefi active surveillance. to further investigate the association between the vaccine and the adverse events and factors associated with vaccine binary and multi variable logistic regression will be used.


Eligibility criteria:
inclusion criteria: * parents, care givers/guardians, whose child receive vaccine. * ≥18 years of age. * willing to adhere to study procedures, which will include a randomization. * willing to participate exclusion criteria: * unable to give informed consent because of cognitive impairment. * those who are both illiterate and don't have mobile phone.

Keywords: participant centered active surveillance adverse event measles immunization
effect of ro on gb during tkr severe varus deformity

Conditions: Genu Varum; Knee Osteoarthritis

Summary: effect of reduction osteotomy on gap balancing during total knee replacement for severe varus deformity

severe varus deformity with a tibio femoral angle of 15° or more as measured on full-length weight-bearing radiographs necessitates extensive release of the medial structures to gain neutral limb alignment during total knee arthroplasty (tka). progressive releases of the medial structures are performed until medial and lateral envelopes are equally balanced. this technique, however, faces a risk of over-release and subsequent instability, ultimately resulting in the use of a thicker polyethylene insert or even a constrained-type prosthesis. reduction osteotomy is known as a soft tissue-sparing technique for soft tissue balancing, and it is capable of reducing the amount of release required to balance the knee and of preventing over release of medial structures. dixon et al . and mullaji et al . proposed the effectiveness of down-sizing the tibial component in the case of knees with severe varus deformity aim of the work: assess the effect of reduction osteotomy on gab balancing during total knee arthroplasty for severe varus deformity -what is the amount of deformity correction achieved with reduction osteotomy during tka in varus knees? - what is the correlation of amount of deformity correction achieved to the amount of bone osteotomized and the degree of varus deformity?

Eligibility criteria:
inclusion criteria: * patients with severe varus deformity more than 15 degrees (long film-mechanical axis) * patients with bone defect of medial tibial condyle exclusion criteria: * patients with extra-articular deformity * patients with valgus deformity

Keywords: reduction osteotomy knee arthroplasty