Kornimate/medical-research-clean huggingface dataset:
effect of timing on efficacy of morphine analgesia after 2-chloroprocaine anesthesia

Conditions: Labor; Analgesia, Epidural

Summary: epidural chloroprocaine is often used in obstetrical anesthesia because of its fast onset and short duration. these properties make it an ideal drug to use for epidural anesthesia in patients undergoing postpartum tubal ligation. when epidural morphine is given after chloroprocaine, there is a decreased efficacy of analgesia as compared to lidocaine (1). several studies have hypothesized a specific opioid receptor mediated antagonism of chloroprocaine (2,3). karambelkar raised the question whether this decreased efficacy is due to a disparity between the time the chloroprocaine anesthesia resolves and the onset of epidural morphine analgesia, resulting in a time window of pain (2). the duration of action of epidural 2-cp anesthesia is 30-45 minutes and the onset of epidural morphine analgesia is 60-70 minutes, therefore the regression of sensory blockade before the onset of the morphine analgesia could result in a window of pain (2). hess and colleagues studied epidural morphine analgesia and women who had a cesarean delivery under spinal bupivacaine anesthesia (3). subjects were randomized to receive epidural 2-cp and morphine or epidural saline and morphine. there was no difference in postoperative analgesia between the two groups (3 and personal communication, dr. philip hess). a literature search cross referencing epidural chloroprocaine, using pub med, did not produce any articles comparing epidural morphine given before the procedure (in an attempt to time the onset of analgesia with the resolution of chloroprocaine anesthesia) to the standard administration time after the procedure.

women undergoing post partum tubal ligation with an epidural in-situ will be randomly double blindedly selected into one of three groups for pain control. the groups are epidural 1) epidural morphine-chloroprocaine 2) epidural chloroprocaine-morphine 3) epidural morphine-lidocaine. groups 1 and 3 will receive morphine 30 minutes prior to local anesthetic dosing followed by saline placebo after local dosing. group 2 will receive placebo 30 minutes prior to local anesthetic dosing followed by epidural morphine. pain scores and supplemental analgesic requirements will be evaluated 30 minutes, 1hr, 2hr, 4hr and every 4 hrs for the first 24hrs.

Eligibility criteria:
inclusion criteria: * all patients with an epidural catheter in situ for labor analgesia, status post a vaginal delivery, and scheduled for a postpartum tubal ligation under epidural anesthesia will be eligible exclusion criteria: * allergy/hypersensitivity to morphine * allergy/hypersensitivity to ester-linked local anesthetics or para-amino benzoic acid (paba) * body mass index \>40 kg/m2 * patients using chronic opioids * history of obstructive sleep apnea * any contraindication to epidural anesthesia

Keywords: analgesia tubal ligation chloroprocaine
digital home blood pressure monitoring in type b aortic dissection patients

Conditions: Aortic Dissection; Hypertension

Summary: the primary objective of this study is to determine the effectiveness of home digital blood pressure monitoring in aiding providers to maintain blood pressure within a therapeutic range in type b aortic dissection patients upon discharge from the hospital.

patients admitted to the cleveland clinic main campus with a diagnosis of type b aortic dissection or intramural hematoma who do not receive a surgical intervention during their index hospitalization, or planned intervention on follow up, and are discharged on medical therapy consisting of strict heart rate control and bp control will be included in the study. they will be either randomized to standard therapy to measure bp at home (standard of care) or intervention arm consisting of withings wireless blood pressure monitor, which will transmit bp recordings from smartphone to mychart/epic (test arm). all patients will first receive a 24 hour ambulatory monitor regardless of treatment assignment to establish baseline bp pattern. following this patients randomized to intervention arm will utilize their withings blood pressure monitor. providers on the study team will then adjust the patient's hypertensive medications to ensure their bp is below a systolic goal of 120 mmhg utilizing downloaded recordings available in the electronic medical record. the primary clinical endpoint is the change in mean 24 hour systolic blood pressure between the start of the study and the end of the study period (4-week period). secondary outcomes will include the number of patients able to achieve a therapeutic systolic blood pressure of 120 mmhg with both mean bp cuff and in office visit at end of 4 week period, increase in size as measured by computed tomography (ct) scan of the aorta, hospitalization or emergency room (er) visits for symptoms from dissection or uncontrolled hypertension, hospitalization or er visits for hypotension, all-cause mortality, and need for surgical intervention (open or endovascular).

Eligibility criteria:
inclusion criteria: * patients discharged from cleveland clinic main campus with principal diagnosis of type b aortic dissection (defined as distal from left subclavian artery) who do not receive a surgical intervention during their hospitalization * arm circumference of 9-17 inches exclusion criteria: * patients who do not have a smart phone

Keywords: withings blood pressure monitor heart rate ambulatory blood pressure
hepatitis vaccination in hiv infection: role of adjuvant interleukin-2

Conditions: HIV Infections; Hepatitis A; Hepatitis B

Summary: the response to vaccination for hepatitis is reduced in patients with hiv infection. the hypothesis of the study is that adjuvant interleukin-2 administered subcutaneously at the time of vaccination improves the response rate.


Eligibility criteria:
inclusion criteria: * adults with stable antiretroviral therapy and negative for hepatitis a or b exclusion criteria: * prior hepatitis a or b

Keywords: interleukin-2 vaccination treatment experienced
neurocognitive functioning in patients with newly diagnosed upper aerodigestive tract cancer receiving treatment at henry-joyce cancer clinic

Conditions: Neurocognitive Impairment; Delirium; Esophageal Cancer; Head and Neck Cancer; Lung Cancer

Summary: rationale: gathering information about how often problems with neurocognitive functioning occur in patients with newly diagnosed upper aerodigestive tract cancers may help doctors learn more about the disease. purpose: this clinical trial is studying neurocognitive functioning in patients with newly diagnosed upper aerodigestive tract cancers receiving treatment at henry-joyce cancer clinic.

objectives: primary * to establish an estimate of the prevalence of baseline neurocognitive impairment prior to initiation of outpatient cancer treatment. * to establish an estimate of the incidence of neurocognitive impairment during outpatient cancer treatment. * to describe how neurocognitive functioning changes over time during cancer treatment. secondary * to identify sociodemographic and clinical factors associated with neurocognitive impairment. * to examine health-related outcomes associated with neurocognitive impairment. outline: patients undergo interview to complete measures of domain-specific neurocognitive functioning, global neurocognitive functioning, subjective neurocognitive functioning, delirium, physical functioning, symptom prevalence and distress, mood states, and medications at baseline before initiation of cancer treatment, at scheduled treatment visits, and at the follow-up visit 3 months after completion of cancer treatment. measures of comorbidity, alcohol use, sensory functioning (vision and hearing), and sociodemographic are completed at baseline only. cancer-related information (diagnosis, staging, and sites of metastasis, if applicable), treatment-related information (planned treatment regimen - chemotherapy and/or radiation therapy), and current medications are obtained at baseline by medical record review. health service use and complications are assessed at each scheduled treatment visit and at the 3-month post-treatment follow-up visit. measures of domain-specific neurocognitive functioning, coping, and quality of life are completed at baseline and at the 3-month follow-up visit.

Eligibility criteria:
disease characteristics: * newly diagnosed solid tumors of the upper aerodigestive system, including cancers of the head and neck, esophagus, or lung * receiving treatment at the henry-joyce cancer clinic at the vanderbilt-ingram cancer center * no known brain metastasis patient characteristics: * able to hear, speak, and understand english * no prior diagnosis of other cancer except basal cell carcinoma prior concurrent therapy: * no treatment plans including prophylactic cranial irradiation

Keywords: delirium cognitive/functional effects hypopharyngeal cancer laryngeal cancer lip and oral cavity cancer metastatic squamous neck cancer with occult primary nasopharyngeal cancer oropharyngeal cancer paranasal sinus and nasal cavity cancer salivary gland cancer esophageal cancer non-small cell lung cancer small cell lung cancer
bortezomib and flavopiridol in treating patients with recurrent or refractory indolent b-cell neoplasms

Conditions: Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue; Nodal Marginal Zone Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Refractory Plasma Cell Myeloma; Splenic Marginal Zone Lymphoma; Waldenstrom Macroglobulinemia

Summary: bortezomib may stop the growth of cancer cells by blocking the enzymes necessary for their growth. drugs used in chemotherapy, such as flavopiridol, work in different ways to stop cancer cells from dividing so they stop growing or die. bortezomib may increase the effectiveness of flavopiridol by making cancer cells more sensitive to the drug. giving bortezomib together with flavopiridol may kill more cancer cells. this phase i trial is studying the side effects and best dose of bortezomib and flavopiridol in treating patients with recurrent or refractory indolent b-cell neoplasms.

primary objectives: i. to determine the recommended phase ii dose of bortezomib and flavopiridol in patients with recurrent or refractory indolent b-cell neoplasms. secondary objectives: i. to determine the toxic effects and maximum tolerated dose of this regimen in these patients. ii. to determine disease-related effects of this regimen in these patients. iii. to determine the pharmacodynamics of this regimen in patients with myeloma. iv. to determine the pharmacokinetics of this regimen in these patients. outline: this is a dose-escalation, multicenter study. patients receive bortezomib iv over 3-5 seconds followed by flavopiridol iv over 1 hour on days 1, 4, 8, and 11. courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Eligibility criteria:
inclusion criteria: * wbc \< 50,000/mm\^3 for patients with circulating tumor cells * no prior allergic reaction to compounds of similar chemical or biological composition to and presumably able to tolerated bortezomib, flavopiridol, allopurinol, sodium polystyrene sulfonate, or dexamethasone * no neuropathy \>= grade 2 * no other condition that would preclude study participation * not pregnant or nursing * fertile patients must use effective contraception during and for 3 months after study participation * prior autologous stem cell transplantation is allowed * no prior allogeneic stem cell transplantation * no other concurrent anticancer agents * no other concurrent investigational agents * hemoglobin \>= 8 g/dl * platelet count \>= 100,000/mm\^3 * absolute neutrophil count \>= 1,500/mm\^3 * bilirubin =\< 2 times upper limit of normal (uln) * ast/alt =\< 3 times uln * creatinine =\ = 50 ml/min
a pilot study using text messaging to communicate with adolescent females in the pediatric emergency department

Conditions: Pregnancy

Summary: the objective of this study is to develop and test an emergency department (ed)-based intervention which uses text messages to facilitate contraception initiation.

our hypothesis is that adolescent females at high pregnancy risk who receive text message reminders and motivational messages that promote contraception and referral to the family planning clinic are more likely to start effective contraception than those who receive standard paper-based referral to the family planning clinic alone.

Eligibility criteria:
inclusion criteria: * aged 14-19 years * sexually active with males in the past three months * presenting to the ed for a reproductive health complaint. exclusion criteria: * presently pregnant * too ill for participation per the attending physician * cognitively impaired * in foster care or a ward of the state * does not speak english or spanish * does not own a cellular or mobile phone with text messaging capabilities * used contraception at last intercourse and/or is currently using any "highly effective" or "effective" form of contraception (as defined by the world health organization) * does not live in manhattan or the bronx

Keywords: pregnancy pregnancy, unplanned reproductive behavior pregnancy in adolescence text messaging
neuromodulation and language acquisition (project stage ia)

Conditions: Healthy

Summary: the purpose of this study is to determine whether levodopa, pergolid, rivastigmine, or modafinil are effective in boosting semantic language acquisition in healthy subjects.

our prior work shows that d-amphetamine and the dopamine precursor levodopa markedly improve word learning success in healthy subjects. in this randomized, placebo-controlled, double-blind clinical trial, we probe whether a mixed d1/d2 dopamine agonist (pergolid) or cholinergic neuromodulation (rivastigmine) or a general centrally arousing substance (modafinil) will yield a learning enhancement comparable to using levodopa in healthy subjects. our results show that the dopamine agonist pergolide impaired learning in healthy subjects compared to placebo, whereas cholinergic neuromodulation had no effect.

Eligibility criteria:
inclusion criteria: * healthy subjects * 20-35 years old * right handedness * left language dominance (as assessed by functional transcranial doppler ultrasonography \[ftcd\]) exclusion criteria: * neurological/psychiatric/metabolic/cardiac disorders * asthma * known allergic reactions to one of the experimental drugs * other drugs affecting the central nervous system * leisure drug ingestion during the past 4 weeks (urine test) * smoking cessation during the past 2 weeks * \> 6 cups of coffee or energy drinks per day * \> 10 cigarettes per day * \> 50 grams of alcohol per day

Keywords: language acquisition plasticity stroke recovery associative learning
a comparison of three nutritional assessment methods predicting prognosis in copd with respiratory failure

Conditions: Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency

Summary: this is a retrospective study of patients diagnosed with chronic obstructive pulmonary disease (copd) with respiratory failure and admitted in west china hospital during january 2014 to march 2016 by review of medical records. the following variables will be retrospectively studied: age, sex, marriage, height, weight, respiratory rate, pao2, paco2, nutritional risk screening 2002 (nrs 2002) score, alb, short-term and long-term prognostic outcomes, and so on. the purpose of this study is to compare the predictive power of three widely used nutritional assessment methods (bmi, nrs 2002 and alb) predicting the prognostic outcomes in a cohort of copd patients with respiratory failure.


Eligibility criteria:
inclusion criteria: * newly diagnosis of copd at west china hospital during january 2014 to march 2016 * partial pressure of o2 (pao2) \ 50 mmhg * age ≥ 18 years * respiratory rates \> 23 bpm exclusion criteria: * pregnancy or during lactation * ventilatory dysfunction due to neuromuscular disorders, acute and chronic thromboembolic disease, severe illness in other systems * incomplete medical profiles
to evaluate 24-hr glucose after od vs bd azd1656

Conditions: Type II Diabetes

Summary: the purpose of this study is to compare the 24-hour glucose profiles in diabetic patients treated with metformin following once daily and twice daily oral dosing


Eligibility criteria:
inclusion criteria: * type ii diabetes patients, female with non child-bearing potential * type 2 diabetes mellitus (t2dm) diagnosis confirmed by c-peptide \>0.3nmol/l and no glutamic acid decarboxylase (gad) antibodies at enrolment (screening) * treatment with metformin as single therapy for t2dm for at least 30 days prior to enrolment and the metformin dose must have been unchanged during this period exclusion criteria: * history of ischemic heart disease, symptomatic heart failure, stroke, transitory ischemic attack or symptomatic peripheral vascular disease * any clinically significant abnormality identified on physical examination, laboratory test or ecg, which in the judgement of investigator would compromise the subject's safety or successful participation in the clinical study

Keywords: type ii diabetes 24 hour glucose profile
tongue advancement for obstructive sleep apnea

Conditions: Sleep Apnea, Obstructive

Summary: the objective of this study is to assess the feasibility, safety and effectiveness of tongue stabilization using aspire medical advance™ system for the treatment of obstructive sleep apnea (osa). success is defined as a statistically significant reduction in ahi measured by polysomnography (psg) from baseline to 6 months.

obstructive sleep apnea (osa) is a major health problem in the united states and can result in excessive daytime sleepiness and cardiovascular problems. the primary treatment for osa today is continuous positive airway pressure (cpap). many patients however are unable to tolerate sleeping with a cpap machine. surgery is one of the main treatment options available today to these cpap-intolerant patients. however, current methods of sleep surgery are painful, morbid, and/or lack decent effectiveness. this trial will measure the effectiveness of the advance system, an implantable medical device to treat osa. in the trial, patients who meet the study entry criteria receive a baseline sleep study (psg). the advance system is then implanted and 6 months after implantation, another psg is performed. the trial will compare the baseline and the 6 month apnea-hypopnea indices

Eligibility criteria:
inclusion criteria: * documented diagnosis of obstructive sleep apnea with ahi 15-50 measured within a year prior to enrollment with no major change in bmi * bewteen 20 and 65 years old * body mass index (bmi) ≤ 32 * patient has been offered cpap and has refused or failed to continue cpap treatment * identified evidence of airway collapse, primarily at the base of the tongue * signed informed consent to participate in this clinical study exclusion criteria: * prior osa surgery except tonsillectomy, nasal surgery and uvulopalatopharyngoplasty; no airway surgery within 3 months prior to enrollment. * airway collapse at the level of the soft palate (palatal collapse). * enlarged tonsils (3+ and 4+) * anatomy unable to accommodate the implant * severe mandibular deficiency/retrognathia * unable and/or not willing to comply with treatment follow-up requirements. * pregnancy. (female subjects of childbearing potential must have a negative pregnancy test prior to enrollment and should maintain adequate contraception during the study) * breastfeeding women * active systemic infection * allergy to any medication used during implantation * previous history of neck or upper respiratory tract cancer * history of radiation therapy to neck or upper respiratory tract * dysphagia * major cardiovascular and pulmonary disorders * other medical, social or psychological problems that, in the opinion of the investigator, preclude them from receiving this treatment and the procedures and evaluations pre- and post-treatment * enrollment in another pharmacological or medical device study that may effect or bias the results of this clinical study

Keywords: obstructive sleep apena tongue surgery
effectiveness of adaptive servoventilation (asv) in patients with central sleep apnea due to chronic opioid use

Conditions: Obstructive Sleep Apnea; Central Sleep Apnea (Diagnosis); Chronic Opioid Use

Summary: prospective, randomized, blinded, cross-over study assessing the effectiveness of adaptive servo-ventilation (asv) in treating patients who have obstructive sleep apnea (osa) complicated by central sleep apnea (csa) due to the chronic use of opioid medications

the trial seeks to determine the efficacy and patient comfort of asv and bi-level positive airway pressure (pap) modes for the treatment of obstructive sleep apnea (osa), complicated by csa secondary to opioid use. subjects will be randomized to one of two groups, utilizing a cross-over design to evaluate the two modes with the subject as their own control. subjects will be asked to undergo two psg studies; one with asv titration and one with bi-level treatment, using the current pressure prescription. the study comprises two visits. subjects will be asked to complete patient satisfaction questionnaires following their psg studies. it is anticipated that total subject participation will be no longer than one month.

Eligibility criteria:
inclusion criteria: * at least 18 years old * taking opioid medications for at least 6 months. opioid medications include but are not limited to: oxycodone, fentanyl, methadone, levorphanol, hydromorphone, and morphine * using bi-level pap for at least 30 days exclusion criteria: * primary heart or lung disease, for example: chronic obstructive pulmonary disease, pulmonary fibrosis, severe heart failure, uncorrected congenital heart disease, pulmonary hypertension * primary neurologic disease, for example: neuromuscular disease, previous stroke or cognitive impairment * narcolepsy * acute upper respiratory tract infection * pregnant

Keywords: sleeping opioid medications positive airway pressure