Kornimate/medical-research-clean huggingface dataset:
quality of awakening and impact on cognitive function after administration of sugammadex in robotic radical cystectomy

Conditions: Anesthesiology Management

Summary: with the aim of enhancing the quality of surgery, the robotic cystectomy is often conducted using continuous intravenous infusion of curare, which ensures maximum neuromuscular relaxation until the end of the intervention. sugammadex, administered for the reversal of deep neuromuscular blocked, enable rapid awakening. moreover, sugammadex seems to have a positive effect also on the recovery of cognitive function, psychomotor coordination and mental ability, effects undocumented in literature. the aim of the investigators study was to assess whether the reversal with sugammadex after intraoperative continuous infusion of rocuronium, can improve the quality of awakening.


Eligibility criteria:
inclusion criteria: * asa score ≤ iii * patients underwent robotic cystectomy exclusion criteria: * cerebrovascular disease * bmi ≥ 30

Keywords: sugammadex delayed emergence from anesthesia curare robotic surgical procedures
effect of pioglitazone versus metformin on bone health in postmenopausal women with type 2 diabetes

Conditions: Diabetes Mellitus; Diabetes Mellitus, Type 2; Glucose Metabolism Disorders

Summary: the study tests whether pioglitazone (pio)as compared to metformin (met)affects bone health including bone mineral density, bone turnover markers, and osteocyte biomarker in patients with type 2 diabetes (t2dm).

women with t2dm exhibit normal or higher bone mineral density (bmd) for their age, but with approximately twice the overall risk of bone fragility compared with nondiabetic subjects. known the apparent association between t2dm and the risk of bone fragility, examining the effects of commonly used oral antidiabetic agents; such as met and thiazolidinediones (tzds; for example rosiglitazone \[ros\] or pio), on bmd and/or bone turnover is of great clinical relevance for both diabetic patients and their treating physicians. recent clinical trials, showed that women treated with ros had higher risk of bone fragility and self-reported adverse events. similarly, women on long-term treatment with pio for t2dm experienced higher incidence of distal extremity fractures. tzds are agonists of the nuclear transcription factor peroxisome proliferator- activated receptor-γ (ppar-γ) which increase insulin sensitivity and improve glycemic control in t2dm. ppar (γ) acts also as a molecular factor that favours adipogenesis over osteoblastogenesis of mesenchymal stem cells. the latter was suggested as a potential mechanism for the effects of tzds on bone among others. in humans, tzds decrease bmd and increase bone fragility risk. this study tests whether pioglitazone as compared to met (both are commonly used in the treatment of t2dm in saudi arabia and other countries) affects bone health including bone mineral density, bone turnover markers, and osteocyte biomarker in patients with t2dm.

Eligibility criteria:
inclusion criteria: * bmd t-score greater than -2.5 at the total hip, femoral neck, and lumbar spine; * no prior antidiabetic therapy; * drug-naïve with glycosylated hemoglobin a1c (hba1c) ≥ 7.0 to ≤ 10.0%. 53.2 mmol/mol to 88.2 mmol/mol); * body-mass index of 40 kg/m2 and less; * stable body weight for at least 4 months. exclusion criteria: * type 1 diabetes mellitus (presence of gad auto antibodies); * history of diabetes or uncontrolled hypertension; * treatment with antidiabetic agents including tzds; * chronic diseases known to affect bone; * previous treatment with estrogens and other medications known to affect bone ; * creatinine clearance less than 60 ml/min

Keywords: pioglitazone metformin hyperglycemic agents physiological effects of drugs bone health
beyondsilos - more personalised and coordinated care and improved outcomes for elderly patients

Conditions: Heart Failure; Stroke; COPD; Diabetes

Summary: the study evaluates the impact of the new organisational models developed in the framework of the beyondsilos pilot service in order to provide ict supported integrated health and social care to elderly patients

the overall aim of the evaluation carried out in beyondsilos is to identify the differences introduced by implementing ict supported integrated care in different domains according to the mast evaluation framework, including safety, clinical and social outcomes, resource use and cost of care, user/carer experience and organisational changes. the focus of the evaluation will be the impact of so called "horizontal" integration, which is the integration between social care and health care, and the changing organisational models for elderly patients. the hypothesis in this study is that integrated care (ic) will lead to a more personalised and coordinated care, improve outcomes for elderly patients, deliver more effective care and support, and provide more cost efficient health and social services.

Eligibility criteria:
potential participants are selected by screening electronic healthcare and social care records or/and the hospital / national databases and/or during long term condition annual reviews in the community setting. if necessary, candidates are informed about the nature and the objectives of the evaluation. if a candidate passes the inclusion/exclusion criteria and signs the informed consent form, if necessary, they participate in the evaluation. inclusion criteria: * age ≥65 years. * presence of health needs specified as: presence of heart failure, stroke, copd or diabetes (diagnosed at hospital or at specialist visit) plus at least one additional chronic disease / condition included in the charlson comorbidity index (cci). * presence of social needs based on barthel index of activities of daily living and instrumental activities of daily living (iadl). * reasonable expectation of permanence in the beyondsilos project for the whole data collection period (18 months). * informed consent, signed if necessary (by the subject or his/her delegate). * capability to handle ict equipment / devices alone, or with the help from a delegate. * presence of good/reliable communication connection at home (internet, telephone or what is needed for the ict connection). exclusion criteria: subjects who have been registered with an active cancer diagnosis and undergoing treatment, has undergone an organ transplant, or is undergoing dialysis prior to enrolment. * subjects in a terminal state * people with an aids diagnose.

Keywords: information technology telemedicine integrated care mast framework organizational change social care elderly patients
effect of the sheath of rectus abdominis block combined with the transverse plane

Conditions: Nerve Block; Surgical Conditions

Summary: the situation of demand for surgical conditions is quite high when lymph node resection involved in the surgery type, especially abdominal aortic lymph node dissection, and commonly, the surgeons complained about the interference from the intestine which pushed the investigators to increase the level of neuromuscular blockade close to deep nmb. to avoid the application of deep nmb and promote good surgical conditions for laparoscopic gynecological surgery with lymph nodes resection, the investigators explored other preoperative ways to cooperate with surgeons more harmoniously. it's well known that epidural anesthesia and epidural anesthesia combined with spinal anesthesia have the effect of muscle relaxation which has been applied in clinical practice widely. one study indicated that the transverse abdominal plane (tap) block could change muscle thickness and achieve the effect of muscle relaxation. it leads investigators to a hypothesis that the sheath of rectus abdominis block combined with transverse abdominal plane block may suppress the signal transmission of abdominal nerve, and may be beneficial to improve surgical conditions.

the investigators conducted this study to test the hypothesis that compared with moderate nmb， the sheath of rectus abdominis block combined with transverse abdominal plane block may reduce the frequency of additional ask for muscle relaxants to optimize surgical conditions, and also provide postoperative analgesia on the premise of moderate nmb.

Eligibility criteria:
inclusion criteria: 1. asa grade i\~ ii; 2. aged 18-55 years; 3. bmi 19 \~ 23kg/m2; 4. laparoscopic total hysterectomy and bilateral adnexectomy and/or pelvic lymphadenectomy under elective general anesthesia lasted for more than 2 hours; 5. informed consent has been signed. exclusion criteria: 1. the patient had a history of abdominal surgery; 2. for patients who are professional athletes and weight trainers, abdominal muscle tension can be changed through strength training need to be excluded. 3. allergic to any of the drugs used in the experiment; 4. pregnant or lactating women; 5. patients with severe mental and neurological symptoms cannot cooperate with the study; 6. those who participated in other clinical trials within 3 months before being enrolled in the study; 7. the researcher believes that other reasons are not suitable for clinical trials; 8. patients who have changed their surgical methods or received only palliative surgical treatment; 9. patients with abnormal coagulation function;

Keywords: tapb moderate nmb surgical conditions
the brain structure and neural network changing the before and after ventriculo-peritoneal shunting in the normal pressure hydrocephalus patients

Conditions: Normal Pressure Hydrocephalus

Summary: with the advent of the aging society, dementia becomes the focus of common people. as for the neurodegeneration dementia, no disease modifying treatments have been discovered. idiopathic normal pressure hydrocephalus (inph) is considered as one of reversible dementia, which can be hint by the surgery. in addition, dementia of inph is the typical subcortical dementia. therefore exploring the pathogenic mechanism is conducive to the early diagnosis and treatment. this research is to monitor the changing of inphgs, cognitive function, walking ability as well as brain construction imaging and neural network before and after ventriculo-peritoneal shunting in order to demonstrate the pathogenesis of triads. in the process, the supplementary test, for instance, csf tap test, will be validated the predictive value.


Eligibility criteria:
inclusion criteria: ncluded will be subjects with a probable diagnosis of nph. the diagnosis will be based primarily on presence of gait impairment plus at least one other impairment in urinary symptoms, cognition impairment or both. 1. are 50 years old or older 2. patients who understand the study protocol 3. patients who meet the criteria for nph 1. a typical personal history 2. a typical brain imaging on head ct or mri 3. normal lp findings excluding other conditions 4. exclusion of other conditions causing the symptomatology exclusion criteria: 1. patients below the age of 50 years. 2. patients who underwent shunt surgery before

Keywords: shunting brain constructure neural network
residual effect of chlorhexidine-alcohol compared to triclosan-alcohol

Conditions: Infectious Diseases

Summary: currently there are few options for skin antisepsis, commercially antiseptic triclosan is mainly used. to have more options, this study is necessary, where investigators will determine the residual effect of 2% chlorhexidine in 70% isopropyl alcohol and 1% triclosan in 70% isopropyl alcohol and choose the one with the best characteristics for skin antisepsis.

2% chlorhexidine has been used as an antiseptic for invasive procedures, such as the skin preparation for surgery or insertion of intravascular catheters, thereby decreasing the incidence of infections. the preparation of the skin with antiseptics, helps mechanically clean the surface of the skin to be subjected to surgical intervention, removing fat, sweat, dead cells and kill bacteria that are in the skin. it has been shown that 2% chlorhexidine in solution with 70% isopropyl alcohol has greater activity than chlorhexidine in aqueous solution. the constant use of triclosan causes resistance of some microorganisms on some antibiotics.it has been shown that 0.5% of triclosan in 60% alcohol isopropyl chlorhexidine is more effective than alcohol. the aim of the study is to know if 2% chlorhexidine has more residual effect than triclosan 1%, both antiseptic diluted in 70% isopropyl alcohol.

Eligibility criteria:
inclusion criteria: * healthy adult volunteers * volunteers who have completed the stabilization phase of skin flora. * volunteers who does not taken a shower or bath 24 hours before the test. exclusion criteria: * volunteers with a score below 100 colony forming unit per square centimeter (cfu/cm2) of forearm skin surface in the control after the stabilization of the skin flora. * history of skin allergies or atopy, as well as reactions to alcohol, soaps, iodine, chlorine or latex.

Keywords: antiseptics administration cutaneously anti-infecting agents, local
uremic toxins in the icu: patients after cardiac surgery

Conditions: Renal Failure

Summary: study of the kinetics of uremic toxins in the icu patients with acute renal failure, in order to optimize the dialysis dose: patients after cardiac surgery.the sampling of blood and dialysate will be done during dialyses with different durations (4, 6 and 8h)


Eligibility criteria:
inclusion criteria: * icu patients after cardiac surgery with acute renal failure

Keywords: icu patients with acute renal failure after cardiac surgery
effect of mechanical insufflation-exsufflation on respiratory parameters in two neuromuscular populations.

Conditions: Mechanical Insufflation-exsufflation Session ( With Cough Assist)

Summary: a single session of mechanical insufflation-exsufflation (with cough assistò) may improve airway flow and gas exchange in neuromuscular atrophy patients. the goal of this study is to confirm the beneficial effects of this treatment in a larger neuromuscular population, to study its mechanisms of action and to assess whether the effects observed persist over time. a better knowledge of this treatment should help to define its position in the respiratory management of neuromuscular patients.

30 sma and dmd adult patients will be recruited in the home ventilation unit of the intensive care department of raymond poincaré hospital (assistance publique-hôpitaux de paris,garches, france). respiratory parameters and comfort will be evaluated before and after (5min, 1h, 3h) a mi-e session. vital capacity, maximal inspiratory and expiratory pressures (pimax and pemax), peak cough flow and peak expiratory flows will be measured. breathing pattern will be recorded allowing the measurements of respiratory frequency, tidal volume, inspiratory time (ti),total breath (ttot) during tidal breathing and the calculation of tension-time index (tt0.1). gas exchange will be evaluated by measuring end tidal co2, transcutaneous co2 and pulse oxymetry. respiratory comfort will be assessed with a visual analog scale. optoelectronic plethysmography will be use to perform regional ventilation evaluation. using chest wall motion analysis we will compute respiratory participation of upper, lower thorax and abdomen, right and left side. results should allow to analyse the effects of mi-e on regional ventilation. the mechanisms of action of mi-e on respiration and chest-wall motion will be analysed and the persistence of the beneficial effect of mi-e will be assessed.

Eligibility criteria:
inclusion criteria: * adults aged more than 18 years * written consents * neuromuscular disorders * hemodynamic stability exclusion criteria: * pulmonary disorder * acute respiratory failure * cognitive deficit

Keywords: neuromuscular disorders mechanical insufflation-exsufflation respiratory parameters plethysmography opto electronic vital capacity
study of adults with low growth hormone who survived childhood cancer where treatment caused low bone density

Conditions: Osteopenia

Summary: the purpose of this project is to evaluate the hypothesis that bisphosphonate treatment given to growth hormone deficient patients (regardless of current growth hormone replacement therapy status and without changing that status) significantly increases total body bone mineral density during an eighteen month period of treatment combined with calcium and vitamin d when compared to calcium and vitamin d treatment alone.

adult patients with dexa scan (bone scan) z-scores \< -1.0 (meaning low bone density) in at least one site will be selected for randomization. all patients who qualify for randomization will undergo baseline bloodwork for serum bone specific alkaline phosphatase (bsap) and n-terminal telopeptides of collagen (ntx) levels. recent bloodwork obtained as part of their ongoing long-term pediatric oncology and/or endocrine clinic follow-up evaluation will be reviewed to exclude any baseline correctable confounding causes of osteopenia (low bone density). all women of childbearing potential will have a pregnancy test. for those patients already on growth hormone replacement therapy, growth hormone will be administered as per standard of care, with standard dose ranges adjusted based upon igf-1(insulin like growth factor) monitoring. those patients not currently receiving growth hormone replacement therapy will not be placed on therapy as a part of this study. patients on and off growth hormone replacement therapy will be randomized in a block design to the two treatment arms to assure equal numbers in each treatment arm. the bisphosphonate to be utilized will be provided to the arm ii patients at no charge. all arm ii patients will receive the same bisphosphonate regimen, risedronate 35 mg per oral once weekly for 18 months. all patients on arms i and ii will also receive vitamin d (400 iu p.o. daily) and calcium carbonate (500 mg p.o. twice daily) free of charge for eighteen months.

Eligibility criteria:
inclusion criteria: * growth hormone deficiency as a complication of treatment for pediatric malignancy * dexa (bone densitometry)with z-scores of \< -1.0 in at least one site exclusion criteria: * dexa (bone densitometry)with z-scores \< -1.0 in at least one site * subjects \<18 years old * pregnant or lactating patients * any contraindication for or unwillingness to consider bisphosphonate treatment * inability or unwillingness to undergo bone density evaluation * other correctable causes of decreased bone mineral density

Keywords: osteopenia growth hormone deficiency pediatric malignancy
implementation of ischemic heart disease clinical practice guidelines

Conditions: Ischemic Heart Disease

Summary: the purpose of this study is to design and evaluate targeted implementation strategies to fully integrate the vha clinical practice guidelines for ischemic heart disease into vha clinical practice. effectively implementing the guideline will enhance the quality, appropriateness, timeliness, and cost effectiveness of care delivered to veterans with ischemic heart disease.

background: the purpose of this study is to design and evaluate targeted implementation strategies to fully integrate the vha clinical practice guidelines for ischemic heart disease into vha clinical practice. effectively implementing the guideline will enhance the quality, appropriateness, timeliness, and cost effectiveness of care delivered to veterans with ischemic heart disease. objectives: the long-term objective of this study is to identify the best strategies for implementing the ihd guidelines to improve guideline adherence and provider acceptance. the specific objectives of the study are to: 1) describe the temporal aspects of guideline acceptance and adherence over three periods of time: pre-implementation, post-implementation of general strategies, and post- implementation of targeted strategies; 2) assess the relative effectiveness of targeted intervention strategies on guideline adherence; 3) identify the relationships among provider beliefs, attitudes, and their intentions to use guidelines; 4) identify the costs associated with implementation of general and targeted implementation strategies; and 5) describe provider satisfaction with targeted implementation strategies. methods: qualitative (focus groups, interviews with key informants) and quantitative methods (surveys, chart reviews) are used to address study objectives. a survey will be sent to providers to measure beliefs and attitudes that predict provider acceptance to clinical practice guidelines. patient level data will be collected from reviews of charts from each facility. based on provider focus groups we will design targeted strategies to overcome system barriers and address needs identified by providers to support clinical practice guideline implementation. a randomized trial will be conducted to assess the relative effectiveness of the targeted intervention strategies. status: data collection has ended. we are currently evaluating adherence data at all sites following introduction of case management to determine if the intervention increases adherence to the guidelines.

Eligibility criteria:
inclusion criteria: none exclusion criteria:
exercise and muscle stimulation in patients with knee osteoarthritis

Conditions: Osteoarthritis, Knee; Self Stimulation; Exercise Addiction

Summary: objective: to evaluate the effectiveness of neuromuscular electrical stimulation (nmes) combined with closed kinetic chain (ckc) exercises in patients with knee oa.

abstract: introduction: osteoarthritis (oa) is a degenerative and debilitating change that affects the synovial joints. objective: to evaluate the effectiveness of neuromuscular electrical stimulation (nmes) combined with closed kinetic chain (ckc) exercises in patients with knee oa. methods: nineteen patients with knee oa were enrolled and randomized into two groups: group i was treated with ckc + nmes, and group ii was treated with ckc + nmes placebo. both groups underwent 20 sessions of mini-squat exercises at 30 degrees of knee flexion that were associated with and interspersed with nmes for 5 minutes at a frequency of 40 hertz (hz), 10 minutes at 70 hz and an addition 10 minutes at 150 hz, for a total of 25 minutes. the data were analyzed using spss (statistical package for the social sciences) version 17.0. data were expressed as a frequency, mean and standard deviation and were statistically analyzed using a one-way analysis of variance (anova) for repeated measurements followed by bonferroni's post-hoc test. the investigators also used an unpaired student's t-test and kruskal-wallis and wilcoxon tests with a level of significance of p \< 0.05.

Eligibility criteria:
inclusion criteria: * patients with grade i or grade ii knee oa (based on the kellgren-lawrence classification; * which was diagnosed by a medical traumatologist; * radiographic changes that demonstrated a reduced joint space in at least one of the compartments of the knee; * subchondral bone sclerosis; * consent to participate in the study exclusion criteria: * patients who had grade iii and grade iv knee oa (based on the kellgren-lawrence classification); * who were involved in another rehabilitation program outside the center; * who presented with clinical symptoms that would prevent them from participating in the exercises; * who had heart disease; * cardiac pacemakers; * periarticular metal implants; * who experienced changes in sensitivity; * who had a previous history of knee injury (meniscus, ligaments, sprains); * who had uncontrolled diabetes; * neurological disorders with cognitive impairments; * rheumatic diseases; * history of knee trauma in the last six months; * prior knee surgery; * three consecutive unexcused absences.

Keywords: closed kinetic chain nmes knee osteoarthritis