Kornimate/medical-research-clean huggingface dataset:
early versus late adjunctive vasopressin in septic shock

Conditions: Sepsis; Septic Shock

Summary: the goal of the casper-pilot study is to develop clinical decision support (cds) technology within epic to randomize patients with septic shock to early versus standard of care vasopressin initiation. the primary aim of this study will be to test the hypothesis that cds technology can be utilized to create two distinct cohorts of patients reflecting different times of vasopressin initiation based on norepinephrine dose requirements. secondarily, this study will evaluate the proportion of patients whose norepinephrine dose at the time of vasopressin initiation is within the specified range for the intervention arm they were randomized to. other outcomes of evaluation will include adherence to the developed cds technology and comparison of clinical outcomes between the two treatment arms.

sepsis is a highly prevalent and morbid disease estimated to account for up to 20% of annual deaths globally. if not rapidly identified and intervened upon, patients with sepsis may progress to septic shock, which is associated with mortality rates up to 50%. patients with septic shock have persistent hypotension requiring vasoactive agents to augment blood pressure despite fluid resuscitation. norepinephrine is recommended first-line by the surviving sepsis campaign (ssc) guidelines for patients with septic shock. if mean arterial pressure (map) remains inadequate on norepinephrine, vasopressin is suggested as the second-line adjunctive agent. over 30% of patients with septic shock in the united states (us) receive adjunctive vasopressin, with use rising over time. despite increased use over time, ideal patient selection and initiation timing for adjunctive vasopressin in the course of a patient's shock are not well elucidated. the 2021 iteration of the ssc guidelines note that initiating vasopressin when the patient requires between 0.25 and 0.5 mcg/kg/min of norepinephrine "seems sensible". yet, many questions remain regarding the timing of vasopressin initiation. the goal of this proposal is to evaluate the timing of vasopressin initiation in patients with septic shock based on the norepinephrine requirements at the time of vasopressin initiation. this pilot study will attempt to develop cds technology in which to answer this clinical question.

Eligibility criteria:
inclusion criteria: * age ≥ 18 years * diagnosis of septic shock * admitted to cleveland clinic main campus medical icu * receiving continuous infusion of norepinephrine at a dose \> 5 mcg/min at time of enrollment exclusion criteria: * administration of any other vasoactive agent other than norepinephrine at time of enrollment * initiation of vasopressin by provider outside of the context of study when ne \< 10 mcg/min (before bpa firing)

Keywords: sepsis septic shock vasopressors vasopressin
correlation between alignment of lower limb and clinical outcome after total knee prosthesis.

Conditions: Osteoarthritis of the Knee Joint

Summary: evaluation of the clinical results after total knee prosthesis, and correlation with the alignment of the lower limb. radiological measurements by means of 3d technology will be performed. the clinical result will be stipulated by means of standardized questionnaires (koos, kss and oxford knee score-questionnaire).


Eligibility criteria:
inclusion criteria: * patient with osteoarthritis of the knee joint, without severe bone deformation exclusion criteria: * none

Keywords: osteoarthritis
study on the effect of mitomycin c 0.02% on the corneal endothelial after photorefractive keratectomy in moderate myopia

Conditions: Myopia

Summary: in this study 126 eyes in 63 patients with moderate bilateral myopia and astigmatism between -3 and -5 (se difference between two eyes should not be more than 0.75 and the residual corneal thickness\>350 μ ) were entered in the study. one eye went randomly under prk with mitomycin c 0.02% in 15 min and then the other eye went under the operation without mmc. ucva,bcva, refractory error after the operation and the number of endothelial cells before and after the surgery would be compared in 6 months.


Eligibility criteria:
inclusion criteria: * 19 \< age \< 60 * refractory error stabled for at least one year * no corneal pathology * -3 \< bilateral myopia and astigmatism \< -5 with no difference more than 0.75 between 2 eyes exclusion criteria: * keratoconus * ectatic corneal disease * glaucoma * corneal dystrophy * lens changes affecting the visual acuity * anterior or posterior uveitis * corneal scar
effects of multimodal treatment of headache in a day clinic service

Conditions: Headache Disorders

Summary: the observational study aims to investigate the effects of a multimodal treatment program for headache patients in a day clinic service. the setting provides one week of treatment including a combination of medical consultation, physiotherapy, psychological therapy, occupational therapy, progressive muscle relaxation and disease specific education. outcome measures are the disease-specific impact on daily activities, general quality of life, psychological impact and headache frequency. moreover, the study sought to identify parameters that best predict efficacy of the intervention. therefore, standardized questionnaires are established in three points in time, to evaluate the pre- and post-treatment status.

duration of treatment: 5 days; first questionnaire (v0): minimal 4 weeks prior to the treatment appointment; second questionnaire (v1): on the first day of the treatment program; third questionnaire (v2 / follow up): 3 month (+- 6 weeks) after finishing the treatment; data collection through patient self-report; follow-up via mail

Eligibility criteria:
inclusion criteria: * diagnosis of a headache disorder * written informed consent for collecting and analysing data and conducting a follow-up evaluation exclusion criteria: * premature interruption of the treatment * repeated treatment

Keywords: multimodal treatment quality of life day clinic service
art therapy in progressive supranuclear palsy

Conditions: Progressive Supranuclear Palsy

Summary: our aim is to study the effect of art therapy for people with psp, with a focus on alleviating the symptoms associated with psp, enhancing the overall quality of life for patients, and reducing caregiver stress. overall, through our collaborative efforts on this study, we hope to unlock the benefits of art therapy for this vulnerable patient population, ultimately improving their overall well-being and enhancing their quality of life.

progressive supranuclear palsy (psp) is typically manifested by a multitude of distressing symptoms, including bradyphrenia and bradykinesia, speech dyspraxia, visual problems, and postural instability with high risk of falls. these symptoms not only inflict physical hardships on patients but also have profound emotional and psychological implications. thus, a decline in self-esteem, a reduction in the quality of life, and heightened stress for caregivers is remarkable. in recent years, art therapy has garnered attention as a potentially effective intervention for individuals grappling with neurodegenerative disorders. art therapy encompasses a wide array of activities that promote cognitive and motor skills, including shape recognition, motion perception, sensory-motor integration, abstraction, and eye-hand coordination. as a result, it holds promise as a therapeutic tool for addressing the intricate challenges faced by psp people. although art therapy has demonstrated positive outcomes in enhancing visual cognitive skills, refining visual exploration strategies, and bolstering general motor function in parkinson's disease, its potential in the context of psp remains largely unexplored. given the unique symptomatology and emotional toll of psp, patients suffering from this condition stand to benefit significantly from the healing and therapeutic effects of art therapy. in light of these considerations, our proposal aims to bridge this knowledge gap by implementing and rigorously studying the impact of art therapy on psp patients. our aim is to investigate the effect of art therapy for people with psp, with a focus on alleviating the symptoms associated with psp, enhancing the overall quality of life for patients, and reducing caregiver stress. overall, through our collaborative efforts on this study, we hope to unlock the benefits of art therapy for this vulnerable patient population, ultimately improving their overall well-being and enhancing their quality of life.

Eligibility criteria:
inclusion criteria: * diagnosis of progressive supranuclear palsy * have the cognitive ability to provide informed consent exclusion criteria: * primary neurological diagnosis other than progressive supranuclear palsy * cognition too impaired to provide informed consent
uspio-enhanced and diffusion-weighted mri for the detection of pelvic lymph node metastases

Conditions: Prostate Cancer; Bladder Cancer

Summary: preoperative detection of lymph node metastases in patients with prostate or bladder cancer is crucial for selection of the appropriate treatment strategy (surgery, androgen deprivation with/or without radiation therapy or chemotherapy) and thus for patient prognosis. until now ct or mri have been the modalities of choice for preoperative staging procedures. however, current morphological assessment of lymph nodes based on size and shape is unable to detect smaller metastases or liable to give false positive results on lymph nodes with reactive hyperplasia. we hypothesize that uspio-enhanced mri combined with dw-mri will be able to detect pelvic lymph node metastases preoperatively with high sensitivity and specificity.


Eligibility criteria:
inclusion criteria: * patients with histologically proven prostate cancer (t1-2n0m0 gleason score 6-10) scheduled for radical prostatectomy or patients with histologically proven bladder cancer (t1-3bn0m0g3) scheduled for cystectomy * written informed consent to participate in this trial. exclusion criteria: * patients with contraindications for mri (e.g. pacemaker, metal implants, claustrophobia). * patients in a critical cardiovascular state, with risk of decompensation after administration of the uspio contrast agent. * patients with hemochromatosis or an allergy to dextran or iron compounds. * pregnant or breast-feeding women. * patients who have received gadolinium complexes within 2 days or iron oxide particles within 7 days before mri. * patients who underwent chemotherapy or radiotherapy before surgery. * patients whose degree of cooperation is incompatible with carrying out the study. * patients with contraindications to glucagon administration.

Keywords: prostate cancer bladder cancer pelvic lymph node metastases diffusion-weighted mri sinerem (uspio)-enhanced mri imaging influence on surgery noninvasive detection of pelvic lymph node metastases influence of imaging protocol on surgical outcome
regeneration of liver: portal vein embolization versus radiofrequency assisted ligation for liver hypertrophy (rebirth)

Conditions: Liver Resection; Cancer

Summary: the aim of this study is to compare two different techniques (portal vein embolization and radiofrequency assisted liver partition with portal vein ligation) for increasing liver volume prior to major liver resection.

liver resection remains the gold standard treatment for patients with liver tumours providing them the only chance for long-term survival. in up to 45% of cases that are amenable to surgical resection, an extended hepatectomy (removal of part of the liver) is usually necessary to achieve a clear resection margin. however, there must be enough liver left behind to meet the demands of the body. indeed, liver failure due to insufficient remnant liver volume is still the principal cause of postoperative death following a major liver resection. the liver receives its main blood supply from two vessels (the portal vein and the hepatic artery). in order to decrease the complications and improve the safety of extensive liver surgery in patients with insufficient future liver remnant volume (flrv), pre-operative embolization (i.e. blockage) of part of the portal vein can be undertaken. this has the effect of inducing growth of the liver on the unaffected side. thus, when the resection is carried out, an increased flrv (of around 12%) reduces post-operative liver failure. an alternative technique is to perform surgical ligation of the portal vein along with splitting of the liver. the diseased portion of liver is left in the body for 7-10 days while the healthy side is induced to grow. during this time, the diseased portion continues to support the body's requirement for liver function and reduces the risk of liver failure. flrv has been shown to increase by around 74% with this technique. however, there are more postoperative complications with the alternative technique such as bile leaks. the aim of this study is to test a new way of splitting the liver so that the increased flrv can be achieved without the increased complication rate.

Eligibility criteria:
inclusion criteria: * age ≥ 18 years * any patient requiring right or extended right hepatectomy with flrv less than 25% on preoperative volumetric study * who performance status 0, 1 or 2 * patient able to comply with protocol requirements and deemed fit for surgical resection * written informed consent exclusion criteria: * inability to give informed consent * pregnancy * who status 3 or 4 * new york heart association classification grade iii or iv

Keywords: liver hypertrophy liver resection liver metastases portal vein ligation portal vein embolization radiofrequency splitting
impact of vitamin a on multiple sclerosis (ms)

Conditions: Relapsing Remitting Multiple Sclerosis

Summary: the aim of this study is the comparison between the effects of supplementation with 25000 iu preformed vitamin a (retinyl palmitate) or placebo for first 6 months and 10000 iu/day for next 6 months on disease activity and progression in patients with multiple sclerosis.

multiple sclerosis (ms) is a chronic inflammatory disease where th1 like responses from myelin-specific cd4+ t cells, as secretion of pro-inflammatory ifnγ, are believed to play a major role in the pathogenesis. the myelin-specific t cells that mediate tissue destruction in ms are believed to become activated outside the central nervous system (cns) in lymphoid tissue and when they cross the blood brain barrier they will re-encounter their antigen. immune deviation is the redirection of the immune response from most often th1 like responses to th2 like responses, even though the opposite can also occur. vitamin a or vitamin a-like analogs known as retinoids, are potent hormonal modifiers of type 1 or type 2 responses but a definitive description of their mechanism(s) of action is lacking. high level dietary vitamin a enhances th2 cytokine production and iga responses, and is likely to decrease th1 cytokine production. retinoic acid(ra) inhibits il12 production in activated macrophages, and ra pretreatment of macrophages reduces ifnγ production and increases il4 production in antigen primed cd4 t cells. supplemental treatment with vitamin a or ra decreases ifnγ and increases il5, il10, and il4 production.

Eligibility criteria:
inclusion criteria: * patients who have used interferon beta in last 3 months * patients with 0-5 edss exclusion criteria: * patients who have diseases which affect on th1/th2 balance such as asthma, active viral infections, and autoimmune diseases, or * patients who have allergy to vitamin a compounds, or * patients who have used vitamin supplements in last 3 months.

Keywords: multiple sclerosis immune system vitamin a (msfc)multiple sclerosis functional composite (edss)expanded disability status scale (mri)magnetic resonance imaging
peer outreach and navigation intervention to increase prep uptake among women at high risk for hiv

Conditions: Pre-exposure Prophylaxis; HIV-1-infection

Summary: this pilot study will assess the feasibility and acceptability of a peer outreach and navigation intervention designed to increase access and promote hiv pre-exposure prophylaxis (prep) uptake among women at high risk for hiv.

women who engage in exchange sex (i.e., sex in exchange for money, drugs, or other services) remain are at substantial risk for hiv infection. (1-6) due to a confluence of social and structural factors, exchange sex is relatively prevalent among women from socially and economically marginalized groups, such as women who are transgender, unstably housed/homeless and/or those who use and/or inject drugs. (1-3, 19-23) the overarching goal of this research is to decrease new hiv infections among women who engage in exchange sex. daily oral hiv pre-exposure prophylaxis (prep) is an innovative method of hiv prevention that women, themselves, can control; as such, prep has the potential to reduce the risk of hiv acquisition among women who engage in exchange sex. therefore, the investigators developed a theory-guided behavioral intervention (prep-up) which utilizes street-based peer outreach and navigation to increase access to prep and promote prep uptake among women involved in exchange sex. specifically, prep-up involves a peer delivering prep education and counseling during street-based outreach followed by offer of a prep care appointment along with peer navigation (e.g., appointment accompaniment and reminders, etc.) for the first several prep care visits. the objective of this study is to assess the feasibility and acceptability of prep-up. to implement prep-up, the investigators will collaborate with an established community-based organization (cbo) in east harlem, ny, which uses street-based peer outreach and navigation to connect individuals to needed health and social services. medical and pharmacy records will be reviewed to assess prep initiation. the investigators will conduct self-report surveys at baseline and at a week 4-12 follow-up visit that will collect data about sexual and drug use risk behaviors, perceived hiv risk, and prep-related knowledge, attitudes, and self-efficacy to assess for temporal changes in these variables. additionally, individual interviews will be conducted post-intervention with a subset of the women as well as the cbo staff and leadership to access acceptability of the intervention.

Eligibility criteria:
inclusion criteria: 1. ≥18 years old 2. fluent in english 3. self-identifies as female or male-to-female transgender (or on the spectrum) exclusion criteria 1) incapable of providing informed consent (i.e., acutely intoxication, active psychosis, etc.)

Keywords: hiv prevention prep peer navigation women
does pregabalin improve post-operative pain after c-section delivery

Conditions: Postoperative Pain

Summary: pregabalin due to its antihyperalgesic effect, has proven its efficacy on neuropathic pain, essentially in nociceptive surgeries. few studies have attempted to identify the utility of pregabalin as a premedication before cesarean delivery. the investigators aimed to determine whether or not pregabalin as premedication improves analgesia post cesarean delivery.

the investigators conducted a controlled, randomised, prospective and double-blind trial. one hundred thirty eight participants were included, with american society of anesthesiologists physical status classification of i to ii, with pregnancies of at least 36 weeks of gestation who were scheduled for elective caesarean delivery under spinal anaesthesia. one hour before induction of anaesthesia participants received a capsule containing sugar placebo (placebo group), pregabalin 150 mg or pregabalin 300 mg. data related to surgical history, pre-existing medical problems, indications for cesarean and peroperative hemodynamic changes were analyzed. the primary outcome was first analgesic request. secondary outcomes included maternal pain scores at rest and during movement, rescue analgesics consumption, sedation, nausea, vomiting, pruritus and apgar scores. all maternal secondary outcome variables were recorded 0, 2, 4, 6, 12, 18, and 24 h after delivery. common side effects linked to pregabalin such as somnolence, blurred or abnormal vision, or fetal distress were collected.

Eligibility criteria:
inclusion criteria: * american society of anesthesiologists class i or ii * single pregnancies at term * under spinal anesthesia exclusion criteria: * conversion to general anesthesia * post partum hemorrhage requiring specific resuscitation * local anesthetic toxicity * violation of the protocol

Keywords: postoperative pain pregabalin cesarean section
quality end-of-life care in nursing homes

Conditions: Quality of End-of-life Care in Nursing Homes

Summary: the purpose of this study is to examine key organizational structures and processes (leadership, teamwork, communication, palliative care) and their impact on the quality of end-of-life care for dying residents and their family members.

as the american population ages, nursing homes are rapidly becoming a dominant site for death. currently, 25% of all deaths occur in nursing homes and 35% of all elders over the age of 85 die in nursing homes. by 2020, 40% of those over 65 will die in nursing homes. nursing home residents die in pain with undue psychosocial suffering. for all permanently placed residents, death is inevitable. nonetheless, how residents die, is not. there have been long standing concerns about the quality of care and quality of life in nursing homes. although there is some evidence that the quality of care for nursing home residents has improved, serious problems continue in areas that potentially affect end-of-life such as dehydration, pressure ulcers, and pain. efforts to improve care have rarely considered the dynamic nature of nursing home structure and process factors, such as staffing levels, leadership of the director of nursing, or communication and teamwork among staff that facilitate or impede the organization's ability to improve care processes. findings from our preliminary studies in nursing homes indicate that organizational structure and process factors make a difference in end-of-life care for residents and their family members. more specifically, staff education, staffing levels, leadership of the director of nursing (don) and administrator, teamwork and communication among direct care staff, and incorporating palliative care clinical practices into day-to-day care had a profound impact on outcomes such as the honoring of end-of-life preferences, symptom management, and satisfaction with care. a more generalizable understanding of key structure and process factors and their relationship to resident care and outcomes at the end-of-life will provide a foundation for future intervention studies aimed at improving care.

Eligibility criteria:
inclusion criteria (nursing homes): * 60 beds or greater exclusion criteria (nursing homes): * less than 60 beds inclusion criteria (nursing home staff): * 19 years of age or older * trained to provide resident care exclusion criteria (nursing homes): * less than 19 years of age * staff on units exclusively medicare or average length of stay less than 30 days inclusion criteria (family member/significant other): * 19 years of age or older * somewhat to very involved in resident's care and decision-making exclusion criteria (family member/significant other): * not involved in resident's care and decision-making * resident was in the nursing home less than 31 days * resident was less than 65 years old