Kornimate/medical-research-clean huggingface dataset:
using data-driven implementation strategies to improve the quality of cirrhosis care

Conditions: Cirrhosis, Liver

Summary: this veteran affairs (va) quality improvement project aims to understand which data-driven implementation strategies promote evidence based practices that improve high-quality care for veterans with cirrhosis.

nearly 120,000 veterans in care have cirrhosis, or advanced liver disease, from alcohol, hepatitis c, fatty liver disease, or other causes, and this number is rapidly increasing. there are life-saving measures that providers can take to prevent harm from cirrhosis. the three most impactful of these measures include providing access to post-discharge follow-up and screening for liver cancer and esophageal varices (veins that can cause catastrophic bleeding). however, only about one-third of veterans receive care aligned with these three evidence-based practices (ebps). therefore, there is an urgent need to improve access to high-quality care for veterans with this common condition. by focusing on strategies that most successfully encourage implementation of evidence-based practices the investigators can address the urgent need to improve the quality and timeliness of care for veterans with cirrhosis who receive care at va hospitals. this quality improvement intervention seeks to understand which implementation strategies, or discrete activities that are conducted to promote ebp implementation, improve cirrhosis care. the aims of this evaluation are to: (1) empirically determine which combinations of implementation strategies ('data-driven strategies') are associated with the successful implementation of ebps for veterans with cirrhosis, (2) use intervention mapping to operationalize the 'data-driven' implementation strategies developed in the first aim, and (3) evaluate whether applying data-driven implementation strategies increases the use of ebps for cirrhosis, using a hybrid type iii stepped wedge cluster randomized trial. the investigators will measure cirrhosis care at all va sites and use the data from aims 1 and 2 to provide feedback to all sites. the investigators anticipate that more intensive implementation interventions will directly impact 12 of the lowest-performing sites.

Eligibility criteria:
inclusion criteria: * veterans who have cirrhosis, or advanced liver disease, and receive care at va. exclusion criteria: * n/a

Keywords: hepatitis c liver diseases hepatitis virus diseases cirrhosis, liver liver cirrhoses hepatic cirrhoses implementation science strategies evaluation
evaluation of immunization coverage of premature infants leaving chu d'angers according to the recommended regimen during the first 4 months (vacciprem)

Conditions: Premature Birth

Summary: premature children are particularly vulnerable in terms of infection and vaccinated in a specific, reinforced vaccination schedule. however, the beginning of the vaccination of these children is often postponed and the vaccination schedule little followed.concerning the vaccination of premature children, the national recommendations of the high council of public health (hcsp) are different from those of the french experts in pediatric vaccinology. the hcsp recommends a vaccination schedule beginning at the age of 8 weeks postnatal, including, as for full-term infants, two injections at 2-month intervals of vaccine against diphtheria, tetanus, poliomyelitis, haemophilus influenzae b type, whooping cough and hepatitis b. anti-pneumococcal vaccination is recommended at 2, 3 and 4 months of life. the french experts of the infectious pediatric pathology group (gpip) of the french pediatric society recommend a primary vaccination against whooping cough, diphtheria, tetanus, poliomyelitis, haemophilus influenzae b (dtpcoqhib) and hepatitis b at 2, 3 and 4 months for children born before 33 weeks of amenorrhea (wa), and at 2 and 4 months for those born between 33 and 36 weeks + 6 days. primary anti-pneumococcal vaccination is recommended at 2, 3 and 4 months for all children born prematurely before 37wa. on the other hand, the cocooning vaccination of the parents against whooping cough is recommended in case of birth at term as of premature birth. this cocooning strategy has not been sufficiently applied, justifying a recall in 2008 for all adults who have not received pertussis vaccination during the last ten years. the investigators seek to evaluate the follow-up of the recommended vaccination schedule of premature children leaving angers university hospital and the reasons associated with the non-monitoring of the calendar in order to identify possible lines of work to improve immunization compliance.


Eligibility criteria:
inclusion criteria: * child born before 37 weeks of amenorrhea * child hospitalized in resuscitation and neonatalogy unity of angers hospital exclusion criteria: * child transfered to an another unity before to go home * child without french parents

Keywords: vaccin
orthotics, pain & fear of falling

Conditions: Foot Pain; Foot Functionality; Fear of Falling

Summary: to investigate and compare the use of a prefabricated orthotic, with and without a metatarsal pad in decreasing pain and fear of falling in older adults.

it is estimated that around 24% of community-dwelling adults over the age of 45 experience frequent foot pain. falls and fear of falling are also significant issues in this population as both can result in avoidance of activities and decreased physical performance. in cases where fear of falling decreases physical performance and increases activity avoidance, it actually becomes a risk factor for falling itself. previous studies have shown that various types of orthotic insoles improve balance and reduce lower-extremity pain in older adults. however, research which directly compares the effects of two different types of insoles is limited. hence, this randomised control trial will investigate and compare the use of a prefabricated orthotic, with and without a metatarsal pad, in decreasing pain and fear of falling in older adults. this randomised control trial will be conducted over a 6-week period. the study population will include 206 participants who will be randomised into 2 groups (group a and group b). participants in group a will receive an orthotic with a metatarsal pad and participants in group b will receive a neutral orthotic without the metatarsal pad. all participants will be required to continue with usual activities, using the orthotic wherever possible for a period of 6 weeks. participants will be asked to provide data in the form of completed surveys twice, once at the study onset and once at the end.

Eligibility criteria:
inclusion criteria: * a least 60 years of age * live in a community-based setting * are capable of ambulation * have some form of self-identified foot pain exclusion criteria: * compromised skin integrity of the lower limbs * peripheral neuropathy and lack of sensation in the feet. * previous history of foot surgery and * inability to follow the instructions and procedures of the research protocol.
evaluation of oe-mri in patients with h&n cancer

Conditions: Head and Neck Squamous Cell Carcinoma

Summary: assessment of the use of oxygen enhanced mri scanning in a cohort of patients with head and neck squamous cell carcinomas to identify areas of hypoxia with tumours and relate this to treatment outcomes.

oxygen-enhanced mri (oe-mri) is a technique being actively investigated for imaging hypoxia within cancer tissues. preliminary clinical data demonstrates the feasibility of using this methodology to study patients with head and neck squamous cell carcinoma (hnscc). the investigators wish to investigate using this methodology to identify hypoxic subvolumes within hnscc that may have greater resistance to standard radiotherapy treatment and investigate the association of such hypoxic regions with treatment outcomes.

Eligibility criteria:
inclusion criteria: non-patient volunteer inclusion criteria: * age 18 years and above * signed written informed consent patient inclusion criteria: * histologically proven or strong clinical suspicion of squamous cell carcinoma of the head and neck * suitable for undergoing radical radiotherapy or chemoradiotherapy according to local protocols within the head and neck cancer mdt * age 18 years and above * adequate physical fitness (who performance status 0 to 2) * signed written informed consent exclusion criteria: non-patient volunteer exclusion criteria: * contraindications to mri scans as identified following completion of the nottingham university hospitals nhs trust (nuh) standard mr safety screening protocol * severe chronic obstructive pulmonary disease (copd) who are at risk of type 2 respiratory failure or require supplemental oxygen * volunteers who are pregnant as identified through the nuh standard mr safety screening protocol patient exclusion criteria: * poor physical fitness (who performance status greater than 2) * contraindications to mri scans as identified following completion of the nuh standard mr safety screening protocol * severe chronic obstructive pulmonary disease (copd) who are at risk of type 2 respiratory failure or require supplemental oxygen * patients who are pregnant or breast-feeding (due to iv contrast use in the routine clinical scan) as identified through the nuh standard mr safety screening protocol

Keywords: oxygen enhanced mri
optical treatment of migraines using the avulux™ optical filter in the form of spectacle lenses.

Conditions: Migraine

Summary: the primary objective of this study is to evaluate the efficacy of the avulux device in reducing the impact of migraine headaches as measured by improvement in headache impact test (hit-6tm) scores at three weeks when compared to a control/sham device.

avulux™ is intended to decrease the impact of headache and migraine on normal daily life and the ability to function, and reduce the frequency and severity of headache, in adult patients diagnosed with episodic migraine headache or chronic migraine. avulux™ consists of a pair of optical filters in the form of spectacle lenses, provided in standard spectacle frames or as clip-on units, coated with a thin film that effectively blocks light at specified wavelength ranges while minimizing distortion of the visible spectrum. the optical filters block a portion of the optical spectrum that is suspected to stimulate photophobic responses that trigger some, and exacerbate most, migraines.

Eligibility criteria:
inclusion criteria: 1. patient is 18 years or older 2. patient is willing and able to provide written informed consent 3. patient is willing and able to complete all scheduled study visits 4. diagnosis of migraine, based on the following primary headache characteristics: 1. at least 5 attacks fulfilling criteria b-d: 2. headache attacks lasting 4-72 hours (untreated or unsuccessfully treated) 3. headache has at least two of the following characteristics: * unilateral location * pulsating quality * moderate or severe pain intensity * aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) 4. during headache at least one of the following: * nausea and/or vomiting * photophobia and phonophobia 5. not attributed to another disorder exclusion criteria: 1. patients with other light sensitive conditions, such as iritis. 2. patients who have less than 4 headache days per month 3. patients who have chronic daily headaches. 4. patients who have had any change in their migraine treatment within the 4 weeks prior to the trial onset.
daoib combined with tdcs for early-phase dementia

Conditions: Transcranial Direct Current Stimulation; Dementia

Summary: this is a 24-week randomized, double-blind, placebo-controlled trial. we will enroll patients with amci or mild ad. all patients will receive 2 weeks of tdcs (5 sessions per week, 10 sessions in total) during the first 2 weeks of the study, and will also be allocated randomly to either of 2 treatment groups for 24 weeks: (1) daoib group; (2) placebo group. we will assess the patients every 8 weeks during the treatment period (weeks 0, 8, 16, and 24). we hypothesize that augmentation with daoib will yield better effect than tdcs alone in improving the cognitive function, global functioning and quality of life in patients with amci or mild ad.


Eligibility criteria:
inclusion criteria: * clinical diagnosis of alzheimer's disease or mild cognitive impairment * mmse between 10-26 * cdr 1 or 0.5 exclusion criteria: * hachinski ischemic score \> 4 * substance abuse/dependence * parkinson disease, epilepsy, dementia with psychotic features * major depressive disorder * major physical illnesses * severe visual or hearing impairment
teams r34 #3: team communication training for pediatric depression screening

Conditions: Depression; Children

Summary: pediatric depression is a global concern that has fueled efforts for enhanced detection and treatment engagement. while many health systems have implemented components of depression screening protocols, there is limited evidence of effective follow-up for pediatric depression. a key barrier to prompt service linkage is timely team communication and coordination between clinicians and staff across service areas. this project aims to refine and test a team communication training implementation strategy to improve implementation of an existing pediatric depression screening protocol in a large pediatric healthcare system. the implementation strategy will target team mechanisms at the organizational-level and provider-level. team communication training is hypothesized to lead to improved, efficient, and effective decision-making to increase the frequency of depression screening and timely service linkage. findings are expected to yield better understanding of how to optimize team communication activities and patterns in the pediatric depression screening to treatment cascade. this should also culminate in improved patient engagement and outcomes, which are critical to address the youth mental health crisis.

aim 1: use mixed methods to refine a team communication training implementation strategy to improve implementation of an existing health system universal depression screening protocol (clinical intervention) aim 2: use a two-arm hybrid type 3 implementation-effectiveness pilot trial to assess the initial effectiveness of the team communication training strategy on implementation of the depression screening protocol. aim 3: use mixed methods to assess team/organizational (intra-organizational alignment, implementation climate) and team member/provider (communication, coordination, psychological safety, shared cognitions) mechanisms of the team communication training implementation strategy and a novel application of natural language processing methods.

Eligibility criteria:
inclusion criteria: inclusion criteria for all groups of participants are intentionally broad to ensure valid analyses: 1. employed as medical staff and/or a medical or health provider at rady children's hospital san diego. 2. experience providing or supporting care to children and adolescents with mental health care needs. exclusion criteria: any individual that does not meet the inclusion criteria will be excluded from study participation.

Keywords: depression screening team communication team effectiveness
supporting the health of adults undergoing orthopedic surgery during the recovery period

Conditions: Delirium

Summary: delirium (acute confusion) is a highly prevalent condition among hospitalized elders with substantial morbidity within the hospital and beyond. particular patient populations are at high risk for poor outcomes after an episode of delirium. patients with hip and other long bone fractures are at increased risk of developing delirium (acute confusion) which impedes functional recovery. this is a pilot study to test the tolerability and efficacy of donepezil, a cholinesterase inhibitor medication used commonly in persons with dementia, for the prevention of new or worsening delirium in aged hip and other long-bone fracture patients. additional purposes involve gathering a small amount of patients' serum to better understand the pathophysiology of delirium in this population. the purposes of this pilot study are to determine: 1) the safety and tolerability a cholinesterase inhibitor medication) in aged hip and long bone fracture patients, 2) to obtain estimates of subject accrual and preliminary estimates of effect size on the development of new delirium symptoms to allow for planning of a larger, definitive trial, 3) to better understand the underlying causes of delirium by examining whether a measure of blood anticholinergic activity relates to the incidence and persistence of delirium symptoms, and 4) to explore the interaction between anticholinergic activity, donepezil therapy, and delirium symptoms.


Eligibility criteria:
inclusion criteria: * hip or other long bone fracture undergoing operative repair * age of 70 years or older * the ability to communicate effectively in english (including adequate hearing) * residence within a 50 mile radius of the bidmc * life expectancy 6 months or greater * not currently on cholinesterase inhibitor therapy * not with known hypersensitivity to cholinesterase inhibitors * not a previous study participant or refusal exclusion criteria: * patients with sick sinus syndrome or greater than 1st degree av block without a pacemaker * patients with a pathologic fracture due to metastatic cancer * patients with advanced dementia or total functional dependence.

Keywords: delirium postoperative confusion hip fracture long bone fracture
peer support for post intensive care syndrome self-management

Conditions: Critical Illness; Sepsis; Shock, Septic; Shock; Respiratory Failure; Respiratory Distress Syndrome, Adult; Shock, Hypovolemic; Chronic Disease

Summary: a prospective, 2-arm, single-blind, randomized controlled clinical feasibility trial design is planned. forty cci survivors will be randomized (1:1) to either the ps-pics (peer support) intervention or usual care (control) group.

randomized participants will complete 4 study assessments: 1) baseline data at hospital discharge; 2) baseline data post-hospital discharge and before the start of the weekly peer support intervention; 3) post-intervention at the conclusion of the 90-day weekly peer support intervention; and 4) follow-up at 6-months post-hospital discharge. the weekly peer support intervention will be delivered by a small pool of critical illness survivor peers (mentors) recruited from the study site from previous research. peer support mentors will be trained in peer support and mi, and will deliver 3 months of weekly mi interventions (phone-based) to cci survivors randomized to the intervention group. participants randomized to the usual care group will not receive the weekly peer support/mi intervention but will receive the usual discharge planning services currently provided at hospital discharge. participants in both groups will be contacted by the research team for 4 telephone-based assessments. the design will allow us to test the feasibility and potential impact of the ps-pics intervention on social relationship measures, depression and self-management. data collection and analyses are guided by the individual and family self-management theory. the individual and family self-management theory illustrates the interaction of the process of self-management with risk and protective factors, and short-term and long-term outcomes.

Eligibility criteria:
inclusion criteria: * age18 years or older * icu length of stay 8 days or longer * expected to survive hospitalization with a discharge destination to home within 28 days of hospital discharge * diagnosed with 2 or more chronic conditions. exclusion criteria: * death prior to hospital discharge * enrollment in hospice services at the time of hospital discharge * non-communicative * no access to telephone * incarcerated

Keywords: post-intensive care syndrome (pics) chronic critical illness
monitoring brain waves in response to visual and/or auditory stimulation in parkinson's disease patients

Conditions: Parkinson's Disease

Summary: voltage fluctuation as a result of brain activity will be recorded into the computer using an eeg device.

patients with parkinson's disease may have gait disturbances including freezing of gait. visual and auditory stimuli may improve gait. investigators will analyze brain wave during walking while giving the subject different stimuli. the voltage fluctuation (in hundreds of microvolts) will be recorded using the eeg cap and amplifier into a computer.

Eligibility criteria:
inclusion criteria: • patients with parkinson's disease that are ambulatory and can sign a written informed consent exclusion criteria: * patients with parkinson's disease who are not ambulatory * patients with dementia * patients that are blind * patients that have severe hearing impairment
the "power 15 study": safety study of inhalation of ventavis with the power disc-15 setting

Conditions: Pulmonary Hypertension

Summary: a comparison of safety and inhalation times of ventavis (iloprost) inhalation solution delivered by i-neb utilizing power disc-6 and power disc-15 "power 15 study"


Eligibility criteria:
inclusion criteria: * male or female, aged 18-85 years * have a current diagnosis of symptomatic pulmonary arterial hypertension (pah) classified by one of the following: a) idiopathic pulmonary arterial hypertension (ipah) or familial pulmonary arterial hypertension (fpah); b) pah associated with one of the following connective tissue diseases and mild or no lung parenchymal disease: scleroderma spectrum of disease, systemic lupus erythematosis, or mixed connective tissue disease, c) pah associated with repaired atrial septal defect (asd), ventricular septal defect (vsd), or patent ductus arteriosis (pda) ≥ 1 year post-operative from screening, d) pah associated with human immunodeficiency virus (hiv), or e) pah associated with the use of anorexigens (e.g. fenfluramine-phentermine) * on a stable and well tolerated dose regimen of ventavis (5 μg per dose) for at least 4 weeks prior to the screening visit, using the i-neb aad system equipped with power disc-6 exclusion criteria: * receipt of any prostacyclin or prostacyclin analogue other than ventavis within the 12 weeks preceding the screening visit * receipt of atrial septostomy within the 6 months preceding screening * history of left-sided heart disease * clinically relevant obstructive lung disease * chronic renal or liver disease * uncontrolled systemic hypertension or hypotension * cerebrovascular event within the 6 months preceding screening

Keywords: pah iloprost ventavis pulmonary arterial hypertension actelion pharmaceuticals cotherix