Kornimate/medical-research-clean huggingface dataset:
diagnostic reasoning with customized gpt-4 model

Conditions: Pathologic Processes; Disease

Summary: this study will assess the impact of immediate access to a customized version of gpt-4, a large language model, on performance in case-based diagnostic reasoning tasks. specifically, it will compare this approach to a two-step process where participants first use traditional diagnostic decision support tools to support their diagnostic reasoning before gaining access to the customized gpt-4 model.

artificial intelligence (ai) technologies, particularly advanced large language models like openai's chatgpt, have the potential to enhance medical decision-making. while chatgpt-4 was not specifically designed for medical applications, it has demonstrated promise in various healthcare contexts, including medical note-writing, addressing patient inquiries, and facilitating medical consultations. however, its impact on clinicians' diagnostic reasoning remains largely unknown. clinical reasoning is a complex process that involves pattern recognition, knowledge application, and probabilistic reasoning. integrating ai tools like chatgpt-4 into physician workflows could help reduce clinician workload and decrease the likelihood of missed diagnoses. however, chatgpt-4 was neither developed nor validated for diagnostic reasoning, and it may produce misleading information, including plausible but incorrect conclusions that could misguide clinicians. if not used appropriately, it may fail to improve-and could even hinder-clinical decision-making. therefore, it is essential to study how clinicians use large language models to support clinical reasoning before integrating them into routine patient care. this study will examine how immediate access to a customized version of chatgpt-4 impacts performance on case-based diagnostic reasoning tasks, compared to a stepwise approach. in the stepwise approach, participants will first use traditional diagnostic decision support tools to support their case reasoning before interacting with a customized chatgpt-4 model, at which point they will have the opportunity to revise their initial answers. participants will be randomized into different study arms and will respond to diagnostic cases by providing three differential diagnoses, along with supporting and opposing findings for each. they will also identify their top diagnosis and propose next diagnostic steps. independent reviewers, blinded to treatment assignment, will evaluate their responses.

Eligibility criteria:
inclusion criteria: * participants must be licensed physicians and have completed at least post-graduate year 1 (pgy1) of medical training. * training in internal medicine, family medicine, or emergency medicine. exclusion criteria: * not currently practicing clinically. * participated in one of our previous studies that used the same six diagnostic cases.

Keywords: computer-assisted diagnosis large language models clinical reasoning
the effect of virtual reality application on pain and anxiety level in stone crushing with shock waves: a randomized controlled trial

Conditions: Shockwave Lithotripsy; Pain; Anxiety; Virtual Reality; Nursing

Summary: this research was planned as a randomized controlled experimental study in order to evaluate the effect of virtual reality application on pain and anxiety caused by the procedure during stone crushing process (eswl) with shock waves.

although urinary tract stones often remain asymptomatic at first, they can cause pain, hematuria, infection, decreased kidney function and kidney failure over time and can seriously affect the quality of life of people if not treated with appropriate methods. extracorporeal shockwave lithotripsy (eswl) has been practiced as a treatment method to remove urolithiasis from the kidneys and ureters since the early 1980s. the process is based on the principle that the sound waves obtained from a source other than the body are turned into shock waves and sent to the stone and the stone is broken down. relief of pain and anxiety during eswl; in addition to maintaining patient comfort and satisfaction, it is extremely important to reduce the movement of the patient during the procedure and to facilitate the imaging and targeting of the stone. diverting attention is one of the most preferred methods to reduce the pain that occurs in patients while the diagnosis and treatment procedures are carried out. this method; it is a method that focuses the attention of patients on a different point and keeps the symptoms they experience under control and reduces them. strategies to divert attention include the application of virtual reality, which has been one of the methods that have attracted attention in recent years. the individual focuses his attention on the image by moving away from real life with the glasses connected to the device worn on his head and the sounds coming from the headphones and feels as if he is in a different world thanks to these glasses. in practice, it is aimed to reduce the patient's pain, discomfort and anxiety by drawing the patient's attention from pain and painful treatment procedures to a fun virtual environment.

Eligibility criteria:
inclusion criteria: * applying to the stone crushing unit for the first time * body mass index below 30 * those aged 18-65 who are literate and have no vision or hearing problems * have not taken any analgesics other than the analgesic routinely administered before the procedure exclusion criteria: * untreated urinary tract infections * severe skeletal system malformations that prevent focusing on the stone * severe obesity * arterial aneurysm near the stone * patients with anatomical obstruction conditions in the distal part of the stone
the efficacy of chlorhexidine gluconate gel dressing in preventing surgical drain site infection

Conditions: Drain Site Complication

Summary: this study aims to evaluate if the application of chlorhexidine gluconate dressing on surgical drain sites can decrease drain site infection vs the standard of care (dry, sterile gauze).


Eligibility criteria:
inclusion criteria: 1. age 18 years or older 2. receiving two surgical drains during one of the following types of operative procedures: breast reduction, breast augmentation, abdominoplasty, panniculectomy, brachioplasty, thigh lift, lower body lift, belt lipectomy, back latissimus dorsi reconstruction, bilateral breast reconstruction, or bilateral chest reconstruction. these drains may be in fairly close proximity to one another but they must emerge from different areas of the skin, that way they can be considered to be located in two different sites. exclusion criteria: 1. concurrent implantation of any foreign objects, such as a breast implant 2. patients who receive postoperative antibiotics without a suspected or identified site of infection 3. subjects allergic to or hypersensitive to chlorhexidine gluconate. before enrolling in the study, patients will be asked about previous exposure to chlorhexidine products and about their allergies. those with potential allergic or adverse reaction to chlorhexidine will be excluded from the study.

Keywords: tegaderm
pprom registry (preterm premature rupture of membranes)

Conditions: Fetal Membranes, Premature Rupture; Preterm Premature Rupture of the Membranes; Oligohydramnios; Premature Birth

Summary: preterm premature rupture of membranes (pprom) before 37 weeks of pregnancy is responsible for 40% of preterm births in the united states. the pprom registry aims to identify possible causes of pprom, evaluate trends in expectant management, measure maternal and fetal care, and to review short term and long term outcomes of affected pregnancies and births.

detailed description preterm premature rupture of membranes (pprom) is a factor in 40% of preterm births. the earlier in pregnancy pprom occurs, the greater the potential latency period. threats to the pregnancy include placental abruption, umbilical cord prolapse, infection, and insufficient pulmonary development, and preterm delivery. management of pprom may include immediate delivery, induction, or expectant management. it is still unclear what is considered best practice for the course of treatment in pprom pregnancies and post- delivery care of pprom babies in neonatal intensive care units (nicu), as well as the long term outcomes of pprom survivors. unfortunately, there are few recent studies available for review and those that exist often do not reflect the current treatments or innovations that have taken place, especially in neonatal care. many of the studies available focusing on pprom have very small sample sizes, as well as very short follow-up post-delivery, resulting in a wide range of reported outcomes, especially regarding the morbidity and mortality associated with pprom. the pprom registry is the first of its kind and will provide a large cohort of data for study. the purpose of this registry is to better understand pregnancies and births impacted by pprom. this includes how pprom is managed in pregnancy and in how pprom neonates are cared for in the nicu; identifying trends in expectant management, and to detect short term and long term outcomes of those affected.

Eligibility criteria:
inclusion criteria: * women diagnosed with preterm premature rupture of membranes (pprom) prior to 37 weeks of pregnancy exclusion criteria: * those without a clinical diagnosis or confirmation of pprom in pregnancy * diagnosis of prom beyond 37 weeks of pregnancy

Keywords: pprom
enhancing social connections among rural community members with disordered eating

Conditions: Eating Disorders (Excluding Anorexia Nervosa); Disordered Eating; Disordered Eating Behaviors; Eating Disorder Symptom

Summary: this study is about testing a short program that uses social support to help people with disordered eating. the goal is to see if this program can help people build better habits and feel better about eating while reducing harmful symptoms. in the long run, this project wants to make it easier for people with eating problems to get help and recover, especially for those in rural areas or other groups who don't often get the care they need. participants will complete self-report measures online, and complete a digital single-session program.


Eligibility criteria:
inclusion criteria: * adult (18+ years old) * disordered eating * live in the united states of america exclusion criteria: * bmi below 18.5

Keywords: eating disorder disordered eating
5-ht3 receptor antagonist (ramosetron) vs loperamide for the treatment of low anterior resection syndrome(ralars)

Conditions: LARS - Low Anterior Resection Syndrome

Summary: safety \& efficacy of 5-ht3 receptor antagonist (ramosetron) versus loperamide for the treatment of low anterior resection syndrome (rallars): multicenter randomized controlled trial


Eligibility criteria:
inclusion criteria: * mid and low rectal cancer (av\<15cm) * stage ii, iii, preop long-course ccrt, then ileostomy repair * about 1\~12 months after operation (no stomy) * about 1\~6 months after ileostomy repair * major lars exclusion criteria: * recurred rectal cancer * stage iv * ibd * uncontrolled preoperative fecal incontinence or constipation
mindfulness: a novel approach for the management of diabetes-related distress

Conditions: Emotional Distress; Type 2 Diabetes; Stress

Summary: the purpose of this study is to evaluate the impact of stress reduction on physiological and psychological variables in adults with type 2 diabetes (t2dm) who have moderate to severe levels of diabetes-related emotional distress. subjects will be randomized to one of two interventions. we will evaluate the impact of the interventions on glucose metabolism, blood pressure, diabetes-related distress and quality of life. additionally, we will investigate the role of neuroendocrine dysfunction, systemic inflammation and diabetes self-care practices as mediators in the relationship between increased stress, adverse glucose metabolism and elevated blood pressure in those subjects with t2dm.


Eligibility criteria:
inclusion criteria: 1. age \> 30 years 2. male or female 3. duration of diabetes 1-15 years from time of initial diagnosis 4. diagnosis of t2dm made/confirmed by physician 5. completed diabetes education in the past 6. most recent hga1c \>7%; measurement must be within the past 6 months either in physicians office or at the thriving with diabetes boot camp class 7. treatment for diabetes must include any or all of the following modalities: diet, exercise, oral medications, insulin or other injectable diabetic medication 8. score \> 30 on the problem area in diabetes (paid) questionnaire 9. able to use a glucometer for self-monitoring of blood glucose values 10. most recent clinic blood pressure less than 180/95 exclusion criteria: 1. history of ketoacidosis 2. age at diagnosis of t2dm \< 30 years 3. score \>15 on the phq-9 4. previous training in relaxation or meditation techniques 5. current practice of yoga, tai chi or any other mind-body movement for \> 60 minutes per week 6. current use of a psychoactive drug for less than 3 months or not yet on a stable dose 7. inability to participate fully or behave appropriately in the group treatment setting, as observed by baseline acknowledgement of substance abuse, psychotic episode(s), psychiatric hospitalization or history of self- harm within the past 2 years, or current suicidal or homicidal ideation 8. inability to complete standardized instruments because of a cognitive deficit or language barrier 9. current use or use within the past 3 months of oral glucocorticoids, excluding intraocular, topical or inhaled preparations 10. history of inflammatory diseases including rheumatoid arthritis and inflammatory bowel disease 11. use of immune modulating agents 12. night shift work or other type of schedule in which sleep wake cycle is disrupted 13. women who consume \> 7 alcoholic drinks per week and men who consume \> 14 drinks per week 14. current use or history of daily tobacco use within the past 1 year 15. end stage renal failure on dialysis 16. pregnancy or post partum \<3 months 17. subjects with known secondary causes of hypertension including renal artery stenosis, pheochromocytoma, coarctation of aorta, hyperaldosteronemia 18. non-dominant arm circumference \> 46cm 19. unwilling to accept randomization
collecting patient-reported experiences with radiation dermatitis in breast cancer patients undergoing radiotherapy

Conditions: Breast Carcinoma

Summary: this study evaluates patient-reported experiences of radiation dermatitis in patients with breast cancer undergoing radiotherapy.


Eligibility criteria:
inclusion criteria: * adults ≥ 18 * patients diagnosed with breast cancer * currently undergoing or recently completed radiotherapy * willing to provide verbal/oral consent exclusion criteria: * persons \< 18 * inability to provide verbal consent * non-english speakers (unless translations are available)
efficacy 2 part study of identification of keloid biomarkers and effect of qax576 on keloid recurrence

Conditions: Keloids

Summary: this is a 2-part study. in the first part (part i, 8 subjects), biopsies will be obtained from the resection site after keloid shaving and two weeks following resection to assess and select biomarkers to determine the biologic effects that occur in shaved keloids. no drug will be administered. in part ii (32 patients) will be randomized to receive qax576 or placebo. an initial drug infusion will be followed by shave removal of keloids 6 - 8 days later followed by two additional drug infusions 4 weeks apart. two weeks following resection, punch biopsies will be performed to assess biomarker responses. patients will be followed-up for 52 weeks after first drug administration to assess keloid recurrence (clinically and by 3d imaging), and by physician's and patient's cosmetic assessments, and safety.


Eligibility criteria:
inclusion criteria: - patients with two or more keloids on the trunk, upper extremities or thighs. the keloids must meet specified size criteria and have been present for greater than or equal to 1 year, been stable in size and symptoms for at least 6 months. exclusion criteria: * use of other investigational drugs at the time of enrollment, or history of hypersensitivity to any of the study drugs or to drugs of similar chemical classes (e.g. lidocaine, epinephrine, and topical antibiotics as bacitracin and neomycin). * history of repeated recurrence of keloid after prior surgical removal (4-5 times removed). * keloids near the hands, joints, and anogenital areas as recurrence might cause significant problems. * any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or excretion of drugs, or which may jeopardize the patient in case of participation in the study other protocol-defined inclusion/exclusion criteria may apply.

Keywords: keloids recurrence
a randomized controlled trial of eculizumab in aqp4 antibody-positive participants with nmo (prevent study)

Conditions: Neuromyelitis Optica; Neuromyelitis Optica Spectrum Disorder

Summary: the objectives of this time-to-event study were to assess the efficacy and safety of eculizumab as compared with placebo in participants with neuromyelitis optica spectrum disorder (nmosd) who were anti-aquaporin-4 (aqp4) antibody-positive.


Eligibility criteria:
key inclusion criteria: 1. male or female participants ≥ 18 years old. 2. diagnosis of nmo or nmosd. 3. aqp4 antibody seropositive. 4. historical relapse of at least 2 relapses in the last 12 months or 3 relapses in the last 24 months with at least 1 relapse in the 12 months prior to the screening. 5. expanded disability status scale score ≤ 7. 6. if a participant entered the study receiving immunosuppressive therapy (ist) for relapse prevention, the participant must have been on a stable maintenance dose of ist(s), as defined by the treating physician, prior to screening and must have remained on that dose for the duration of the study, unless the participant experienced a relapse. 7. female participants of childbearing potential were to have a negative pregnancy test (serum human chorionic gonadotropin). participants were required to practice an effective, reliable, and medically approved contraceptive regimen during the study and for up to 5 months following discontinuation of treatment. key exclusion criteria: 1. use of rituximab within 3 months prior to screening. 2. use of mitoxantrone within 3 months prior to screening. 3. use of intravenous immunoglobulin within 3 weeks prior to screening.

Keywords: neuromyelitis optica neuromyelitis optica spectrum disorder devic's disease, transverse myelitis optic neuritis relapse eculizumab soliris nmo-igg cns autoimmune disorders demyelinating disorders nmo nmosd
ch14.18 pharmacokinetic study in high-risk neuroblastoma

Conditions: Neuroblastoma

Summary: the purpose of this study is to compare the pharmacokinetics (blood levels) and safety of chimeric (ch) 14.18 manufactured by two independent drug makers (united therapeutics \[utc\] or the national cancer institute \[nci\]).

this is a multi-center, randomized, open-label, two-sequence, cross-over study for eligible subjects with high-risk neuroblastoma to assess the comparability of ch14.18 manufactured with utc drug product and ch14.18 manufactured with nci drug product. subjects will be randomly allocated to receive ch14.18 manufactured by utc or nci during courses 1 and 2 followed by ch14.18 manufactured by other manufacturer (utc or nci) during courses 3, 4, and 5.

Eligibility criteria:
inclusion criteria: * diagnosis of high-risk neuroblastoma * 8 years of age or younger at diagnosis of high-risk neuroblastoma * patients must have completed therapy including intensive induction followed by autologous stem cell transplantation (asct) and radiotherapy \* radiotherapy may be waived for patients who either have small adrenal masses which are completely resected up front, or who never have an identifiable primary tumor * must meet the international neuroblastoma response criteria (inrc) for cr, vgpr, or pr for primary site, soft tissue metastases, and bone metastases and must also meet the protocol specified criteria for bone marrow response as follows: \* no more than 10% tumor (of total nucleated cellular content) seen on any specimen from a bilateral bone marrow aspirate/biopsy * patient who have no tumor seen on the prior bone marrow, and then have ≤ 10% tumor on any of the bilateral marrow aspirate/biopsy specimens done at pre-asct and/or pre-enrollment evaluation will also be eligible * no more than 12 months from starting the first induction chemotherapy after diagnosis to the date of asct \* for patients who became high-risk neuroblastoma after initial non-high risk disease, the 12 months period should start from the date of induction therapy for high-risk neuroblastoma to the date of asct * no progressive disease at time of registration except for protocol-specified bone marrow response * adequate hematological, renal, hepatic, pulmonary and cardiac function * cns toxicity \< grade 2 exclusion criteria: * prior anti-gd2 antibody therapy * prior vaccine therapy for neuroblastoma * concurrent anti-cancer or immunosuppressive therapy
genetic and neural factors in alcohol-related cognition

Conditions: Alcohol Abuse

Summary: this study is about how genetic and brain factors impact cognitive processes and behavior after alcohol consumption. participation in this project will contribute to a better understanding of biological factors that influence alcohol misuse. this study will be completed in two laboratory visits.

some study details are purposely omitted at this time to preserve scientific integrity. full details will be posted at the conclusion of the study.

Eligibility criteria:
inclusion criteria: * english speaking * no current or regular use of prescribed or illicit psychoactive drugs * free of major health problems (e.g., diabetes, hiv, parkinson's disease) * free of a neurological or psychiatric disorders * no current drug abuse (e.g., recreational drug use). * right hand dominant * free of claustrophobia * free of pregnancy or suspected pregnancy * absent mri risk factors (e.g., implanted medical device, body mass index \> 35, braces) * free of medical conditions that render individuals with overly sensitive hearing * non-naive to alcohol consumption exclusion criteria: * not meeting inclusion criteria listed above
an observational study of dosage patterns in routine clinical practice in patients with rheumatoid arthritis (act-life)

Conditions: Rheumatoid Arthritis

Summary: this observational study will evaluate the dosage patterns, safety and efficacy of roactemra/actemra (tocilizumab) in clinical practice in patients with moderate to severe rheumatoid arthritis who have not responded or are intolerant to at least one disease-modifying antirheumatic drug (dmard) or tnf inhibitor. data will be collected from each patients for 12 months.


Eligibility criteria:
inclusion criteria: * adult patients, \>/= 18 years of age * moderate to severe rheumatoid arthritis (ra) of at least 6 months duration * non-responder or intolerant to at least one dmard or tnf inhibitor treatment * initiated on treatment with roactemra according to summary of product characteristics (spc) indications exclusion criteria: * history of autoimmune disease or of any joint inflammatory disease other than ra * pregnant or lactating women * patients who have started roactemra treatment in a clinical trial or for compassionate use * treatment with any investigational drug in the previous 4 weeks (or at least 5 times the half-life of the drug)