Kornimate/medical-research-clean huggingface dataset:
stepped care to optimize pain care effectiveness

Conditions: Pain

Summary: pain is the most common physical symptom in primary care, accounting for an enormous burden in terms of patient suffering, quality of life, work and social disability, and health care and societal costs. pain is particularly prevalent among veterans. four major barriers to optimal care include underdetection of pain, inadequate initial treatment, failure to monitor adherence and symptom response, and failure to adjust treatment in patients not responding or intolerant of initial therapy. therefore, we propose to conduct the stepped care to optimize pain care effectiveness (scope) study, a randomized clinical effectiveness trial in primary care.

scope will enroll 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity, and randomize them to either the stepped care intervention or usual care control group. the intervention will be based upon the empirically-validated three-component model which in scope will involve collaboration between the primary care physician, a nurse pain care manager, and a supervising physician pain specialist. scope will involve a telemedicine approach coupling automated home-based symptom monitoring with telephone-based nurse care management. the intervention will consist of optimized analgesic management using a stepped care approach to drug selection, symptom monitoring, dose adjustment, and switching or adding medications. all subjects will undergo comprehensive outcome assessment at baseline, 1, 3, 6 and 12 months by interviewers blinded to treatment group. our principal aim is to test whether scope is more effective than usual care in reducing pain as measured by the brief pain inventory. secondarily, we will test the impact on other pain outcomes (e.g., severity, self-efficacy, use of self-management strategies), emotional functioning, health-related quality of life, and treatment satisfaction.

Eligibility criteria:
inclusion criteria: scope will enroll 250 primary care veterans with persistent (3 months or longer) musculoskeletal pain of moderate severity and randomize them to either the stepped care intervention or usual care control group. exclusion criteria: individuals who: * have filed a pain-related disability claim in the last 6 months; * do not speak english; * have moderately severe cognitive impairment; * have schizophrenia, bipolar disorder, or other psychosis; * are actively suicidal; * have current illicit drug use; or * have an anticipated life expectancy of less than 12 months.

Keywords: pain telecare collaborative care
transcranial doppler in mild and moderate traumatic brain injury (tbi)

Conditions: Trauma, Brain

Summary: utility of transcranial doppler as an early predictor of neurological deterioration in mild and moderate traumatic brain injury

transcranial doppler done to tbi patients on admission and follow up was done and secondary neurological deterioration was documented

Eligibility criteria:
inclusion criteria: * patient with traumatic brain injury and glasgow coma scale 9_15 exclusion criteria: unstable or patient on mechanical ventilation, sever brain injury , patient receive anticoagulant

Keywords: trans , cranial, tbi
treating postictal symptoms using ibuprofen and nifedipine

Conditions: Epilepsy; Epilepsies, Partial

Summary: this study will evaluate the effect of ibuprofen or nifedipine on post-seizure hypoperfusion and neurological deficits in patients with epilepsy. one group will receive ibuprofen, another will receive nifedipine, and anther placebo.

immediately following seizures, brain blood flow is significantly reduced for approximately one hour and is located to the brain area where the seizure originated. this may contribute to symptoms that patients experience immediately following seizures and in between seizures. animal studies have shown that that giving anti-inflammatory drugs (e.g., ibuprofen) and blood pressure medications (e.g., nifedipine) prevents the hypoperfusion and behavioural impairments seen in animals immediately following seizures. thus, two classes of inexpensive and well-tolerated drugs - already in clinical use - have been identified that can be tested in humans to prevent the serious consequences that follow seizures. the investigators will study 90 subjects admitted to hospital for epilepsy investigations. the investigators will randomly divide the patients into three treatment groups (30 patients each). patients will receive either placebo, ibuprofen, or nifedipine while in hospital. the effect of each of these treatments on the severity of hypoperfusion and neurological deficits that follows seizures will then be assessed.

Eligibility criteria:
inclusion criteria: * age \> 16 yrs, frequent seizures (\>1 per week) and cognitive ability sufficient to complete neuropsychological testing. exclusion criteria: * multiple seizure onset zones, contraindications to ct or mr imaging, any contraindication to ibuprofen or nifedipine, as well as current or recent (\< 2 months) exposure cox-2 inhibitor or calcium channel blocker.

Keywords: postictal blood flow
a study comparing swallowed flovent and placebo in patients with eosinophilic disorders

Conditions: Eosinophilic Esophagitis

Summary: the purpose of this study is assessing the efficacy of swallowed flovent® vs. placebo for the treatment of eosinophilic esophagitis (ee).


Eligibility criteria:
inclusion criteria: * signed informed consent for study by parent or guardian. assent will be obtained from all minors 11 years of age and older. * age older than or equal to 3 years and younger than or equal to 30 years * endoscopic findings consistent with ee (edema, furrowing, exudates, rings) * histological findings to include proliferation of basal layer and peak eosinophil density ≥24 per high power field (400x). this degree of tissue eosinophilia has been shown to correlate well with poor-responsiveness to acid suppression therapy, suggesting it is a primary eosinophilic disease and not secondary to gerd\[11\]. * allergy evaluation including skin-prick testing with multiple food antigens to insure elimination diet is not indicated. * if allergic to specific foods, option to be on a minimum 3 months of elimination diet without detectable resolution by repeat endoscopy with biopsies demonstrating no improvement to disease. * patients enrolled at cchmc will be under the direct care of dr. putnam or any of the other staff gastroenterologists at this institution who will supervise endoscopic procedures. patients may also be enrolled at institutions other than cchmc, but the diagnosis of ee must be validated by an expert pathologist in ee at cchmc (margaret collins, md). * 20 additional patients without ee will be enrolled as unaffected controls for purposes of comparison with patients with ee. enrollment pool will comprise patients undergoing routine upper endoscopy and having no identifiable pathology. exclusion criteria: * patients with history of poor tolerance to fp, patients unable to cooperate with use of mdi, pregnant females, patients inhaling any corticosteroid for asthma, and patients with concurrent or recent (within 3 months) use of systemic steroids.

Keywords: eosinophilic esophagitis
meropenem versus meropenem plus glycopeptide in patients with febrile neutropenia after allogenic blood stem cell transplantation

Conditions: Allogenic Blood Stem Cell Transplantation; Febrile Neutropenia

Summary: observational study to compare the treatment in neutropenic patients after allogenic blood stem cell transplantation, with meropenem or meropenem plus glycopeptide.

observational study cost-effectivity to compare the treatment in neutropenic patients after allogenic blood stem cell transplantation, with meropenem or meropenem plus glycopeptide. the study will be done in two consecutive cohorts of patients. first cohort: meropenem 1g/8h ev second cohort: meropenem 1g/8h and glycopeptide (vancomycin 1g/12 h or teicoplanin 400 mg/24h)

Eligibility criteria:
inclusion criteria: * age \> 18 years * patients submitted to allogenic transplant * neutropenia: neutrophils account \< 500/mm3 or neutrophils account \< 1000/mm3 with prevision to decrease until 500/mm3 at the next 24-48 h * signs and symptoms to infection * fever: temperature\> 38,3 ºc registered one time, or 38 ºc en two times separated 60 minutes in a period of 12 h. exclusion criteria: * medical history of meropenem or glycopeptides hypersensitivity * renal failure or creatinine in serum \> 2,25 mg/dl or creatinine clearance \< 40 ml * liver insufficiency * childbearing potential or breast feeding period * contraindications to meropenem, vancomycin or teicoplanin

Keywords: febrile neutropenia
effect of a novel sweetener on the ph of dental plaque.

Conditions: Dental Caries

Summary: bacteria that live in the mouth can digest fermentable carbohydrates such as sucrose, fructose, and glucose to make acid. this acid can cause demineralization of the tooth and lead to dental caries or decay. noncariogenic carbohydrate sweeteners, such as sugar alcohols, can be used to replace fermentable carbohydrates in foods, thereby decreasing the risk of caries. in order for a sweetener to be labeled as a noncariogenic sweetener, the fda requires that when present in food, the food should not lower the dental plaque ph below 5.7 either during or up to 30 minutes after consumption. the purpose of this study is to determine whether a new developmental sweetener can be fermented by the bacteria in the mouth and lead to acid production. this will be done by measuring the ph of dental plaque following consumption of the sweetener.


Eligibility criteria:
inclusion criteria: * good general health as evidenced by the medical history. * male or non-pregnant, non-lactating females ages 18 to 75 inclusive. * caries experience in the past year. * more than 5 decayed, missing, or filled teeth demonstrating a high caries experience. * acidogenic plaque as demonstrated by a drop in ph to 5.7 or lower when challenged with sucrose rinse at the screening visit. * willing to abstain from all oral hygiene procedures, brushing and flossing, for 48 hours prior to each test day and drink only water for the four (4) hours prior to each test. * willing to abstain from the use of mouthwashes during the study. exclusion criteria: * presence of orthodontic appliances. * systemic conditions which could influence the ph of the oral cavity (i.e., diabetes, salivary gland disorders etc.). * use of medications that would influence the ph of the oral cavity. specifically, concomitant use of neuroleptics, atropine, chemotherapeutic agents, diuretics, antibiotics, antihistamines, decongestants, and muscle relaxants. also, anticipated need for intermittent use of any medications in these classes or history of use during the 72 hours immediately prior to the screening visit. * patients with aggressive periodontitis, acute necrotizing ulcerative gingivitis, or gross decay at discretion of investigator. * females who by self report are pregnant, lactating, planning to be pregnant during the study period, or women of childbearing potential who are unwilling to commit to the use of a medically approved form of contraception during the study period. * exposure to any investigational agent within the 30 days prior to study visit 1 * individuals requiring prophylactic antibiotics * allergy or intolerance to food ingredients and products including artificial sweeteners.
the acute effects of different stretching techniques

Conditions: Muscle Stretching Exercises; Hamstring Muscles

Summary: the flexibility of the hamstring muscles is very important and many stretching methods are applied on the hamstring muscles for reducing muscle resistance on movement. the objective of this study was to investigate the acute effects of static stretching and the mulligan traction straight leg raise (tslr) technique administered to the hamstring muscles on reducing its resistance to movement by using ultrasound elastography in healthy individuals.

the study will be included 22 healthy male volunteers. static stretching will be administered to the hamstring muscles in the first group and the mulligan tslr technique will be administered on the same muscle in the second group. active knee extension angles of the individuals will be evaluated by a digital goniometer and muscle elasticity will be assessed by ultrasound elastography. acute effects of mulligan tslr on reducing muscle resistance to movement will be evaluated by ultrasound elastography for the first time in this study. in our study, it was planned to examine the acute effects of static stretching and mulligan tslr techniques on reducing muscle resistance to movement by ultrasound elastography in healthy individuals with hamstring shortness.

Eligibility criteria:
inclusion criteria: * participants with short hamstring muscles (active knee extension angle below 70 degree), * without knee, hip, ankle, or waist pathology, * who had not undergone any surgery on the lower extremity were included in the study. exclusion criteria: * individuals with musculoskeletal, neurological, or vestibular problems, * bone pathologies, * joint laxity, * diabetes, * metabolic syndrome, * arthritic or inflammatory problems were excluded.

Keywords: hamstrings stretching exercises ultrasound elastography
evolution of symptoms after sacrospinofixation with posterior isthmic band

Conditions: Apical Prolapse

Summary: prolapse is a condition that can cause disabling pelvic, urinary or sexual function disorders and impaired quality of life. regarding the prolapse of the middle floor, the vaginal sacrospinofixation according to richter is the reference technique for the suspension of the vaginal fundus. but the technique of sacrospinofixation vaginally is not without several difficulties in the short term but also in the medium and long term. recently, anchoring devices have been developed to limit the dissection of the sacrospinous ligament and the operative exposure by the sometimes traumatic valves. the investigating team uses a technical variant in the form of an isthmic posterior strip of light weight and whose arms are sutured to the sacrospinous ligaments. the advantages of this isthmic strip are based on its small size, its very low basis weight and its wide mesh (improvement of tolerance) via a mini-invasive vaginal approach (thus allowing ambulatory care). patient functional discomfort is the main problem related to the presence of a prolapse, therefore, the researchers wish to evaluate patient feelings following the use of this isthmic band. the researchers' hypothesis is that the sacrospinofixation technique with posterior isthmic band bilateral sacrospinous colposuspension (bsc) mesh (agency for medical innovations (ami) laboratory) improves symptoms experienced by patients with mid-level prolapse.


Eligibility criteria:
inclusion criteria: * women over 18 * apical prolapse requiring surgical correction of grade ii or greater in the pelvic organ prolapse quantification (pop-q) classification * patients who wish an intervention because of the discomfort caused by prolapse * sacrospinofixation procedure with posterior isthmic band bilateral sacrospinous colposuspension (bsc) mesh provided * person having expressed his non-opposition exclusion criteria: * apical prolapse of stage \< ii in the pelvic organ prolapse quantification (pop-q) classification, and prolapse without functional discomfort * disorders leading to an unacceptable risk of postoperative complications sought during the interrogation of the patient (disorders of blood coagulation, disorders of the immune system, progressive diseases ....) * reduced mobility of the lower limbs (not allowing positioning for surgery) * pregnancy or any plans for pregnancy during the study period * evolutionary or latent infection * known hypersensitivity to polypropylene * inability to understand the information given * person deprived of liberty, under guardianship.
stitch2 (simplified therapeutic intervention to control hypertension and hypercholesterolemia)

Conditions: Hypertension; Hypercholesterolemia

Summary: the objective of this study is to assess if the implementation of a treatment algorithm including initial treatment with a low dose diuretic/ace-inhibitor or arb combination and subsequently a low dose dhp-ccb/statin combination will improve the management of hypertension/hypercholesterolemia compared to guidelines-base management at family practices.

utilization of fixed dose combination therapy has been advocated as an adherence-enhancing strategy and has been so recommended in the 2007 canadian hypertension education program (chep) recommendations. further, in a previous study (stitch) it was demonstrated that a simplified treatment algorithm utilizing initial therapy with a low dose fixed-dose combination therapy improved blood pressure control in hypertensive patients. however, the effectiveness of either a simplified treatment algorithm or the initial use of fixed dose combination therapies for 2 risk factors in hypertensive dyslipidemic patients has yet to be determined. therefore, the current study is designed to determine whether utilization of a fixed dose combination hypertension/hypercholesterolemia therapy results in improved adherence, patient satisfaction as well as improved rates of reaching target ldl cholesterol and blood pressure.

Eligibility criteria:
inclusion criteria: * male or female subjects 18 years or older * documented diagnoses of hypertension and of hypercholesterolemia or current therapy for these conditions * uncontrolled hypertension (sbp \>140 mmhg or dbp \>90 mmhg) or cholesterol levels above their threshold based on their global atherosclerotic risk profile (based on atp iii assessment) * ability to give written informed consent exclusion criteria: * ischemic heart disease, atrial fibrillation, chronic kidney disease and significant liver disease * currently prescribed 3 or more drugs to control blood pressure * currently prescribed 2 or more drugs to control hypercholesterolemia * participating in other hypertension/hypercholesterolemia studies

Keywords: hypertension hypercholesterolemia family physicians fixed dose combination therapy cluster randomized controlled trial
treatment of patients with nocturia (non-pk study)

Conditions: Nocturia

Summary: the purpose of this study is to evaluate a treatment of nocturia. the hypothesis is that ser120 will decrease the number of nocturic episodes compared to placebo.


Eligibility criteria:
inclusion criteria: * male and female 50 years or older * nocturia of 6 or more months duration averaging 2 episodes or more per night exclusion criteria: * chf * diabetes * diabetes insipidus, renal insufficiency, hepatic insufficiency * incontinence * illness requiring steroids * current or past urologic malignancy * nephrotic syndrome * unexplained pelvic masses * urinary bladder neurological dysfunction * urinary bladder surgery or radiotherapy * sleep apnea * pregnant or breast feeding
a clinical trial of prax-944 in participants with essential tremor

Conditions: Essential Tremor

Summary: this is a 2-part clinical trial to evaluate the efficacy, safety, and tolerability of 40 and 120 mg oral prax-944 compared to placebo in the treatment of adults with essential tremor. part a is designed to study the dose titration from 20 to 40 mg every morning (qam) (ie, 2 weeks with 7 days at each dose level). part b is designed to study the dose titration from 20 to up to 120 mg qam with at least 14 days of dosing at the highest tolerated dose for each participant. blood levels of prax-944 will also be measured throughout the trial and pharmacokinetics will be evaluated.


Eligibility criteria:
inclusion criteria: 1. clinical diagnosis of et consistent with movement disorders society criteria, a duration of et of at least 3 years and with onset before the age of 65 2. tetras upper limb score (ie, sum of bilateral upper limb items 4a, 4b, and 4c) of ≥10 as rated by the investigator at screening and baseline or a score of ≥2 on 2 or more of the following tetras activities of daily living (adl) subscale items: (2) feeding with a spoon, (3) drinking from a glass, (5) dressing, (6) pouring, (9) writing or a score of ≥2 on 1 of the following tetras adl subscale items: (2) feeding with a spoon, (3) drinking from a glass, (5) dressing, (6) pouring, or (9) writing and a score of ≥2 on both of the following tetras adl subscale items: (10) working and (12) social impact 3. if currently receiving any medication for et, is on a stable dose of any of these medications for et for 28 days prior to screening and is willing to maintain stable doses throughout the trial. if receiving primidone for et, is willing and able to discontinue 14 days prior to day 1. 4. body mass index (bmi) between 18 and 40 kg/m2 (inclusive). exclusion criteria: 1. sporadically using a benzodiazepine, sleep medication, or anxiolytic that would confound the assessment of tremor. 2. trauma to the nervous system within 3 months preceding the onset of tremor. 3. history of other medical, neurological or psychiatric condition that may explain or cause tremor, including but not limited to parkinson's disease, dystonia, cerebellar disease, family history of fragile x syndrome, traumatic brain injury, alcohol abuse or withdrawal, benzodiazepine abuse or withdrawal, multiple sclerosis, polyneuropathy, and endocrine states such as hyperthyroidism. 4. prior magnetic resonance-guided focused ultrasound or surgical intervention for et such as deep brain stimulation or thalamotomy. 5. botulinum toxin injection for et in the 6 months prior to screening. 6. unwilling or unable to refrain from alcohol 24 hours before and during clinical trial visits. 7. history of substance use disorder

Keywords: movement disorder benign essential tremor familial tremor hereditary essential tremor movement disorder agents calcium channels, t-type