Kornimate/medical-research-clean huggingface dataset:
level of burn out of surgical residents working in all hospitals of lahore

Conditions: Burn Out Syndrome

Summary: the term burnout was coined by psychologist herbert freudenberger in 1974 in an article entitled "staff burnout" in which he discussed job dissatisfaction precipitated by work-related stress. a broadly applicable description defines burnout as a state of mental and physical exhaustion related to work or care giving activities. a long-standing conceptual and operational definition characterized burnout as a triad of emotional exhaustion (emotional over extension and exhaustion), depersonalization (negative, callous, and detached responses to others), and reduced personal accomplishment (feelings of competence and achievement in one's work) in the world health organization international classification of diseases, 10th revision, burnout is defined as a "state of vital exhaustion." although no specific diagnosis of burnout is mentioned in the diagnostic and statistical manual of mental disorders, burnout is a clear syndrome with significant consequences. burnout in health care professionals has gained significant attention over the last several years. given the intense emotional demands of the work environment, clinicians are particularly susceptible to developing burnout above and beyond usual workplace stress. residency training, in particular, can cause a significant degree of burnout, leading to interference with individuals' ability to establish rapport, sort through diagnostic dilemmas, and work though complex treatment decision making. overall, burnout is associated with a variety of negative consequences including depression, risk of medical errors, and negative effects on patient safety. the goal of this review is to provide medical educators and leaders with an overview of the existing factors that contribute to burnout, the impact of burnout, inter specialty variation, and suggestions for interventions to decrease burnout.


Eligibility criteria:
inclusion criteria: * general surgical resident exclusion criteria: * residents of all other specialties * all the general surgical consultants
platelet inhibitory effect of clopidogrel in patients treated with omeprazole, pantoprazole, or famotidine

Conditions: Coronary Heart Disease; GI Bleeding

Summary: current guidelines recommend the addition of proton pump inhibitors (ppi) to patients taking double anti-platelet therapy (aspirin and clopidogrel) to prevent upper gi bleeding1. many post percutaneous coronary intervention (pci) patients are treated with dual anti-platelet medications as well as ppi to prevent upper gi bleeding. recently, it was shown that ppi interact with the p450 system in the liver and reduce the platelet inhibitory effect of clopidogrel2,3. clopidogrel is activated by cyp2c19, which also metabolizes ppi4. furthermore, a recent article showed increased mortality in patients taking ppi and clopidogrel compared with patients taking clopidogrel without ppi protection5. the degree of reduction in the platelet inhibitory properties of clopidogrel might vary among the different ppi4. the use of ppi for gi protection in patients treated with dual anti-platelet therapy is not based on randomized trials, but rather on expert opinion. since h2 blockers are also effective in preventing acid secretion and are not known to interact with the p450 system that affects clopidogrel, the investigators hypothesized that these group of drugs will not interfere with the positive antiplatelet effects of clopidogrel and therefore will offer a good alternative treatment option.

in this study we will compare 3 different anti-acids regimens and their effect on platelet function

Eligibility criteria:
inclusion criteria: 1. subject is at least 18 years old. 2. subject is willing to comply with pre-specified follow-up evaluation and can be contacted by telephone. 3. use of clopidogrel (\>=75mg) and aspirin(\>=75mg) for at least 1 month. exclusion criteria: 1. known allergy to ppi of h2 blockers 2. known thrombocytopenia or thrombocytopathia 3. subject is currently enrolled in another investigational study of a new drug, biologic or device at the time of study screening. note: subjects who are participating in the long term follow-up phase of a previously investigational and now fda-approved product are not excluded by this criterion. 4. subject with symptomatic heart failure of lvef ≤ 25% 5. acute myocardial infarction within the past 30 days. 6. no acute inflammatory event during the past month (e.g. infection, autoimmune or acute coronary event) 7. concurrent medical condition with a life expectancy of less than 12 months. 8. known severe renal failure (serum creatinine level \>2.5 mg/dl). 9. history of bleeding diathesis or coagulopathy or inability or unwillingness to receive blood transfusions. 10. evidence of active gastrointestinal bleeding or a history of such bleeding that is not known to have been treated and proven to have resolved. 11. history of hepatitis (viral, ischemic or chemically-induced); clinical jaundice, history of cirrhosis. 12. patient treated with anticoagulant medication (coumadin, lmwh)

Keywords: gi bleeding clopidogrel aspirin prevention angiography
patient-controlled intravenous analgesia with remifentanil infusion for labour

Conditions: Pain

Summary: epidural analgesia for pain relief in labor may not be suitable for all patients, and intravenous patient controlled analgesia (iv pca) with opioids offers the best alternative. the purpose of this study is to assess the effectiveness of two methods remifentanil administration in the form of either an infusion or pca demand bolus (intravenous injection of a single dose over a short period of time). currently, our hospital gives remifentanil by demand bolus, however it may be equally effective, with less side effects, to give the drug as an infusion.

the study will be conducted as a randomized trial with two arms: group i- continuous infusion of remifentanil with stepwise increase in infusion rates and group ii- demand bolus only with stepwise increase in bolus dose, as per the patient's analgesic requirement. visual analog scores will be the primary outcome. maternal and fetal side effects will be recorded. the results of this study will determine the regimen that suits the patients needs for painless labor with high efficacy, less adverse effects and a higher patient satisfaction.

Eligibility criteria:
inclusion criteria: * written informed consent * term pregnancy in labour with singleton fetus in cephalic presentation * patients requesting systemic analgesia * patients with contraindication for regional anesthesia without fetal compromise (coagulopathy, thrombocytopenia, refusal, etc.) exclusion criteria: * refusal to sign written informed consent * inability to communicate in english * opioid dependence or addiction * patients on methadone * allergy or hypersensitivity to remifentanil * fetal heart rate abnormalities * fetal congenital anomalies

Keywords: labour analgesia pregnancy ivpca
identification of correlates of protection against shigella and enterotoxigenic escherichia coli infections

Conditions: Dysentery

Summary: the aim of this study is to accelerate the development of vaccine candidates against diarrheal diseases caused by shigella and enterotoxigenic escherichia coli (etec). we plan to identify cases of laboratory-proven shigellosis and etec-associated diarrhea, to study humoral and cellular immune parameters following natural infections with shigella and etec, and to compare the level of pre-existing local, humoral and cellular immune parameters in cases of shigellosis and etec-associated diarrhea and in matched controls.


Eligibility criteria:
inclusion criteria: * lab-confirmed shigella or etec * individuals or patients without diarrheal disease exclusion criteria: * n/a
post market clinical follow up of resmed mask systems

Conditions: Obstructive Sleep Apnea

Summary: post market follow up study to systematically and proactively collect supplementary real world data to confirm the usability and performance of the new generation mask systems. .

this is an open label, prospective, multi-centre, single arm study for post market clinical follow up. the study will be conducted in the home environment remotely. eligible participants currently using older generations of cpap masks will use the new generation resmed mask system in the same mask category to their own (nasal, full face, pillow) in place of their own mask for 90 nights and complete a series of questionnaires at specified study checkpoints.

Eligibility criteria:
inclusion criteria: * participants willing to give written informed consent * participants who can read and comprehend english * participants who ≥ 18 years of age * participants being treated for osa for ≥ 6 months * participants currently using a suitable mask system * participants currently using cpap device compatible with airview, or with download capacity from cpap machine from data cards exclusion criteria: * participants using bilevel flow generators * participants who are or may be pregnant * participants with a pre-existing lung disease/ condition that would predispose them to pneumothorax (for example: copd, lung cancer; fibrosis of the lungs; recent (\< 2years) case of pneumonia or lung infection; lung injury. * participants believed to be unsuitable for inclusion by the researcher * participants who or whose bed partner has implantable metallic implants in the head, neck and chest region affected by magnetic fields (non-ferrous implants may be acceptable) (for masks with magnetic clips only)
conditioned open-label placebos to facilitate opioid reduction in patients with chronic non-cancer pain

Conditions: Chronic Non-cancer Pain

Summary: this study aims to evaluate whether the reduction of the daily morphine equivalent dose (med) in patients with chronic non-cancer pain (cncp) can be decreased with an open-label placebo (olp) intervention in comparison to an electronic monitoring (em) control group. the participants will receive the intervention (opl or em) over the duration of six weeks. diverse psychological and health measures will be assessed with questionnaires over the course of the intervention. furthermore, evaluation outcomes, qualitative outcomes and safety outcomes will be assessed. it is hypothesized that the olp-intervention group in comparison to the em-control group will have a significantly lower consumption of med over the course of the study. furthermore, this study aims to evaluate whether the olp intervention can reduce opioid withdrawal symptoms in comparison to the control group.

cncp is a major global health problem and is often treated with opiod medication, although risks outweigh the benefits. therefore, recent studies suggest that an open-label placebo (olp) treatment, the placebo treatment with full disclosure of being a placebo, has proven to be an effective, clinically relevant, and evidence-based treatment in cncp syndromes. furthermore, a new line of research indicated that olps have been shown to be feasible for the reduction of active medication in opioid use disorder. in line with the conditioning paradigm, the drug as the unconditioned stimulus is paired with the neutral stimulus of an olp in a learning phase. then, the olp alone becomes a conditioned stimulus.

Eligibility criteria:
inclusion criteria: * signed informed consent * ≥ 18 years of age * german speaking * chronic non-cancer pain ≥ 6 months in duration * chronic opioid medication for \> 3 months * oral intake of opioid medication * motivation for opioid reduction * participants have a primary treating physician who performs the reduction of the opioid medication * having access to a computer or tablet with an email-account exclusion criteria: * having psychotic symptoms * suicidality * cognitive impairment to everyday life * planned surgery within the next two months * known illegal drug or harmful alcohol consumption * intolerance of the ingredients of the placebo pill (e.g., lactose, sucrose, corn-starch) * serious health problems that make study participation impossible * simultaneous participation in other studies with investigational drugs or cncp specific interventions
diagnostic and monitoring significance of ctdna methylation analysis by ngs in benign and malignant pulmonary nodules

Conditions: Pulmonary Nodules

Summary: anchordx is using circulating tumor dna (ctdna) methylation analysis by next-generation sequencing (ngs) to develop a blood-based assay for differentiating benign and malignant pulmonary nodules early. the purpose of this study is to evaluate the diagnostic performance of this assay in patients with pulmonary nodules.

this is a prospective, multi-center, observational cohort study and seeks to enroll 10,560 participants with pulmonary nodules smaller than 3 cm in diameter from 21 hospitals in china. all participants will be followed up with chest ct or low-dose computed tomography (ldct) scans for 2-3 years ( baseline, 3 months, 6 months, 12 months, 24 months and 36 months). their blood samples, ct or ldct scans data, and clinical data will be collected at each visit and formalin-fixed paraffin-embedded (ffpe) tissues will be collected when participants who receive pneumonectomy or percutaneous lung biopsy.

Eligibility criteria:
inclusion criteria: * 18 years and older * pulmonary nodules diagnosed by chest ct or low-dose computed tomography (ldct) scans * non-calcified pulmonary nodules with the diameter between 5mm to 30mm * including solid nodules, mixed ground-glass opacity nodules and pure ground-glass opacity lung modules * new cases of pulmonary nodules or diagnosed within 60 days prior to enrollment * agree to finish the patient pulmonary history questionnaire * agree to be followed up for 2-3 years * agree to provide a written informed consent exclusion criteria: * pregnant or lactating women * received any pneumonectomy or percutaneous lung biopsy before enrollment * recipients of blood transfusions within 30 days prior to enrollment * patients with tumors identified within 2 years prior to enrollment except non-melanoma skin cancer * fail to understand or provide a written informed consent

Keywords: circulating tumor dna (ctdna) dna methylation analysis next-generation sequencing (ngs) low-dose computed tomography (ldct)
molecular mechanisms of helium-neon laser on melanocyte regeneration in skin equivalent vitiligo model

Conditions: Vitiligo

Summary: this current three-year proposal aims to clarify the mechanisms of melanocyte destruction and regeneration in vitiligo lesions using both traditional cell culture and skin equivalent model (organotypic culture).

melanocytes (mcs) are melanin-producing cells of the skin that are derived from neural crest cells. vitiligo vulgaris is a common depigmentation disorder resulting from destruction of functional mcs in the affected skin. although this disorder affects all races and occurs in approximately 1% of the world population, its pathogenesis remains obscure. recovery from vitiligo is initiated by the activation, proliferation, and migration of melanoblasts (mbs) to the epidermis. the subsequent maturation of mbs leads to production of melanosomes that will be transferred to the juxtaposed keratinocytes. the beam of a low-energy laser produces a temperature elevation of less than 0.5 ℃. therefore, light-mediated reaction by such laser irradiation is referred to as biostimulation. mitochondrial cytochrome c oxidase is considered as a photoacceptor of low-energy laser. low-energy he-ne laser has numberous clinical applications. our previous studies showed that he-ne laser irradiation can induce repigmentation in vitiligo vulgaris. however, the exact mechanisms of he-ne laser irradiation in repigmentation are not elucidated thoroughly. in the past, we have demonstrated the coexistence of both antikertinocyte (anti-kc) and antimelanocyte (anti-mc) igg antibodies (abs) in vitiligo patients and explored their potential roles in vitiligo. this current three-year proposal aims to clarify the mechanisms of melanocyte destruction and regeneration in vitiligo lesions using both traditional cell culture and skin equivalent model (organotypic culture). in the first year, we shall focus on the regeneration of mcs and mbs by he-ne laser with or without the presence of anti-mc igg antibodies from vitiligo patients, as well as the involved photodynamic mechanisms. our goal for the second year is to investigate the regeneration of mcs and mbs by he-ne laser with or without the presence of anti-kc igg antibodies from vitiligo patients. in the final year of our project, we shall explore the effects of he-ne laser combine antibody-dependent cellular cytotoxicity (adcc) on the regeneration of mcs and mbs. our results will provide more information for the effectiveness of he-ne laser irradiation in treating vitiligo.

Eligibility criteria:
inclusion criteria: * healthy adults and patients with vitiligo exclusion criteria: * systemic disease
motion sickness medications and vestibular time constant

Conditions: Drug Reaction

Summary: sea sickness represents a major limitation on the performance of ships' crew. one of the challenges faced by the physician in the motion sickness clinic when prescribing anti-sea sickness medication is to select the appropriate drug for the patient. difficulties arise due to high variability in the response to different drugs. in the case of sea sickness, the current procedure is to examine the drug's efficacy in each individual during real time exposure to sea conditions. a number of studies have documented the presence of sea sickness drug receptors in the vestibular nuclei, which determine the vestibular time constant. two clinical vestibular tests which evaluate the time constant are the velocity step and okan tests. the purpose of the proposed study is to evaluate the influence of motion sickness drugs on the vestibular time constant, as a possible bioequivalent of drug potency in the individual subject. eighty crew members will be recruited and divided into groups responsive and non-responsive to the sea sickness drugs scopolamine and meclizine. subjects having a wiker score of 7 in waves 1 meter high without drug treatment, and no improvement in symptoms after treatment will be defined as non-responsive to sea sickness drugs. subjects having a wiker score of 7 in waves 1 meter high without drug treatment, and a wiker score of 4 or less after treatment, will be defined as responsive to drug therapy. kwells, bonine and placebo, will be assigned to each subject in a random, double-blind fashion. each group will perform the velocity step and okan tests before, one and two hours after drug or placebo administration.


Eligibility criteria:
inclusion criteria: * healthy soldiers between the ages of 18 to 40, who suffering from sea sickness * 48 hours prior to session without any use of medications * soldiers who vomit in waves 1.5 meter high without drugs treatment exclusion criteria: * anamnestic hearing impairment * ear infection of any kind * pathological finding in an otoneurological examination, witch will be done by a trained neurophysiologist / a physician. in any case of pathological finding, patient will be advised to continue medical assesment. * vision pathologies the interfere with vng test. * withdrawal of informed consent by the patient of any cause.
long term follow-up study 16-20 years after hepatitis b vaccination in newborns of mothers who were seropositive for hepatitis b envelope antigen (hbeag) & hepatitis b surface antigen (hbsag)

Conditions: Hepatitis B

Summary: this study is performed to evaluate the persistence of anti-hepatitis b surface antigen (hbs) antibodies up to 16, 17, 18, 19 and 20 years after administration of the first dose of the study vaccine, engerix-b™. no new subjects will be recruited in this long-term follow-up study. the protocol posting has been updated in order to comply with the fda amendment act, sep 2007.

the primary study was to evaluate the immunogenicity and protective efficacy of hepatitis b vaccine administered according to a 0, 1, 2, 12 month schedule in newborns of anti-hepatitis b envelope antigen positive (hbeag+) and anti-hepatitis b surface antigen positive (hbsag+) mothers. results from the primary study have shown that the vaccine was immunogenic and protected neonates of hbeag positive mothers against hepatitis b chronic carriage. the present study is carried out to evaluate the anti-hbs persistence and the prevalence and incidence of other hepatitis b markers (hbsag, anti-hepatitis b core antigen {anti-hbc}, hbeag, alanine aminotransferase/aspartate aminotransferase {alt/ast}), and the clinical significance of the hbsag and anti-hbc positive cases observed during the long-term from year 16-20. no vaccine will be administered during the long term follow up period.

Eligibility criteria:
inclusion criteria: * subjects who had participated in the primary study. * written informed consent obtained from the subject.

Keywords: hepatitis b
selenium in treating patients with prostate cancer

Conditions: Prostate Cancer

Summary: rationale: selenium may prevent or slow the growth of prostate cancer. purpose: this randomized phase ii trial is studying how well selenium works in treating patients with prostate cancer.

objectives: * to investigate the ability of selenium to prevent progression in patients with adenocarcinoma of the prostate. * to investigate the ability of selenium to effectively modulate biomarkers of prostate cancer. * to determine if selenium modifies the progression of prostate cancer based on an analysis of initial biopsy, subsequent blood biomarkers, and urological symptoms. * to further establish the safety of chronic supplementation with selenium in these patients. outline: patients are stratified according to gleason score (low vs moderate). patients are randomized to 1 of 3 treatment arms. * arm i: patients receive oral placebo once daily for 48 months in the absence of disease progression or unacceptable toxicity. * arm ii: patients receive low-dose oral selenium once daily for 48 months in the absence of disease progression or unacceptable toxicity. * arm iii: patients receive high-dose oral selenium once daily for 48 months in the absence of disease progression or unacceptable toxicity. blood and tissue samples are collected periodically for biomarker laboratory studies. blood samples are analyzed for levels of prostate-specific antigen, chromogranin a, alkaline phosphatase, alpha tocopherol, lycopene, and other vitamins; levels of selenium by atomic absorption spectrometry; and oxidative damage to dna. tissue samples are analyzed for levels of bcl-2, p53, ki-67, thioredoxin reductase, thioredoxin, and glutathione peroxidase by immunohistochemistry and for apoptotic index by tunel assay. patients complete urological symptom questionnaires and other questionnaires periodically.

Eligibility criteria:
disease characteristics: * biopsy-proven adenocarcinoma of the prostate within the past 48 months * prostate-specific antigen \< 50 ng/ml * gleason score \< 8 * currently undergoing "watchful waiting" for prostate cancer * no metastatic disease patient characteristics: * life expectancy ≥ 3 years * ast and alt ≤ 1.5 times upper limit of normal (uln) * alkaline phosphatase ≤ 1.5 times uln * bilirubin ≤ 1.5 times uln * creatinine ≤ 1.5 times uln * no other malignancy within the past 5 years, except nonmelanoma skin cancer prior concurrent therapy: * no prior hormone therapy, radiotherapy, chemotherapy, or surgery for prostate cancer * at least 90 days since prior and no concurrent selenium (as a dietary supplement or as part of a multivitamin) exceeding 50 mcg/day

Keywords: adenocarcinoma of the prostate stage i prostate cancer stage ii prostate cancer stage iii prostate cancer stage iv prostate cancer