Kornimate/medical-research-clean huggingface dataset:
covid pandemic institutional management

Conditions: Covid19

Summary: covid-19 has increased organizational tensions within health services (lack of resources, difficulties in recruiting healthcare professionals , elderly and polypathological patients, etc.) and tested the reliability of health facilities. this project aims to draw lessons so that hospitals can transform themselves while improving their reliability to face future crises and other exceptional situations. research hypothesis: crisis management arrangements lack sensitivity to uncertainty, which manifests itself in lower quality of care and efficiency losses for the entire institution. the virtuous practices implemented during the crisis spontaneously incorporated principles of the highly reliable organization. the integration of principles from complexity theory into the management of institutions promotes high reliability organization. sustaining these virtuous practices in order to anticipate and cope with crises requires the activation of two interconnected levers: a shared vision (by patients, healthcare professionals, ars, has, and the ministry in the first place) of the meaning of the action taken by hospitals, and the development of a policy enabling hospitals to become both learning and highly reliable. main objective: to evaluate the management process of the covid-19 epidemic by the university hospitals of the auvergne-rhône-alpes region, and the structures linked to them (establishments in their territory, ars, user associations), in terms of points of improvement and good practices. this evaluation concerns the preparation, management and exit phases of the crisis.


Eligibility criteria:
inclusion criteria: * establishments : * 4 university hospitals: lyon, st etienne, clermont ferrand, grenoble * establishments in the same territories, public and private * professionals and members of the institutions' bodies: * governance: management and chair of the cme * management (care, communication, medical, technical, logistics, it, personnel) * clinical and public health cluster governance * medical, paramedical and non-medical staff in the departments most concerned (emergency and ems reception, intensive care, infectiology, hygiene, virology, imaging, occupational medicine in particular) * organizations representing the personnel * members of the users' representatives committee * adult patients hospitalized for at least 48 hours during the study period (quantitative study by questionnaires). exclusion criteria: * none

Keywords: covid-19 institutional management process professional experience crisis management
neural correlates of repeated tdcs

Conditions: Mild Cognitive Impairment

Summary: healthy ageing and pathological ageing in the context of a neurodegenerative disease are both associated with changes in brain network integrity. episodic memory is especially affected in alzheimer's disease, but is also decreased in healthy ageing. consequently, the memory-relevant brain networks are especially altered. transcranial direct current stimulation (tdcs) has previously been implemented in different clinical- and non-clinical settings and has shown to beneficially influence network connectivity. the neural correlates of single-session tdcs have been investigated, however, the neural effects of repeated tdcs remain unknown. furthermore, knowledge about the (long-term) neural mechanisms of repeated tdcs can give valuable insights and possibly pave the ground for exploring tdcs as a treatment option in future studies.


Eligibility criteria:
inclusion criteria: patients * diagnosis of mci based on the latest research criteria (clinical assessment at the memory clinic (prof. frans rj verhey): presence of at least a memory impairment, memory complaints expressed by the patient or informant, no problems in daily life functioning, no dementia and presence of biomarkers (albert et al., 2011) * clinical dementia rating score of 0.5 (cdr distinguishes a stage of questionable dementia (cdr 0.5) from people termed healthy (cdr 0) and those with mild dementia (cdr 1) * mini-mental state examination (mmse) 23 and being mentally competent (in general, individuals with a mmse 18 are considered mentally competent) * age: between 60 and 85 years old * 50% female * right-handedness * average level of education (cbs level 3-4-5-6) healthy controls * average neuropsychological test results, in accordance with normative data, corrected for age, education and gender * no substantial memory complaints (according to the participant) * age: between 60 and 85 years old * 50% female * right-handedness * average level of education (cbs level 3-4-5-6) * normal or corrected to normal vision exclusion criteria: * psychoactive medication use * abuse of alcohol and drugs * cognitive impairment due to alcohol/drug abuse or abuse of other substances * past or present psychiatric or neurological disorders (major depression, schizophrenia, bipolar disorder, psychotic disorder (or treatment for it), epilepsy, stroke, parkinson's disease, multiple sclerosis, brain surgery, brain trauma, electroshock therapy, kidney dialysis, menière's disease, brain infections) * major vascular disorders (e.g. stroke) * heart diseases or pacemakers * contraindications for scanning (e.g. brain surgery, cardiac pacemaker, metal implants, claustrophobia, body tattoos) * large scars or fresh wounds on the scalp

Keywords: tdcs mild cognitive impairment fmri healthy ageing
prone positioning and regional ventilation in mechanically ventilated covid-19 patients

Conditions: Severe Acute Respiratory Syndrome Coronavirus 2; Electric Impedance; Prone Positioning

Summary: the consensus therapeutic strategy implies that covid patients with acute lung injury due to coronavirus are routinely placed in prone position in an attempt to improve oxygenation by increasing ventilation homogeneity. the purpose of the study is to quantify with the electrical impedance tomography (eit) the changes in the ventilation and aeration in the dorsal regions of the lung when the patient is placed in prone position.

patients with acute respiratory distress syndrome (ards) frequently develop atelectasis in dorsal lung regions because of gravity and the compression by the heart and the diaphragm. since lung perfusion is predominantly distributed in lower lung regions, a reduction of ventilation in these areas results in further ventilation-perfusion mismatch, called shunt. the development of atelectatic lung regions necessitate the use of higher ventilation pressures, which in turn results in excessive transpulmonary pressures and ventilation-induced lung injury in the ventral regions. therefore it is common to promote the prone position in patients with ards in order to improve ventilation-perfusion matching and thus, protect the ventral regions from hyperinflation. in patients with covid-19-related ards, the value of such therapeutic strategy based on placing in prone position has not been completely elucidated. the aims of the study are to determine whether prone positioning improves dorsal regional ventilation when compared to supine position. moreover, another aim is to assess the changes in intrapulmonary shunt following patient position changes.

Eligibility criteria:
inclusion criteria: patients fulfilling all the following criteria are eligible for the study: * mechanically ventilated * fit the berlin definition for moderate or severe acute respiratory distress syndrome (arterial oxygen partial pressure over inspiratory fraction of oxygen less than 200 mmhg) * infection with coronavirus confirmed * scheduled to undergo prone positioning exclusion criteria: * patients with pacemakers, defibrillators or other electrically active implants * patients with damaged skin or impaired skin contact of the electrodes due to wound dressings * patients with chest tubes * history of thoracic surgery or lung resection
the detours trial: de-escalating empiric treatment: opting out of rx for selected patients with suspected sepsis - opt-out protocol trial

Conditions: Antibiotic Stewardship

Summary: the objective of this study is to implement an opt-out protocol to guide appropriate de-escalation of antibiotics in qualifying patients. the protocol, determined over the course a year with the help of a large, well-rounded expert panel, will be used by pharmacists to recommend de-escalation of antibiotics to hospital providers. providers can then decide whether or not to follow the recommendation in determining the best treatment pathway for his or her patient.


Eligibility criteria:
inclusion criteria: * blood culture preliminary results that indicate no growth as of 48-96 hours. (exception: patients with a single positive blood culture for coagulase negative staphylococcus and no central line in place will also be included). * still on broad spectrum antibiotic therapy after 48-96 hours. exclusion criteria: * adult patients who are located in icu wards.

Keywords: antibiotic de-escalation sepsis antimicrobial stewardship
integrated treatment program for osteoarthritis of the knee

Conditions: Osteoarthritis Knee

Summary: the purpose of this study is to determine the ability to assimilate and implement an integrated treatment program osteoarthritis of the knee, including the diagnosis and follow-up by a family physician in primary care clinics, combined with patient self-care training and physiotherapy program


Eligibility criteria:
inclusion criteria: * active complaint of knee pain * diagnosis of knee osteoarthritis according to x-ray * morning stiffness of less than 30 minutes and/or crepitus in active movement * ability to read hebrew exclusion criteria: * previous participation in physiotherapy treatment program * gout in knee, rheumatoid arthritis, fibromyalgia * complaints that appear in a knee which was operated in the past * dementia * severe limitations in mobility

Keywords: osteoarthritis knee self care treatment outcome patient education as topic physical therapy modalities
thyroid surgery with the new harmonic scalpel: a prospective randomized study

Conditions: Thyroidectomy

Summary: the objective of this study is to compare the results of total thyroidectomy using the new harmonic scalpel device (focus) to that with the previously available harmonic scalpel device (harmonic ace).

although the harmonic scalpel has been shown to be safe and effective in thyroid surgery, several surgeons consider the previously available instruments to be large and cumbersome, especially in terms of tissue fine grasping and dissection capabilities. to this context, an innovative technical improvement of the device for thyroid surgery has very recently been implemented and has been made available in 2008. utilization of this new device, however, has not been evaluated in any study. the objective of this prospective randomized study is to compare the results of total thyroidectomy using the new harmonic scalpel device (focus) to that with the previously available harmonic scalpel device (harmonic ace) in respect to hemostasis, operative time and postoperative complications. all patients submitted to total thyroidectomy are randomized into two groups: those submitted to total thyroidectomy using the focus device (group α) and those with harmonic ace (group β).

Eligibility criteria:
inclusion criteria: * total thyroidectomy exclusion criteria: * hemithyroidectomy * additional surgical procedures together with the total thyroidectomy (i.e. parathyroidectomy or cervical lymph node dissection)

Keywords: thyroid surgery total thyroidectomy harmonic scalpel
value of pct when diagnosing candidemia

Conditions: The Value of Procalcitonin in Patients With Suspected Candidemia

Summary: this study is a retrospective analysis to identify and compare the shift in inflammatory biomarkers in icu patients immediately before and after the first identification of candidemia.

as above.

Eligibility criteria:
inclusion criteria (all has to be fullfilled): * icu patients with blood cultures showing growth of candida species * clinical records including daily data on wbc, crp, procalcitonin and body temperature exclusion criteria: * age lower than 18 years * blood cultures with growth of candida species before icu admission * incomplete records of daily wbc, crp, procalcitonin or body temperature
folic acid and omega -3 fatty acid supplementation in depressed older adults

Conditions: Depression

Summary: our specific aim is to determine the impact of folic acid and omega-3 supplementation on the severity of depressive symptoms among depressed adults aged 65 and above.


Eligibility criteria:
inclusion criteria: 1. age 65+ (year of birth -1942 or below) 2. depression (as defined by the dsm-iv diagnostic criteria for depression: major or minor depression or dysthymia) exclusion criteria: 1. co-existing psychiatric disorder (except anxiety disorders) 2. moderate and severe cognitive impairment 3. current treatment with anticoagulants, antithrombotics and fibrinolytics 4. current severe angina with exertion 5. chronic renal insufficiency 6. liver cirrhosis 7. alcohol or drug abuse
pilates method and therapeutic exercise in children that play string instruments

Conditions: Postural Kyphosis; Postural Lordosis; Postural Low Back Pain

Summary: introduction: an inappropriate posture in children for a while kept playing some instrument of the group of the rubbed string, can cause pain and alterations of the spine, as it continues to consolidate. objective: to study the benefits acquired during the application of the pilates method combined with therapeutic exercise against the therapeutic exercise to reduce alterations of the vertebral rachis in children from 10 to 14 years old who play instruments of rubbed strings.

material and methods: a pilot study designed by a randomized controlled trial in two parallel intervention groups was carried out; 9 children performed the combination of the pilates method and therapeutic exercise (experimental) and 7 children performed the therapeutic exercise (control). at the beginning and at the end of the study, pain measurements have been made through the visual analogue scale (eva), and the kinovea programme for the alignment of shoulder, scapula and hip postures.

Eligibility criteria:
inclusion criteria: * subjects with typical development and ages between 10 and 14 years old. * subjects who play the violin, viola, cello or double bass. subjects who have learned to play the violin, viola, cello or double bass in this school year or up to a maximum of four previous years, eligible to receive pilates classes. * subjects with cognitive ability to understand simple orders. * subjects who are enrolled this year in orchestrated neighborhoods. exclusion criteria: * subjects whose ages are not between 10 and 14 years of age. * subjects who do not play the violin, viola, cello, or double bass.subjects who have more than four school years playing the violin, viola, cello or double bass. * subjects who do not have cognitive capacity to understand simple orders. * subjects who are not registered this year in orchestrated neighborhoods. * subjects who do not complete the four sessions of therapeutic exercise + pilates or therapeutic exercise.

Keywords: pilates therapeutic exercise children string instruments vertebral column
new local treatment of radiation-induced proctitis

Conditions: Radiation Proctitis

Summary: a prospective single-center observational study to evaluate the effectiveness of a local treatment with a mixture of hyaluronic acid, chondroitin sulfate and poloxamer 407 in patients with radiation-induced proctitis.


Eligibility criteria:
inclusion criteria: * proven symptomatic acute or chronic radiation-induced proctitis; * current or prior radiation therapy in the pelvic area; * patients with complications connected to the radiation therapy. exclusion criteria: * lack of informed consent; * non-adherence to study protocol; * pregnancy.

Keywords: radiation proctitis hyaluronic acid chondroitin sulfate poloxamer 407 local treatment rectoscopy
effects of bevespi on ventilation and gas exchange abnormalities in copd assessed by 129xe mri

Conditions: COPD

Summary: the purpose of this study is to determine whether the new inhaler, bevespi improves lung function. magnetic resonance imaging (mri) using inhaled hyperpolarized 129xe gas, that can provide useful images of the functioning of the lung will be used as a new measure to determine change in function. the investigator anticipate these images will provide more specific information about lung disease than standard lung function tests in response to treatment.

the study will characterize ventilation and gas transfer distributions in gold ii and iii copd patients and assess the potential for these physiological parameters as a novel phenotyping method using magnetic resonance imaging (mri) using inhaled hyperpolarized 129xe gas. the study will additionally quantify regional ventilation and gas transfer response to glycopyrrolate/formoterol in gold ii and iii copd patients.

Eligibility criteria:
inclusion criteria: * clinical diagnosis of copd confirmed by post-bronchodilator spirometry demonstrating (forced expiratory volume at 1 second(fev1)/forced vital capacity (fvc) \< 0.70 and forced expiratory volume at 1 second (fev1) in gold 2 or 3 stage (30%≤ (forced expiratory volume at 1 second \[fev1\] \< 80%) * willing and able to give informed consent and adhere to visit/protocol schedules * women of childbearing potential must have a negative urine pregnancy test exclusion criteria: * upper respiratory tract infection within 6 weeks * chronic systemic corticosteroid use \> 10 mg/day of prednisone * chronic oxygen use (intermittent or continuous) * previous lung resection surgery or decortication * previous history of pneumothorax * evidence of interstitial, occupational or chronic infectious lung disease by imaging studies * history of exposure to occupational or environmental hazards that are known to cause lung diseases * for women of child bearing potential, positive pregnancy test * major chronic illnesses which in the judgement of the study physician would interfere with participation in the study * patients who are not willing to withhold copd inhalers for the run-in period. * mri is contraindicated based on responses to mri screening questionnaire * subject is pregnant or lactating * respiratory illness of a bacterial or viral etiology within 30 days of mri * subject has any form of known cardiac arrhythmia * subject does not fit into 129xe vest coil used for mri * subject cannot hold his/her breath for 15 seconds * subject deemed unlikely to be able to comply with instructions during imaging
pilot study evaluating the efficacy and safety of metformin in melanoma

Conditions: Metastatic Melanoma (Stage IIIC Non-résécable or no Surgically Curable or Stage IV With Classification AJCC)

Summary: in western countries, melanoma represents a major mistake of public health by its frequency, lethality and the increasing of incidence. surgery can cure melanoma diagnosed very early. in other cases, it exists a risk of recurrence of lymph node and visceral. at the stage of visceral metastases, the prognosis of melanoma is catastrophic, with a median survival of 6 months. indeed, the reference chemotherapy by dacarbazine induces a very limited response rate of 10-20%, the ipilimumab which has been authorized in the second intention, has a response rate of 10%, and other available treatments don't have a superior efficiency. metformin is an oral antidiabetic of biguanides family which acts by inducing the activation of ampk, a molecule which is inactivated in many cancers including the melanoma. in agreement with these data, several preclinical studies suggested that metformin has antineoplastic activity. in the case of melanoma, a study published recently has showed that metformin inhibits proliferation of melanoma cells in vitro and we confirmed for our part these results in our laboratory (inserm u895).


Eligibility criteria:
inclusion criteria: * major patients with metastatic melanoma (stage iiic non-résécable or no surgically curable or stage iv with classification ajcc) in progression after a first-line of treatment by vemurafenib or chemotherapy, and non-eligible or non-responders to ipilimumab. metastases measurable by recist criteria. hematologic, renal and hepatic appropriate functions. negative pregnancy test. exclusion criteria: * patients with symptomatic brain metastases and performans status (ps)\>2. patients with carcinomatous meningitis. pregnant or breathfeeding women. patients with a contraindication to the metformine. hiv infection, active infection with hbv or hcv. patients already treated with metformin in the context of diabetes.
treatment of sebaceous hyperplasia with pdl and nd:yag versus erbium:yag: a randomized controlled trial

Conditions: Sebaceous Hyperplasia

Summary: the purpose of this study is to compare treatment of sebaceous hyperplasia with pulsed dye laser (pdl) plus neodymium doped yttrium aluminum garnet laser (nd:yag) versus erbium doped yttrium aluminum garnet (erbium:yag) laser versus electrodesiccation and curettage (ed\&c). this is a randomized clinical trial. approximately 18 participants will enrolled. each participant will have their sebaceous hyperplasia lesions randomized to receive either erbium:yag, pdl plus nd:yag, or ed\&c treatment. solitary lesions will be randomized to a group, thus, a patient may receive all three treatments, each on different lesions. lesions will be treated twice, 2-6 weeks after the first treatment. lesion size and count will be measured before treatment and at follow-up 4-12 weeks after the first treatment. this study is a pilot study designed to determine the feasibility of these procedures. subjects currently living in the chicago metropolitan area and meet inclusion/exclusion criteria will be considered for enrollment.


Eligibility criteria:
inclusion criteria: 1. ≥18 years of age 2. receiving cosmetic treatment for sebaceous hyperplasia 3. in good general health as assessed by the investigator 4. participants must have the ability to understand and the willingness to sign a written informed consent prior to registration on study exclusion criteria: 1. patient pregnant or nursing 2. patient with history of poor wound healing that would result in hypertrophic scar or keloid at the discretion of the physician 3. patient with recent sun exposure that would result in pigment changes at the discretion of the physician 4. subject unwilling to sign an irb approved consent form 5. participants who are unable to communicate or cooperate with the investigator due to language problems, poor mental development, or impaired cerebral function are not eligible