Kornimate/medical-research-clean huggingface dataset:
virtual reality as a substitute for procedural sedation during epidural steroid injections

Conditions: Lower Back Pain; Lumbar Radiculopathy

Summary: this study examines the impact of virtual reality compared to sedation (midazolam and/or fentanyl) and no intervention on pain experienced from an epidural steroid injection (esi). the intervention group (who receive virtual reality as a distraction modality) is compared to a sedation group and a control group.

all patients enrolled in the study will already be undergoing lumbar epidural steroid injections for lumbar radicular pain as part of their clinical care. the epidural approach will either be transforaminal or interlaminar depending on clinical judgment (i.e. transforaminal esi for unilateral pain, interlaminar esi for bilateral pain). the study will consist of 3 groups: virtual reality, sedation, and a control group which receives no intervention (i.e. standard of care). the virtual reality group will receive virtual reality via a headset containing a menu of 6 programs that the subject can choose; the sedation group will receive from 1-5 mg of midazolam and up to 150 mcg of fentanyl as clinically indicated, and the control group will not receive an intervention (standard of care). all subjects will also receive 1% lidocaine local anesthetic through a 25-gauge needle for superficial anesthesia, which is standard of care. subjects will be randomized to each of these groups, with sub-allocation being done stratified by the type of esi (transforaminal vs. interlaminar). a secondary pilot study will evaluate whether a processed electroencephalogram (peeg) and continuous colored density spectral array monitored via a four-channel masimo sedline frontal eeg sensor can serve as a biomarker for painful stimulation and the effectiveness of distraction and sedation to reduce acute pain.

Eligibility criteria:
inclusion criteria: * males and females; ages 18-90 years * lumbosacral radicular pain with a baseline average of leg pain score of \> 4/10, mri findings (if available) consistent with symptoms, duration of pain \> 6 weeks, and no previous lumbar spine surgery. * documented diagnosis of radicular pain caused by herniated disc, central stenosis, foraminal stenosis, degenerative disk disease * willingness to adhere to undergo esi with either sedation (midazolam and or fentanyl) or with virtual reality * able to appear for a follow up visit between 24-40 days following the intervention exclusion criteria: * mri findings discordant with symptoms (absence of herniated disc, spinal stenosis or severe disc degeneration without nerve root impingement (e.g. annular tears) that could explain symptoms) * previous lumbosacral spine surgery at the area affected * prior esi within the past 6 months * allergy to contrast dye * poorly controlled psychiatric conditions that could affect outcomes (e.g. active substance abuse) or impose a barrier to participation (e.g. anxiety disorder requiring procedural sedation) * morbid obesity (bmi \>40)

Keywords: epidural steroid injection virtual reality distraction sedation lumbar radiculopathy
platelet transfusion in critically ill patients with thrombocytopenia

Conditions: Thrombocythemia

Summary: thrombocytopenia is a common biological disorder in critically ill patients. the main supportive treatment is platelet transfusion with the aim of preventing and treating bleeding and securing invasive procedures. current guidelines suggest that prophylactic platelet transfusion should probably be administered in non-bleeding critically ill patients at platelet count triggers of 10 to 20 g/l, albeit with very low certainty since extrapolated from studies carried out in stable patients with hematological malignancies. indications for prophylactic platelet transfusion have not been properly addressed in adult icu patients with regard to their particular risk of bleeding and prognosis. we propose the trampoline study in order to address two different platelet count thresholds of 10 g/l (low threshold) or 20 g/l (high threshold) for the prevention of icu-acquired bleeding in critically ill patients with severe thrombocytopenia.


Eligibility criteria:
inclusion criteria: 1. age ≥ 18 y.o. and 2. hospitalisation in the icu with at least one of the following life support during the current icu stay (past or ongoing, regardless of indications) * circulatory support (inotropes/ vasopressors at any dose) * respiratory support (invasive mechanical ventilation, non-invasive ventilation, continuous positive airway pressure (cpap), high-flow nasal oxygen, o2 supply ≥ 6 l/min) * renal replacement therapy for metabolic disturbances and/or acute and acute-on chronic kidney failure (if not previously under chronic hemodialysis) and 3. platelet count ≤ 20 g/l within the last 24h (first occurrence at any time during the icu stay) and 4. expected icu stay for at least 48 hours from the time of enrollment and 5. signed consent by the patient or his/her relative, or under an emergency procedure (emergency enrollment notified in the medical file, with requirement for confirmation consent a posteriori) exclusion criteria: 1. major bleeding (who grade 3-4) or mild bleeding (who grade 2) within the present hospitalization 2. major surgery within the recent 72 hours 3. intracranial or retinal bleeding within the recent 7 days 4. non- or contra-indication to prophylactic platelet transfusion (immune thrombocytopenia, thrombotic microangiopathy) 5. indications for increased prophylactic platelet transfusion threshold \&gt; 20 g/l (conditions associated with increased risk of bleeding including, but not limited to extra-corporeal membrane oxygenation, therapeutic anticoagulant treatment, fibrinolysis...) 6. known full refractory status to platelet transfusion (prophylactic transfusion not recommended) 7. prophylactic platelet transfusion already applied at platelet count ≤ 20 g/l during the present icu stay 8. patient opposed to transfusion of blood products 9. moribund patients (death expected within the next 24 hours) 10. pregnancy/breastfeeding 11. not covered by french social security (health insurance) 12. patient under safeguarding of justice

Keywords: platelet transfusion thrombocythemia
efficacy of lisdexamfetamine dimesylate for promoting occupational success in young adults with adhd

Conditions: Attention Deficit Disorder With Hyperactivity

Summary: there has been little research on the third area of impairment noted in the diagnostic and statistical manual of mental disorders - "occupational functioning." individuals with adhd experience job-related impairments including a greater likelihood of being unemployed and not enrolled in school and for those that were employed they were in a lower status occupation, relative to typically-developing comparison peers. the current literature on analogue workplace settings and the effects of lisdexamfetamine dimesylate includes office-based tasks similar to school seat work. unfortunately, this is inconsistent with the typical work environment most common for individuals with disabilities such as adhd where food preparation is the most common job following high school. therefore, medication effects in this type of setting, most common for individuals with adhd entering the workforce, need to be studied. the investigators propose to study workplace behavior in an analogue work setting in a laboratory "pizza place." individuals with adhd will participate in an interview with a supervisor each day, have a list of deliveries that need to be managed, deal with situations that require occupational judgment and appropriate customer service, and drive to make deliveries accurately and on-time. these behaviors can be reliably assessed within the laboratory. twenty young adults will participate in two "workdays" within a randomized, double-blind, placebo-controlled design wherein participants will be administered placebo and .3 mg/kg lisdexamfetamine dimesylate in a counter-balanced order.


Eligibility criteria:
inclusion criteria: * diagnosis of adhd * parental permission and/or teen consent/assent as appropriate * between 16-25 years of age * iq greater than or equal to 70 * permit or license to drive * ability to read and understand english exclusion criteria: * any medical condition that would contraindicate use of stimulant medication * any prior adverse response to lisdexamfetamine dimesylate or other stimulant medication * use of concurrent,non-stimulant psychoactive medication * diagnosis of schizophrenia or presence of thought disorder symptoms * autism spectrum disorder
a comparison of diagnostic testing modalities in the assessment of asthma

Conditions: Asthma

Summary: this study aims to assess the concordance of international asthma guidelines in the diagnosis of asthma and explore the presence of airways disease using additional non-guideline physiologic criteria, such as ios (impulse osciollometry), not included in the guidelines, but available in the portsmouth lung function service.

asthma is a widespread condition that affects millions of people worldwide. it is characterized by symptoms such as difficulty breathing, coughing, and wheezing. diagnosing asthma involves identifying certain indicators like airflow obstruction, airway sensitivity, and inflammation. however, different international guidelines, including those from organizations such as nice (national institute for health and care excellence), gina (global initiative for asthma), and bts (british thoracic society)/sign (scottish intercollegiate guidelines network), have varying criteria for diagnosis. this can lead to inconsistencies in identifying patients with asthma. this study aims to evaluate the effectiveness of different diagnostic approaches, including impulse oscillometry (ios), in diagnosing asthma. ios is a simple and non-invasive test that measures lung function. it has the potential to enhance the accuracy and ease of asthma diagnosis. despite its promise, current research on the role of ios in diagnosing asthma in adults is limited. to address these gaps in knowledge, the study will examine the data of patients attending the severe asthma service at queen alexandra hospital in portsmouth. with an "opt-out" consent process, routine outpatient lung function data will be analysed, paying special attention to the usefulness of ios compared to other lung function indices in diagnosing asthma. by conducting this study, the aim is to contribute valuable insights to the field of asthma diagnosis. the study findings may help refine the methodology of diagnosing asthma and potentially expand the diagnostic toolkit to include ios. this could improve the precision and ease of managing asthma, leading to better outcomes for patients.

Eligibility criteria:
inclusion criteria: * the patient will meet all the following criteria to be considered eligible for the study: * aged 18 years or over. * all patients who have attended full asthma workups from november 2021 till date * willing and able to consent to use their data in this study (opt-out form or e-consent). * patients referred to the portsmouth asthma service for diagnosis and further management of presumed asthma. comorbidities are common in asthma, thus patients with co-existing conditions such as obesity, bronchiectasis or copd will be included. exclusion criteria: * the participant may not enter the study if either of the following apply: * unable to comprehend the study and provide informed consent, e.g., insufficient command of english in the absence of someone who can adequately interpret. * patients with other primary respiratory conditions, such as ild.

Keywords: lung function impulse oscillometry
reducing blood pressure in patients with high cardiovascular risk

Conditions: Myocardial Infarction; Hypertension; Stroke

Summary: bp-reach is a study of a team-based (pharmacist and health coach) program for lowering blood pressure for people with a prior stroke or heart attack in the los angeles department of health services healthcare system. the goal of this clinical trial is to test if this team based program is better at helping people reduce their blood pressure than usual care for people with prior heart attack or stroke. the main questions it aims to answer are: * do people in the reach bp program have lower blood pressure at 12 months compared to those getting usual care? * do people in the reach bp program have better life's essential 8 scores and patient experience compared to those getting usual care?

hypertension is the leading contributor to preventable death and a major risk factor for recurrent cardiovascular events. to enhance bp control after stroke or myocardial infarction (mi), multilevel interventions are needed that incorporate health system and patient level factors. bp-reach aims to test the impact of an intervention on systolic blood pressure (sbp) for individuals with a history of stroke or mi in a randomized controlled trial in the los angeles department of health services healthcare system. the primary outcome will be change in systolic blood pressure (sbp) at 12 months. hypothesis: patients randomized to the intervention will achieve \>2.4 mm hg greater reduction in sbp at 1 year versus those randomized to usual care. the study population will include participants from the inpatient and outpatient settings in los angeles county department of health services health centers. the participants will be randomized in a 1:1 fashion to usual care or intervention, stratified by site, language and cardiovascular event (myocardial infarction, stroke). outcomes will be collected from all participants at baseline, 3 month and 12 month timepoints. the primary outcome is sbp. participants randomized to the intervention arm will receive additional a home blood pressure monitor, monthly phone calls from a health coach, and medication initiation and titration by a clinical pharmacist. the pharmacist will follow los angeles county department of health services expected practices, which align with the acc/aha guidelines for blood pressure control and aha guidelines for secondary stroke prevention.

Eligibility criteria:
inclusion criteria: * patients of la general medical center, rancho los amigos, olive medical center or harbor-ucla medical center with ischemic stroke, hemorrhagic stroke, or myocardial infarction * english or spanish speaking * systolic blood pressure (sbp) ≥ 130 mm hg exclusion criteria: * age \< 35 years * sbp \< 130 mm hg * only speaks a language other than english or spanish * cannot provide informed consent due to dementia or aphasia

Keywords: stroke myocardial infarction hypertension self-management chronic disease
registry type study to monitor for adverse drug reactions to fedoruk manufactured [f-18]-fludeoxyglucose

Conditions: Positron-Emission Tomography and Cone-Beam Computed Tomography

Summary: this is a single-centre, open-label, non-randomized clinical trial designed to monitor the occurrence of adverse events associated with \[f-18\]-fdg injection manufactured by the fedoruk centre. \[f-18\]-fdg injection used in this clinical trial will be identical to commercial \[f-18\]-fdg that is already used at royal university hospital (ruh).

this study will document the use of fedoruk-manufactured \[f-18\]-fdg injection (citrate formulation) in patients referred for \[f-18\]-fdg pet or pet/ct imaging at royal university hospital (ruh) in saskatoon, sk. this investigational agent is produced using procedures, raw materials, equipment and quality standards that are equivalent to commercially-approved \[f-18\]-fdg injection (glucovision®, manufactured by the cpdc in hamilton on). this is a single-centre, open-label, non-randomized study to monitor for adverse drug reactions among subjects administered fedoruk-manufactured \[f-18\]-fdg injection. eligible subjects are those who would normally be referred by their physician for \[f-18\]-fdg pet or pet/ct imaging at ruh in saskatoon, sk. the primary goal of this study is to permit immediate access, with appropriate regulatory and reb oversight, to fedoruk-manufactured \[f-18\]-fdg injection pending commercial approval. monitoring for adverse drug reactions, during and after subjects are administered fedoruk-manufactured \[f-18\]-fdg injection, will support the primary objective of this study. based on the well-established safety profile of \[f-18\]-fdg and the comparability of fedoruk-manufactured \[f-18\]-fdg injection to commercially-approved \[f-18\]-fdg injection (glucovision®), it is not expected that any adrs will be observed.

Eligibility criteria:
inclusion criteria: * referred by treating physician to receive \[f-18\]-fdg and pet or pet/ct imaging; * meets all current local clinical criteria for receiving \[f-18\]-fdg and pet or pet/ct imaging; * ability to understand and the willingness to sign, or (in the case of paediatric patients) a parent/guardian who understands and is willing to sign, a written informed consent document; exclusion criteria: * pregnant women; all women of child-bearing potential will have a confirmed negative urine pregnancy test prior to administration of \[f-18\]-fdg injection; * subjects unwilling or unable to stop breast feeding for 24 hours; * subjects who are medically unstable, based on the principal investigator's assessment

Keywords: pet ct pet/ct
cognitive rehabilitation during transcranial direct current stimulation

Conditions: Transcranial Direct Current Stimulation; Neurocognitive Disorders

Summary: the purpose of this study is to explore whether active transcranial direct current stimulation during cognitive rehabilitation tasks can boost cognitive enhancement without severe side effects in mild cognitive impairment or mild dementia patients.

this study explores the additive effect of transcranial direct stimulation compared to sham stimulation during cognitive rehabilitation tasks in mild cognitive impairment or mild dementia patients. potential participants are recruited by physicians' referral or self-entry. informed consent by a clinical research coordinator and research physician is performed followed by screening. participants who passed screening go through 10 sessions of active or sham transcranial direct current stimulation and are evaluated their cognitive function at screening, at the end, and two weeks after the intervention. for quality assurance, independent researcher regularly monitor and audit as participants are enrolled in the trial.

Eligibility criteria:
inclusion criteria: * participants with a diagnosis of either major neurocognitive disorder or mild neurocognitive disorder, defined in diagnostic and statistical manual of mental disorder (dsm-5) * taking the stable dose of psychotropic medication, such as cholinesterase inhibitors or nmda(n-methyl-d-aspartate) receptor antagonist, for the past two weeks * ambulant by oneself with or without aiding devices. exclusion criteria: * with severe psychotic symptoms requiring antipsychotic treatment * with risks of hospitalization within 6 weeks because of severe depression and/or suicide ideation * clinically contraindicated to electroconvulsive therapy (ect) or transcranial direct current stimulation (tdcs) * with the mini-mental state examination (mmse) score of less than 18 or the clinical dementia rating scale (cdr) score of more than 2, * unable to participate for more than 2 days during the trial * unable to write a sentence or copy a figure on mmse at screening.

Keywords: cognitive rehabilitation
post laparoscopy shoulder pain and postoperative trendelenburg position

Conditions: Shoulder Pain

Summary: laparoscopic surgery has become a standard of care for many gynecological surgeries due to its lower morbidity, pain and cost compared to open techniques. unfortunately, the use of carbon dioxide (co2) to insufflate the abdomen is a major contributor to post operative shoulder pain. shoulder pain post laparoscopy is common and it is a major cause of patient dissatisfaction. the aim of our study is to evaluate the efficacy of positioning the patient in trendelenburg, post operatively for 24 hours, on shoulder pain reduction. our hypothesis is based on the assumption that complete co2 deflation is not possible and that trendelenburg positioning will help displace co2 from the sub diaphragmatic area thus reducing the diaphragmatic and phrenic nerve irritation causing pain.

a prospective randomized controlled study with 54 patients in each of the two arms. group s (control) will undergo the standard laparoscopic procedure and the patients will be placed in supine head up position postoperatively. in group t (interventional); the patients will be positioned in trendelenburg position once fully awake and cooperative in the post-anesthesia case unit (pacu) and will remain in this position for the first 24 hours postoperatively. postoperative nrs(numeric rating scale) score for shoulder pain and nausea will be collected at arrival to pacu, \& 4, 6, 12 and 24 hours postoperatively. in addition, total amount of rescue pain and nausea medication used by the patient will be recorded. data collected will be analyzed and compared between the two groups. the independent t- test will be used to compare postoperative shoulder pain, with nrs scores treated as continuous variable, between the two groups.

Eligibility criteria:
inclusion criteria: * female patients * age: 18 years to 60 years, american society of anesthesiologist physical status (asa) 1 or 2 * diagnostic or operative gynecologic laparoscopy {4 port sites, three 5 mm trocars (suprapubic, right and left iliac fossa) and one 10 mm trocar (umbilical)} between one and 3 hours duration. * abdominal incisions less than 1.5 cm. * steady abdominal insufflation pressure of 14 mm hg following a gradual insufflation over a 5-minute period. * insufflation at a steady maximal flow of 30 l/min exclusion criteria: * conversion to laparotomy. * abdominal insufflation pressure more than 14 mm hg. * medical drug allergy to paracetamol, ketoprofen and/or tramadol. * presence of gastro-esophageal reflux (gerd) * pregnancy * patient with thrombophilias and or at high risk of deep vein thrombosis (dvt) * obesity body mass index (bmi) greater than 40 * one day surgery patients

Keywords: laparoscopy shoulder pain trendelenburg position