Kornimate/medical-research-clean huggingface dataset:
a care management intervention for non-cardiac chest pain

Conditions: Chest Pain

Summary: the investigators developed and implemented an eight-week multicomponent care management intervention for non-cardiac chest pain. team members including a cardiologist, nurse, and psychiatrist. impressions and recommendations were shared with the patient's primary care physician. measures of chest pain severity, frequency and impact and measures of psychological health and health-related quality of life were completed at baseline and intervention completion.

the investigators developed and implemented an eight-week multicomponent care management intervention for non-cardiac chest pain. the care management team consisted of a nurse, cardiologist, and psychiatrist. following a one-time consultation visit with the cardiologist and nurse, evaluation and treatment recommendations were conveyed to the participant's primary care physician. then, the nurse completed eight weekly phone calls with the participant to provide support, introduce therapeutic principles, and assist with coordination of care, under the supervision of a psychiatrist. intervention feasibility was assessed on several domains including adherence, recruitment, attrition, safety, and data collection. to examine preliminary efficacy, participants completed likert scales of chest pain symptom severity, frequency and impact, and measures of psychological health (patient health questionnaire-9, general anxiety disorder-7, patient health questionnaire-15) and health-related quality of life (12-item short form survey) at baseline and intervention completion.

Eligibility criteria:
inclusion criteria: * diagnosis of non-cardiac chest pain, defined as chest pain recurring at least once per week for two weeks with at least two of the following objective tests: (1) electrocardiogram without ischemic changes; (2) negative cardiac enzymes; (3) non-ischemic cardiac stress test. * primary care physician affiliated with the institution exclusion criteria: * history or subsequent diagnosis of cardiac disease * objectively diagnosed alternative medical etiology of chest pain (e.g., gastroesophageal disease) * resolution of chest pain prior to enrollment * cognitive impairment, assessed using a six-item screen * inability to communicate in english * lack of telephone access (precluding weekly phone call participation).

Keywords: non-cardiac chest pain atypical chest pain collaborative care
gait evaluation in haemophiliac patients

Conditions: Hemophilia A; Hemophilia B

Summary: joint damage secondary to recurrent haemarthroses and chronic synovitis represents the commonest clinical manifestation of haemophilia. incapacitating pain, loss of joint stability and mobility, axial deviation, deterioration and decreased function are the most frequent complains in patients with severe haemophilic arthropathy in this context, the purpose of our study is to examine and analyse specific changes in gait in patients suffering from haemophilic arthropathy and determine the impact on health-related quality of life in terms of conceptual components of pain and stiffness, psychosocial stress, disability, and activity limitations as recommended by the international classification of function (icf) recently published by the world health organization.


Eligibility criteria:
inclusion criteria: * haemophilia a or b * aged more than 4 years exclusion criteria: * impossibility to walk on a treadmill * recent joint haemarthrosis or muscle haematoma

Keywords: gait haemophilia arthropathy
a comparison of two colonoscopic withdrawal techniques

Conditions: Intestinal Polyps

Summary: this study will compare two strategies for colonoscope withdrawal, using polyp detection as the primary outcome measure, to determine the optimal withdrawal strategy. null hypothesis: on withdrawal of the colonoscope, examining patients with dynamic position change does not yield more polyps than the supine position. alternative hypothesis: on withdrawal of the colonoscope, examining the patients with dynamic position change improves polyp detection compared to the supine position.

the identification and removal of polyps has been shown to prevent bowel cancer. although colonoscopy is the best technique to identify polyps, polyps can be missed even in expert hands. inspection of the bowel occurs predominantly during colonoscope withdrawal. tailoring a patients position according to the segment of bowel being examined (dynamic position change) is a technique that has been shown to improve visualisation of the bowel wall and polyp detection. however, changing patient position during colonoscope withdrawal has not been widely accepted in clinical practice. this may be because of a lack of awareness of the literature, a perception that the benefit is negligible and the inconvenience of changing a patients position in addition to the small number of publications demonstrating this to be beneficial. we plan to compare the detection of polyps when colonoscope withdrawal is done with dynamic position change (a planned series of position changes to optimise mucosal visualisation) and the supine position (laid on back). these strategies will be compared by performing a double colonoscope withdrawal; the first withdrawal will be performed either supine or in the dynamic position. this will be followed by a second insertion and withdrawal in the alternative position. the order in which these strategies are performed will be randomised i.e. supine then dynamic or dynamic then supine.

Eligibility criteria:
inclusion criteria: * having a diagnostic colonoscopy * age \>40 and \<80 exclusion criteria: * inflammatory bowel disease * known polyposis syndrome * poor mobility which would limit a patients ability to turn

Keywords: polyp detection supine colonoscope withdrawal patient position dynamic position change
analgesic efficacy of ultrasound-guided bilateral pecto-intercostal plane block in pediatric cardiac surgery

Conditions: Regional Anesthesia

Summary: the goal of this study is to compare patients outcome in two groups. the first group will be applied pecto-intercostal fascial block additional to general anesthesia and the second group will not. this is a single-center, prospective, observational trial to study the efficacy of pecto-intercostal fascial block (pifb) in patients undergoing pediatric congenital cardiac surgery requiring median sternotomy and cardiopulmonary bypass. the children are aged between 6 months to 12 years with american society of anesthesiologists (asa) score 2 or 3. the main question it aims to answer are: the investigators' first question is if applying pecto-intercostal fascial block just after anesthesia induction reduces postoperative pain status. secondly, if this pain status makes any reduction in preoperative opioid consumption. the investigators aim to find out; if there is any difference in opioid consumption during operation and postoperative 24-hour, postoperative face, legs, activity, cry, consolability (flacc) scale, length of intensive care unit and hospital stays, and other complications.


Eligibility criteria:
inclusion criteria: * patients undergoing pediatric congenital cardiac surgery requiring median sternotomy and cardiopulmonary bypass. * age between 6 months and 12 years * asa score 2 or 3 * risk adjustment for congenital heart surgery (rachs-1) score under 4 exclusion criteria: * patients who need mechanical ventilation support before surgery * patients who need to stay intubated more than 24 hours after surgery * patients undergo complex cardiac surgery with rachs-1 score higher than 4. * patients without consent * having allergic reaction to bupivacaine * having cardiac surgery before (redo patient)

Keywords: pecto-intercostal fascial block pediatric congenital cardiac surgery postoperative pain management
rehabilitation in chronic obstructive pulmonary disease outpatients

Conditions: Chronic Obstructive Pulmonary Disease

Summary: a retrospective analysis on a cohort of unselected copd patients admitted to pulmonary rehabilitation (pr) performed in one rehabilitation centre has shown that the usual program is feasible and effective even in the presence of complex comorbidities, although some combined diseases might reduce the overall proportion of patients who respond to pre-defined outcomes criteria (crisafulli e, et al. thorax 2008;63:487-92). the aim of this prospective study is to describe the pattern of prevalence of the most frequently associated copd-comorbidities and the clinical impact on rehabilitation outcomes, referred to 3 teaching and 1 private hospitals admitting for pulmonary rehabilitation purposes.


Eligibility criteria:
inclusion criteria: * presence of copd as defined and classified according to the global initiative for chronic obstructive lung disease (gold) guidelines * ability to perform a rehabilitation program. exclusion criteria: * patients with asthma or any other pulmonary diseases (either obstructive or restrictive. * patients no able to complete a rehabilitation program

Keywords: copd (chronic obstructive pulmonary disease) outpatients rehabilitation comorbidities patient-centered outcome
cardioprotective effect of ripc in patients undergoing tavi

Conditions: Effectivity of RIPC in Outcomes of TAVI Procedure

Summary: we aim to investigate whether ripc (remote ischemic preconditioning) is effective in the tavi setting to reduce post-procedural myocardial damage and improve patient outcome. accordingly, we aim to investigate whether ripc can be introduced as an integral part of the tavi procedure, in order to reduce post-procedural myocardial damage and potentially improve patient outcome.

transcatheter aortic valve implantation (tavi) is associated to myocardial injury, defined as post-procedural cardiac troponin (ctn) elevation. earlier experiences have shown that myocardial damage can be encountered in a percentage of patients that varies from 1.5% to 17%, depending on the access route (transfemoral and transapical, respectively). the degree of rise in ctn after tavi emerged as an independent predictor of mortality. remote ischaemic preconditioning (ripc) consists of brief episodes of ischaemia applied to remote organs or tissues and has shown to result in a significant reduction in postoperative troponin levels in cardiac and non-cardiac surgery patients. lately, growing evidence suggests that post-procedural troponin decreases due to ripc application protocols protocols and is associated with improved outcome. the patients will be divided into two groups. in group 1, rips will be induced with three cycles of inflation of a blood-pressure cuff on the left arm to 200 mmhg for 5 min., followed by 5 min. of reperfusion while the cuff is deflated. in controls (group 2), the cuff will be placed around the left arm without being inflated.

Eligibility criteria:
inclusion criteria: * indication for elective tavi following heart team discussion * stable hemodynamic conditions without circulatory support or catecholamines exclusion criteria: * myocardial infarction at least 3 months before enrollment * stroke/tia at least 3 months before enrollment * severe chronic kidney disease (defined as a baseline serum creatinine of \> 1.5 mg/dl or an estimated glomerular filtration rate (egfr) of 60 ml/min/1.73 m2 ) * pci at least 3 months before enrollment * abnormal (\>99th percentile of laboratory cut-off) baseline values of biomarkers of myocardial ischemia (i.e. tnt, ck-mb) * abnormal nse values at baseline (local laboratory cut-off values)
treatment of women with pcos of phenotype d

Conditions: PCOS (Polycystic Ovary Syndrome)

Summary: in this study, female patients diagnosed with pcos of phenotype d will be enrolled. they generally display the following characteristics: menstrual cycle alterations; polycystic ovary morphology at ultrasound; normal blood levels of androgen, particularly testosterone; no signs of clinical hyperandrogenism. current treatments for this condition include insulin sensitizers (such as metformin) and hormonal contraceptives. however, this specific phenotype of pcos do not feature metabolic or hormonal alterations, and the efficacy of these treatments has lately been questioned. in the present clinical trial, patients will be given a dietary supplement containing dioscorea extract (source of diosgenin, a natural analog of progesterone), vitamin d and alpha-lactalbumin for six month. restoration of regular menstrual cycle and physiological ultrasound appearance of the ovaries will be the primary goal of the intervention.


Eligibility criteria:
inclusion criteria: * diagnosis of pcos of phenotype d, according to the rotterdam criteria and the egoi-pcos criteria exclusion criteria: * diagnosis of pcos of phenotype a, b or c, according to the rotterdam criteria and the egoi-pcos criteria * hormonal treatments; * treatments with inositol or other insulin sensitizers (such as metformin); * insulin resistance or pre-diabetes condition * bmi \> 30 * endocrinological alterations * chronic pharmacological therapies * major pathological conditions (e.g. tumors or autoimmune diseases)

Keywords: pcos phenotype d diosgenin dioscorea
laparoscopic single-site surgery versus conventional entry in ovarian cystectomy

Conditions: Ovarian Cyst Benign

Summary: the aim of this work is to evaluate the postoperative consequences of laparoendoscopic single site surgery relative to conventional laparoscopy in presumed benign ovarian cyst. the hypothesis is that single incision technique might offer advantages over the standard multi-port laparoscopy as potentially leading to less postoperative pain and improved cosmoses from a relatively hidden umbilical scar, as well as risk reduction of postoperative wound infection, hernia formation and elimination of multiple trocar site closure


Eligibility criteria:
inclusion criteria: * the patients are aged 18 to 45 years with bmi \< 35 kg/m2 and that they exhibit a surgical indication for a presumed benign ovarian pathology (pbop) according to rcog guideline no. 62. 2011: * simple ovarian cysts \>7cm and \<15cm. * persistent simple cyst for more than 3 months. * symptomatic patients with complicated cyst (e.g. hemorrhagic cyst, torsion, etc) exclusion criteria: * • previous midline laparotomies as suspected massive adhesions affecting intraoperative maneuvers and time. * chronic pelvic pain, endometriosis or pelvic inflammatory diseases will be excluded to avoid pelvic adhesions and bias in the quantification of postoperative pain. * do not possess a native umbilicus giving difficult access to single port. * the 'risk of malignancy index' (rmi) should be used to exclude those women at greater risk of malignancy. using an rmi cut-off of 200, a sensitivity of 70% and specificity of 90% can be achieved. if features suggestive of malignancy are encountered, a gynecological oncologist should be consulted regarding further evaluation and staging. * benign teratomas for the difficulty of extraction after removal that affects the intraoperative maneuvers and time. * contraindication to any laparoscopy like any medical condition worsened by pneumoperitoneum or the trendelenburg position. * contraindication to general anesthesia as all laparoscopic procedures are done under ga. * contraindication to non-steroidal anti-inflammatories, paracetamol, or tramadol.
apixaban in patients with left ventricular thrombus

Conditions: Left Ventricular Thrombus

Summary: open label randomized controlled clinical trial to evaluate the efficacy and safety of apixaban versus warfarin in treating left ventricular thrombus in patients with acute or recent myocardial infarction (mi).


Eligibility criteria:
inclusion criteria: all the following criteria must be fulfilled: * ages between 18 and 80 years, * history of anterior wall mi, either acute (within a week) or recent (within a month) * evident left ventricular thrombus (lvt) by transthoracic echocardiography, * naïve to oral anticoagulants (oac) * stable to start oac exclusion criteria: * other indications for oac, * patients with contraindications for oac, * right ventricular thrombus or atrial thrombus, * history of confirmed stroke or other systemic embolization within the previous six months, * high bleeding risk, * severe renal impairment, * patients with expected difficulties to follow the inr strictly.
outcomes with tight control of hyperglycemia in cardiac surgery patients

Conditions: Cardiac Surgical Procedures; Hyperglycemia

Summary: patients with or without diabetes may have high blood sugar levels due to stress response of the body during heart surgery. this study is being done to determine if maintaining normal blood sugar levels during open-heart surgery by using intravenous insulin results in a lesser incidence of death, wound infections in the chest, disturbances of heart rhythm, kidney failure, stroke and prolonged time on the breathing machine (artificial ventilation) within 30 days after surgery.

rigorous intraoperative glycemic control may be of paramount importance in affecting outcomes after cardiac surgery. there is evidence that strict control of glucose levels postoperatively results in improved outcomes in patients undergoing cardiac surgery. there is currently no consensus on optimal management of hyperglycemia intraoperatively. the aim of this prospective randomized controlled clinical trial is to determine whether normalization of intraoperative glucose levels with insulin improves outcomes. the comparison group will be treated with current standard practice to control hyperglycemia during surgery. the primary outcome is a composite of mortality, sternal wound infections, prolonged pulmonary ventilation, cardiac arrhythmias (new-onset atrial fibrillation, heart block requiring permanent pacemaker, cardiac arrest), stroke and acute or worsening renal failure within 30 days after surgery. secondary outcome measures are length of intensive care unit and hospital stay as well as safety and efficacy of the study insulin infusion protocol.

Eligibility criteria:
inclusion criteria all subjects accepted for this study must be: 1. \>=18 years of age 2. undergoing an elective cardiac surgical procedure exclusion criteria subjects who have one or more of the following will be excluded from the study: 1. undergoing surgery not utilizing cardiopulmonary bypass 2. unable to grant informed consent or comply with study procedure 3. undergoing emergency open heart-surgery 3. are allergic to any of the excipients in insulin
conservative management for pas pilot

Conditions: Placenta Accreta

Summary: conservative in situ management is a promising alternative treatment to hysterectomy for patients with placenta accreta spectrum and may be safer and preferable for some patients. this study will assess feasibility of a future randomized clinical trial comparing these treatments and provide novel data to inform shared decision-making and cost-effective care for patients with this deadly pregnancy disorder.

placenta accreta spectrum (pas) is an extremely morbid and increasingly common pregnancy condition that often results in massive obstetric hemorrhage. the standard treatment in the united states is hysterectomy, but this treatment is complex, morbid, and costly. a promising alternative for pas treatment is conservative in situ management (cm), a strategy in which the placenta is left in the uterus. unfortunately, there are insufficient data available to compare outcomes of these two treatments because past studies are limited by non-randomized study designs, minimal inclusion of patient values in making treatment decisions, and nominal consideration of economic barriers to care. a large clinical trial comparing pas treatments is needed. but there are key logistic barriers to an adequately powered trial, including questions of whether patients will enroll and adhere to randomization allocation. this pilot trial will evaluate the feasibility of randomizing patients to cm versus hysterectomy for pas. while pilot studies cannot make final assessments of safety and efficacy between interventions, safety and efficacy will be monitored, including those related to hemorrhage, transfusion, infection and re-operation.

Eligibility criteria:
inclusion criteria: * age 18 and older * history of cesarean delivery and placenta previa or anterior low-lying placenta and suspected of having pas on prenatal imaging (ultrasound/mri) * patients who would typically be recommended for hysterectomy * planned delivery between 34w0d and 36w0d gestation. exclusion criteria: * plan to delivery before neonatal viability (\<24 weeks gestation) * hospitalized for antenatal hemorrhage * have a low antenatal suspicion for pas based on imaging * are pregnant with multiples (twins, triplets) * have a uterine fetal demise

Keywords: pregnancy
gerofit exercise intervention for older adults with sickle cell disease (sickle-fit study)

Conditions: Sickle Cell Disease

Summary: the purpose of this study to assess the feasibility, acceptability, and safety of a personalized exercise training program adapted from gerofit to improve physical health and quality of life for adults with scd

the purpose of this study is to adapt and pilot the gerofit personalized exercise intervention for older adults with sickle cell disease (age ≥ 40 years). the sickle cell disease functional assessment (scd-fa) will be performed at steady state at baseline and every 3 months to track progress. endpoints include feasibility, acceptability, and safety. all participants will be interviewed to identify barriers and facilitators to exercise and how to better optimize the exercise intervention.

Eligibility criteria:
inclusion criteria: * have a diagnosis of sickle cell disease (any genotype) confirmed by hemoglobin electrophoresis, high performance liquid chromatography, or genotyping * understand and speak fluent english. exclusion criteria: * diagnosed with moderate or severe cognitive impairment based on icd-10 codes or report from their outpatient provider * unable to self-consent * wheelchair-bound * successfully treated with hematopoietic stem cell transplantation for scd * have moderate to severe uncorrected visual or auditory impairment * oxygen-dependent * pregnant * have severe avascular necrosis requiring an assist device * unstable cardiac disease.

Keywords: sickle cell anemia older adults exercise geriatrics functional impairment