Persius/hicric huggingface dataset:
Quality Assurance Review Center

# Overview
The Quality Assurance Review Center (QARC) is a publicly funded, not-for-profit healthcare organization located in Providence, Rhode Island. QARC provides radiotherapy quality assurance and diagnostic imaging data management to all of the National Cancer Institute (NCI) sponsored cooperative groups. In addition, QARC contracts privately with the pharmaceutical industry to provide its services in clinical trials for anti-cancer drugs. The center receives radiotherapy data from around one-thousand hospitals in both the United States and abroad. Over thirty-thousand cases have been reviewed at QARC since its inception in 1977. The center also maintains a strategic affiliation with the University of Massachusetts Medical School in Worcester, Massachusetts.

# Departments and Divisions
QARC is divided into three separate sectors, namely that of Physics/Dosimetry, Data Management, and Operations.

## Physics/Dosimetry Department
The Physics/Dosimetry department is primarily concerned with evaluating the radiation dose calculations submitted with each patient on any given protocol. In addition, the department works closely with various institutions, which include the public oncology groups and the private pharmaceutical industry, to develop and implement new benchmarks for specific areas of radiation therapy. In keeping with its responsibility as a quality assurance agent, the department participates in initial, interventional, and final reviews so as to assure the highest degree of integrity with regard to protocol guidelines.

## Data Management Division
The Data Management division receives and processes all forms of data relating to any given patient on any given protocol. Typical forms of data include diagnostic imaging, physics benchmarks, and radiology reports. The diagnostic imaging segment of data management usually involves Computed Tomography (CT), Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) scans. Occasionally, QARC will obtain Gallium and Bone scans insofar as a protocal mandates them. With the shift toward nuclear medicine in radiology, QARC seeks to build and maintain a vast database with its data management division.

## Operations Department
The Operations department is predominantly focused on constructing and sustaining working relationships between QARC and the various NCI supported oncology groups as well as the pharmaceutical industry. It also collaborates with its UMASS Medical School affiliate in matters pertaining to accounting and employment. Past and present pharmaceutical contracts for clinical trials at QARC include Sanofi-Aventis, Amgen, and GlaxoSmithKline. The NCI oncology groups including ACOSOG, COG, ECOG, SWOG, and CALGB all mandate that the radiotherapy materials for their protocols be sent to QARC for review.
Resident survival guide project

# Overview
The resident survival guide project is a high quality collaborative effort between the Wikidoc editor, associate and assistant editors with prior expertise in medical education and training in various specialties.  This project is designed in a simple but efficient way to address common medical conditions encountered by medical graduates in training such as interns, residents and house staff officers.  Some of the goals for this project is to enhance the abilities of medical and surgical residents in various specialties to properly evaluate, diagnose and treat patients presenting acutely with common medical problems.  It also implements the evidence based approach that healthcare professionals should follow when treating common public health conditions.

# Statement of Need
Despite different cultures and circumstances, interns and residents all around the world share common needs. Some of those needs are:
- A quick and effective way to diagnose and treat acute medical problems without having to read a monograph during emergency situations
- A convenient and simple guide to stay informed about the newest approaches and standards of care for common acute medical emergencies
- A systematic approach during emergency situations to help reduce medical errors commonly encountered by interns and residents due to long work hours

# How Can WikiDoc Meet Those Needs
A joint effort has been initiated among Wikidoc chief, scholars on campus and remote collaborators to provide residents worldwide with a quick and efficient guide to acute medical conditions commonly encountered by house staff.  The Wikidoc resident survival guide project specifically addresses house staff in its approach.  It enhances the abilities of medical and surgical residents in various specialties to properly evaluate, diagnose and treat patients presenting acutely with common medical problems.  It also implements the evidence based approach that healthcare professionals should follow when treating common public health conditions.

# How Can You Help WikiDoc Meet Those Needs
The resident survival guide project prefers input from medical professionals with prior graduate training or practice experiences.
- Medical and surgical residents and fellows
- Attending physicians
- Lecturers, instructors, associate professors and full professors in a medical school in the field of contribution
- Post doctoral fellows with prior or current medical practice experience
Wikidoc always welcomes remote contributions from qualified candidates.  If you're equally interested and qualified to participate in the resident survival guide project, the Wikidoc foundation will be happy to hear from you and guide you on how to start.  Once you're on board as an editor, you will be able to select your topic of expertise and start editing.  This way, the resident survival guide project will continue to grow and expand addressing more and more emergency medical conditions encountered by house officers worldwide.
Radial catheterization pitfalls

# Overview
The data that had been published up till now entails an incidence of about 2% to 34% of radial artery spasm, which would result in transfemoral approach being used instead. .
So some precautions should be made beforehand in anticipation of such complications.

# Potential Pitfalls of the Radial Approach to Cardiac Catheterization
1- Radial artery spasm:-
- In order to decrease the incidence of radial artery spasm, some interventionist tend to give light sedation as well as intra-arterial Nitroglycerin and calcium channel blocker (verapamil or diltiazem) in order to relax the smooth muscles of the radial artery.
2- Vessel tortuosity. Some of the tortuous forms are:-
- Alpha shape radial artery.
- S-shaped radial artery.
- Proximal and distal omega shaped radial artery.
- Brachial alpha loop.
- High origin radial artery.
A lot of techniques has been used to overcome tortuosities. when a regular 0.35" J-wire is unable to cross the tortuous vessel, a PTCA 0.014" is used to cross this part. Then Balloon-Assisted Tracking (BAT)  can be useful. It is a technique in which a small compliant balloon usually 2.0mm X 15.0 or 20.0 mm  is inflated at the tip of the Guide-in catheter with half to one third of the balloon is inside the catheter. Balloon is inflated slightly over the nominal pressure, the catheter is then steered across the tortuous vessel over the PTCA wire. This technique can also be used in case of radial artery spasm.
3- Guide catheter support and selection may be reduced.
4- Loss of radial artery pulse in 4% of cases.
5- Potential increase in the duration of the procedure and fluroscopy time
6- The radial artery has been instrumented should there be a desire to use it as a conduit for CABG
7- It is the second and not the first approach learned by trainees
8- There is a learning curve in treating spasm, navigating anatomy, and manipulating catheters
9- Anatomically there can be a loop in the artery near the brachial in about 10% of cases
10- Smaller sheaths are required (4-8F)
Ranitidine detailed information
Ranitidine (INN) (Template:PronEng) is a histamine H2-receptor antagonist that inhibits stomach acid production. It is commonly used in the treatment of  peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). It is currently marketed over the counter under the trade name Zinetac and Zantac by GlaxoSmithKline and by many other companies under various other names.

# Clinical use
Certain preparations of ranitidine are available over the counter (OTC) in various countries. In the United States, 75 mg and 150 mg tablets are available OTC. In Australia, packs containing 7 or 14 doses of the 150 mg tablet are available in supermarkets, small packs of 150 mg and 300 mg tablets are Schedule 2 Pharmacy Medicines. Larger doses and pack sizes still require a prescription.
Outside of the United States, ranitidine is combined with bismuth (which acts as a mild antibiotic) as a citrate salt (ranitidine bismuth citrate, Tritec), to treat Helicobacter pylori infections.  This combination is usually given with clarithromycin, an antibiotic.

# History and development
Ranitidine was developed by Glaxo (now GlaxoSmithKline) in an effort to match the success of Smith, Kline & French (also now GlaxoSmithKline) with the first histamine H2-receptor antagonist cimetidine. Ranitidine was the result of a rational drug-design process using what was by then a fairly refined model of the histamine H2-receptor and quantitative structure-activity relationships (QSAR).
Glaxo refined the model further by replacing the imidazole-ring of cimetidine with a furan-ring with a nitrogen-containing substituent, and in doing so developed ranitidine. Ranitidine was found to have a far-improved tolerability profile (i.e. fewer adverse drug reactions), longer-lasting action, and ten times the activity of cimetidine.  Ranitidine has 10% the affinity that cimetidine has to P450 so it causes fewer side effects, but other H2 blockers Famotidine and Nizatidine have no CYP450 significant interactions.
Ranitidine was introduced in 1981 and was the world's biggest-selling prescription drug by 1988. It has since largely been superseded by the even more effective proton pump inhibitors, with omeprazole becoming the biggest-selling drug for many years.
Restless legs syndrome overview

# Overview
Restless legs syndrome is a condition that is characterised by an irresistible urge to move one's legs. It is poorly understood, often misdiagnosed, and believed to be a neurological disorder. Many people tap their feet or shake their legs resulting from a nervous tic, consumption of stimulants, drug side-effects or other factors; this is usually innocuous, unnoticed, and does not interfere with daily life, quite distinct from Restless Leg Syndrome.
It is sometimes mistakenly called "Ekbom's syndrome," but that is an entirely different condition that shares part of the Wittmaack-Ekbom syndrome eponym: delusional parasitosis, as both syndromes were described by the same person, Karl-Axel Ekbom. 

# Historical Perspective
In a 1945 publication titled 'Restless Legs', Karl-Axel Ekbom described the disease and presented eight cases used for his studies.
Earlier studies were done by Thomas Willis (1622-1675) and by Theodor Wittmaack. Another early description of the disease and its symptoms were made by George Miller Beard (1839-1883).

# Pathophysiology
As with many diseases with diffuse symptoms, there is controversy among physicians, if RLS is a distinct syndrome. The US National Institute of Neurological Diseases and Stroke publishes an information sheet  characterizing the syndrome but acknowledging it is a difficult diagnosis. Some physicians doubt that RLS actually exists as a legitimate clinical entity, but believe it to be a kind of "catch-all" category, perhaps related to a general heightened sympathetic nervous system (SNS) response that could be caused by any number of physical or emotional factors. Other clinicians associate it with lumbosacral spinal subluxations and life stress.

# Epidemiology and Demographics
Many doctors express the view that the incidence of restless leg syndrome is exaggerated by manufacturers of drugs used to treat it.  Other physicians consider it a real entity that has specific diagnostic criteria.
Retained products of conception

# Overview
Retained products of conception complicate nearly 1% of all pregnancies. It occurs with greater frequency after termination of pregnancy than after vaginal or cesarean delivery.

# Differentiating Retained products of conception from other diseases
- Differentiation of these entities is important because retained products of conception is treated conservatively or with curettage while gestational trophoblastic disease may require chemotherapy.
- -human chorionic gonadotropin remains elevated in patients with gestational trophoblastic disease but falls to an undetectable level over 23 weeks in patients with retained products of conception.

# Diagnosis
- Common symptoms include vaginal bleeding and abdominal or pelvic pain, similar to patients with gestational trophoblastic disease.
Patient #1: US and CT images demonstrate retained products of conception
Patient #1: MR images demonstrate retained placental tissue
Revised Geneva score calculator

# Revised Geneva Score Calculator
Recently in 2006, the revised Geneva score was introduced with a more standardized and simplified algorithm to help predict the probability that a patient has a pulmonary embolism.

## Calculation of the Revised Geneva Score for PE
This handy calculator computes the pre-test probability of pulmonary embolism using revised Geneva criteria.
Check all boxes that apply to your patient:
function calcScore(){
var score = 0;
if(document.forms.checked == 1){score += 1;}
if(document.forms.checked == 1){score += 3;}
if(document.forms.checked == 1){score += 2;}
if(document.forms.checked == 1){score += 2;}
if(document.forms.checked == 1){score += 3;}
if(document.forms.checked == 1){score += 2;}
if(document.forms.checked == 1){score += 3;}
if(document.forms.checked == 1){score += 5;}
if(document.forms.checked == 1){score += 4;}
document.forms.value = score;
if(score <= 3){document.forms.value = "Low probability of PE (8%)";}
if(score >= 4 && score <= 10){document.forms.value = "Intermediate probability of PE (28%)";}
if(score >= 11){document.forms.value = "High probability of PE (74%)";}

## Interpretation of the Revised Geneva Score for PE
Shown below is the interpretation of the revised Geneva score:
- Score 0-3 points: Low probability of PE (8%)
- Score 4-10 points: Intermediate probability of PE (28%)
- Score  11 points: High probability of PE (74%)
Ribavirin indications and usage

# Indications And Usage

## Chronic Hepatitis C (CHC)
REBETOL (ribavirin) in combination with interferon alfa-2b (pegylated and nonpegylated) is indicated for the treatment of Chronic Hepatitis C (CHC) in patients 3 years of age and older with compensated liver disease .
The following points should be considered when initiating REBETOL combination therapy with PegIntron or INTRON A:
- These indications are based on achieving undetectable HCV-RNA after treatment for 24 or 48 weeks and maintaining a Sustained Virologic Response (SVR) 24 weeks after the last dose.
- Combination therapy with REBETOL/PegIntron is preferred over REBETOL/INTRON A as this combination provides substantially better response rates .
- Patients with the following characteristics are less likely to benefit from re-treatment after failing a course of therapy: previous nonresponse, previous pegylated interferon treatment, significant bridging fibrosis or cirrhosis, and genotype 1 infection . ==
- No safety and efficacy data are available for treatment of longer than one year.
Rifaximin indications and usage

# Indications And Usage
To reduce the development of drug-resistant bacteria and maintain the effectiveness of XIFAXAN and other antibacterial drugs, XIFAXAN when used to treat infection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.  When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy.  In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

## Travelers Diarrhea
XIFAXAN 200 mg is indicated for the treatment of patients ( 12 years of age) with travelers diarrhea caused by noninvasive strains of Escherichia coli .

### Limitations of Use
XIFAXAN should not be used in patients with diarrhea complicated by fever or blood in the stool or diarrhea due to pathogens other than Escherichia coli.

## Hepatic Encephalopathy
XIFAXAN 550 mg is indicated for reduction in risk of overt hepatic encephalopathy (HE) recurrence in patients  18 years of age.
In the trials of XIFAXAN for HE, 91% of the patients were using lactulose concomitantly. Differences in the treatment effect of those patients not using lactulose concomitantly could not be assessed.
XIFAXAN has not been studied in patients with MELD (Model for End-Stage Liver Disease) scores > 25, and only 8.6% of patients in the controlled trial had MELD scores over 19.  There is increased systemic exposure in patients with more severe hepatic dysfunction .
Risk adjusted return on capital
Risk adjusted return on capital (RAROC) is a risk based profitability measurement framework for analysing risk-adjusted financial performance and providing a consistent view of profitability across businesses. 
Note, however, that more and more Risk Adjusted Return on Risk Adjusted Capital (RARORAC) is used as a measure, whereby the risk adjustment of Capital is based on the capital adequacy guidelines as outlined by the Basel Committee (currently Basel II).
Broadly speaking, in business enterprises, risk is traded off against benefit.  RAROC is defined as the ratio of risk adjusted return to economic capital. Economic capital is a function of market risk, credit risk, and operational risk. This use of capital based on risk improves the capital allocation across different functional areas of banks, insurance companies, or any business in which capital is placed at risk for an expected return above risk-free.
RAROC system allocates capital for 2 basic reasons
- Risk management
- Performance evaluation
For risk management purposes, the main goal of allocating capital to individual business units is to determine the bank's optimal capital structure (i.e., economic capital allocation is closely correlated with individual business risk).
As a performance evaluation tool, it allows banks to assign capital to business units based on the economic value added of each unit.
Sacral anterior root stimulator
An implantable medical device enabling patients with a spinal cord lesion to empty their bladders.

# History
From 1969 onwards Brindley  developed the sacral anterior root stimulator, with successful human trials from the early 1980's onwards. Early attempts were confounded by the fact that the nerve roots that supply both the bladder and sphincter muscles would contract simultaneously on stimulation, cancelling each other's effect.

# Description
This device is implanted over the sacral anterior root ganglia of the spinal cord; controlled by an external transmitter, it delivers intermittent stimulation which improves bladder emptying. It also assists in defecation and enables male patients to have a sustained full erection.
The related procedure of sacral nerve stimulation  is for the control of incontinence in otherwise able-bodied patients.
Salmeterol detailed information

# Overview
Salmeterol is a long-acting beta2-adrenergic receptor agonist drug that is currently prescribed for the treatment of asthma and chronic obstructive pulmonary disease COPD.  It is currently available as a metered-dose inhaler (MDI) or a proprietary device inhaler.

# Indications
It is a long acting beta-adrenoceptor agonist (LABA), usually only prescribed for severe persistent asthma following previous treatment with a short-acting beta agonist such as salbutamol and is prescribed concurrently with a corticosteroid, such as beclometasone.  The primary noticeable difference of salmeterol to salbutamol is that the duration of action lasts approximately 12 hours in comparison with 46 hours of salbutamol.
When used regularly every day as prescribed, inhaled salmeterol decreases the number and severity of asthma attacks. However, like all LABA medications, it is not for use for relieving an asthma attack that has already started.
Inhaled salmeterol works like other beta 2-agonists, causing bronchodialation by relaxing the smooth muscle in the airway so as to treat the exacerbation of asthma. The long duration of formoterol action occurs by the formoterol molecules initially diffusing into the plasma membrane of the lung cells, and then slowly being released back outside the cell where they can come into contact with the beta-2 adrenoceptors. Formoterol has been demonstrated to have a faster onset of action than salmeterol as a result of a lower lipophilicity, and has also been demonstrated to be more potenta 12 g dose of formoterol has been demonstrated to be equivalent to a 50 g dose of salmeterol.

# Formulations
Currently available long-acting beta2-adrenoceptor agonists include salmeterol, formoterol, bambuterol, and sustained-release oral albuterol. Combinations of inhaled steroids and long-acting bronchodilators are becoming more widespread; the most common combination currently in use is fluticasone/salmeterol (Advair in the United States, Seretide in the UK).

# History and concerns
Salmeterol, marketed and manufactured by GlaxoSmithKline, in the 1980s and was released as Serevent in 1990. However, the product is under license from Allen & Hanburys.(UK)
In November of 2005, the American FDA released a health advisory, alerting the public to findings that show the use of Long-acting 2-agonists could lead to a worsening of symptoms, and in some cases death.
Whilst the use of inhaled LABAs are still recommended in asthma guidelines for the resulting improved symptom control,
further concerns have been raised, by a large meta-analysis of the pooled results from 19 trials with 33,826 participants, that salmeterol may increase the small risks of asthma deaths and this additional risk is not reduced with the additional use of inhaled steroids (e.g. as with the combination product Fluticasone/salmeterol).
This seems to occur because although LABAs relieve asthma symptoms, they also promote bronchial inflammation and sensitivity without warning.
Sandbox:Inflammatory dermatosis

# Overview
Inflammatory dermatosis of penis represents a group of inflammatory conditions which effect the penis causing Balanitis. Pathogenesis, risk factors, clinical features, laboratory findings and treatment vary from condition to condition.
- Please click here to know more about Zoon's Balanitis
- Please click here to know more about Balanitis xerotica obliterans
- Please click here to know more about Lichen sclerosus
- Please click here to know more about Lichen planus
- Please click here to know more about Psoriasis
- Please click here to know more about Circinate balanitits
- Please click here to know more about Eczema
- Please click here to know more about Seborrhoeic dermatitis
- Please click here to know more about Fixed drug eruption

# Distinguishing clincal features, diagnosis, management of balanitis due to inflammatory dermatosis
Distinguishing clincal features, diagnosis, management of balanitis due to inflammatory dermatosis, include:
Sandbox adult CHD complications

# AHA SCIENTIFIC STATEMENT - 2017

# Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease

## Advantages and Disadvantages of Imaging Modalities for Detection of Liver Disease and Screening for HCC in Patients With Congenital Heart Disease(CHD)

## Types of Heart Disease That May Be Associated With Liver Disease

## Consideration for Liver Surveillance in Adults With Congenital Heart Disease

## Genetic Syndromes With Cardiac Disorders and Associated Endocrinopathies

## Screening for Atherosclerotic Cardiovascular Risk Factors in Adults With Congenital Heart Disease