Can patients interpret health information? An assessment of the medical data interpretation test.

Objective: To establish the reliability/validity of an 18-item test of patients' medical data interpretation skills.

Design: Survey with retest after 2 weeks. Subjects.

Celebrity endorsements of cancer screening.

Celebrities often promote cancer screening by relating personal anecdotes about their own diagnosis or that of a loved one. We used data obtained from a random-digit dialing survey conducted in the United States from December 2001 through July 2002 to examine the extent to which adults of screening age without a history of cancer had seen or heard or been influenced by celebrity endorsements of screening mammography, prostate-specific antigen (PSA) testing, or sigmoidoscopy or colonoscopy. The survey response rate was 72% among those known to be eligible and 51% among potentially eligible people accounting for those who could not be contacted.

Advertising by academic medical centers.

Background: Many academic medical centers have increased their use of advertising to attract patients. While the content of direct-to-consumer pharmaceutical advertisements (ads) has been studied, to our knowledge, advertising by academic medical centers has not. We aimed to characterize advertising by the nation's top academic medical centers.

The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence.

Background: The incidence of esophageal adenocarcinoma is rising dramatically. This increase may reflect increased disease burden, reclassification of related cancers, or overdiagnosis resulting from increased diagnostic intensity, particularly upper endoscopy for patients with gastroesophageal reflux disease or Barrett esophagus.

Methods: We used the National Cancer Institute's Surveillance, Epidemiology, and End Results database to extract information on incidence, stage distribution, and disease-specific mortality for esophageal adenocarcinoma as well as information on related cancers.

Regulation of P-Rex1 by phosphatidylinositol (3,4,5)-trisphosphate and Gbetagamma subunits.

P-Rex1 is a guanine-nucleotide exchange factor (GEF) for the small GTPase Rac. We have investigated here the mechanisms of stimulation of P-Rex1 Rac-GEF activity by the lipid second messenger phosphatidylinositol (3,4,5)-trisphosphate (PtdIns(3,4,5)P3) and the Gbetagamma subunits of heterotrimeric G proteins. We show that a P-Rex1 mutant lacking the PH domain (DeltaPH) cannot be stimulated by PtdIns(3,4,5)P3, which implies that the PH domain confers PtdIns(3,4,5)P3 regulation of P-Rex1 Rac-GEF activity.

Estrogen receptor beta and breast cancer.

A second estrogen receptor, estrogen receptor-beta, was identified in 1996 and has led to an intensive re-evaluation of the role of estrogens in normal physiological and disease processes. While much has been learnt about this new receptor, there remain many outstanding questions, particularly regarding its prognostic significance and therapeutic implications.

The value of benefit data in direct-to-consumer drug ads.

Direct-to-consumer (DTC) pharmaceutical ads typically describe drug benefits in qualitative terms; they rarely provide data on how well the drug works. We describe an evaluation of a "prescription drug benefit box"-data from the main randomized trials on the chances of various outcomes with and without the drug. Most participants rated the information as "very important" or "important"; almost all found the data easy to understand.

Surgical mortality as an indicator of hospital quality: the problem with small sample size.

Context: Surgical mortality rates are increasingly used to measure hospital quality. It is not clear, however, how many hospitals have sufficient caseloads to reliably identify quality problems.

Objective: To determine whether the 7 operations for which mortality has been advocated as a quality indicator by the Agency for Healthcare Research and Quality (coronary artery bypass graft [CABG] surgery, repair of abdominal aortic aneurysm, pancreatic resection, esophageal resection, pediatric heart surgery, craniotomy, hip replacement) are performed frequently enough to reliably identify hospitals with increased mortality rates.

P-Rex2, a new guanine-nucleotide exchange factor for Rac.

We have identified a new guanine-nucleotide exchange factor, P-Rex2, and cloned it from human skeletal muscle and brain libraries. It has widespread tissue distribution but is not expressed in neutrophils. P-Rex2 is a 183 kDa protein that activates the small GTPase Rac and is regulated by phosphatidylinositol (3,4,5)-trisphosphate and the beta gamma subunits of heterotrimeric G proteins in vitro and in vivo.

Cervical cancer screening among women without a cervix.

Context: Most US women who have undergone hysterectomy are not at risk of cervical cancer-they underwent the procedure for benign disease and they no longer have a cervix. In 1996, the US Preventive Services Task Force recommended that routine Papanicolaou (Pap) smear screening is unnecessary for these women.

Objective: To determine whether Pap smear screening among women who have undergone hysterectomy has decreased following the recommendation.

Surgical options for the treatment of venous ulcers.

Venous ulcers are a difficult problem for both patient and physician. Healing of venous ulcers with compression therapy and elevation, although usually successful, often takes months. Some venous ulcers do not heal with conservative therapy, or if they do, can often recur.

The frequency of Pap smear screening in the United States.

Background: U.S. professional medical societies and the national health systems of all other industrialized nations recommend that most women need not undergo Papanicolaou (Pap) smear screening annually.

Enthusiasm for cancer screening in the United States.

Context: Public health officials, physicians, and disease advocacy groups have worked hard to educate individuals living in the United States about the importance of cancer screening.

Objective: To determine the public's enthusiasm for early cancer detection.

Design, Setting, And Participants: Survey using a national telephone interview of adults selected by random digit dialing, conducted from December 2001 through July 2002.

Phosphoinositide 3-kinase-dependent activation of Rac.

The monomeric GTPase Rac and the lipid kinase phosphoinositide 3-kinase (PI3K) are intracellular signalling enzymes that each regulate a huge range of cellular functions. Their signalling pathways overlap. Several pathways lead from PI3K activation via the production of the lipid second messenger phosphatidylinositol (3,4,5)-triphosphate (PtdIns(3,4,5)P(3)) to the activation of guanine-nucleotide exchange factors (GEFs) that activate Rac.

Laparoscopic removal of a symptomatic rudimentary uterine horn in a perimenarchal adolescent.

An adolescent patient with a symptomatic, noncommunicating, rudimentary uterine horn is described. Diagnosis was suggested by ultrasonography and treatment was by laparoscopic resection. A review of other pediatric cases as well as the adult literature gives evidence that laparoscopic resection is worth considering in such cases.

Are deaths within 1 month of cancer-directed surgery attributed to cancer?

Background: Cancer mortality should include not only deaths from cancer but also deaths from cancer treatment. By convention, deaths within 30 days of a surgical procedure are considered treatment-related deaths in the calculation of operative mortality-that is, the chance of dying from surgery. How cause of death is attributed in patients who die within 1 month of cancer-directed surgery is unknown.

P-Rex1, a PtdIns(3,4,5)P3- and Gbetagamma-regulated guanine-nucleotide exchange factor for Rac.

Rac, a member of the Rho family of monomeric GTPases, is an integrator of intracellular signaling in a wide range of cellular processes. We have purified a PtdIns(3,4,5)P3-sensitive activator of Rac from neutrophil cytosol. It is an abundant, 185 kDa guanine-nucleotide exchange factor (GEF), which we cloned and named P-Rex1.

Hospital volume and surgical mortality in the United States.

Background: Although numerous studies suggest that there is an inverse relation between hospital volume of surgical procedures and surgical mortality, the relative importance of hospital volume in various surgical procedures is disputed.

Methods: Using information from the national Medicare claims data base and the Nationwide Inpatient Sample, we examined the mortality associated with six different types of cardiovascular procedures and eight types of major cancer resections between 1994 and 1999 (total number of procedures, 2.5 million).