tbuckley/cabot-search huggingface dataset:
Helping patients access high quality health information
Authors: S. Shepperd, D. Charnock, B. Gann
Journal: BMJ (1999)

The provision of consumer health information was pioneered in the United States: organisations such as Planetree (a not for profit, community based healthcare initiative) were among the first to provide information services.1 Over the years several organisations in the United Kingdom—including the College of Health, the Help for Health Trust, the Health Education Authority, the Health Education Board for Scotland, and self help groups—have provided information on a wide range of health topics directly to patients or consumers. Similar initiatives have been undertaken in Europe, Canada, Australia, and New Zealand.2 More recently, developments in Britain such as local consumer health information services, the Patient Partnership Strategy,3 and initiatives at the King's Fund4 5 have improved awareness of and access to evidence based consumer health information. These developments have come at a time when the amount of health information is increasing, particularly through the internet—and amid increasing concern about the varying quality of health information accessed by patients. We outline some steps to help health professionals advise patients on where to find good quality health information in this rapidly changing field.

#### Summary points

Patients require access to good quality, evidence based information so they can take an active part in decisions about their health care

The amount of information available to patients is increasing, particularly through the internet

The quality of this information remains variable

Health professionals need to be able to direct patients to sources of good quality consumer health information, including health related websites

Some of the organisations in the United Kingdom that are funded to provide health information for patients and the public are listed in box 1.

### The internet

The internet offers access to health information provided by many different organisations and agencies Several providers offer gateway services that operate a selective process, only including information …
Yellow Fever Vaccine and Avian Leukosis Virus
Authors: HARRY C. NOTTEBART
Journal: Annals of Internal Medicine (1984)

Letters and Corrections1 July 1984Yellow Fever Vaccine and Avian Leukosis VirusHARRY C. NOTTEBART JR., M.D.HARRY C. NOTTEBART JR., M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-101-1-148_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The recommendations of the Immunization Practices Advisory Committee for yellow fever immunization have recently been updated again (1). This vaccine is extremely safe, with perhaps fewer serious reactions than most vaccines, but I am surprised that few authorities mention that the yellow fever vaccine is probably contaminated with avian leukosis virus (2, 3). In fact, most authorities do not mention this (1, 4, 5). Considering the safety record of the yellow fever vaccine, the presence of this other virus is apparently not significant, but this information should be provided to those who administer this vaccine....References1. Yellow fever vaccine: recommendations of the Immunization Practices Advisory Committee. MMWR. 1984;32:679-82,687-8. MedlineGoogle Scholar Reprinted in Ann Intern Med. 1984;100:540-2. LinkGoogle Scholar2. PINHEIRO F. Yellow fever. In: BRAUDE AI, ed. Medical Microbiology and Infectious Diseases. Philadelphia: W.B. Saunders Co.; 1981:1159. Google Scholar3. GEARBOWENKEMP JGG. Yellow fever. In: FEIGIN RD, CHERRY JD, eds. Textbook of Pediatric Infectious Diseases. Philadelphia: WB Saunders Co.; 1981:1098. Google Scholar4. HRUSKA J. Yellow fever virus. In: MANDELL GL, DOUGLAS RG JR, BENNETT JE, eds. Principles and Practice of Infectious Diseases. New York: John Wiley & Sons; 1979:1253-7. Google Scholar5. HOEPRICH P. Immunoprophylaxis of infectious diseases. In: HOEPRICH PD, ed. Infectious Diseases. 2nd ed. Hagerstown, Maryland: Harper & Row Publishers, Inc.; 1977:210. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: HARRY C. NOTTEBARTJR., M.D.Affiliations: University of Virginia Richmond, VA 23234 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 July 1984Volume 101, Issue 1Page: 148-148KeywordsFeversSafetyVaccines ePublished: 1 December 2008 Issue Published: 1 July 1984 PDF downloadLoading ...
Value of Serial Troponin T Measures for Early and Late Risk Stratification in Patients With Acute Coronary Syndromes
Authors: L. Kristin Newby, Robert H. Christenson, E. Magnus Ohman, Paul W. Armstrong, Trevor D. Thompson, Kerry L. Lee, Christian W. Hamm, Hugo A. Katus, Cresha Cianciolo, Christopher B. Granger, Eric J. Topol, Robert M. Califf
Journal: Circulation (1998)

Background —The baseline cardiac troponin T (cTnT) level strongly predicts short-term mortality in acute coronary syndromes, but the added value of later measures to predict short- and long-term outcome and in the context of baseline clinical characteristics is unclear. Methods and Results —Relations between baseline, peak, and 8- and 16-hour (late) cTnT results and outcomes were assessed in 734 patients in a GUSTO-IIa substudy. Proportional-hazards models assessed the prognostic information gained from late cTnT when added to a mortality model containing the baseline cTnT result and clinical factors. At baseline, 260 patients were cTnT-positive (&gt;0.1 ng/mL), 323 became positive later, and 151 remained negative (≤0.1 ng/mL). Mortality at 30 days was 10% in the baseline-positive group, 5% in late-positive patients, and 0% in negative patients. After adjustment for baseline characteristics, any positive cTnT result predicted 30-day mortality (baseline, χ 2 =8.96, P =0.0113; 8-hour, χ 2 =6.51, P =0.0107; 16-hour, χ 2 =8.40, P =0.0038). Both the 8- and the 16-hour results added to the strength of the baseline result (baseline+8-hour, χ 2 =12.04, P =0.0072; baseline+16-hour, χ 2 =13.52, P =0.0036). Only age and ST-segment elevation were stronger predictors of 30-day mortality than baseline cTnT; results were similar for prediction of 1-year mortality. Most of the mortality difference between cTnT-positive and -negative patients occurred within the first 30 days. Conclusions —The cTnT level is a strong, independent predictor of short-term outcome in acute coronary syndromes. The addition of later samples to a baseline level is useful to evaluate the risk of serious cardiac events.
Urinary Estriols: Are They of Value in Normoglycemic Diabetic Pregnancy?
Authors: Peter E Fern, George M Grunert, Stephen B Lewis
Journal: Diabetes Care (1982)

The purpose of the study was to assess the value of 24-h urinary estriols in the management of diabetic pregnancies. Twenty-seven pregnant diabetic patients (White's class B through R) received insulin dosages twice daily as a combination of NPH and regular insulin. Laboratory and home monitored blood glucose was maintained within the range of 70–150 mg/dl. From 32 wk onward daily 24-h urinary estriols, weekly fetal heart rate monitoring, and, when indicated, amniotic fluid lecithin/sphingomyelin ratio were used to evaluate fetal well-being. Fetal heart rate and amniotic fluid testing were of value while urinary estriols failed to be useful in management or timing of delivery. We conclude that when third-trimester normoglycemia is maintained in pregnant diabetic patients, one obviates the need for the costly and odious task of daily urine estriol measurements.
Differential effects of 24-hydroxycholesterol and 27-hydroxycholesterol on β-amyloid precursor protein levels and processing in human neuroblastoma SH-SY5Y cells
Authors: Jaya RP Prasanthi, Amber Huls, Sarah Thomasson, Alex Thompson, Eric Schommer, Othman Ghribi
Journal: Molecular Neurodegeneration (2009)

Abstract Background Activation of the liver × receptors (LXRs) by exogenous ligands stimulates the degradation of β-amyloid 1–42 (Aβ42), a peptide that plays a central role in the pathogenesis of Alzheimer's disease (AD). The oxidized cholesterol products (oxysterols), 24-hydroxycholesterol (24-OHC) and 27-hydroxycholesterol (27-OHC), are endogenous activators of LXRs. However, the mechanisms by which these oxysterols may modulate Aβ42 levels are not well known. Results We determined the effect of 24-OHC and/or 27-OHC on Aβ generation in SH-SY5Y cells. We found that while 27-OHC increases levels of Aβ42, 24-OHC did not affect levels of this peptide. Increased Aβ42 levels with 27-OHC are associated with increased levels of β-amyloid precursor protein (APP) as well as β-secretase (BACE1), the enzyme that cleaves APP to yield Aβ. Unchanged Aβ42 levels with 24-OHC are associated with increased levels of sAPPα, suggesting that 24-OHC favors the processing of APP to the non-amyloidogenic pathway. Interestingly, 24-OHC, but not 27-OHC, increases levels of the ATP-binding cassette transporters, ABCA1 and ABCG1, which regulate cholesterol transport within and between cells. Conclusion These results suggest that cholesterol metabolites are linked to Aβ42 production. 24-OHC may favor the non-amyloidogenic pathway and 27-OHC may enhance production of Aβ42 by upregulating APP and BACE1. Regulation of 24-OHC: 27-OHC ratio could be an important strategy in controlling Aβ42 levels in AD.
Role of persistent amenorrhea in bone mineral metabolism of young hemodialyzed women
Authors: José R. Weisinger, Leyda Gonzalez, Hector Alvarez, Eddy Hernandez, Raúl G. Carlini, Freya Capriles, Mercedes Cerviño, Ruby Martinis, Virgilio Paz-Martínez, Ezequiel Bellorín-Font
Journal: Kidney International (2000)
Outbreak of tuberculosis after minimal exposure to infection.
Authors: V R Rao, R F Joanes, P Kilbane, N S Galbraith
Journal: BMJ (1980)

The identification of a case of respiratory tuberculosis in a swimming-baths attendant whose sputum was smear positive was followed by intensive contact tracing of children aged 8-11 years who had visited the baths. An outbreak was discovered that otherwise might not have been detected. Out of 3764 children, 108 (2.9%) had evidence of infection: there were 16 cases of tuberculosis, of which 11 were symptomless but showed lesions on chest radiography, and a further 92 with tine test grade 3 or 4 without clinical or radiological signs. The contact of these children with the index case was apparently minimal. Early detection, isolation, and treatment of infectious cases of respiratory tuberculosis and vigorous contact tracing should be given more priority in tuberculosis control.
Reversal of Allergic Airway Hyperreactivity after Long-term Allergen Challenge Depends on γδ T Cells
Authors: Zhi-Hua Cui, Anthony Joetham, M. Kemal Aydintug, Yoon-Soo Hahn, Willi K. Born, Erwin W. Gelfand
Journal: American Journal of Respiratory and Critical Care Medicine (2003)

Long-term allergen exposure can attenuate inflammation and revert airway hyperreactivity to normal responsiveness. A model of such reversal was established in which airway hyperreactivity and inflammation in ovalbumin-sensitized and challenged mice were decreased after multiple daily airway challenges. This change in responsiveness and inflammation was associated with a transition from a helper T cell Type 2 to a helper T cell Type 1 cytokine-biased profile in bronchoalveolar lavage fluid. Cell transfer from long-term exposed mice into hyperreactive mice also restored normal airway responsiveness, establishing the mechanism underlying the reversal of the hyperreactivity as active suppression, but did not affect eosinophilic airway inflammation. Conversely, airway hyperreactivity, suppressed as a result of long-term allergen exposure, could be reestablished by depleting gammadelta T cells, in particular Vgamma4+ cells. Antigen-specific tolerance of alphabeta T cells or suppression by non-gammadelta T cells did not play a role in the reversal to normal airway responsiveness and gammadelta T cells did not play a role in the regulation of the allergic inflammatory response. These findings show that normal responsiveness in previously hyperreactive mice, achieved after long-term allergen challenge, is based on several, apparently independent regulatory mechanisms. One of these, focused on airway responsiveness, involves active suppression and requires gammadelta T cells.
A 42 year old man with acute chest pain: case outcome
Authors: G Sodeck, B Partik, H Domanovits
Journal: BMJ (2003)

Three weeks ago (26 April, p 920), we presented the case of Peter Hartl, a 42 year old man who presented to his local emergency department with severe retrosternal chest pain. Initial investigation ruled out myocardial ischaemia (3 May, p 974). He had spiral computed tomography to exclude a pulmonary embolus because of his persistent dyspnoea and suggestive findings on echocardiography and chest radiography. To …
Evaluation of thyroid and parathyroid functions; proceedings of the third applied seminar of the Association of Clinical Scientists.
Authors: George Milles
Journal: JAMA (1963)

This monograph covers all parameters of thyroid and parathyroid function in detail, supplemented by a bibliography into 1962. The physiology of the thyroid serves as the real introduction, although "Physiological Considerations in the Management of Patients with Hyperthyroidism" might have served even better. "Chromatographic Fractionation of Iodinated Compounds" is well detailed. D'Angelo's pioneer work in "Measurement of Thyrotropin in Plasma" was neglected in the otherwise excellent coverage of this subject. Basal metabolic rate, in two pages and 63 references, proves the viability of this much debated procedure. The sources of error in the "Measurement of Serum Protein-Bound Iodine" are pinpointed and an alkaline ash method is given in detail. The exacting technique for the measurement of the butanol-extractable iodine is given in sufficient detail to serve as a working guide. The section on radioisotopes includes the red cell uptake of I-131-tagged triiodothyronine. The presence of antithyroid antibodies in the blood
Bile-Acid Malabsorption
Authors: R. P. Sarva
Journal: JAMA (1979)

<h3>To the Editor.—</h3> We read the stimulating report by Hutcheon et al (241:823, 1979) concerning observation of bile-acid malabsorption in three postcholecystectomy patients and the response to cholestyramine therapy. Our group has reported a similar experience<sup>1-3</sup>in three postcholecystectomy patients in whom bile-acid malabsorption was shown by studies using the bile-acid breath test and the measurement of fecal excretion of radioactively labeled bile acids. In two of these three patients, the diarrhea responded to cholestyramine. We termed this entity "Type 3" bile-acid diarrhea, with "Type 1" being found in diseases or after resection of terminal ileum, and "Type 2" being defined as a defect of active ileal bile-acid transport in the absence of ileal disease or resection.<sup>4</sup> We believe that among the possible mechanisms that could be responsible for bile-acid diarrhea after cholecystectomy, an ileal transport defect is the most likely. Increased demands on the bile-acid transport system, resulting
Scintillation Scanning in Differential Diagnosis
Authors: Frederick J. Bonte, J. S. Krohmer, C. H. Tseng, Marion C. L. Baldwin
Journal: JAMA (1961)

Radioisotope scintillation scanning has been applied to the diagnostic problem presented by thoraco-abdominal masses in the midline. The technique consists of the intravenous injection of human serum albumin iodinated with the radioactive isotope I 131 and the use of a scintillation-scanning apparatus to reveal the distribution of the tracer-tagged blood pools within the thorax and upper abdomen. Study is facilitated by superposing the transparent record given by the scintillation-scanning apparatus upon the matching chest roentgenogram. The cases of 4 patients here described illustrate the safety and usefulness of this method as a substitute for contrast roentgen aortography in the differential diagnosis between midline solid tumors and aneurysms of the great vessels.
Diagnosis and Staging of Prostatic Carcinoma by Endoscopic Biopsy
Authors: R. Barnes
Journal: Endoscopy (1969)

A more accurate histopathological diagnosis of prostatic carcinoma can be obtained if the surgeon, while doing endoscopic removal of the prostate, selects pieces for biopsy study from the dorsal portion of the gland near the capsule, from areas of soft tissue which may be encountered and from orange-yellow pieces. The stage of the malignancy and a prognosis can be more accurately estimated by receiving specific information on the pathology report as to the per cent of all the tissue which is malignant, the position in the prostate of the malignant pieces and the grade of malignancy (cell structure).
Electron microprobe analysis of human labial gland secretory granules in cystic fibrosis.
Authors: K Izutsu, D Johnson, M Schubert, E Wang, B Ramsey, A Tamarin, E Truelove, W Ensign, M Young
Journal: Journal of Clinical Investigation (1985)

X-ray microanalysis of freeze-dried labial gland cryosections revealed that Na concentration was doubled and the Ca/S concentration ratio was decreased in secretory granules of labial glands from patients with cystic fibrosis (CF) when compared with glands from normal subjects. Other results suggested that the decrease in the Ca/S concentration ratio resulted from an increase in S concentration. These findings imply that mucous granules in labial saliva showed a CF-related increase in Na and S content, and such changes would be expected to affect the rheology of the mucus after exocytosis. In contrast with a previous study in human parotid glands, no evidence was found for CF-related changes in cytoplasmic or nuclear Na, K, and Ca concentrations. Significant elemental differences were found between secretory granules and nuclei and cytoplasm of control cells.
The Fetal Electrocardiogram
Authors: Richard F. Mattingly
Journal: JAMA (1963)

CURRENT INTEREST in the field of human reproduction has created greater demands for accurate evaluation of intrauterine environment. The fetal heart has served as the main indicator of abnormal fetal physiology by evidencing altered myocardial contractility, producing both bradycardia and tachycardia, as well as irregularities in rate. Although one-half century has transpired since the accidental recording of the first fetal heart beat by Cremer in 1906, active interest and progress in this new field of fetal cardiology has been limited to the past decade. With our growing experience and understanding, fetal electrocardiographic (ECG) technique is beginning to emerge as a research tool of wide promise. Based on more than 4,500 fetal ECG case studies, this report will demonstrate the present and future vistas in the study of the fetal heart in the field of human reproduction.  Technique  A variety of high-sensitivity recording systems are utilized effectively in recording the fetal
CONSTITUTIONAL INADEQUACY OR NEURASTHENIA
Authors: Samuel Ralph
Journal: JAMA (1942)

<h3>To the Editor:—</h3> That was a fascinating article by Dr. Walter C. Alvarez in the July 4 issue. He always writes well and interestingly. Of course, all of us old practitioners recognized the class of patients to which the doctor chooses to apply a new label—constitutional inadequacy. Yes, we are all acquainted with that class of chronics who wander from office to office, from clinic to clinic, and finally wind up with some quack or fall a prey to some patent nostrum. It is with the new name, however, that I wish to take issue with the author. The label seems a bit vague, too long, too hackneyed. If we can only find a simple label, of one word or of two words joined together for euphony! I didn't have to go far. Under the heading of the Cause of the Trouble, Dr. Alvarez states "Actually, in most cases I
VACCINATION WITH MIXED CULTURES FROM THE NOSE IN HAY-FEVER
Authors: CHARLES B. MORREY
Journal: JAMA (1913)

About four years ago I reported good results in treating ordinary colds with vaccines, 1 and I have sccessflly used the method as occasion arose since that time. This suggested a similar procedure with regard to hay-fever. Opportunity did not arise until the summers of 1911 and 1912, as detailed below. Since I am not in regular practice, only such persons as came voluntarily to be experimented on were available. Vaccines were prepared in the following manner:  Swabs similar to diphtheria swabs are rubbed over the nasal mucosa after the patient has first thoroughly blown the nose to remove dust and possible saphrophytes. The swabs were rubbed over the surface of large 19 mm. agar-slant tubes. Two slants are inoculated to avoid possible loss or lack of material. The tubes are incubated twenty-four hours. If little growth appears it is spread over the surface and incubated twenty-four hours longer. When, in either case, there is a heavy growth, this is rubbed off in normal salt solution,
Breakdown of gliadin peptides by intestinal brush borders from coeliac patients.
Authors: G Bruce, J F Woodley, C H Swan
Journal: Gut (1984)

The 9missing peptidase9 hypothesis to explain the aetiology of coeliac disease has never been satisfactorily resolved and recent reports suggest that coeliac brush borders may have depressed levels of specific peptidase enzymes. It has been inferred from these studies that the subsequent brush border digestion of gliadin peptides may therefore be defective. In this present study a sensitive fluorometric assay was used to measure the hydrolysis of a peptic-tryptic digest of gliadin by both normal and coeliac brush borders. The coeliac brush borders were as efficient as the normals in hydrolysing gliadin peptides and showed no depression of any specific peptidase activity.
Driving and Alzheimer Disease-Reply
Authors: L. Jaime Fitten
Journal: JAMA (1996)

<h3>In Reply.</h3> —Dr Mattes' letter raises two important points. The first concerns the type of motor vehicle crash and moving violation found in our experimental groups. This is of significant interest to both traffic safety and clinical investigators. Unfortunately, our sample sizes did not permit meaningful statistical analysis of this question based on DMV data. Ordinarily, much larger groups are used for this type of analysis. Because only major crashes are recorded by the DMV, we enriched the adverse driving event data by administering a detailed, structured interview to caregivers living with the demented subjects. The interview probed the caregiver about unrecorded collisions and about "close calls" such as running a red light or driving the wrong way down a one-way street. While we reported the principal findings from the combined DMV interview data in our recent article, we are currently reexamining the interview data to address additional qualitative issues
There’s a goat behind door number 3: from Monty Hall to medicine
Authors: David J. Friedman, Laurence A. Turka, Simon C. Robson
Journal: Journal of Clinical Investigation (2011)

In the 18th century, Thomas Bayes developed his eponymous theorem that teaches us that pretest probabilities can be altered by new information, such as when game show host Monty Hall revealed the goat behind one of the remaining doors in "Let's Make A Deal." Bayesian analysis is a key feature of many medical decisions. In this issue of the JCI, Lee and colleagues apply this concept to inflammatory bowel disease to identify gene expression-based biomarkers of disease severity. Importantly, these biomarkers allowed patients to be stratified into two groups: those at high risk for disease recurrence or the need for immunosuppressive treatment escalation and those with a more benign disease course.