Table of Contents

June 4, 2002; 136 (11)

Articles

  • In humans, impaired heat dissipation is a major mechanism by which cocaine elevates body temperature. When healthy, cocaine-naive persons are subjected to passive heating, pretreatment with even a small dose of intranasal cocaine impairs sweating and cutaneous vasodilation (the major autonomic adjustments to thermal stress) and heat perception (the key trigger for behavioral adjustments).

  • Bloodstream infections are significantly reduced in patients with central vascular lines who receive chlorhexidine gluconate versus povidone-iodine for skin site disinfection. Use of chlorhexidine gluconate rather than povidone-iodine for catheter-site care is a simple and effective means of reducing vascular catheter–related infections.

  • Self-reported and performance-based measures of function can differ in women who have experienced a recent cerebrovascular event. Although more difficult to collect, results of a performance-based measure may provide important information about long-term health outcomes.

Brief Communications

  • Estimates of adverse event rates from medical record review, including those reported by the U.S. Institute of Medicine in its 2000 report on medical errors, are highly sensitive to the degree of consensus and confidence among reviewers.

Academia and Clinic

  • This essay looks at the placebo effect of alternative medicine as a distinct entity by reviewing current knowledge about the placebo effect and how it may pertain to alternative medicine. Five components of the placebo effect—patient, practitioner, patient–practitioner interaction, nature of the illness, and treatment and setting—are examined.

  • Among all types of medical errors, cases in which the wrong patient undergoes an invasive procedure are sufficiently distressing to warrant special attention. Nevertheless, institutions underreport such procedures, and the medical literature contains few discussions about them. This article examines the case of a patient who was mistakenly taken for another patient's invasive electrophysiology procedure.

Review

  • Recent years have witnessed a rapidly growing crisis in antimicrobial resistance, especially among microorganisms that cause nosocomial infection. To better understand common risk factors among multiresistant organisms, this review explores risk factors for nosocomial infection with methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, Clostridium difficile, extended-spectrum β-lactamase–producing gram-negative bacilli, and Candida.

Perspectives

  • This paper examines the various ways that the terms terminal sedation and refusal of hydration and nutrition have been used in the medical literature.

Editorial

  • In this issue, with the paper by Chassin and Becher, Annals launches a new series, “Quality Grand Rounds.”

Letters

Medical Writings: Book Notes

Ad Libitum

Book Listings

Medical Notices

Summaries for Patients