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Articles 
Ming Wei, Larry W. Gibbons, Tedd L. Mitchell, James B. Kampert, Chong D. Lee, and Steven N. Blair Low cardiorespiratory fitness was associated with increased risk for impaired fasting glucose and type 2 diabetes. A sedentary lifestyle may contribute to the progression from normal fasting glucose to impaired fasting glucose and diabetes.
Sue J. Goldie, Milton C. Weinstein, Karen M. Kuntz, and Kenneth A. Freedberg Women with HIV infection have a higher risk for cervical squamous intraepithelial lesions than do women without HIV infection. In HIV-infected women, cervical cancer screening with annual Papanicolaou smears after two negative smears obtained 6 months apart offers quality-adjusted life expectancy benefits at a cost comparable to that of other clinical preventive measures.
David Hasdai, Amir Lerman, Diane E. Grill, Charanjit S. Rihal, and David R. Holmes, Jr. In this study, successful percutaneous coronary revascularization did not substantially supplant the use of antianginal medications, which were commonly used despite the marked improvement in anginal status. This finding may reflect reluctance to alter therapy once symptoms of angina subside.
Mary Beth Hamel, Joan M. Teno, Lee Goldman, Joanne Lynn, Roger B. Davis, Anthony N. Galanos, Norman Desbiens, Alfred F. Connors, Jr., Neil Wenger, Russell S. Phillips for the SUPPORT Investigators Patient age may influence decisions to withhold life-sustaining treatments, independent of patients' preferences for and ability to benefit from such treatments. This study found that even after adjustment for differences in patients' prognoses and preferences, older age was associated with higher rates of decisions to withhold ventilator support, surgery, and dialysis.
Brief Communications
Didier Pittet, Philippe Mourouga, Thomas V. Perneger and the Members of the Infection Control Program Transmission of microorganisms from the hands of health care workers is the main source of cross-infection in hospitals and can be prevented by handwashing. In this study, compliance with handwashing was moderate. The variation across hospital ward and type of health care worker suggests that targeted educational programs may help improve compliance with handwashing guidelines.
Anders Widell, Bertil Christensson, Thomas Wiebe, Claes Schalén, Hans Bertil Hansson, Tobias Allander, and Mats A.A. Persson In a pediatric oncology ward, a patient infected with HCV genotype 1b generated nine subsequent cases of infection. Contamination of multidose vials was the most likely mode of HCV transmission.
Perspectives
Carol Levine and Connie Zuckerman A persistent tendency to equate patients' families with trouble is evident in both the literature and the practice of medicine. Physicians' primary responsibilities are to their patients, but physicians should try to adhere to an ethic of accommodation. This ethic emphasizes the need to negotiate care plans that do not compromise patients' basic interests but do recognize the importance, capacities, and limitations of family members.
Medicine and Public Issues
Richard Smith, Howard Hiatt, and Donald Berwick Many groups of professionals that give and affect health care have established separate codes of ethics for their own disciplines, but no shared code exists that might bring all stakeholders in health care into a more consistent moral framework. Responding to this concern, a multidisciplinary group recently developed a basic and generic statement of ethical principles. The statement is intended to offer clear guidance for tough calls in real-world settings.
Editorials
John M. Boyce As indicated in Pittet and colleagues' study in this issue, careful handwashing or antisepsis remains one of the most important measures for preventing the spread of pathogens in the hospital. After tolerating poor handwashing compliance for 150 years, it is time for hospitals and health care professionals to get serious about improving hand hygiene in hospitals.
Robert C. Moellering, Jr. A disturbing number of reports have shown the inexorable development of bacterial resistance to almost all available antimicrobial agents. Development of the drug linezolid suggests that we may not have exhausted the opportunities to find antimicrobial agents with novel mechanisms of action. However, we cannot continue to rely on the discovery of antimicrobial agents as the principal element in the control of bacterial disease.
On Being a Doctor
Robert Burns A physician and his new patient try to talk to each other.
Letters Screening for Thyroid Disease
Impaired Glucose Tolerance in HIV-Positive Patients Receiving and Those Not Receiving Protease Inhibitors
Thrombotic Thrombocytopenic Purpura after Ecstasy-Induced Acute Liver Failure
Severe Hepatotoxicity Associated with Troglitazone
Current Health Care Environment
Doing Everything
Preservation of the Chief Medical Residency
William R. Jewell
Philippe O. Szapary
Mohan Singh Dhariwal
Michael R. Cummings
Paul Kefalides
Chris Dwyer
Stephen M. Campbell and Richard Wernick The 1997 literature included important information on new treatment approaches to rheumatoid arthritis, ways to moderate toxic effects of antirheumatic drugs, state-of-the-art laboratory testing, and low back pain. | |||||||||||||||||||||||||||||||||||||||||||||||
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