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Articles 
Lisa A. Prosser, Aaron A. Stinnett, Paula A. Goldman, Lawrence W. Williams, Maria G.M. Hunink, Lee Goldman, and Milton C. Weinstein Cost-effectiveness of cholesterol-lowering treatments was found to vary significantly when adjusted for sex, age, and the presence or absence of additional risk factors. Primary prevention with a step I diet seems to be cost-effective for most risk subgroups but not for otherwise healthy young women. Primary prevention with a statin may not be cost-effective for younger men and women with few risk factors, given the option of secondary prevention and of primary prevention in older age ranges.
David A. Ganz, Karen M. Kuntz, Gretchen A. Jacobson, and Jerry Avorn The cost-effectiveness ratios of statin therapy in older patients who have previously had myocardial infarction are reasonable under a variety of assumptions about drug efficacy, drug cost, and rates of cardiac and cerebrovascular events. Pending results of randomized, controlled trials of secondary prevention in patients in this age group, statin therapy seems to be as cost-effective as many routinely accepted medical interventions in this setting.
Kishan J. Pandya, Richard F. Raubertas, Patrick J. Flynn, Harry E. Hynes, Richard J. Rosenbluth, Jeffrey J. Kirshner, H. Irving Pierce, Vladimir Dragalin, and Gary R. Morrow Oral clonidine at a dosage of 1 mg/d is effective against tamoxifen-induced hot flashes in postmenopausal women with breast cancer.
Brief Communications
Han-Mou Tsai, Lawrence Rice, Ravindra Sarode, Thomas W. Chow, and Joel L. Moake In patients who developed ticlopidine-associated thrombotic thrombocytopenic purpura (TTP), autoantibodies to von Willebrand factor metalloproteinase were formed; this led to the same type of von Willebrand factor abnormalities seen in patients with idiopathic acute TTP. The findings suggest that failure to process large and unusually large von Willebrand factor multimers in vivo caused binding of von Willebrand factor to platelets, systemic platelet thrombosis, and TTP.
Konstantinos Raymondos, Bernhard Panning, Martin Leuwer, Guido Brechelt, Thomas Korte, Michael Niehaus, Jürgen Tebbenjohanns, and Siegfried Piepenbrock This prospective study demonstrates that administration of adrenaline into the airways is hemodynamically effective and increases adrenaline plasma levels in adults with severe cardiac disease.
Academia and Clinic
James E. Smith, Robert L. Winkler, and Dennis G. Fryback Computing the positive predictive value (PPV) is difficult in the case of a new test for a rare disorder. The authors present some tools for thinking about PPV calculations for such scenarios.
Reviews
Kavita Nanda, Douglas C. McCrory, Evan R. Myers, Lori A. Bastian, Vic Hasselblad, Jason D. Hickey, and David B. Matchar Available high-quality data are insufficient to allow estimation of test operating characteristics of new cytologic methods for cervical screening. Future studies of these technologies should apply adequate reference standards. Most studies of the conventional Papanicolaou test are severely biased: The best estimates suggest that the test is only moderately accurate and does not achieve concurrently high sensitivity and specificity.
Perspectives
Karen E. Steinhauser, Elizabeth C. Clipp, Maya McNeilly, Nicholas A. Christakis, Lauren M. McIntyre, and James A. Tulsky This study describes the attributes of a good death, as understood by various participants in end-of-life care.
Medicine and Public Issues
Robert Dickler and Gina Shaw The authors examine the overall financial and organizational effect of the Balanced Budget Act of 1997 on teaching hospitals in the United States and consider its effect on residency education.
Editorials
Alan M. Garber The studies by Ganz and Prosser and their colleagues in this issue evaluate statin therapy in clinically important populations that were not studied adequately in randomized trials. These studies reinforce the message that lipid management for secondary prevention should be a high priority, regardless of whether the patient is female or male, young or old.
On Being a Doctor
Bruce Leff How had such a ripe opportunity for a "good" death been botched so badly, and why had so many people experienced such suffering?
Bhuvana Chandra
Letters Antithrombotic Therapy To Prevent Stroke in Patients with Atrial Fibrillation
Chronic Infection and Coronary Risk
Elevated Ambulatory and Normal Office Blood Pressure
The Sharer
Diagnosis of Intercritical Gout
Transmission of Tuberculosis in a Jail
Prophylactic Fluconazole in Liver Transplant Recipients
Role of Communication Skills Training
Update in Preventive Medicine
Gated Myocardial Perfusion Scan Leading to Diagnosis of Unsuspected Massive Pulmonary Embolism
Infection with Hepatitis C Virus Genotype 4 Is Associated with a Poor Response to Interferon- A Common Problem with Therapy for HIV Infection
Most Gastric Low-Grade B-Cell Lymphomas of Mucosa-Associated Lymphoid Tissue Persist after Helicobacter pylori Eradication
Immediate Cerebral Angiography and Mechanical Fragmentation of Cerebral Embolus after Percutaneous Myocardial Revascularization
Rapid Bioprosthetic Valve Degeneration in a Patient Undergoing Hemodialysis
Gerald Schulman
Christopher Maylahn
Linda Gundersen
George N. Braman
Carolyn Theresa Cleary
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