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Articles 
Kraig S. Kinchen, John Sadler, Nancy Fink, Ronald Brookmeyer, Michael J. Klag, Andrew S. Levey, and Neil R. Powe Late evaluation of patients with chronic renal failure by a nephrologist is associated with greater burden and severity of comorbid disease, black ethnicity, lack of health insurance, and shorter duration of survival.
Saif S. Rathore, Yongfei Wang, Martha J. Radford, Diana L. Ordin, and Harlan M. Krumholz Among elderly persons, women have lower rates of cardiac catheterization use after an acute myocardial infarction than men. However, this difference was attenuated after multivariable adjustment, and it occurred primarily in patients with equivocal indications. The authors found no sex variations in procedure use among patients who had strong indications for cardiac catheterization.
Thomas D. Rea, Susan R. Heckbert, Robert C. Kaplan, Nicholas L. Smith, Rozenn N. Lemaitre, and Bruce M. Psaty In patients who had myocardial infarction, smoking was associated with an elevated risk for recurrent coronary events. In persons who quit smoking after infarction, the risk declined to equal that of nonsmokers by 3 years after cessation.
Brief Communications
Mori J. Krantz, Laurent Lewkowiez, Helen Hays, Mary Ann Woodroffe, Alastair D. Robertson, and Philip S. Mehler The authors describe 17 methadone-treated patients who developed torsade de pointes. Given the likely expansion of methadone treatment into primary care, further investigation of these findings is warranted.
Academia and Clinic
Richard A. Garibaldi, Raja Subhiyah, Mary E. Moore, and Herbert Waxman The In-Training Examination in Internal Medicine (IM-ITE) provides residents and program directors with an objective assessment of each resident's performance on a written, multiple-choice examination and the performance of the residency program compared with that of its peers. The authors found that IM-ITE scores generally improve with year of training, time spent in internal medicine training before the examination, and time permitted to complete the examination.
Reviews
Ethan A. Halm, Clara Lee, and Mark R. Chassin High volume is associated with better outcomes across a wide range of procedures and conditions, but the magnitude of the association varies greatly. The clinical and policy significance of these findings is complicated by the methodologic shortcomings of many studies. Differences in case mix and processes of care between high- and low-volume providers may explain part of the observed relationship between volume and outcome.
History of Medicine
Charles S. Bryan and M. Shawn Stinson In 1914, Lewellys F. Barker, William Osler's successor as Professor of Medicine at the Johns Hopkins University School of Medicine and physician-in-chief at the Johns Hopkins Hospital, resigned to enter private practice rather than accept the terms of a full-time plan, whereby professors in clinical departments would receive fixed salaries and have no financial incentives to see patients. The predicaments he faced in 1914 continue to pester the medical profession in the United States.
Clinical Guidelines
U.S. Preventive Services Task Force* The U.S. Preventive Services Task Force recommends that women 65 years of age and older be screened routinely for osteoporosis and that routine screening begin at 60 years of age for women at increased risk for osteoporotic fractures.
Heidi D. Nelson, Mark Helfand, Steven H. Woolf, and Janet D. Allan This systematic review supports the U.S. Preventive Services Task Force's position on osteoporosis screening.
Editorials
Norman G. Levinsky In this issue, Kinchen and colleagues provide important new information about the timing of referral of patients with chronic renal failure to nephrologists and the influence of this factor on survival once patients receive dialysis.
On Being a Doctor
Ananya Das After training in the United States for 7 years, the decision to come back to India was not an easy one. Most of my Indian friends who had gone to the States for advanced training had opted to stay. I had always wanted to return to India.
Letters Long-Term Outcome in Lupus Nephritis
Quality Indicators for Management and Prevention of Falls
Alternative Medicine: A Mirror Image for Scientific Medicine
Clinical Inertia
Guidelines for the Management of Patients with Chronic Stable Angina
High-Dose Cyclophosphamide for Treatment of Aplastic Anemia
Postoperative Pulmonary Complications
Permanent Paralysis of the Right Phrenic Nerve
Diagnosis by Death
Central Pontine Myelinolysis
Correction: Identification of Persons at High Risk for Type 2 Diabetes Mellitus
Charles D. Ponte
Philip C. Carling
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