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Articles 
Donna L. Washington, Carl D. Stevens, Paul G. Shekelle, Philip L. Henneman, and Robert H. Brook Clinically detailed standardized screening criteria can safely identify patients at public hospital emergency departments for referral to next-day care. However, larger studies are needed to assess the possibility of adverse effects.
Shelley R. Salpeter, Thomas M. Ormiston, and Edwin E. Salpeter Cardioselective ß-blockers do not produce clinically significant adverse respiratory effects in patients with mild to moderate reactive airway disease. The results were similar for patients with concomitant chronic airway obstruction. Given their demonstrated benefit in such conditions as heart failure, cardiac arrhythmias, and hypertension, cardioselective ß-blockers should not be withheld from patients with mild to moderate reactive airway disease.
Joel M. Kremer, Mark C. Genovese, Grant W. Cannon, Jacques R. Caldwell, John J. Cush, Daniel E. Furst, Michael E. Luggen, Ed Keystone, Michael H. Weisman, William M. Bensen, Jeffrey L. Kaine, Eric M. Ruderman, Patricia Coleman, David L. Curtis, Elliot J. Kopp, Seth M. Kantor, Jonathan Waltuck, Herbert B. Lindsley, Joseph A. Markenson, Vibeke Strand, Bruce Crawford, Indra Fernando, Karen Simpson, and Joan M. Bathon Combination therapy with leflunomide and methotrexate provides statistically significant clinical benefit in patients with active rheumatoid arthritis who are receiving methotrexate therapy. Leflunomide plus methotrexate is generally well tolerated and can be used safely with appropriate monitoring of liver enzyme and hematologic measures.
Brief Communications
Stephen D. Shafran, Laura D. Mashinter, Peter Phillips, Richard G. Lalonde, M. John Gill, Sharon L. Walmsley, Emil Toma, Brian Conway, Ignatius W. Fong, Anita R. Rachlis, Kurt E. Williams, Gary E. Garber, Walter F. Schlech, III, and Fiona Smaill Discontinuation of successful disseminated Mycobacterium avium complex therapy after a successful response to highly active antiretroviral therapy is safe and reduces patients' pill burdens, potential drug adverse effects, drug interactions, and costs of therapy.
Academia and Clinic
Terry L. Brandt, Clifford R. Romme, Nicholas F. LaRusso, and Keith D. Lindor The authors describe a novel incentive system designed to promote high-quality care and increase patient access to health care while enhancing clinical and academic productivity and physician satisfaction. Key components of this system include annual targets, flexibility in meeting these targets, and ability to convert clinical productivity that exceeds what was necessary to meet the target to support scholarly activities.
Reviews
Matthew L. Esson and Robert W. Schrier New information about the importance of early diagnosis and supportive care for patients with acute tubular necrosis has emerged. However, randomized trials of these interventions are needed to test their effect on the morbidity and mortality of this condition.
NIH Conferences
David S. Goldstein, David Robertson, Murray Esler, Stephen E. Straus, and Graeme Eisenhofer The term dysautonomia refers to a change in autonomic nervous system function that adversely affects health. The authors discuss chronic autonomic failure; autonomic function in chronic orthostatic intolerance, essential hypertension, panic disorder, and congestive heart failure; and dysautonomia and the chronic fatigue syndrome and neurocardiology.
Editorials
Eric B. Larson In this issue, Washington and colleagues describe a system designed to identify persons in an emergency department who have symptoms related to abdominal and pelvic pain, musculoskeletal pain, or respiratory infection and meet criteria for deferred care. The deferred care approach is one solution to the complex problem of emergency department overcrowding that faces many busy urban centers. A better overall solution would be widespread availability of timely and effective ambulatory care, based on continuous physician–patient relationships.
Paul E. Epstein Salpeter and colleagues' elegant meta-analysis in this issue has helped put to rest a question that is both clinically important and controversial: Can cardioselective ß-blockers be used safely in patients with recognized obstructive lung disease?
On Being a Doctor
Brett DiGiovanna Mr. Rosen looked at me and asked if I still took anatomy, telling me that medical students were spoiled. I asked him why. "The formaldehyde," he replied, "you never had to smell a rotting body on a battlefield."
Richard B. Weinberg The most peculiar thing about being fired is that everybody stops talking to you. "It's time for a change," they told me, and with that, my decade of service as a section head was over.
Letters Inaccurate Glucose Determination by Fingerstick in a Patient with Peripheral Arterial Disease
Subgroup Results in the DASH-Sodium Trial
Public Expectation for Annual Physical Examinations
Diphtheria and Tetanus Immunity
Lyme Disease Controversy: Use and Misuse of Language
Octreotide Therapy for the Sjögren Syndrome
Correction: Guidelines for Using Antiretroviral Agents among HIV-Infected Adults and Adolescents
Kate Scannell My entrenched skepticism about the ability of a single view to function as collective truth has fostered in me a driving curiosity about other peoples' experiences and a ready desire to hear them—elements that have enlivened my life as a physician and writer.
James Nora and Bradley N. Doebbeling
Evelyn V. Hess
Timothy Lahey
George Young
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