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Articles 
Sean P. Keenan, Tasnim Sinuff, Deborah J. Cook, and Nicholas S. Hill Patients receiving standard therapy for severe exacerbations of chronic obstructive pulmonary disease (COPD) benefit from noninvasive positive-pressure ventilation (NPPV). However, hospitalized patients with milder COPD exacerbations do not benefit from NPPV.
Willem J.J. Assendelft, Sally C. Morton, Emily I. Yu, Marika J. Suttorp, and Paul G. Shekelle This meta-analysis found no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain.
Andrew L. Rosenberg, Timothy P. Hofer, Cathy Strachan, Charles M. Watts, and Rodney A. Hayward Accepting transfer patients can adversely affect measures of efficiency and quality of care, even after use of the most thorough, precise methods to adjust for case mix. If organizations that collect and publish measures of hospital quality of care fail to account for this phenomenon, referral centers may have an incentive to refuse to accept very sick patients in transfer from other hospitals.
Brief Communications
Lydia A. Bazzano, Jiang He, Paul Muntner, Suma Vupputuri, and Paul K. Whelton Inflammation and hyperhomocysteinemia may be important mechanisms by which smoking promotes atherosclerotic disease.
Academia and Clinic
Daniel C. Cherkin, Karen J. Sherman, Richard A. Deyo, and Paul G. Shekelle Massage seems to be effective for persistent back pain, spinal manipulation has small clinical benefits equivalent to those of other common back pain therapies, and the effectiveness of acupuncture remains unclear. All of these treatments seem to be relatively safe.
Reviews
Thomas J. Wang, Daniel Levy, Emelia J. Benjamin, and Ramachandran S. Vasan Asymptomatic left ventricular systolic dysfunction (LVSD) precedes congestive heart failure in many patients. While several landmark trials have enrolled patients with asymptomatic LVSD, those patients make up only a subset of the people who are possible candidates for screening. The available evidence is inadequate to decide about screening for LVSD in the general population.
Perspectives
Michael G. Shlipak Patients with heart failure and renal insufficiency have been underrepresented in clinical trials of drugs for congestive heart failure. This paper reviews the evidence and suggests ways to balance benefit and harm when treating heart failure in the presence of renal insufficiency.
Clinical Guidelines
U.S. Preventive Services Task Force* The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routine screening for dementia in older adults.
Malaz Boustani, Britt Peterson, Laura Hanson, Russell Harris, and Kathleen N. Lohr This systematic review evaluates the evidence that screening for dementia can alter health outcomes.
Editorials
Finlay A. McAlister This editorial focuses on the dilemma at the heart of Dr. Shlipak's paper in this issue: How can we extrapolate from trials conducted in highly selected patients to a broader population of patients who have the same condition but do not meet the trial eligibility criteria?
Letters Urinary Catheters: A One-Point Restraint?
A Lesson in Poverty
Ethics and Complementary and Alternative Medicine
Correction: Malignant Glioma Physiology
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