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Articles 
Justin A. Ezekowitz, Paul W. Armstrong, and Finlay A. McAlister Implantable cardioverter defibrillators prevent sudden cardiac death regardless of baseline risk. However, their impact on total mortality is sensitive to baseline risk for arrhythmic death. Decisions about resource allocation for these devices depend on accurate stratification of patients according to risk.
Christophe Piketty, Teresa M. Darragh, Maria Da Costa, Patrick Bruneval, Isabelle Heard, Michel D. Kazatchkine, and Joel M. Palefsky HIV-positive men may acquire anal human papillomavirus infection and anal squamous intraepithelial lesions in the absence of anal intercourse. All HIV-positive men with CD4+cell counts less than 500 x 106 cells/L, regardless of history of anal intercourse, should be considered for anal cytologic screening; however, the efficacy of this procedure to prevent anal cancer in these populations is unknown.
Eric L. Knight, Meir J. Stampfer, Susan E. Hankinson, Donna Spiegelman, and Gary C. Curhan High protein intake was not associated with renal function decline in women with normal renal function. However, high total protein intake, particularly of nondairy animal protein, may accelerate renal function decline in women with mild renal insufficiency.
Brief Communications
Stephen Bent, Thomas N. Tiedt, Michelle C. Odden, and Michael G. Shlipak Ephedra (ma huang) use is associated with a greatly increased risk for adverse reactions compared with other herbs, and its use should be restricted.
G Caleb Alexander, Rachel M. Werner, Angela Fagerlin, and Peter A. Ubel A substantial number of the prospective jurors interviewed in this study sanctioned physicians' deception of insurance companies to obtain coverage for a needed service.
Academia and Clinic
John J. Norcini, Linda L. Blank, F Daniel Duffy, and Gregory S. Fortna In the mini–clinical evaluation exercise (mini-CEX), a faculty member evaluates a resident's care for a patient during a 15- to 20-minute visit several times a year. The mini-CEX offers an assessment process based on a broad set of patients, clinical settings, and patient problems.
Reviews
J. Michael Lane and Joel Goldstein The authors describe the smallpox vaccine, review risks from vaccination, estimate the actual number of deaths from vaccination that might occur after widespread vaccination today, comment on risk for smallpox spread from a bioterrorism attack, and discuss options for preattack vaccination policy.
Harold R. Collard, Sanjay Saint, and Michael A. Matthay The authors recommend considering several interventions to reduce the incidence of ventilator-associated pneumonia: semi-recumbent positioning, sucralfate rather than H2-antagonists in patients at low to moderate risk for gastrointestinal tract bleeding, aspiration of subglottic secretions, and oscillating beds. They do not recommend selective digestive tract decontamination because routine use may increase antimicrobial resistance.
Perspectives
Alan S. Cross and Steven M. Opal It is time to test a new therapeutic paradigm for sepsis based on an improved understanding of the pathophysiology of the septic process and the recognition that we may have reached the limits of monotherapy.
Paul A. Grayburn and L David Hillis The paradigm is shifting from predicting which patient is at high risk for a perioperative cardiac event to minimizing the likelihood of such an event with specific perioperative pharmacologic therapy.
Editorials
Alfred E. Buxton In this issue, Ezekowitz and colleagues summarize mortality data from eight recent trials of implantable cardioverter defibrillators. Although the patients included in these studies (coronary disease and ejection fraction < 0.3) were at high risk for sudden death, more than 56% of patients with myocardial infarction who later die suddenly have an ejection fraction greater than 0.3. The real challenge lies in identifying potential victims in this large reservoir of lower-risk patients.
On Being a Doctor
Elisha H. Atkins At the small city hospital where I trained, "they" were us. When I went to work in a health center in another, poorer city, I made every attempt to establish common ground with my patients, but it required work, extrapolation, straining across a growing gap of language, culture, and circumstance. No one required more work than Nora and her family.
Letters Tests of Glycemia
The Wrong Patient
Robert M. Wachter, Kaveh G. Shojania, Sanjay Saint, Amy J. Markowitz, and Mark Smith—RESPONSE Bad Outcomes of Questionable Medical Decisions
A Novel Defect in Interferon- Myiasis in a Traveler: A Moving Story
Hypercalcemia after 1,25-Dihydroxyvitamin D3 Production in an End-Stage Kidney
J. Marc Overhage and Paul Dexter
Raymond R. Townsend
Peter H. Stone The author discusses unstable coronary artery disease; treatments of chronic coronary artery disease; risk factors for atherosclerotic cardiovascular disease; management of heart failure; valvular disease; peripheral vascular disease; and arrhythmia. | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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