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Articles 
Gary P. Wormser, Roshan Ramanathan, John Nowakowski, Donna McKenna, Diane Holmgren, Paul Visintainer, Rhea Dornbush, Brij Singh, and Robert B. Nadelman A 10-day course of doxycycline was sufficient for patients with erythema migrans. Extending doxycycline treatment to 20 days or adding one ceftriaxone dose at the beginning of a 10-day course of doxycycline did not enhance therapeutic efficacy. Regardless of regimen, objective evidence of treatment failure was extremely rare.
Drew J. Winston, Richard T. Maziarz, Pranatharthi H. Chandrasekar, Hillard M. Lazarus, Mitchell Goldman, Jeffrey L. Blumer, Gerhard J. Leitz, and Mary C. Territo Itraconazole is more effective than fluconazole for long-term prophylaxis against invasive fungal infections after allogeneic hematopoietic stem-cell transplantation. Except for gastrointestinal side effects, itraconazole is well tolerated.
Michael J. Kovacs, Marc Rodger, David R. Anderson, Beverly Morrow, Gertrude Kells, Judy Kovacs, Eleanor Boyle, and Philip S. Wells A dosing nomogram for starting warfarin anticoagulation achieves a therapeutic international normalized ratio more quickly if the first dose is 10 mg rather than 5 mg.
Brief Communications
Robert Raschke, Jack Hirsh, and James R. Guidry Few published randomized, controlled trials comparing low-molecular-weight heparin with unfractionated heparin used validated therapeutic ranges for adjusted partial thromboplastin time or standardized protocols for adjusting unfractionated heparin dose. This departure from good clinical trials practice may have biased the results of previous trials in favor of low-molecular-weight heparin.
Academia and Clinic
Michael K. Gould, Gillian D. Sanders, Paul G. Barnett, Chara E. Rydzak, Courtney C. Maclean, Mark B. McClellan, and Douglas K. Owens In patients with a solitary pulmonary nodule, positron emission tomography with 18-fluorodeoxyglucose is the preferred option when the pretest probability and computed tomography findings disagree or when the pretest probability of malignancy is intermediate and the patient is at high risk for surgical complications. In most other circumstances, computed tomography–based strategies result in similar quality-adjusted life-years and lower costs.
Reviews
Ajit N. Babu, Steven M. Kymes, and Sharon M. Carpenter Fryer For more than a century, eponymous signs of aortic regurgitation have occupied a prominent place in medical textbooks. The evidence that these signs are accurate indicators of aortic regurgitation is weak. To sustain the place of these signs in the traditions of clinical diagnosis, we need better evidence about their accuracy.
Perspectives
Robert L. Fine and Thomas Wm. Mayo By enacting a law regulating end-of-life decisions, Texas became the first state to provide a mechanism for resolving medical futility disputes and other end-of-life ethical disagreements. Data collected at a large tertiary care teaching hospital strongly suggest that this law represents a first step toward practical resolution of this controversial area of modern health care.
Position Papers
Stephen M. Salerno, Patrick C. Alguire, and Herbert S. Waxman This paper presents the American College of Physicians' recommendations for initial assessment of competency in the interpretation of resting electrocardiograms. The article also contains recommendations about maintaining competency and using computer-assisted electrocardiogram interpretation.
Stephen M. Salerno, Patrick C. Alguire, and Herbert S. Waxman This systematic review provides detailed supporting evidence for the American College of Physicians' recommendations on competency in electrocardiogram interpretation. The authors found no evidence that attaining or maintaining competency requires a specific minimum number of electrocardiogram interpretations.
Editorials
Allen C. Steere Over the years, physicians have prescribed longer and longer courses of antibiotic therapy for erythema migrans (often 21 to 30 days), primarily to treat persistent subjective symptoms. Investigators have begun to question whether longer courses of therapy accomplish this goal. In this issue, Wormser and colleagues show that treating erythema migrans for longer than 10 days does not improve outcomes.
On Being a Doctor
Faith T. Fitzgerald It is not with a recommendation that all follow suit that I write this piece, but rather to let those teaching physicians who are unhappy, frustrated, rushed, and harried in the modern academic environment know there is a quieter place, an older place, a more fulfilling place—the subdued hospital in the dark of night.
Christine Seibert I felt a brief prick on the pad of my right third finger. I did not say or do anything to alert the resident with whom I was working, but instead continued until the lumbar puncture on our patient with end-stage AIDS was finished.
Letters Quality Grand Rounds
Screening for Depression in Adults
Michael Pignone, Bradley Gaynes, Kathleen Lohr, Jerry Rushton, and Cynthia Mulrow—RESPONSE Screening for Breast Cancer
The Mammography Dilemma
Correction: Factors That Affect Accuracy of Screening Mammography
Carol R. Horowitz, Anthony L. Suchman, William T. Branch, Jr., and Richard M. Frankel The internists in the authors' study wrote about miracles and mistakes, sharing their own lives and their patients' lives, witnessing profound experiences, and receiving acknowledgment for a job well done. Through these experiences, they gained a deeper appreciation of what it means to be a human being and a doctor. They learned that their caring actions meant everything to their patients.
Linda Farber Post
Patricia Charache
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