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Articles 
Roberto Caporali, Marco A. Cimmino, Gianfranco Ferraccioli, Roberto Gerli, Catherine Klersy, Carlo Salvarani, Carlomaurizio Montecucco for the Systemic Vasculitis Study Group of the Italian Society for Rheumatology The purpose of combination therapy with prednisone and methotrexate in polymyalgia rheumatica is to reduce the amount of prednisone required to maintain remission. In this randomized trial, the addition of methotrexate to prednisone reduced the incidence of flare-ups and the amount of prednisone needed to maintain remission.
Delphine Hu, Edward W. Hook, III, and Sue J. Goldie Annual Chlamydia trachomatis screening for all women 15 to 29 years of age and selective targeting of those with a history of infection for semiannual screening is very cost-effective. This analysis extends the upper end of the recommended age range for screening from age 25 to age 29.
Chung-Jyi Tsai, Michael F. Leitzmann, Walter C. Willett, and Edward L. Giovannucci A high intake of polyunsaturated and monounsaturated fats reduces cholesterol biosynthesis. In this long-term study of a large cohort of men, a diet high in unsaturated fats was associated with a reduced risk for gallstone disease.
Improving Patient Care
Steven Ornstein, Ruth G. Jenkins, Paul J. Nietert, Chris Feifer, Loraine F. Roylance, Lynne Nemeth, Sarah Corley, Lori Dickerson, W. David Bradford, and Cara Litvin In this trial of 20 primary care practices, intervention practices received quarterly site visits, had meetings about quality improvement, and received copies of practice guidelines and quarterly performance reports. Control practices received only the guidelines and performance reports. Both groups had about the same improvement in providing guideline-recommended care for cardiovascular disease.
Eric A. Coleman and Robert A. Berenson Transitional care is concerned with assuring continuity of purpose during the transfer from one level of care to another. It is a time of risk to the patient, at least in part because the involved health professionals do not take responsibility for assuring a smooth transition.
Reviews
Teruhiko Terasawa, C. Craig Blackmore, Stephen Bent, and R. Jeffrey Kohlwes Computed tomography is probably more accurate than ultrasonography for diagnosing appendicitis in adults and adolescents. This conclusion is uncertain because we have so few studies in which all study participants received the gold standard diagnostic reference test.
Robert D. Newman, Monica E. Parise, Ann M. Barber, and Richard W. Steketee This systematic review of malaria deaths in the United States from 1963 through 2001 describes trends, elucidates risk factors, and identifies potential public health actions to prevent future malaria-related deaths among U.S. travelers.
Medicine and Public Issues
Thomas Bodenheimer The author discusses universal health insurance strategies, summarizes and critiques the Bush and Kerry health insurance plans, and explores the use of tax credits to facilitate the purchase of individual insurance policies. He contrasts the presidential candidates' proposed strategies to those of professional organizations such as the American College of Physicians and the American Medical Association.
Clinical Guidelines
Vincenza Snow, Patricia Barry, Stephan D. Fihn, Raymond J. Gibbons, Douglas K. Owens, Sankey V. Williams, Christel Mottur-Pilson, Kevin B. Weiss for the American College of Physicians/American College of Cardiology Chronic Stable Angina Panel* This paper summarizes the treatment and follow-up recommendations of the 2002 American College of Cardiology/American Heart Association guideline. It covers patients with chronic stable angina who have not had a recent acute myocardial infarction or revascularization procedure and asymptomatic patients with known or suspected coronary disease based on electrocardiographic evidence of previous myocardial infarction, coronary angiography, or abnormal results on noninvasive tests.
Editorials
John H. Stone Readers must decide whether Caporali and colleagues' trial of methotrexate in polymyalgia rheumatica reveals a kernel of truth about methotrexate or bespeaks the curse of Tantalus: a desirable result placed just beyond the reach of those who would grasp it.
Walter E. Stamm The findings reported by Hu and colleagues in this issue reinforce recommended practice for chlamydia screening and force us to confront our failure to fully implement the clinical practices that the evidence so strongly supports.
On Being a Doctor
David P. Steensma I've learned from past trips that it may be easy to escape the daily routine of the clinic, but it is not so simple to leave the patients behind. During breaks from paddling, when my friend and I let our small boat drift aimlessly in the current, I often find myself puzzling over an ongoing difficult case, wondering how an old patient is doing, or simply remembering. Today I can't get the French man out of my mind.
Letters Chronic Pancreatitis Associated with Adult-Onset Type II Citrullinemia: Clinical and Pathologic Findings
Shu-ichi Ikeda, Shigeyuki Kawa, Yo-ichi Takei, Kanji Yamamoto, Hisashi Shimojo, Ken-ichi Tabata, Keiko Kobayashi, and Takeyori Saheki Survival versus Prognosis in Alzheimer Disease
Screening for Hepatitis C Virus Infection in Adults
Addressing the Limitations of Structured Abstracts
Selective Decontamination of the Digestive Tract and Prevention of Ventilator-Associated Pneumonia
The Domain of General Internal Medicine: A Perspective from Trainees
Eric B. Larson for the SGIM Task Force on the Domain of General Internal Medicine—RESPONSE Variability in Diagnostic Probability Estimates
Beth Miller
Lawrence Charles Parish
Joshua Latzman
Rae Varcoe
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