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Articles 
Karen M. Kuntz, Kirsten E. Fleischmann, Maria G.M. Hunink, and Pamela S. Douglas Exercise electrocardiography or exercise echocardiography resulted in reasonable diagnostic cost-effectiveness ratios for patients at mild to moderate risk for coronary artery disease in terms of age, sex, and type of chest pain. Coronary angiography without previous noninvasive testing resulted in reasonable cost-effectiveness ratios for patients with a high pretest probability of coronary artery disease.
Alan M. Garber and Neil A. Solomon Echocardiography, single-photon emission computed tomography, and immediate angiography are cost-effective diagnostic alternatives to positron emission tomography and other diagnostic approaches. Test selection should reflect local variation in test accuracy.
Jean-François Timsit, Fabrice Bruneel, Christine Cheval, Marie-France Mamzer, Maïté Garrouste-Orgeas, Michel Wolff, Benoît Misset, Sylvie Chevret, Bernard Regnier, and Jean Carlet The incidence of femoral catheter–related infections in critically ill patients can be reduced by using catheters that are subcutaneously tunneled.
Brief Communications
Johan R. Meinardi, Saskia Middeldorp, Pieter J. de Kam, Maria M.W. Koopman, Elisabeth C.M. van Pampus, Karly Hamulyák, Martin H. Prins, Harry R. Büller, and Jan van der Meer Carriers of the factor V Leiden mutation have a greater risk for fetal loss than noncarriers. These data further suggest a greater risk for recurrence of fetal loss in carriers than in noncarriers and a greater risk for fetal loss and stillbirth in homozygous carriers than in heterozygous carriers.
Vallerie V. McLaughlin, Diane E. Genthner, Maureen M. Panella, Dina M. Hess, and Stuart Rich Intravenous prostacyclin may be effective in the treatment of certain types of secondary pulmonary hypertension.
Academia and Clinic
Bernard Lo, Timothy Quill, James Tulsky for the ACP-ASIM End-of-Life Care Consensus Panel In addition to addressing the physical suffering of dying patients, physicians can extend their caring by acknowledging and exploring psychosocial, existential, or spiritual suffering. As patients struggle to find closure in their lives, active listening and empathy have therapeutic value in and of themselves.
Reviews
Susan L. Greenspan and Francis S. Greenspan Women with a history of hyperthyroidism or thyroid-stimulating hormone suppression by thyroid hormone should have skeletal status assessed by bone mineral densitometry, preferably at a site containing cortical bone.
NIH Conferences
Stefan R. Bornstein, Constantine A. Stratakis, and George P. Chrousos Adrenocortical masses are among the most common tumors in humans. This paper discusses new aspects of adrenocortical tumorigenesis, the implications of these aspects, and the recent advances in the diagnosis and management of adrenocortical tumors.
Editorials
Bernard Lo, Lois Snyder, and Harold C. Sox The paper by Lo and colleagues in this issue launches a new series of articles about end-of-life care. These articles will provide practical advice and guidance to clinicians who are not specialists in palliative care and for whom the care of dying patients is not an everyday aspect of their practice.
Frank Davidoff Much has been made of the recent firing of the editor of the Journal of the American Medical Association. What's gotten lost in all the shouting about personalities and principles, unfortunately, is the pragmatic issue of how hard it is to build a journal and how easy it is to destroy one.
On Being a Doctor
Judith E. Nelson When it is not possible to save a life, I have learned and have begun to teach how to save a death—to help a patient preserve comfort and dignity despite overwhelming illness and to help a family understand the inevitability of the death.
Letters Screening Tests for Alcohol Use Disorders
Genetics of Familial Mediterranean Fever
How Physicians Communicate about Advance Directives
Thomas E. Finucane and Timothy S. Loo Three major geriatrics textbooks are reviewed in an attempt to infer how editors and authors see the field of geriatrics and how well they grapple with the complexity of caring for the frail elderly.
J. Cameron Muir
Lois Snyder
Murray Grossman
Laura A. Offutt
Charles Woernle
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