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Articles 
Mary E. Tinetti, Christianna S. Williams, and Thomas M. Gill According to this study, the association among characteristics in several domains (including cardiovascular and neurologic) and dizziness, coupled with the multiplicity of sensations and triggering activities, suggests that dizziness may be a geriatric syndrome. If so, an impairment reduction strategy may be effective in reducing the symptoms and disabilities associated with dizziness.
Kristine E. Ensrud, Tu Duong, Jane A. Cauley, Robert P. Heaney, Randi L. Wolf, Emily Harris, Steven R. Cummings for the Study of Osteoporotic Fractures Research Group* In the elderly women in this study, low fractional calcium absorption in the setting of low calcium intake increased the risk for hip fracture. These findings support the hypothesis of type II osteoporosis, which postulates that decreased calcium absorption is an important risk factor for hip fracture in older persons.
John M. Weiler, John R. Bloomfield, George G. Woodworth, Angela R. Grant, Teresa A. Layton, Timothy L. Brown, David R. McKenzie, Thomas W. Baker, and Ginger S. Watson Previous studies suggest that sedating antihistamines may impair driving performance as much as alcohol does. The participants in this study had similar simulated driving performance when treated with fexofenadine (a nonsedating drug) or placebo. After alcohol use, participants performed the primary task (matching the varying speed of a vehicle they were following) well but not secondary tasks. After participants received diphenhydramine (a sedating drug), driving performance was poorest, indicating that this drug had a greater effect on driving than alcohol did.
Brief Communications
Saroj Vadhan-Raj, Claire F. Verschraegen, Carlos Bueso-Ramos, Hal E. Broxmeyer, Andrzej P. Kudelka, Ralph S. Freedman, Creighton L. Edwards, David Gershenson, Dennie Jones, Mark Ashby, and John J. Kavanagh In patients with gynecologic cancer, therapy with recombinant human thrombopoietin seems to be safe, may attenuate chemotherapy-induced severe thrombocytopenia, and may reduce the need for platelet transfusions.
Philip T. Diaz, Mark A. King, Eric R. Pacht, Mark D. Wewers, James E. Gadek, Haikady N. Nagaraja, Janice Drake, and Thomas L. Clanton Infection with HIV accelerates the onset of smoking-induced emphysema. The results of this study support the emerging concept that cytotoxic lymphocytes may be important in the pathogenesis of emphysema.
Academia and Clinic
Alan H. Morris The mismatch between human memory limitation and excess information almost certainly contributes to the unnecessary variation in clinical practice and to clinical error. This paper considers the problems created by this mismatch and describes a computer-based decision-support system that successfully combines rules based on credible evidence with specific data from individual patients.
Reviews
Leonard A. Mermel Several studies have shown that attention to simple and practical interventions reduces the risk for intravascular catheter–related bloodstream infections. This review updates the expanding body of literature on the prevention of these infections.
Position Papers
Timothy E. Quill, Ira R. Byock for the ACP-ASIM End-of-Life Care Consensus Panel This paper presents terminal sedation and voluntary refusal of hydration and nutrition as potential measures of last resort that can be used to address the needs of certain patients with terminal illness. These methods substantially increase patients' choices at an inherently challenging period of illness.
Editorials
David A. Drachman Tinetti and colleagues' study in this issue emphasizes an important and easily forgotten point: Dizziness, especially among elderly persons, is often due to multiple disorders involving multiple organ systems. This geriatric syndrome requires—and deserves—careful attention to sort out the underlying diagnoses and institute successful treatment.
Sean Hennessy and Brian L. Strom The study by Weiler and colleagues in this issue highlights the importance of determining the possible differential effects of sedating compared with nonsedating antihistamines on driving performance and the risk for motor vehicle crashes.
Letters Trends in Tuberculosis Transmission
Mycophenolate Mofetil-Induced Dyshidrotic Eczema
Venlafaxine-Associated Hepatitis
Hydroxyurea-Induced Leg Ulcers Treated with Apligraf
Understanding Adherence to HIV Medication
Importance of Proper Identification of Stinging Insects
Use of Statins and Fibrates in Hyperlipidemic Patients with Neuromuscular Disorders
Correction: Preference for Site of Terminal Care
Correction: Pancreatic Dysplasia
John H. Felts A student of Thomas Willis, Richard Lower was part of a revival of the Oxford school of physiology in the mid-1600s. Among his many accomplishments were performing the first-ever blood transfusion in animals and the first transfusion in a human in England. He devised the apparatus for maintaining vascular access for cross-circulation and for administration of drugs, blood, and other fluids, from which many of our modern procedures and devices derive.
Mitchell S.V. Elkind
Eliot Schechter
Franklin A. Michota, Jr This Update discusses four areas relevant to the care of hospitalized patients: nosocomial illness, community-acquired pneumonia, deep venous thrombosis, and prognostic variables. | |||||||||||||||||||||||||||||||||||||||||||||||||
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