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Articles 
Eduardo Salazar-Martinez, Walter C. Willett, Alberto Ascherio, JoAnn E. Manson, Michael F. Leitzmann, Meir J. Stampfer, and Frank B. Hu The authors found that higher coffee consumption was associated with a lower incidence of type 2 diabetes mellitus, even after adjustment for age, body mass index, and other risk factors. Caffeine intake from all sources appears to be the determining factor in this relationship.
Paul Muntner, L. Lee Hamm, John W. Kusek, Jing Chen, Paul K. Whelton, and Jiang He In this cross-sectional study based on the Third National Health and Nutrition Examination Survey, patients with chronic kidney disease had lower levels of apolipoprotein A1 and higher levels of homocysteine, lipoprotein(a), fibrinogen, and C-reactive protein.
Issam Raad, Hend A. Hanna, Badie Alakech, Ioannis Chatzinikolaou, Marcella M. Johnson, and Jeffrey Tarrand The authors drew blood cultures simultaneously from the catheter and a peripheral vein. When cultures from the catheter turned positive at least 120 minutes sooner than cultures from a peripheral vein ("differential time to positivity"), the odds that the bacteremia was catheter-related increased substantially.
David L. Paterson, Wen-Chien Ko, Anne Von Gottberg, Sunita Mohapatra, Jose Maria Casellas, Herman Goossens, Lutfiye Mulazimoglu, Gordon Trenholme, Keith P. Klugman, Robert A. Bonomo, Louis B. Rice, Marilyn M. Wagener, Joseph G. McCormack, and Victor L. Yu Production of extended-spectrum ß-lactamases by Klebsiella pneumoniae is a widespread nosocomial problem. Appropriate infection control and antibiotic management strategies are needed to stem the spread of this emerging form of antibiotic resistance.
Improving Patient Care
Steven H. Woolf Ensuring patient safety is essential for better health care, but preoccupation with patient safety could distract us from other problems that pose a greater threat to health.
Reviews
Sergio A. Jimenez and Chris T. Derk This review discusses the clinical and physiologic principles of systemic sclerosis, a disease of unknown origin characterized by excessive deposition of collagen and other connective tissue macromolecules in skin and many internal organs, prominent changes in the microvasculature, and humoral and cellular immunologic abnormalities.
Perspectives
Stephen C. Schoenbaum and Randall R. Bovbjerg In the current malpractice insurance crisis, physicians have focused their advocacy and energy primarily on rapidly increasing liability premiums and demands for legal reform, especially caps on damages. An even more important focus, however, is prevention of injury and improvement of patient safety.
Simon N. Whitney, Amy L. McGuire, and Laurence B. McCullough Informed consent is the legal process used to advance patient autonomy in health care. Shared decision making is a widely promoted ethical approach to the same problem. We should think of these 2 processes as distinct, clinically and ethically, as we approach medical decisions.
Editorials
Lawrence J. Appel In this issue, Muntner and colleagues show that persons with chronic kidney disease have a high prevalence of nontraditional risk factors for cardiovascular disease (CVD). The importance of these risk factors is uncertain in the general population and in patients with chronic kidney disease. Whether they cause CVD or are merely markers of CVD risk is unclear from the available evidence.
Barry M. Farr The study by Raad and colleagues in this issue suggests that a shorter time to positivity in blood cultures drawn from a vascular catheter is a useful diagnostic approach for catheter-related bloodstream infection. Raad and colleagues also note that the specificity (but not the sensitivity) of this test was lower in patients already taking antibiotics when blood cultures were drawn.
Letters Risk Stratification for Noncardiac Surgery
Smallpox Vaccination Risks and Public Policy
Complementary and Alternative Medical Education
The Future of Primary Care
Payment and the Future of Primary Care
Hospice Benefits and Phase I Cancer Trials
Alzheimer Disease: Current Concepts and Emerging Diagnostic and Therapeutic Strategies
Diagnostic Evaluation of Elderly Patients with Mild Memory Problems
Optimized Virologic Response in Hepatitis C Virus Genotype 4 with Peginterferon- Gatifloxacin-Induced Hepatotoxicity and Acute Pancreatitis
Onki Cheung, Kapil Chopra, Tina Yu, Michael A. Nalesnik, Shirish Amin, and A. Obaid Shakil Arm Position and Blood Pressure Measurement
Lisa A. Jackson and Kathleen M. Neuzil
Patricia R. Salber
Bonnie Salomon
George N. Braman
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