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Articles 
Scott M. Stevens, C. Gregory Elliott, Karen J. Chan, Marlene J. Egger, and Kirmanj M. Ahmed These researchers withheld anticoagulation from 375 patients who had negative results on comprehensive (ankle to groin) duplex ultrasonography for a first episode of suspected symptomatic deep venous thrombosis of the leg. The rate of subsequently diagnosed deep venous thrombosis was 0.8% (95% CI, 0.16% to 2.3%).
Tomoshige Hayashi, Edward J. Boyko, Donna L. Leonetti, Marguerite J. McNeely, Laura Newell-Morris, Steven E. Kahn, and Wilfred Y. Fujimoto This prospective study used computed tomography to measure body fat in 300 normotensive Japanese Americans. Ninety-two participants developed hypertension within 10 to 11 years. Greater visceral adiposity was associated with increased risk for hypertension even after adjustment for baseline differences in risk factors for hypertension.
Djamel Messaad, Hocine Sahla, Said Benahmed, Philippe Godard, Jean Bousquet, and Pascal Demoly Giving the suspect drug to an individual with presumed drug allergy can safely confirm or rule out drug hypersensitivity if done in a carefully controlled setting. Results of drug provocation testing were negative in 82.4% of the patients in this case series.
Rainer Rauramaa, Pirjo Halonen, Sari B. Väisänen, Timo A. Lakka, Arno Schmidt-Trucksäss, Aloys Berg, Ilkka M. Penttilä, Tuomo Rankinen, and Claude Bouchard Aerobic exercise did not slow progression of atherosclerosis at the carotid artery bifurcation in middle-aged men. In a subgroup analysis, exercise reduced the rate of progression of atherosclerosis in men who did not take statins.
Improving Patient Care
John W. Williams, Jr., Wayne Katon, Elizabeth H.B. Lin, Polly H. Nöel, Jason Worchel, John Cornell, Linda Harpole, Bridget A. Fultz, Enid Hunkeler, Virginia S. Mika, Jürgen Unützer the IMPACT Investigators* Twelve months of intensive treatment of depression improved mood and functional status in older patients with depression and diabetes but did not affect diabetes-specific outcomes in this randomized trial in patients with good baseline glycemic control.
Peter J. Pronovost, Albert W. Wu, and J. Bryan Sexton Medical errors are common in intensive care units (ICUs), in part because many ICU processes require precise execution of a complex sequence of actions. Avoiding errors requires careful planning, excellent teamwork, and built-in checks for correct implementation. This paper, part of the Quality Grand Rounds series, provides a practical framework for improving patient safety in ICUs.
Perspectives
Abraham Verghese At a recent journal club, I was essentially looking at the children of the foreign medical graduates who had been my peers and colleagues—the children of some of the thousands of foreign-trained physicians scattered across the country. Here was unequivocal proof that my generation had passed the baton. Although they still looked very much like my generation, these kids were now at home in the very places that were effectively closed to us.
Clinical Guidelines
Jamie K. Waselenko, Thomas J. MacVittie, William F. Blakely, Nicki Pesik, Albert L. Wiley, William E. Dickerson, Horace Tsu, Dennis L. Confer, C. Norman Coleman, Thomas Seed, Patrick Lowry, James O. Armitage, and Nicholas Dainiak Terrorists could use highly radioactive material to commit acts of destruction. This consensus document provides guidelines for evaluating, triaging, and medically managing victims with acute radiation injury.
Editorials
Dalia El Kheir and Harry Büller Ultrasonography limited to the common femoral and popliteal veins has been the gold standard for diagnosing symptomatic deep venous thrombosis. After a negative examination, many centers repeat the study 1 week later to exclude propagation of calf vein thrombosis into the thigh. Stevens and colleagues report on the safety of withholding anticoagulation after normal results on a single ankle-to-groin ultrasonographic examination. Will this test become the new gold standard?
Jeffrey L. Jackson, Kent DeZee, and Elizabeth Berbano Although treating depression may not improve the outcome of comorbid illnesses, as a study in this issue suggests, it may dramatically improve the quality of life for patients and their families. Clinicians should continue to look for and treat depression in their patients.
On Being a Doctor
Ranjana Srivastava Five years out of medical school, amid the heady days of youth and with the luxury of being able to gaze straight ahead without any real distractions, I have been blind to the trials that lash someone 15 years older, displaced from country, profession, and family and straining to simply find a hint of solace in each passing day.
Letters Tolerability of Rofecoxib versus Naproxen
Coping with SARS
Improving Geriatrics Training
Hospital Procedure Volume and Outcomes
Isolated Gastric Varices Occurring 5 Years after Chemotherapy for Splenic Lymphoma
Correction: Hospital Procedure Volume and Outcomes
George P. Chrousos
Gary D. Rifkin
Setu K. Vora
Michael C. Peterson
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