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Articles 
Didier Pittet, Anne Simon, Stéphane Hugonnet, Carmen Lúcia Pessoa-Silva, Valérie Sauvan, and Thomas V. Perneger The authors questioned physicians on their beliefs about hand-washing before examining a patient and observed their actual hand-washing practices. Predictors of adherence include being an internist, easy access to hand-washing materials, and belief that hand-washing was important for preventing infection.
Sébastien Gibot, Marie-Nathalie Kolopp-Sarda, Marie C. Béné, Aurélie Cravoisy, Bruno Levy, Gilbert C. Faure, and Pierre-Edouard Bollaert In newly admitted critically ill patients with suspected infection, plasma levels of soluble TREM-1 (triggering receptor expressed on myeloid cells-1) identified those with sepsis. For sepsis, the test for TREM-1 had a 96% sensitivity and an 89% specificity. The likelihood ratio was 8.6 when the test result was positive and 0.04 when it was negative.
Antonino Romano, Rosa-Maria Guéant-Rodriguez, Marinella Viola, Rosa Pettinato, and Jean-Louis Guéant Approximately 11% of patients with positive results on skin tests for penicillin had positive results for cephalosporins. When cephalosporin results were negative, patients uniformly tolerated a challenge with cefuroxime axetil and ceftriaxone. Physicians should avoid using cephalosporins in patients with positive results on penicillin skin tests unless results on skin tests for cephalosporins are negative.
Chun-Su Yuan, Gang Wei, Lucy Dey, Theodore Karrison, Linda Nahlik, Spring Maleckar, Kristen Kasza, Michael Ang-Lee, and Jonathan Moss American ginseng reduces the international normalized ratio (a measure of warfarin's anticoagulant effect) by 0.19. When prescribing warfarin, physicians should ask patients about ginseng use.
Improving Patient Care
Jeanne M. Huddleston, Kirsten Hall Long, James M. Naessens, David Vanness, Dirk Larson, Robert Trousdale, Matt Plevak, Miguel Cabanela, Duane Ilstrup, Robert M. Wachter the Hospitalist–Orthopedic Team Trial Investigators A hospitalist–orthopedic surgeon comanagement team model reduced minor postoperative complication rates. Length of stay, cost, and major complications did not change. The nurses and surgeons preferred the comanagement model over standard care.
Reviews
Peter C. Minneci, Katherine J. Deans, Steven M. Banks, Peter Q. Eichacker, and Charles Natanson In randomized trials done before 1989, high-dose glucocorticoids reduced survival in patients with sepsis. In randomized trials done after 1997, a 5- to 7-day course of physiologic hydrocortisone doses increased survival in septic patients.
Perspectives
Barry R. Davis, Curt D. Furberg, Jackson T. Wright, Jr., Jeffrey A. Cutler, Paul Whelton the ALLHAT Collaborative Research Group This paper reviews key aspects of the design, analyses, findings, and conclusions of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). The authors also address several frequent comments about heart failure and diabetes outcomes.
Clinical Guidelines
Vincenza Snow, Patricia Barry, Stephan D. Fihn, Raymond J. Gibbons, Douglas K. Owens, Sankey V. Williams, Kevin B. Weiss, Christel Mottur-Pilson the ACP/ACC Chronic Stable Angina Panel* This guideline is an update of the 1999 guidelines on chronic stable angina published by the American College of Physicians and the American College of Cardiology/American Heart Association. It covers diagnosis and risk stratification for patients with symptomatic chronic stable angina who have not had an acute myocardial infarction or revascularization procedure in the previous 6 months.
Editorials
Robert A. Weinstein After more than 150 years of prodding, cajoling, educating, observing, and surveying of physicians, hand hygiene adherence rates remain disgracefully low. As suggested by a study in this issue, we must change the rules so that health care workers expect to be observed and given direct, immediate feedback.
Geno J. Merli In this issue, Huddleston and colleagues report on the first step toward a new approach to the perioperative care of surgical patients: the hospitalist–orthopedic surgeon comanagement team. The expansion of hospitalist care into comanagement of perioperative care is the direction of the future.
John M. Luce In this issue, the authors of a meta-analysis make two conclusions: 1) Low, but not high, doses of corticosteroids reduce the mortality from septic shock, and 2) all patients who have vasopressor-dependent sepsis should receive low-dose corticosteroids. This editorial discusses how the investigators reached these conclusions and why the author agrees with the first conclusion but not the second one.
The Editors The opinion of an expert has value. The problem is finding a way to maximize the benefits of that expertise while minimizing the risk for harm resulting from real or perceived bias due to a potential conflict of interest. The safest place to try is a peer-reviewed journal with vigilant editors.
On Being a Doctor
H. Joan Waitkevicz She walked from somewhere, hatless in the sun. She was too polite to turn her back on a priest and nun, however long they spoke with her. She knew she wanted health care and went to considerable trouble to get it.
Boris D. Veysman Today is the last day of yet another intensive care unit rotation, and I am writing my "off-service" notes. One patient stands out—"Mr. Jones," an intensive care patient I "inherited" from the last intern. Every time I am in the intensive care unit, I care for at least one patient like him and I always leave his note until the end, dreading it because of what it is going to say. It will show that I am a failure and a criminal.
Letters Impact of ALLHAT on the Role of Angiotensin-Converting Enzyme Inhibitors in the Primary Prevention of Heart Failure
ALLHAT, or the Soft Science of the Secondary End Point
Atorvastatin-Induced Polyneuropathy
Prevention of Hepatocellular Carcinoma
Managing Patients with Nonvariceal Upper Gastrointestinal Bleeding
The Crucial Link between Literacy and Health
Screening for Family and Intimate Partner Violence
Christina Nicolaidis the American Medical Women's Association and The Physicians Against Violence Interest Group of the Society of General Internal Medicine Screening for Family Violence: What's an Evidence-Based Doctor To Do?
Successful Management with Intravenous Immunoglobulins of Acquired von Willebrand Disease Associated with Monoclonal Gammopathy of Undetermined Significance
Jennifer Best
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