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Articles 
Hossein A. Ghofrani, Frank Reichenberger, Markus G. Kohstall, Eike H. Mrosek, Timon Seeger, Horst Olschewski, Werner Seeger, and Friedrich Grimminger Fourteen mountain climbers received sildenafil and placebo in random order at low altitude while breathing hypoxic gas and again at an elevation of 5400 m. Sildenafil reduced hypoxic pulmonary hypertension at rest and with exercise and increased maximum exercise capacity and cardiac output.
Judith A.C. Rietjens, Agnes van der Heide, Astrid M. Vrakking, Bregje D. Onwuteaka-Philipsen, Paul J. van der Maas, and Gerrit van der Wal Terminal sedation precedes a substantial number of deaths in the Netherlands. In about two thirds of most recent cases, physicians indicated that in addition to alleviating symptoms, they intended to hasten death.
Richard G. Bach, Christopher P. Cannon, William S. Weintraub, Peter M. DiBattiste, Laura A. Demopoulos, H. Vernon Anderson, Paul T. DeLucca, Elizabeth M. Mahoney, Sabina A. Murphy, and Eugene Braunwald After acute coronary syndromes, older people have a larger risk for poor ischemic outcomes than younger people. Despite this increased risk, a routine early invasive strategy can significantly improve ischemic outcomes in elderly patients with unstable angina and non–ST-segment elevation myocardial infarction.
Improving Patient Care
Eric G. Neilson, Kevin B. Johnson, S. Trent Rosenbloom, William D. Dupont, Doug Talbert, Dario A. Giuse, Allen Kaiser, Randolph A. Miller the Resource Utilization Committee* The authors studied the effect of a computer-based medical order entry system on unnecessary test ordering. Two strategies reduced test orders: computer prompts that questioned repetitive orders for routine tests and unbundling the tests in a metabolic panel. The system did not affect patient readmission rates, length of stay, transfer to intensive care units, or mortality rates.
Academia and Clinic
Arlene S. Ash, Phyllis L. Carr, Richard Goldstein, and Robert H. Friedman Female medical school faculty do not advance as rapidly and are not as well compensated as similar male colleagues. Deficits for female physicians are greater than those for nonphysician female faculty. Compared to men, deficits are greater for female faculty with more seniority.
Updates
Kurt Kroenke and Lia Logio This year's Update in General Internal Medicine incorporates articles on thromboembolic disease, imaging, hypertension, combination therapy versus single-drug therapy, preventive medicine, pain, and physician satisfaction.
Perspectives
Risa Lavizzo-Mourey and John R. Lumpkin The American College of Physicians' position statement on racial and ethnic disparities is comprehensive and can be a model for other specialties and disciplines. The emphasis on enhancing cultural competency is important because such competency can improve outcomes.
Sherrie H. Kaplan and Sheldon Greenfield We must not let the call for action to reduce disparities in health get lost in niggling debates over the details of implementation. Yet the details are precisely where the difficulties lie. The leadership of U.S. medicine must question whether some of the proposed solutions will actually produce better health care for minorities.
Neil R. Powe and Lisa A. Cooper The direct evidence that increasing the diversity of the physician workforce improves health status is not ironclad, but, on balance, the American College of Physicians is right to support action to diversify the health professional workforce.
Theodore Pincus The American College of Physicians' position paper presents a largely "physician-centric" perspective on how to improve health of minorities. This "biomedical model" is spectacularly successful in high-intensity, acute medical care but plays a much smaller role in the outcomes of general health and chronic diseases.
Position Papers
American College of Physicians* This position paper provides ample evidence that compared to nonminorities, minorities do not always receive the same quality of health care, do not have the same access to health care, are less represented in the health professions, and have poorer overall health status. This statement sets forth specific actions for reducing these disparities.
Editorials
Lewis J. Rubin and Robert Naeije In this issue, Ghofrani and colleagues report on a study that is a technical and logistic tour de force. We must nevertheless ask the following questions: How do their results fit into the current understanding of how hypoxia limits exercise capacity? Are there plausible alternative explanations for their findings?
Muriel R. Gillick Rietjens and colleagues' description of physician behavior near the end of their patients' lives can help us decide whether the ethical concerns raised by terminal sedation are merely theoretical or whether they lead to harm. The data are not reassuring.
Christine Laine and Barbara J. Turner An article in this issue provides the most recent evidence that, despite near-equal representation of women and men in medicine, equal compensation eludes us. Physicians should be mortified that no other profession in the United States exhibits greater salary disparities by sex.
On Being a Doctor
John H. Stone The news came via e-mail: "Well, the day has come. I am now profoundly deaf. ... I'm O.K. with that—as much as one can be." With that Internet message, Stacey informed us that our efforts to preserve her hearing had failed. Feeling utterly powerless in the wake of her e-mail, I realized then that my admiration for her had only begun.
Letters Leprosy Accidentally Transmitted from a Patient to a Surgeon in a Nonendemic Area
Metabolic Markers of Insulin Resistance in Overweight Persons
Physician Support for Covering and Caring for the Uninsured
Albuminuria and Mortality in Hypertension
Screening and Interventions for Obesity in Adults
Successful Octreotide Treatment of Chylous Pleural Effusion and Lymphedema in the Yellow Nail Syndrome
Konstantinos Makrilakis, Spyridon Pavlatos, Georgios Giannikopoulos, Christos Toubanakis, and Nikolaos Katsilambros
Mark J. Brown
Christian Guilleminault
Anthony J. Chiaramida
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