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Articles 
Stephen E. Kimmel, Jesse A. Berlin, Muredach Reilly, Jane Jaskowiak, Lori Kishel, Jesse Chittams, and Brian L. Strom In this case–control study, rofecoxib was associated with higher odds of myocardial infarction than celecoxib. Although cardiovascular effects varied between the different cyclooxygenase-2 inhibitors, further studies, preferably randomized trials, are needed to fully understand the differences between them.
Jordi Carratalà, Núria Fernández-Sabé, Lucía Ortega, Xavier Castellsagué, Beatriz Rosón, Jordi Dorca, Ana Fernández-Agüera, Ricard Verdaguer, Joaquín Martínez, Frederic Manresa, and Francesc Gudiol The authors identified patients who had community-acquired pneumonia, were in Pneumonia Severity Index risk class II and III, and did not have a compelling reason for hospitalization. They randomly assigned these patients to outpatient or inpatient treatment with levofloxacin. Outpatient care was as safe and effective as hospital care and was more satisfying.
Lisa M. Kern, Neil R. Powe, Michael A. Levine, Annette L. Fitzpatrick, Tamara B. Harris, John Robbins, and Linda P. Fried In this controlled, nonrandomized trial of screening for osteoporosis in older adults, people in 2 states received dual-energy x-ray absorptiometry of the hip. In 2 other states, they received no screening. Screening was associated with 36% fewer incident hip fractures over 6 years. This effect was larger than expected, which raised concerns about unmeasured factors influencing fracture rates differently in the 2 groups.
Improving Patient Care
Anil Jain, Ashish Atreja, C. Martin Harris, Meghan Lehmann, Jon Burns, and James Young The authors' institution used its electronic medical record to rapidly identify and notify individual patients and their providers about the withdrawal of rofecoxib. For medical practices with electronic medical records, this experience is a model for mass communication with patients about urgent health care issues.
Reviews
Sean M. Caples, Apoor S. Gami, and Virend K. Somers Obstructive sleep apnea remains an important public health problem because of its neurocognitive sequelae. This review covers the epidemiology, clinical presentation, and diagnosis of obstructive sleep apnea; the cardiorespiratory physiology of normal and disordered sleep; the pathophysiologic mechanisms of obstructive sleep apnea during sleep and wakefulness; and resulting cardiovascular diseases.
Clinical Guidelines
U.S. Preventive Services Task Force* The U.S. Preventive Services Task Force recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men who have ever smoked. It makes no recommendation for or against screening for AAA in 65- to 75-year-old men who have never smoked and recommends against routine screening for AAA in women.
Craig Fleming, Evelyn P. Whitlock, Tracy L. Beil, and Frank A. Lederle According to the best-quality evidence on screening for abdominal aortic aneurysm (AAA), inviting men age 65 years and older to attend AAA screening reduces AAA-related mortality.
Editorials
Axel Finckh and Mark D. Aronson The authors believe that cyclooxygenase-2 (COX-2) inhibitors, in particular at higher dosages and for longer-term use, should not be a first-line therapy for patients who can tolerate alternative therapies. We urgently need further research to document the safety of long-term use of COX-2 inhibitors and nonselective nonaspirin nonsteroidal anti-inflammatory drugs.
Lionel Mandell Physicians often admit patients with community-acquired pneumonia who are at low risk according to the Pneumonia Severity Index. Before randomly assigning low-risk patients to inpatient or outpatient care, the authors of a trial reported in this issue first excluded patients with a compelling medical or social reason for hospital admission. The good outcomes suggest that evaluating patients for outpatient treatment should be a 2-step process.
Steven R. Cummings In this issue, Kern and colleagues report that a cohort of older women and men who underwent bone mineral density (BMD) measurement at the hip had a lower rate of hip fractures than a cohort who did not have this testing. Although confounding may explain these results, we should recommend BMD testing, preferably of the hip, to white women older than 65 years of age and to younger women with strong risk factors for fracture.
Robert Badgett and Cynthia Mulrow Jain and colleagues' report in this issue shows one example of using information technology to communicate medical knowledge about a dramatic event: the withdrawal of rofecoxib. We must find ways for institutions to do it right every day, even when the event is not high-profile.
On Being a Doctor
Audrey Young I hesitated on the sidewalk in front of the building. I didn't make house calls as a hospitalist, and now I wished I'd had some practice. There wasn't any pressing reason to visit, since Helen's injury wasn't grave or urgent, and we had no major treatment decisions to make. I was calling unannounced, in jeans and a wool cap. If only I had an agenda to open and close the visit.
John McClenahan She was one of my first patients—well born, feisty, loyal. A flirt. She came to me with her most trifling complaints—perhaps, I secretly hoped, as an excuse to chat. Slender, elfin, twice a year at my office door she parked her Ford station wagon and without a word laid a box of Godiva chocolates and a quart of Wild Turkey on the table. Eventually her daughters brought her to Heavenly Rest, where she sits at her window and waits, unburdened by reason or regret.
Letters A Clinical Prediction Rule for the Severe Acute Respiratory Syndrome
Manipulative Therapy for Patients with Shoulder Symptoms
Dose-Dense Chemotherapy for Node-Positive Breast Cancer
Glycemia and Risk for Cardiovascular Disease
Registration of Clinical Trials
The Curse of Tantalus
Professionalism and the Medical Student
Endocarditis Due to a Novel Cardiobacterium Species
Susan E. Hoover, Steven H. Fischer, Rebecca Shaffer, Bryan M. Steinberg, and Daniel R. Lucey Dysphagia Aortica
JudyAnn Bigby
Shanker Dixit
D. A. Feinfeld
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