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Articles 
Karen J. Sherman, Daniel C. Cherkin, Janet Erro, Diana L. Miglioretti, and Richard A. Deyo The authors randomly assigned 101 adults with chronic low back pain to receive 12 weeks of yoga, 12 weeks of conventional therapeutic exercise classes, or a self-care book. At 12 weeks, the yoga group had less bothersome symptoms and better back-related function than the self-care book group. Differences between conventional exercise and yoga were not consistent at different times in the study.
Yoav Golan, Michael P. Wolf, Stephen G. Pauker, John B. Wong, and Susan Hadley The authors measured the cost-effectiveness of 4 empirical anti-Candida strategies, 4 culture-based anti-Candida strategies, and 1 strategy of no Candida treatment in high-risk patients in the intensive care unit. For a patient who has not responded to empirical antibiotics for suspected infection, empirical fluconazole should reduce mortality at an acceptable cost. Empirical treatment in patients at low risk for infection is not justified.
Andre C. Kalil, Josh Levitsky, Elizabeth Lyden, Julie Stoner, and Alison G. Freifeld Two strategies are used to prevent serious cytomegalovirus (CMV) infection in solid organ transplant recipients. One is universal prophylaxis with antiviral drugs. The other consists of periodic monitoring for CMV infection and antiviral drugs if infection is present. Both reduce the risk for CMV organ disease and allograft rejection, but only universal prophylaxis also reduces bacterial and fungal infections and death.
Improving Patient Care
Donald M. Yealy, Thomas E. Auble, Roslyn A. Stone, Judith R. Lave, Thomas P. Meehan, Louis G. Graff, Jonathan M. Fine, D. Scott Obrosky, Maria K. Mor, Jeff Whittle, and Michael J. Fine The authors implemented a guideline for deciding whether to manage community-acquired pneumonia in the hospital or at home. Guideline implementation strategies were low, moderate, and high intensity. Both moderate-intensity and high-intensity strategies safely increased the proportion of low-risk patients who were treated as outpatients. Only the high-intensity strategy improved adherence to recommended processes of care for outpatients and inpatients.
Reviews
Giorgos Bamias, Mark R. Nyce, Sarah A. De La Rue, and Fabio Cominelli Ulcerative colitis and Crohn disease share certain similarities but are clearly distinct diseases. Recent research challenges our conception of the pathophysiology of inflammatory bowel disease and the simple dichotomy between Crohn disease and ulcerative colitis. This review presents emerging pathophysiologic concepts and discusses their effect on the classic paradigms for inflammatory bowel disease.
Perspectives
Karen B. DeSalvo Hurricane Katrina has provided an unprecedented opportunity to rebuild the health care system of New Orleans. My hope is that we don't retreat to comfortable ways but seize the day and develop a fully integrated health care system for the underserved, complete with an electronic health record. The posthurricane health care system should proactively identify at-risk patients before their conditions deteriorate. It should monitor quality of care in an open and positive way that will lead to continuous improvement. It could be a showcase.
History of Medicine
Ralph Madeb, Leonidas G. Koniaris, and Seymour I. Schwartz Although the discovery of insulin in Toronto by Dr. Frederick G. Banting and colleagues has been well chronicled, the story of how insulin therapy was introduced into the United States has been less discussed. The first patient to be treated with insulin in the United States resided in Rochester, New York, a city with a then newly developed medical school that also tried to recruit Dr. Banting. A series of letters from that period provides a description of the course of a juvenile patient with diabetes before and after the use of insulin as a therapeutic agent.
Editorials
Stephen Dummer Because of better antiviral drugs and sensitive viral assays, cytomegalovirus (CMV) disease is becoming less threatening to post-transplantation patients. However, proponents of universal antiviral drug prophylaxis cannot agree with those who prefer testing for CMV and treating as needed. In this issue, Kalil and colleagues present their meta-analysis of trials of these 2 approaches to CMV disease prevention. Because the study is a summary of previously published trials, it does not really break new ground. Nonetheless, it will probably affect thinking in this field.
On Being a Doctor
Ari Mosenkis As I was en route to the parking lot on a cold autumn night, my pager started beeping. I was a new renal fellow on call, and this was an all-too-familiar, yet still unnerving, occurrence. The number to call back was one I didn't recognize: the OR. When I returned the call, I learned that a heart transplant had failed with disastrous complications. The patient was hypotensive and grossly volume overloaded. The transplant team was requesting intraoperative dialysis. Minutes later, after probing unfamiliar corridors, I arrived at the scene.
Letters Screening for HIV
Unintended Consequences
Medicare Coverage of Angiotensin-Converting Enzyme Inhibitors
Tumor Necrosis Factor- Silvia Bosello, Maria De Santis, Barbara Tolusso, Angelo Zoli, and Gianfranco Ferraccioli
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