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Articles 
Susan Davis, Mary-Anne Papalia, Robert J. Norman, Sheila O'Neill, Margaret Redelman, Margaret Williamson, Bronwyn G.A. Stuckey, John Wlodarczyk, Karen Gard'ner, and Andrew Humberstone Davis and colleagues evaluated the effects of 3 doses of exogenous testosterone and placebo, all administered with a metered-dose transdermal spray, on sexual function. They randomly assigned 261 premenopausal women who reported a decrease in satisfying sexual activity and had a morning serum free testosterone level less than 3.8 pmol/L (<1.1 pg/mL). After 16 weeks, the daily 90-µL dose of transdermal testosterone improved self-reported sexual satisfaction by a mean of 0.8 satisfactory sexual event per month. The rate with higher and lower testosterone doses did not differ from the rate with placebo.
Barbara J. Turner, Christopher S. Hollenbeak, Mark Weiner, Thomas Ten Have, and Simon S.K. Tang Little is known about the quality of care received by patients with multiple unrelated comorbid conditions. The authors examined the electronic medical records of 15 459 patients with uncontrolled hypertension at 6 primary care practices. Most patients had 2 or more comorbid conditions unrelated to hypertension, such as arthritis, gastroesophageal reflux, or thyroid disease. At office visits, clinicians were less likely to intensify treatment for uncontrolled hypertension in patients with multiple unrelated conditions.
Reviews
Robert A. Brodsky Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematopoietic stem-cell disorder caused by a mutation that leads to increased susceptibility to complement-induced hemolysis. An expensive but highly effective drug markedly reduces the activity of PNH. This narrative review describes the history of the condition, its molecular biology and clinical manifestations, diagnostic testing, and therapeutic options.
Matthew T. James, Joslyn Conley, Marcello Tonelli, Braden J. Manns, Jennifer MacRae, Brenda R. Hemmelgarn for the Alberta Kidney Disease Network Catheter-related infections are a major cause of illness among patients receiving long-term hemodialysis with a central venous catheter. This systematic review found 16 randomized trials that assessed the potential benefits of applying antibiotics topically to the catheter exit site or instilling them intraluminally into the catheter. Compared with no antibiotic therapy, prophylaxis with either topical or intraluminal antibiotics reduced bloodstream infections and the need to remove the catheter because of infection.
Perspectives
Kimberly A. Workowski, Stuart M. Berman, and John M. Douglas, Jr. Prevention and control of gonorrhea is an important public health concern. Over the past 60 years, the increasing prevalence of multiple antibiotic-resistant strains of Neisseria gonorrhoeae has begun to limit therapeutic options. Workowski and colleagues describe comprehensive strategies for sustaining the effectiveness of antimicrobials and maintaining control over endemic gonorrhea.
Medicine and Public Issues
Aaron S. Kesselheim and Niteesh K. Choudhry In response to increasing prescription drug costs, more U.S. patients and policymakers are importing less-expensive pharmaceuticals from other countries. Federal legislators continue to debate whether to legalize importation. Three factors affect whether U.S. patients and policymakers can rely on other countries as sources of imported prescription drugs: the feasibility of strategies to ensure the safety of the product, how the import price compares with domestic prices, and how importation might affect the exporting country's pharmaceutical market.
Editorials
Rosemary Basson Sexual dissatisfaction is highly prevalent among women, ranging from 17% to 25%. We know enough about its causes to formulate a logical approach to treating sexual dissatisfaction in women. In this issue, the article by Davis and colleagues suggests that transdermal testosterone might be used to manage sexual dissatisfaction in premenopausal women. Their study showed only very modest benefit of testosterone treatment, and the authors caution against the widespread adoption of testosterone therapy in sexually dissatisfied premenopausal women.
On Being a Doctor
Katherine Chang Chretien Long before my daughter was born, I acquired a top-of-the-line breast pump. My maternity leave was over when Jolie was 11 weeks old, and it was time to bring my pumping to work. I had to plunge right into patients, housestaff, actual medicine, while I contended with pumping and separation anxiety. My days, which had always been busy, were now nonstop action—I saw time in an entirely different light: the vanishing minutes of a working mother.
Letters Could Increasing the Duration of Triple Therapy Be a Clinically Useful Strategy?
When to Switch Therapy in Patients with Severe Community-Acquired Pneumonia
Does Tiotropium Reduce Hospitalizations in Chronic Obstructive Pulmonary Disease?
How to Improve Coordination of Care
Is It Safe to Conclude that Beers Criteria Medications Led to Few Adverse Events?
Are Pay-for-Performance Programs a Threat to Medical Professionalism?
Memantine-Induced Hepatitis with Cholestasis in a Very Elderly Patient
Nicola Ferrara, Graziamaria Corbi, Annalisa Capuano, Amelia Filippelli, and Francesco Rossi Successful Treatment of Fulminant Clostridium difficile Infection with Fecal Bacteriotherapy
Overanticoagulation with Coumarin and Cutaneous Azole Therapy
Jean-François Alexandra, Eric Pautas, Isabelle Gouin-Thibault, Virginie Siguret, and Marie-Anne Loriot Correction: Improved Diagnostic Evaluation of Suspected Tuberculosis
Correction: Achieving a High-Performance Health Care System with Universal Access
Woodruff J. English
Krista M. Johnson and Holly J. Humphrey
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