This study assessed interns' sleep while working in intensive care units (ICUs) on a traditional schedule (every-third-night call) and on an intervention schedule that limited scheduled work to no more than 16 consecutive hours. The intervention schedule required four, rather than three, interns in the ICU. As confirmed by polysomnography, interns slept more and had fewer attentional failures on the intervention schedule.

Interns working in ICUs were more attentive during night work when their schedule was modified to reduce work hours and eliminate long shifts.

In this study of interns' errors in the ICU, interns made 36 percent more serious errors when working on a traditional schedule (every-third-night call) than when working on a schedule that limited scheduled work to approximately 16 consecutive hours. Most errors were intercepted or did not harm patients.

In this prospective, nationwide study conducted in the Netherlands, the classic triad of fever, stiff neck, and a change in mental status was present in less than half of 696 episodes of bacterial meningitis. The overall mortality rate was 21 percent, but more than 10 percent of survivors had disabilities such as deafness or hemiparesis.

The wide use of new vaccines has changed the pattern of bacterial meningitis in adults. Pneumococcus is now the most common cause, and the rates of death and complications remain high, especially among immunocompromised hosts.

Multiple myeloma, a plasma-cell neoplasm characterized by skeletal destruction, renal failure, anemia, and hypercalcemia, remains incurable. However, recent advances in its treatment, in particular, the use of thalidomide and such new drugs as bortezomib and CC-5013, are promising. This article discusses current therapy for multiple myeloma.

A 34-year-old man was found unconscious and apparently having a seizure. Imaging studies showed a lesion in the right frontal lobe of the brain, with characteristics of a malignant tumor. The authors discuss new approaches to the diagnosis and management of malignant glial tumors.

In this article, Blumenthal describes the nature of current relationships between doctors and the pharmaceutical industry. The report analyzes how financial relationships — which may involve gifts, free meals, consulting fees, or lecture honoraria — influence physicians' prescribing decisions and how the relationships between physicians and drug companies are likely to change in the future.

Studdert et al. describe recent efforts by the federal government and professional organizations to tighten the regulation of financial associations between physicians and the pharmaceutical industry. Payments to doctors (including gifts and consulting fees) by drug companies are violations of the federal anti-kickback law if the payments have the potential to increase the recipients' prescriptions for the companies' products. The Office of the Inspector General, the Pharmaceutical Research and Manufacturers of America, and physicians' organizations have issued guidelines prohibiting many types of financial relationships that have been common.

The genomic sequences of the malarial vector, parasite, and host — the three components of the malarial transmission system — have been known for at least two years. It may be possible to counter the disease by harnessing this genomic information to launch a strategic attack on the parasite during vulnerable stages of its life cycle.