The effectiveness of sterile gloves in reducing blood culture contamination is uncertain, and some protocols recommend their use and others do not. This trial randomly assigned 64 medical housestaff at a single institution to routine or optional sterile gloving during venipuncture to collect samples for blood culture. Among 5265 blood cultures done during routine sterile gloving and 5255 done during optional sterile gloving, contamination rates were 0.6% and 1.1%, respectively, suggesting that routine use of sterile gloves may reduce blood culture contamination.

The mechanism for the better survival of black patients than white patients after stroke is unknown. This study of 5319 black patients and 18 340 white patients with acute stroke found that black patients had lower in-hospital mortality and all-cause mortality at 30 days and 1 year than white patients. Black patients were more likely than white patients to receive life-sustaining interventions and less likely to be discharged to hospice, suggesting that the lower mortality rate among black patients with stroke may result from differences in receipt of life-sustaining interventions.

The relationship between hospital spending and patient outcomes is not well understood. This study of 2 545 352 patients discharged from 208 California hospitals from 1999 to 2008 with 1 of 6 common conditions sought to determine the association between hospital spending and risk-adjusted inpatient mortality. Admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality; this association did not vary by region or hospital size.

The Advisory Committee on Immunization Practices (ACIP) presents the recommended Adult Immunization Schedule for 2011, which includes several changes from the 2010 schedule. This schedule has also been approved by the American Academy of Family Physicians, American College of Obstetricians and Gynecologists, and American College of Physicians (ACP).

The ACP Clinical Guidelines Committee presents the idea of high-value, cost-conscious health care and discusses key concepts that underlie the assessment of the value of health care interventions. The authors believe that focusing on the value of health care interventions will improve both patient outcomes and health care spending.

The ACP Clinical Guidelines Committee discusses the low value of routine imaging in patients with low back pain. Diagnostic imaging is indicated in low back pain only if patients have severe progressive neurologic deficits or signs or symptoms of a serious or specific underlying condition. Yet, many patients who do not fit these criteria receive routine imaging despite evidence that routine imaging is not associated with clinical benefits and can lead to harms. A selective approach to low back imaging, as suggested by the ACP and American Pain Society guideline on low back pain, would improve patient outcomes and reduce costs.

To inform the update of the U.S. Preventive Services Task Force's 2003 recommendation on behavioral counseling to prevent skin cancer, this systematic review searched the literature through February 2010. The authors found few rigorous trials of counseling to promote behaviors to reduce sun exposure and noted that studies of the association of sun-protective behaviors and skin cancer outcomes are limited by the complexity of measuring ultraviolet exposure and sunscreen use, as well as inadequate adjustment for confounders. Yet, they conclude that counseling in primary care settings can increase behaviors that reduce sun exposure and the use of indoor tanning.

In this issue, Kim and colleagues found that routine use of sterile gloves during venipuncture to collect blood culture samples reduced contamination rates. The editorialists discuss the various reasons for this decrease in contamination rates and other lessons for reducing blood culture contamination that we can learn from this trial.

Annually, the ACIP of the Centers for Disease Control and Prevention issues a revised Adult Immunization Schedule that is approved by the major specialty societies representing physicians who care for adults, including ACP. The changes in each year's schedule are driven by advances in our knowledge of vaccines and vaccine-preventable disease. The editorialist highlights the changes to this year's schedule and stresses the importance of vaccination.

In this issue, Owens and colleagues propose that focusing on the value of health care interventions will improve both patient outcomes and health care spending. This editorial highlights the importance to policy debate of definitions and concepts to guide the search for high-value health care, but it contends that the “value-for-money” goal raises many questions that warrant further discussion.

Over her 18 years as my patient, Irene was fond of proving me wrong. The latest lesson came just last week.