JENNIFER A. MAYFIELD, M.D., M.P.H., and RUSSELL D. WHITE, M.D.
More than one fourth of patients with type 2 diabetes use insulin. Advances in our knowledge of insulin physiology, coupled with new insulin preparations, provide more options for the family physician to tailor insulin therapy to the patient's lifestyle and glycemic goal. This article reviews indications for insulin therapy, outlines current injectable preparations, and discusses various insulin regimens.

Patient information:"Your Insulin Therapy," p. 511

DAVID L. SNYDER, PH.D., DAVID DOGGETT, PH.D., and CHARLES TURKELSON, PH.D.
Spinal stenosis is a narrowing of the vertebral canal that compresses spinal nerves and may cause leg pain and difficulty walking. The symptoms of degenerative lumbar stenosis can be treated conservatively with a local anesthetic block or aggressively with decompressive surgery.

STEPHEN D. WIVIOTT, M.D., and EUGENE BRAUNWALD, M.D.
The initial evaluation of unstable angina and non-ST-segment elevation myocardial infarction is directed at confirming the diagnosis and performing a risk assessment. Hospital care includes initial triage, monitoring, and medical therapy, as well as formulation of the treatment strategy.

STEPHEN D. WIVIOTT, M.D., and EUGENE BRAUNWALD, M.D.
One of the most important management decisions is the early strategy regarding coronary angiography and revascularization. Discharge planning involves coordinating medical care, preparing the patient to resume normal activities, and evaluating the need for long-term risk factor reduction.

ALEXANDER K.C. LEUNG, M.B.B.S., and DANIELE PACAUD, M.D.
A thorough history and physical examination can provide important clinical clues in the evaluation of patients with galactorrhea. The decision to treat patients with this condition should be based on the serum prolactin level, the severity of galactorrhea, and the patient's fertility desires.

Patient information:"Galactorrhea: What You Should Know About It," p. 553

• CDC and HICPAC Release Updated Guidelines on the Prevention of Health-Care-Associated Pneumonia
• Use of Transcranial Doppler Ultrasonography
• Nausea and Vomiting in Pregnancy
• Increases in Fluoroquinolone-Resistant Neisseria Gonorrhoeae

Cochrane for Clinicians

• Exercise-Based Rehabilitation for Coronary Heart Disease
• Antihistamines for the Common Cold

Curbside Consultation

• When Patients Cannot Afford Their Medications

FPIN's Clinical Inquiries

• What Clinical Findings Can Be Used to Diagnose Deep Venous Thrombosis?

Putting Prevention into Practice

• Routine Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease

• Why Does a U.S. Primary Care Physician Workforce Crisis Matter?

• Home Schooling Can Be a Beneficial Educational Option
• Treatment of Polycystic Ovary Syndrome in Adolescents
• Differentiating Types of Dementia During Diagnosis
• Importance of Continuous Doula Support During Labor