This issue of the journal can be subdivided into 3 distinct parts. We first continue a theme that will continue to be a focus of this journal: pharmaceutical policy in every dimension as it impacts ambulatory care. I have solicited several responses to the last issue's theme of European pharmaceutical policy. In separate and distinct ways, Drs Nakagawa, Anderson, and Shulman from the United States and Canada address many of the challenges raised in the last issue edited by Dr Apolone. As Dr Nakagawa states in his conclusion: "The issues (European pharmaceutical policymakers) face are strikingly similar to those we face in Canada, and, I believe, worldwide." If for no other reason than the similarity of these concerns throughout the world, we place a special emphasis on pharmaceutical challenges and I encourage submissions on any aspect of pharmaceuticals and ambulatory care management.

The journal has also attempted to include on a regular basis articles on matters pertaining to ambulatory care design. This issue continues this theme with several articles pertaining to emergency rooms and outpatient design challenges with which Kaiser Permanente has dealt.

Ruhe et al.'s important article from the community healthcare setting on staff turnover addresses a challenge for all ambulatory care facilities.

Dr Kazis' series on health status measurement in VA ambulatory care facilities continues together with the regular update from Physicians for Human Rights and the Republic of Texas.