Comparative Effectiveness Research: Challenges for Medical Journals

Editors from a number of medical journals lay out principles for journals considering publication of Comparative Effectiveness Research (CER). In order to encourage dissemination of this editorial, this article is freely available in PLoS Medicine and will be also published in Medical Decision Making, Croatian Medical Journal, The Cochrane Library, Trials, The American Journal of Managed Care, and Journal of Clinical Epidemiology

Career changes in medicine: Part II

We have known for some time that fewer medical students and internal medicine residents are deciding on careers in primary care. As we try to transform primary care into a desirable career choice, we need to know more about when students and residents make their decisions and why they choose primary care (or why they do not). An article in this issue by West and colleagues helps fill this important gap and allows us to follow the career preferences of a large cohort of residents in each of the 3 years of residency

Medical professionalism and the parable of the craft guilds

The medieval European craft guilds are the antecedents of today's professions. As a commentary on the article by Campbell and colleagues in this issue, the Editor argues that, like the guilds, the medical profession exists in a 3-way relationship with government and business. The parable of the guilds teaches us that community institutions must adapt or wither

Standard and Computed Tomography in the Evaluation of Neoplasms of the Chest

Although in practice computed tomography (CT) has nearly replaced standard tomography in the evaluation of chest diseases, an analysis of the literature shows that standard tomography may be preferred in some settings. After a detailed review of studies on test performance, we calculated overall sensitivity and specificity values. Using Bayesian analysis, we then developed guidelines for choosing between computed and standard tomography. A test is recommended if its results might obviate the need for an invasive procedure. Standard tomography is recommended in the detection of mediastinal metastases from lung cancer. In the detection of hilar metastases, standard tomography is recommended for patients who have low pretest probabilities of metastases to this site, and computed tomography is recommended for patients who have high pretest probabilities. Computed tomography is recommended for the detection of calcification in solitary pulmonary nodules. Tomographic procedures are not recommended when the pretest probability is intermediate. The discrepancy between current practice and these guidelines highlights the need for carefully designed, multi-institutional comparative studies of radiographic procedures