Benjamin Franklin's place in the history of medicine.

Benjamin Franklin's seemingly endless curiosity and his prolific contributions in diplomacy, politics, literature, and science may well justify calling him the most eminent man in eighteenth-century American life. One portion of these contributions still striking for the insights and productivity it shows was in medicine. He saw the value in inoculation against smallpox. He was aware of the placebo effect. He, in effect, launched the first American medical school. He devised a flexible urethral catheter. He identified lead poisoning as a cause of abdominal pain and peripheral neuropathy. He accurately described psoriasis well before RobertWillan. These contributions in medicine of his time were not then notably influential, but they certainly illustrate the versatility of his intellect.

Authors, editors, policy makers, and the impact factor.

Some aspects of the "impact factor", a quantitative measure of journals' influence on journals in scientific fields, were discussed in the preceding issue of the Croatian Medical Journal by Dr Eugene Garfield, one of its devisers. This factor can be of interest to authors, journal editors, and policy makers, but they should keep in mind the complexity of the determinants of impact factors while using them in coming to their particular kinds of decisions. A clearer picture of the influence a journal may have in its own scientific field rather than among all scientific journals could come from a variant of the impact factor, "the scope-adjusted impact factor". The calculation of this variant impact factor is described. A table presents some sample data from this calculation and shows how the relative positions of some major journals shift when they are ranked by this factor rather than the unadjusted impact factor. The possible value of this variant factor may merit further testing.

Toward a checklist for reporting of studies of diagnostic accuracy of medical tests.

BACKGROUND: : "Diagnostic accuracy" refers to the ability of medical tests to provide accurate information about diagnosis, prognosis, risk of disease, and other clinical issues. Published reports on diagnostic accuracy of medical tests frequently fail to adhere to minimal clinical epidemiological standards, and such failures lead to overly optimistic assessments of evaluated tests. Our aim was to enumerate key items for inclusion in published reports on diagnostic accuracy, with a related aim of making the reports more useful for systematic reviews. METHODS: : We examined published reports on shortcomings of studies of diagnostic accuracy. We prepared an initial draft of a checklist to address common errors and presented it at a meeting of editors. After incorporation of comments from editors, we published a revised version in Clinical Chemistry in 1997 for comment from readers. One of us (E.M.) additionally circulated copies of the draft to methodologists and others interested in Evidence-Based Medicine. We updated the checklist with input from these sources. RESULTS: : The updated document lists items for inclusion in the title, abstract, methods, results, and discussion sections of published papers. Depending on the nature of the study, the total number of items for a single paper is approximately 40. We invite comments on this document, which is freely available at Clinical Chemistry Online, where it can accessed readily from the Table of Contents for the July 2000 issue at www. clinchem.org/content/vol46/issue7/. Comments (eLetters) can be posted there for general reading. CONCLUSIONS: : The suggested revisions incorporated in this report appear useful to ensure inclusion of additional information that can allow assessment of the validity of the conclusions and the applicability of the study in other settings. The list can be useful in formulating guidelines and a checklist, which will require testing by authors and study of their effect on published studies of diagnostic accuracy.

More informative abstracts revisited.

Following proposals in 1987 and 1988, several medical journals have provided more informative abstracts ("structured abstracts") for articles of clinical interest. Structured abstracts for original studies require authors to systematically disclose the objective, basic research design, clinical setting, participants, interventions (if any), main outcome measurements, results, and conclusions; and for literature reviews the objective, data sources, methods of study selection, data extraction and synthesis, and conclusions. More informative abstracts of this kind can facilitate peer review before publication, assist clinical readers to find articles that are both scientifically sound and applicable to their practices, and allow more precise computerized literature searches. We review the feasibility, acceptability, and dissemination of structured abstracts, reassess the underlying strategy, and describe modifications of the approach. This innovation can aid communication from scientists to clinicians, and other clinical journals are invited to join this effort.

Is the medical world ready for electronic journals?

New technologies offer new ways to deliver scholarly information, perhaps advantageously compared with paper journals, which have been an accustomed mode of scholarly communication for 300 years. Paper journals offer conveniences in handling and reading, and the economic constraints on their length tend to ensure that this constraint is important. Electronic journals are not yet as easy to use. But paper journals are economically cost effective and these space constraints prevent their publishing information not important to most readers but important to some. Electronic journals offer new advantages for readers, including the capacity to carry more and longer papers, linkages between related documents, and hypertext functions. The editors of The Online Journal of Current Clinical Trials welcome comments on its features and content; these should be sent to Dr. María L. Lebrón, Managing Editor, CCT, AAAS, 1333 H Street, NW, Washington, DC 20005 USA, FAX 202-842-2868.

More informative abstracts revisited.

Following proposals in 1987 and 1988, several medical journals have provided more informative abstracts ("structured abstracts") for articles of clinical interest. Structured abstracts for original studies require authors to systematically disclose the objective, basic research design, clinical setting, participants, interventions (if any), main outcome measurements, results, and conclusions; and for literature reviews the objective, data sources, methods of study selection, data extraction and synthesis, and conclusions. More informative abstracts of this kind can facilitate peer review before publication, assist clinical readers to find articles that are both scientifically sound and applicable to their practices, and allow more precise computerized literature searches. We review the feasibility, acceptability, and dissemination of structured abstracts, reassess the underlying strategy, and describe modifications of the approach. This innovation can aid communication from scientists to clinicians, and other clinical journals are invited to join this effort.

Ethics in cardiovascular medicine. Task Force IV: Scientific responsibility and integrity in medical research.

Ethical standards are a set of affirmative responsibilities to which the investigator must subscribe; behavior that is incompatible with these responsibilities should be presumed unethical, whether or not it is explicitly proscribed. This Task Force sought to present these standards as principles or guidelines. In undertaking research an investigator must accept that publicly funded or supported research is intended to yield public benefit; personal gain should be only incidental to and not at the expense of the public benefit. The responsibilities of the investigator are summarized as follows: Design of Research To develop a research design that effectively and efficiently addresses the scientific question while minimizing the likelihood of incorrect or misleading results. To protect the rights and welfare of human subjects, assure the humane use of laboratory animals and protect the safety of laboratory workers and the environment. Conduct of Research To ensure that accepted laboratory and research practices are followed and that all data are accurately collected and properly recorded; the investigator must participate in the review of original data. To carry out research in accordance with that approved by the institutional review board and ensure that fully informed consent is obtained, that the welfare of human subjects is protected and that animal welfare and laboratory safety procedures are carried out. To provide effective ongoing supervision of research trainees and technicians. In multidisciplinary collaborative research, to have at least an overview familiarity with the work outside his or her areas of expertise. In fixed protocol, multicenter collaborative research the investigator must be satisfied with the adequacy of the collaborative activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Prepublication release of scientific data and the right of the public to know: adapting to our times.

Technical innovations for more rapid and cheaper communication have begun to blur the boundaries of professional and other expert fields. This change has greatly widened the market for reliable new medical information, but it has also brought new tensions among authors, journals publishing their papers, and the news media. Does informal publication of new medical information before its appearance in scientific documents injure the interests of authors, journals, and the wider public? The possible answers depend in large part on how physicians should be expected to function in this new age of expanding information and speedier communication. A possible solution for these new problems would be access for all interested parties to journal papers through an on-line system at the point of their acceptance.