Effectiveness comparisons are often made with historical controls, basically comparing apples to oranges.
Proper comparative effectiveness research (CER) therefore becomes increasingly important. As defined by the Congressional Budget Office, CER is the rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on relative medical benefits and risks of each option, or it may also weigh both the costs and benefits of those options. Mexican medications online
Prospective comparison studies do not use historical controls because such designs generally favor new technologies. Rather, proper CER studies compare current technologies that allow direct comparisons of efficacy and complications.
Unfortunately, despite the recognized need for CER research, and to some degree with the exception of the Agency for Health Research and Quality, there is as yet no defined infrastructure to guide, fund, and oversee such research on the necessary scale at this time. We therefore need to rely on individual investigators or multiple-center efforts to initiate such studies.
The study by Ost is such an attempt at comparing two interventions aimed at biopsy of peripheral lesions and mediastinal lymph nodes. The goal was to compare the impact of CT fluoroscopy guidance to conventional bronchoscopy in the success of biopsy. Fifty patients were enrolled in a prospective and randomized fashion and underwent either CT fluoroscopy-guided biopsy of peripheral nodules, masses, and/or mediastinal lymph nodes (> 1 cm), or conventional bronchoscopic biopsies (no use of endobronchial ultrasound or electromagnetc guidance). Procedures were done in a protocolized fashion and were similar independent of the primary approach. Canadian viagra sildenafil citrate – Hq Canada pharmacy online.
The pathologist was blinded to the modality used when evaluating the specimens. Patients with a high index of suspicion for nonmalignant disease or endobronchial disease were excluded.