Highlights of this issue ======================== ## “Fast-tracked” publication A number of biomedical journals designate articles to undergo accelerated review and publication or early release online in order to rapidly disseminate especially important research or public health findings. To assess whether fast-tracked articles are as important as their designation implies, William Ghali and coauthors selected 6 articles published in the *New England Journal of Medicine* and 6 in *The Lancet* that were either prereleased on the journal's Web site or fast tracked. Twelve “control” articles published in the usual way were matched to the case articles according to journal, topic and year of publication. Forty-two general internists rated the articles, using 10-point scales, on 6 dimensions addressing the articles' importance, ease of applicability and impact on health outcomes. For each dimension the mean score was significantly higher for the case articles than for the control articles. However, in 5 of the 12 matched pairs the control article had a higher mean score than the case article across all the dimensions. The authors suggest that the journals' current practices for choosing articles for accelerated publication may be inconsistent. ![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/166/9/1129/F1.medium.gif) [Figure1](http://www.cmaj.ca/content/166/9/1129/F1) Figure. Photo by: Alan King In a related commentary former *New England Journal of Medicine* Editor Jerome Kassirer reflects on his experiences and describes the challenges of choosing between a more metred approach to editing and releasing biomedical information and one of rushing important but sometimes imperfect papers to print. In another commentary André Picard, a health reporter for the *Globe and Mail*, discusses sifting through the published biomedical “wheat and chaff.” He questions whether the energy put into accelerated publication of a few papers would be better spent weeding out marginal ones. See pages [1137](http://www.cmaj.ca/lookup/volpage/166/1137), [1151](http://www.cmaj.ca/lookup/volpage/166/1151) and [1153](http://www.cmaj.ca/lookup/volpage/166/1153) ## Continuing professional development by email Both the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada have recently changed their requirements for continuing professional development (CPD) that physicians must meet to continue to be accredited. Traditional didactic methods such as reading medical journals earn fewer CPD credits than do more active undertakings such as small-group discussions. Erica Weir and John Hoey introduce a new *CMAJ* online CPD course that starts in May and runs 4 weeks. It is an email-based small-group discussion on the health effects of outdoor air pollution linked to a review article in this issue by Alan Abelsohn and coauthors. Participants will earn either MAINPRO-C credits or section 1 Maintenance of Certification credits from their respective colleges. Combining the content standards of a peer-reviewed journal with the convenience afforded by an electronic medium provides flexibility for participants and allows those in remote regions improved access to higher-level CPD credits. See pages [1157](http://www.cmaj.ca/lookup/volpage/166/1157) and [1161](http://www.cmaj.ca/lookup/volpage/166/1161) ## Carotid endarterectomy Occlusion of the carotid artery from atherosclerotic disease results in ischemic stroke in many patients. Surgery may help some patients, but who is a good candidate and who isn't? Henry Barnett and coauthors review the appropriate uses of carotid endarterectomy. Symptomatic patients with at least 70% stenosis of the internal carotid artery are at greatest risk of stroke and may benefit the most from the procedure, especially if they are otherwise healthy, have had a hemispheric transient ischemic attack, have both intracranial and extracranial atherosclerotic disease and have no evidence on angiography of collateral vessels. Others whose risk of perioperative stroke and death is higher but who may still benefit include patients with widespread leukoaraiosis (cerebral white matter changes), those with occlusion of the contralateral internal carotid artery and those with intraluminal thrombus. Patients with 50%–69% stenosis experience less of a benefit from the procedure, and for some, including women and patients with transient monocular blindness only, the harms may outweigh the benefits. There is some benefit from endarterectomy in patients with lacunar stroke and those with a nearly occluded internal carotid artery. Patients with less than 50% stenosis and those who are asymptomatic do not appear to benefit. ![Figure2](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/166/9/1129/F2.medium.gif) [Figure2](http://www.cmaj.ca/content/166/9/1129/F2) Figure. Photo by: J. David Spence See page [1169](http://www.cmaj.ca/lookup/volpage/166/1169) In this issue's Clinical Vistas column J. David Spence and colleagues share the story, and three- dimensional ultrasonographic images, of a patient experiencing cerebral ischemia likely due to thrombi originating from a fissured atherosclerotic lesion in the carotid artery. See page [1189](http://www.cmaj.ca/lookup/volpage/166/1189)