Reports in the scientific and lay press on the current evidence from epidemiological and clinical trials for the benefit of lowering blood cholesterol often appear to be at variance. In May 1993 the British Hyperlipidaemia Association held a symposium at the Royal College of Physicians' to establish where there was agreement and to produce guidelines to identify people who might live longer as ...

Clinical trials have been the main tool used by the health sciences community to test and evaluate interventions, Trials can fall into two broad categories: pragmatic and explanatory. Pragmatic trials are designed to evaluate the effectiveness of interventions in real-life routine practice conditions, whereas explanatory trials aim to test whether an intervention works under optimal situations....

T HE RANDOMIZED CLINICAL TRIAL IS THE GOLD standard for evaluating a therapy, providing the highest evidence for the practice of evidence-based medicine. However, not all randomized clinical trials are informative and the success of the trial in demonstrating a valid treatment or diagnostic effect will depend on the elements of the study design. The purpose of this report is to highlight the es...

OBJECTIVES This review aimed to identify the evidence for the efficacy of archwires used in the alignment stage of orthodontic treatment by undertaking a systematic review of the literature. DATA SOURCES MEDLINE, the Cochrane Central Register of Controlled trials (CENTRAL), EMBASE, and the meta Register of Controlled Trials were searched up to July 2008. Reference lists of identified articles...

OBJECTIVE To assess if authors of randomised clinical trials convey the fact that they have used surrogate outcomes and discussed their validity. DESIGN Cohort study. SETTING Six major general medical journals. PARTICIPANTS Randomised clinical trials published in 2005 and 2006 that used a surrogate as a primary outcome. RESULTS Of 626 published randomised clinical trials, 109 (17%) used...

whAt Is the PRoBleM? Different from trials for regulatory approvals of new interventions aimed to test the efficacy, comparative effectiveness research (CER) is the direct comparison of existing health‐care interventions (compared with active controls) to examine which treatment works best, for whom, and under what settings.[1] Therefore, CER is indispensable to assist consumers, clinicians, pu...

This has resulted in the formation of organisations such as the UK Clinical Research Collaboration (www. ukcrc.org). However, in the two years since implementation of the regulations, recruitment into clinical trials in unconscious patients in emergency situations has been slow in the UK. The evidence base for trauma care was already seriously lacking, and the regulations did not help. Unconsci...

Over the last decade, maggot debridement therapy (MDT) has been recognized by many clinicians as a potential adjunct to conventional therapy, and many patients with non healing, chronic ulcers have been treated. Numerous case reports and case series have described the successful use of MDT in a variety of ulcers. However, comparative clinical trials and in particular randomized controlled trial...

OBJECTIVE We refer to the effectiveness (known as pragmatic or real world) and efficacy (known as explanatory or desired or ideal world) of interventions. However, these terms seem to be randomly chosen by investigators who design clinical trials and do not always reflect the true purpose of the study. A pragmatic-explanatory continuum indicator summary tool was thus developed with the aim of i...