scholarly journals Randomized Controlled Trials of Interventions to Prevent Sexually Transmitted Infections: Learning From the Past to Plan for the Future

2010 ◽  
Vol 32 (1) ◽  
pp. 121-136 ◽  
Author(s):  
Catherine M. Wetmore ◽  
Lisa E. Manhart ◽  
Judith N. Wasserheit

In plastic and reconstructive surgery, innovation and creativity have been foremost, with science and evidence following. Unlike for a number of other specialties, the advances in plastic surgery have largely come from imagination, innovations, and trial and error, rather than from scientific trials. Somewhat more than for the rest of surgery, in plastics (where the art and craft of each particular surgeon counts immeasurably), randomized controlled trials of techniques have failed to be generated in the past, due to the difficulty of objectively assessing the success of surgery with an aesthetic-based nature. Consequently, evidence-based study of plastic surgery is a relatively new and developing field. This chapter focuses on the growing importance of evidence-based surgery in this specialty, showing that scientific trials are now being performed with increasing frequency.


2011 ◽  
Vol 52 (9) ◽  
pp. 642 ◽  
Author(s):  
Joo Yong Lee ◽  
Jae Hoon Chung ◽  
Dong Hyuk Kang ◽  
Jung Woo Lee ◽  
Hong Sang Moon ◽  
...  

The recent history of randomized controlled trials in the prevention of ischaemic heart disease (i.h.d.) is considered. In 1970, it seemed that little could be done to prevent recurrence of the disease and there was almost no information on the potential for preventing its onset. Over the past decade, this rather pessimistic view has changed to one of guarded optimism. Yet there are still no drug regimes that command general support. One reason for the inconclusive results of recent trials may have been the assumption that myocardial infarction and sudden death share the same pathology. Another reason is the diversity of pathogenetic mechanisms and prognoses in i.h.d. Many patients probably stand little chance of benefiting from a particular drug either because it affects mechanisms other than those responsible for their disease or because their prognosis, excellent or hopeless, is unlikely to be influenced whatever treatment they receive. It is consequently difficult to ensure reasonable chances of demonstrating benefits in those who may really stand to gain. A tendency for pharmacological information to become available during or after a large trial, rather than beforehand, has added to the difficulties. Despite all their problems, randomized controlled trials remain the only way of testing drugs for the prevention of arterial disease. Suggestions are made for increasing the chances of clear results in future trials and of reaching the stage of benefit demonstrated sufficiently convincingly to form a basis for clinical practice. These suggestions include the use of factorial designs enabling the evaluation of more than one drug in a particular trial and the development of methods for selecting homogeneous groups of patients.


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