Document Detail

Factorial design provides evidence to guide practice of anaesthesia.
MedLine Citation:
PMID:  16045652     Owner:  NLM     Status:  MEDLINE    
Many scientific articles are written merely to get something published, neglecting the clinician who would like the medical literature to guide their practice. Evidence-based medicine is expected to help in clinical decision-making. Systematic reviews of the literature followed by a meta-analysis of randomized, controlled trials (RCT) have claimed to represent the highest strength of evidence. However, the results published in meta-analyses have not always been confirmed in subsequent large RCTs. An analysis of 12 large RCTs and 19 meta-analyses addressing the same questions found that the outcomes of these large RCTs were not predicted accurately 35% of the time by previously published meta-analyses. Therefore, meta-analyses of several small RCTs do not obviate the need for large, multicentre RCTs, which can still be considered as a gold standard for the development of clinical guidelines or practice plans. Moreover, large RCTs using a factorial design can be highly efficient because they can answer several clinical questions at the same time and offer the only systematic approach to investigate an interaction of combinations in multimodal approaches.
K Korttila; C C Apfel
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  49     ISSN:  0001-5172     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-27     Completed Date:  2005-11-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  927-9     Citation Subset:  IM    
Department of Anaesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland.
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MeSH Terms
Anesthesia / methods*
Evidence-Based Medicine
Meta-Analysis as Topic
Practice Guidelines as Topic
Randomized Controlled Trials as Topic*
Research Design*

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