Contemporary clinical studies

Source Bosworth HB, et al. The take control of your blood pressure study study design and methodology, Contemporary Clinical Trials 28 33 7 (2007). 

Domanchuk, K., Ferrucci, L., Guralnik, J.M., Criqui, M.H., Tian, L., Liu, K., Losordo, D., Stein, J., Green, D., Kibbe, M., Zhao, L., Annex, B., Perlman, H., Lloyd-Jones, D., Pearce, W., Taylor, D., McDermott, M.M. Progenitor cell release plus exercise to improve functional performance in peripheral artery disease The propel study. Contemporary Clinical Trials 36, 502-509 (2013)... 

Clinical Study in Paris. The early nineteenth century also saw the beginnings of clinical epidemiology studies. Pierre Louis recorded and published meticulous observations of the contemporary practice of bloodletting. His methods were mathematical, based on careful studies of patients with inflammatory disease. Among his conclusions Bloodletting did not benefit patients with pneumonia, although it shortened the duration of the disease if done early and the patient survived. 

Ross JF, Mattson JL, Fix AS. Expanded clinical observations in toxicity studies historical perspectives and contemporary issues. Regul Toxicol Pharmacol 1998 28 17-26. 

Hanna, G.L. (2000) Clinical and family-genetic studies of childhood ohsesslve-compulslve disorder. In Goodman, W.K., Rudorfer, M.V., and Maser, J.D., eds. Obsessive-Compulsive Disorder Contemporary Issues in Treatment. Mahwah, NJ Lawrence Erl-haum Associates, pp. 87-103. 

At this point, it may be useful to the reader to understand some of the background that has led to the contemporary design of human clinical trials. Although the concept of a comparative trial was known in the ninth century bc, it remained for James Lind in 1774 to perform his famous trial. Lind was concerned with comparing several different recommended treatments of the day for scurvy. Lind demonstrated that when all of the proposed treatments were compared in a controlled study in human volunteers, only one proved efficacious—citrus fruit. It is important to realize that each of the treatments tested was recommended by recognized authorities of the day. It took the comparative trial to prove that citrus juice cured scurvy and the other treatments were worthless. In the process of applying this scientific method, Lind did much to destroy the credibility of testimonials. 

The possibility that mental illness may be alleviated by biogenic amine precursors is an appealing one (SEDA-4, 18). Tryptophan is a naturally-occurring essential amino acid, which has been advocated as an innocuous health food for the treatment of depression, insomnia, stress, behavioral disorders, and premenstrual syndrome. The availability of amino acids in health food stores and a contemporary interest in natural remedies led to reported widespread use of tryptophan to treat depression. It was estimated in 1976 that up to that time several hundred patients with affective disorders had been studied, with results reported in at least 21 papers (1). However, the results of clinical trials with L-tryptophan in the treatment of depressive disorders are inconsistent (2). 

There are very few tumor types in which the use of chemotherapy can bring about prolonged survival, and possibly cure, for individual patients. The most common reason for this is the development of drug resistance within tumor cells. The laboratory study of resistance to anticancer drugs has resulted in the discovery of numerous mechanisms present within tumor cells that act to reduce their cytotoxic effects. However, the failure to translate this basic laboratory research into improved clinical outcome for patients remains one of the most pressing problems in contemporary cancer research. 

To understand the many conceptual, economic, and political problems that beset contemporary medical practice, that is, medicine as health care, we must distinguish between scientific medicine, whose objects of study are diseases that affect human beings, and clinical medicine, whose objects of study are persons, usually called patients. Making this distinction does not imply that one is intellectually, morally, or practically better or more important than the other. Each enterprise has its own agenda and vocabulary. 

Identification of optimal care for the patient with STEMI is challenging because of the dynamic nature of the evidence base on which clinical decisions are made. The introduction of new agents and devices and refinement of treatment strategies rapidly make prior studies less relevant to contemporary practice. An example of this concept is the prior proscription against routine catheterization and intervention within the first 24 hours after fibrinolysis (78-80). Such an admonition, correct... 

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