Randomization, clinical trial guidelines

A 5 year randomized clinical trial in the United States found that in spite of the availability of hypertensive medication, awareness promotions, and guidelines, only a third of all the hypertensive patients have their blood pressure under effective control due to noncompUance in medication. More tailored behavioral management intervention may help to improve compliance and achieve better control. 

It should be noted that a recent, evidence-based, systematic review of published randomized clinical trials of therapy for toxoplasmic retinochoroiditis fitund only three studies that met the authors criteria for inclusion, two of which were carried out more than 35 years ago. Based on this evaluation the authors concluded that there was a lack of evidence to support routine antibiotic treatment for ocular toxoplasmosis, finding no evidence for a beneficial effect on the duration and severity of signs of the disease process. However, the preponderance of evidence supports the concept that appropriate antibiotic therapy is a community standard of care, which is bolstered by guidelines for treatment in many published sources, plus the responses of those practitioners recently surveyed about their preferred patterns of management of the condition. 

A second fundamental question concerns the role of resynchronization therapy in patients with persistent atrial fibrillation (AF). Atrial fibrillation is common in advanced heart failure (35), but patients with persistent atrial fibrillation were excluded from the majority of randomized clinical trials of resynchronization. Nevertheless, the most recent guidelines classify AF with QRS duration >120 msec to be a Class Ha indication for CRT implantation (1). Three multicenter randomized trials of resynchronization therapy have... 

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