Julian Desmond G
University of Newcastle-upon-Tyne, Newcastle-upon-Tyne, United Kingdom.
J Cardiovasc Electrophysiol. 2003 Sep;14(9 Suppl):S2-5. doi: 10.1046/j.1540-8167.14.s9.18.x.
Practice should, as much as possible, be based on good science. Randomized clinical trials can provide the best evidence, but they have serious limitations. First, many clinical situations, such as cardiac arrest and pain relief, do not lend themselves to randomization. Second, trials seldom can study the effects seen in different subgroups, nor can the results always be extrapolated from the restricted groups of patients recruited into trials. Finally, there is publication bias: the failure to report "negative" trials and the biased presentation of results by investigators and sponsors.
实践应尽可能基于可靠的科学依据。随机临床试验能够提供最佳证据，但它们存在严重局限性。首先，许多临床情况，如心脏骤停和疼痛缓解，并不适合进行随机分组。其次，试验很少能研究不同亚组中观察到的效果，而且试验招募的有限患者群体所得到的结果也不一定总能外推至其他人群。最后，存在发表偏倚：未能报告“阴性”试验结果，以及研究者和资助者对结果的有偏呈现。
