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Related Experiment Video

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Human Egg Maturity Assessment and Its Clinical Application
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Clinically, what ought we to believe?

John D Little1, Lorraine Davison2, Robert D Little3

  • 1Consultant Psychiatrist, Kapiti Community Mental Health Team, Paraparaumu, New Zealand.

Australasian Psychiatry : Bulletin of Royal Australian and New Zealand College of Psychiatrists
|November 1, 2018
PubMed
Summary

Randomised controlled trials (RCTs) offer valuable clinical insights, especially in psychopharmacology. However, RCTs have limitations, and blindly accepting their conclusions, particularly for complex social interventions, is not advisable.

Keywords:
conflicting opinionshierarchies of evidencerandomised controlled trials

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Area of Science:

  • Evidence-based medicine
  • Clinical research methodology

Background:

  • The hierarchy of evidence often places randomised controlled trials (RCTs) at the apex.
  • This study questions the unquestioned reliance on RCTs in all research contexts.

Purpose of the Study:

  • To critically evaluate the position of the randomised controlled trial (RCT) within the hierarchy of scientific evidence.
  • To discuss the limitations of RCTs and the implications for clinical decision-making.

Main Methods:

  • Critical review of the role of RCTs in evidence-based practice.
  • Case illustration of conflicting evidence and differing expert opinions.
  • Proposal of a clinical strategy for managing discrepancies in evidence.

Main Results:

  • Randomised controlled trials (RCTs) provide crucial and clinically relevant data, particularly in psychopharmacology.
  • RCTs are not without flaws, and their conclusions should be critically assessed, especially in complex social interventions.

Conclusions:

  • Automatic deference to RCT conclusions, particularly in complex social interventions, is ill-advised.
  • A clinical strategy is proposed to navigate conflicting evidence and differing opinions, integrating various evidence bases.