To provide perspective for clinicians as they evaluate incorporating single-center trials and small randomized, controlled trials for use in daily practice by reviewing examples from the literature.
Selected examples from the literature, such as check lists, daily screens for weaning readiness, daily spontaneous breathing trials, early resuscitation in sepsis, and daily interruption of sedation are reviewed and the effect of these studies is discussed.
Some single-center trials are adopted rapidly without confirmatory trials. These have then been incorporated into further protocols that have also demonstrated positive results, which illustrate the value of implementing some single-center trials into routine clinical practice. Even with robust published data, knowledge transfer of research results is traditionally slow. Given the negative results of some confirmatory trials, clinicians should carefully appraise published studies and decide whether the results are appropriate for a given patient population.
The results from single-center trials may have an important impact on patient care. Current data do not support the assumption that all single-center trials must be confirmed before adopting the results into clinical practice. Clinicians must carefully evaluate the results of single-center trials within the context of their clinical experience and the preferences of their patients to determine how best to translate research to the bedside.
From the Alpert Medical School at Brown University, Rhode Island Hospital, Providence, RI.
Dr. Levy has received speaking fees from Eli Lilly and Company and has received grants from ESAI.
For information regarding this article, E-mail: Mitchell_Levy@brown.edu