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The advantage of the pragmatic strategy is that if this trial provides evidence in favor of chiropractic therapy, the results can easily be implemented, but future trials will be needed in order to identify the specific components.
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To date, most of these trials have involved single-agent interventions but, increasingly, future trials will test therapeutic combinations that are based on a compelling scientific rationale and testable mechanistic hypotheses.
We submit that adopting these recommendations in future trials will increase the chance of detecting small but clinically relevant treatment effects in critical care medicine.
The current position of LDA in secondary prevention in cardio- and cerebrovascular disease mean that it is unlikely that in future, trials will be run with LDA compared to placebo, but there might be opportunities in studies in primary prevention (as in the ASPREE trial in progress [ 28]) or where LDA is used for other conditions.
The implications of advancements in technology will be examined, and the optimal design of future trials will be discussed.
Future trials will probably compare predefined different duration or discontinuation policies based on clinical response and evolution of biological markers.
The result does not mean that future trials will have the same outcome - they will each turn on the individual facts.
Future trials will be needed to test drugs currently in development for treatment of Candida strains that are resistant to existing therapies.
Future trials will need to weight biomarker outcomes equal to cognitive outcomes especially when the biomarkers are linked to specific mechanisms, such as changes to beta amyloid (Aβ) deposition or brain volume.
Therefore, future trials will test whether higher total ADR dosage, delivered as p97 conjugates, will further increase survival times.
This approach may be useful in those patients who have a recurrent stroke on dual therapy.[17] In light of ESPS 2 and ESPRIT [4], [5] confirming the superiority of aspirin and dipyridamole versus aspirin alone, future trials will need to compare the effect of adding clopidogrel to dual therapy versus dual therapy alone.
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