In offering 'protection' from the difficulties of trial decision making, the knowledge that there are treatments which they cannot access, and from the knowledge that treatment is determined by chance, this approach might be considered 'kinder' to those families allocated to the conventional treatment arm.
However, given the difficulty of trials in palliative care [40, 41, 42], and the number of trials that experience serious problems with recruitment, attrition and contamination, we feel that a detailed phase II study was warranted.
Without the difficulty of trial and error, the optimal input and output membership functions, and control rules of PSO-SFLC are automatically achieved by PSO.
b) the difficulties of recruiting trial participants from primary care are well known.
It will, however, add to the costs and logistical difficulties of the trial when the clusters are numerous and geographically dispersed.
At the end of the trials, participants rated the difficulty of each trial on a visual analog scale (VAS) from 0 mm (extremely easy) to 100 mm (extremely difficult) for laryngoscopic imaging (VAS-LI) and passage of the tracheal tube through the glottis (VAS-PT) [ 11].
But the difficulties of conducting clinical trials or introducing experimental techniques in an emergency setting are daunting.
30 In our view the theoretical and practical difficulties of doing these trials might justify the paucity of research in this field.
On the other hand, ethical and methodological difficulties of randomised controlled trials (RCT) on coercive interventions have only recently been addressed [ 22].
Such trials could also be adapted and carried out in other settings where the disease is endemic and would avert the difficulties of carrying out trials that the authors profess.
