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Future research should focus on larger trials in patients in the ICU and should aim to consolidate the clinical findings and to establish the causal chain of events from increased omega-3 fatty acid status through to improved clinical outcome and the optimal dose of fish oil required to exert the benefits seen.
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Efforts to identify good predictive factors for response are well placed because the outcome measure occurs early and can inform research on larger trial samples in the adjuvant setting.
The results from small clinical trials and post hoc analyses of larger trials on the effect of vitamin D supplementation on glycemic control have been inconsistent.
The results from small clinical trials and post hoc analyses of larger trials on the effect of vitamin D supplementation on glycemic outcomes have been inconsistent (16– 23).
It helps that the F.D.A. has not insisted on large trials with control groups in instances of targeted therapies with few who qualify.
Drug development has therefore focused on large trials with composite indices to assess efficacy [ 11].
In case diversity is larger than inconsistency this may be an indication that total variability among trials in the meta-analysis is even greater than suggested by I. I2 is intrinsically influenced by a potentially overestimated sampling error, thereby underestimating and inherently placing less weight on large trials with many events.
This study used data from one large trial on a selected population of patients in equipoise regarding treatment with either endovascular coiling or neurosurgical clipping, which limits generalizability.
This result relies mainly on three larger trials: ACCORD, 7 ADVANCE, 6 and UKPDS.
The currents guidelines are based on fairly large trials and show acceptable results.
While the study was underpowered to assess an effect on these outcomes, larger trials should answer these open questions.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com