While STRATEGIC trial is underway to explore various strategies to improve the uptake of cervical screening in young women (Kitchener, 2011), we recommend close surveillance of incidence in younger women over the coming years and a greater attempt to reverse the current decline in screening coverage for women aged 25 29 years.
The individual profile design, which includes a large number of different profiles leading to the selection of one out of a large number of different treatments, is easily validated if it is planned and understood as a strategic trial comparing conventional treatment selection to an individualized decision rule (Fig. 1d).
The bottom line, experts at Wharton note, is that the development of the digital living room is still in its early stages, and that means more strategic trials and errors lie ahead.
A change of DMARD therapy has been done successfully every 1 3 months in strategic trials.
The first example for high disease activity, 'as frequently as monthly', leans against available strategic trials evaluating patients every 1 3 months 28 30 in high disease activity.
48 Strategic trials have shown that aiming at low disease activity or remission by adjusting treatment every 1 3 months in conjunction with strict monitoring is associated with a better clinical, radiographic and functional outcome than with an unstructured follow-up.
The level of evidence supporting this statement was low (category III or IV) because strategic trials have hitherto aimed at attaining LDA, 28– 30 while no formal study compared a strategy to treat RA with the target 'remission' with another strategy.
The literature search had revealed that currently no strategic trials addressing a target-oriented, steered therapy were published, although some indirect evidence on optimal therapeutic approaches was available to inform the next stages of the process.
7 In this regard, it is interesting to note that recommendation 3 received one of the lowest mean scores, which is somewhat at odds with most strategic trials which aimed for low disease activity.
This gave a total of 24 publications for this review (figure 1), of which only 7 were strategic trials: 4 trials randomised patients to routine or targeted treatment, 26– 29 two compared different randomised targets 30 31 and one compared targeted treatment to historical control.
Thus, while, there is also additional evidence from strategic trials that employing TNF inhibitors plus MTX early is an effective treatment, 36 49 more recent data suggest that this approach may not be more effective in patients with early RA than starting synthetic DMARDs first and adding a biological agent to the DMARD rapidly (in that study after 3 months) if active disease prevails.
