BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3495 (Published 01 September 2009) Cite this as: BMJ 2009;339:b3495

While we all appreciate the virtues of randomised controlled trials, Minerva was intrigued to read an analysis of data from seven large trials of antiplatelet drugs (Stroke 2009;40:2662-8, doi:10.1161/strokeaha.109.551812). Mortality was significantly higher in patients who did not meet the eligibility criteria for trial enrolment than in eligible patients, although rates of vascular events did not differ between the two groups. The authors say the data confirm that patients with ischaemic strokes or transient ischaemic attacks enrolled in randomised controlled trials are only partly representative of patients in clinical practice.

A multifaceted distraction method seems to have been successful in reducing both the pain and discomfort of immunisation injections in schoolchildren aged 4-6 years. The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of an ethyl chloride spray, which is an established method for reducing pain. The distraction materials included an improvised, plastic, multipronged arm gripper and a vibrating instrument that descended on the other arm, which provided the focusing task and visual distraction (Pediatrics 2009;124:e203-9, doi:10.1542/peds.2007-3466).

The cost-effectiveness …

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