Can the results of large scale clinical trials be applied in clinical practice?

The management of a patient in cardiac failure should lead the physician to ask if the patient might benefit from treatment with an angiotensin conver ting inhibitor. Meta-analyses give a positive reply but often lack detail. Analysis of large scale the-individual case, This analysis starts with vali dation of the methodology (correct randomisation, respect of double blind p rotocol, identity of groups) and synthesis of results expressed, if possibl e, in absolute values. In a second stage, the criteria of inclusion, exclus ion, and the comorbidity of enrolled patients, should be compared with thos e of the patient under consideration. In addition, the amplitude of the the rapeutic benefit and the importance of undesired effects must be taken into account in the therapeutic decision. This approach allows a reasoned presc ription based on documented facts.