Conclusions

Thus, it is important to consider a number of factors when thinking about study participants and the patient in front of you.4 There may be pathophysiological differences that could lead to diminished treatment response. For example, people with atopic eczema may not respond well to reduction to house dust mite if they were not allergic to house dust mite in the first place. There may be important social and economic differences that may diminish treatment compliance and hence response. For example a single parent with four children and a full-time job may not have the time to diligently apply short-contact dithranol to his/her widespread plaque psoriasis every day. Comorbidities such as renal disease might also affect treatment response either directly by affecting drug metabolism and clearance or indirectly through drug interaction and compliance. Many doctors practise this process "automatically" without labelling it as "evidence-based medicine". Sometimes, the patient's baseline risk of adverse events also profoundly affects the effectiveness of the treatment being contemplated. These factors do not mean that it is impossible to apply the results of RCTs to your patient - they are simply prompts to think about when generalising from a published study.

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