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Quoting Eddy Lang <[log in to unmask]>: >We can > all think of examples where lower levels of evidence have been trumped by > quality RCT's (hormone replacement therapy, hyperbaric therapy for carbon > monoxide poisoning... And over-trumped by an RCT with more clinical relevance? See Weaver L et al. Hyperbaric oxygen for acute carbon monoxide poisoning. NEJM;347(14):10571067. I guess the simple message is that any search and appraisal, whether 'quick and dirty' or 'slow and clean' can only ever reflect the state of play at one point in time. Mike Bennett Anaesthesia and Hyperbaric Medicine Sydney