Randomised clinical trials in general practice: lessons from a failure.

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[1]  G. Bettelli,et al.  Antihypertensive treatment of the elderly in general practice. , 1989, Journal of human hypertension.

[2]  J. Vogel.  Management of acute myocardial infarction 1990: A perspective , 1991, Clinical cardiology.

[3]  R Peto,et al.  Why do we need some large, simple randomized trials? , 1984, Statistics in medicine.

[4]  W. Kannel.  Prevalence, incidence, and hazards of hypertension in the elderly. , 1986, American heart journal.

[5]  M. Bonati,et al.  SECOND-GENERATION CLINICAL PHARMACOLOGY , 1986, The Lancet.

[6]  F. Avanzini,et al.  Feasibility of a large prospective study in general practice: an Italian experience. Gruppo di Studio sulla Pressione Arteriosa nell'Anziano. , 1987, British medical journal.

[7]  G. Bettelli,et al.  Awareness, treatment, and control of hypertension in the elderly in a general practice experience , 1989, Clinical cardiology.

[8]  G. Bettelli,et al.  [Isolated systolic hypertension in the elderly]. , 1989, Medicina.

[9]  A L Greer,et al.  The State of the Art Versus the State of the Science: The Diffusion of New Medical Technologies into Practice , 1988, International Journal of Technology Assessment in Health Care.

[10]  B. Dahlöf,et al.  STOP-Hypertension--preliminary communication from the pilot study of the Swedish Trial in Old Patients with Hypertension. , 1987, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[11]  Gruppo Italiano per lo Studio della Soprawivenza nell'Inf Miocardico..  MEDICAL SCIENCE GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction , 1990, The Lancet.

[12]  S. Garattini,et al.  The case of GISSI in changing the attitudes and practice of Italian cardiologists. , 1990, Statistics in medicine.

[13]  A. Liberati,et al.  The Impact of Patient Management Guidelines on the Care of Breast, Colorectal, and Ovarian Cancer Patients in Italy , 1991, Medical care.

[14]  G. Tognoni,et al.  The GISSI Study: further analysis. Italian Group for the Study of Streptokinase in Myocardial Infarction (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico, GISSI). , 1987, Circulation.

[15]  J. Coope.  Hypertension in general practice: what is to be done? , 1984, British medical journal.