***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Recent empirical evidence supports the importance of adequate r and omization in controlled trials . Trials with inadequate allocation concealment have been associated with larger treatment effects compared with trials in which authors reported adequate allocation concealment . While that provides empirical evidence of bias being interjected into trials , trial investigators rarely document the sensitive details of subverting the intended purpose of r and omization . This article relates anonymous accounts run the gamut from simple to intricate operations , from transillumination of envelopes to search ing for code in the office files of the principal investigator . They indicate that deciphering is something more frequent than a rate occurrence . These accounts prompt some method ological recommendations to help prevent deciphering . R and omized controlled trials appear to annoy human nature -- if properly conducted , indeed they should STUDY OBJECTIVE We investigate the efficacy and safety of oral paracetamol compared with oral nonsteroidal antiinflammatory drugs or combination therapy in relieving  pain after blunt limb injury in an emergency department ( ED ) . METHODS This was a double-blind , r and omized , controlled study in an ED of a university hospital in the New Territories of Hong Kong . Three hundred adult patients with painful isolated limb injuries were enrolled . Primary outcome measures were pain relief at rest and with limb movement , adverse events , and patient satisfaction . RESULTS There was no statistical difference in the mean reduction in pain score between any of the combinations at any point , although combination therapy was the first to reach a clinical ly significant reduction in pain score ( < 13 mm ) , and diclofenac-paracetamol combinations consistently produced a greater reduction in mean pain score than either nonsteroidal antiinflammatory drugs or paracetamol alone . All combinations appeared to be safe , although more patients receiving diclofenac-paracetamol combination complained of abdominal pain . The median patient satisfaction scores were poor . CONCLUSION In the doses , frequencies , and routes of administration used for this study , any analgesic benefit of oral paracetamol-nonsteroidal antiinflammatory drug combinations over single nonsteroidal antiinflammatory drugs or paracetamol treatment is small and of doubtful clinical significance . Nonsteroidal antiinflammatory drugs , paracetamol , and diclofenac-paracetamol combinations appeared equally safe in the management of musculoskeletal pain The Medical Research Council has for some years encouraged collaborative clinical trials in leukaemia and other cancers , reporting the results in the medical literature . One unreported result which deserves such publication is the development of the expertise to design and analyse such trials . This report was prepared by a group of British and American statisticians , but it is intended for people without any statistical expertise . Part I , which appears in this issue , discusses the design of such trials ; Part II , which will appear separately in the January 1977 issue of the Journal , gives full instructions for the statistical analysis of such trials by means of life tables and the logrank test , including a worked example , and discusses the interpretation of trial results , including brief reports of 2 particular trials . Both parts of this report are relevant to all clinical trials which study time to death , and wound be equally relevant to clinical trials which study time to other particular classes of untoward event : first stroke , perhaps , or first relapse , metastasis , disease recurrence , thrombosis , transplant rejection , or death from a particular cause . Part I , in this issue , collects together ideas that have mostly already appeared in the medical literature , but Part II , next month , is the first simple account yet published for non-statistical physicians of how to analyse efficiently data from clinical trials of survival duration . Such trials include the majority of all clinical trials of cancer therapy ; in cancer trials , however , it may be preferable to use these statistical methods to study time to local recurrence of tumour , or to study time to detectable metastatic spread , in addition to study ing total survival . Solid tumours can be staged at diagnosis ; if this , or any other available information in some other disease is an important determinant of outcome , it can be used to make the overall logrank test for the whole heterogeneous trial population more sensitive , and more intuitively satisfactory , for it will then only be necessary to compare like with like , and not , by chance , Stage I with Stage III CONTEXT Selective reporting of outcomes within published studies based on the nature or direction of their results has been widely suspected , but direct evidence of such bias is currently limited to case reports . OBJECTIVE To study empirically the extent and nature of outcome reporting bias in a cohort of r and omized trials . DESIGN Cohort study using protocol s and published reports of r and omized trials approved by the Scientific-Ethical Committees for Copenhagen and Frederiksberg , Denmark , in 1994 - 1995 . The number and characteristics of reported and unreported trial outcomes were recorded from protocol s , journal articles , and a survey of trialists . An outcome was considered incompletely reported if insufficient data were presented in the published articles for meta- analysis . Odds ratios relating the completeness of outcome reporting to statistical significance were calculated for each trial and then pooled to provide an overall estimate of bias . Protocol s and published articles were also compared to identify discrepancies in primary outcomes . MAIN OUTCOME MEASURES Completeness of reporting of efficacy and harm outcomes and of statistically significant vs nonsignificant outcomes ; consistency between primary outcomes defined in the most recent protocol s and those defined in published articles . RESULTS One hundred two trials with 122 published journal articles and 3736 outcomes were identified . Overall , 50 % of efficacy and 65 % of harm outcomes per trial were incompletely reported . Statistically significant outcomes had a higher odds of being fully reported compared with nonsignificant outcomes for both efficacy ( pooled odds ratio , 2.4 ; 95 % confidence interval [ CI ] , 1.4 - 4.0 ) and harm ( pooled odds ratio , 4.7 ; 95 % CI , 1.8 - 12.0 ) data . In comparing published articles with protocol s , 62 % of trials had at least 1 primary outcome that was changed , introduced , or omitted . Eighty-six percent of survey responders ( 42/49 ) denied the existence of unreported outcomes despite clear evidence to the contrary . CONCLUSIONS The reporting of trial outcomes is not only frequently incomplete but also biased and inconsistent with protocol s. Published articles , as well as review s that incorporate them , may therefore be unreliable and overestimate the benefits of an intervention . To ensure transparency , planned trials should be registered and protocol s should be made publicly available prior to trial completion BACKGROUND The optimal short-term , symptomatic therapy for osteoarthritis of the knee has not been fully determined . Accordingly , we compared the efficacy of a nonsteroidal antiinflammatory drug , ibuprofen , given in either an antiinflammatory dose ( high dose ) or an analgesic dose ( low dose ) , with that of acetaminophen , a pure analgesic . METHODS In a r and omized , double-blind trial , 184 patients with chronic knee pain due to osteoarthritis were given either 2400 or 1200 mg of ibuprofen per day or 4000 mg of acetaminophen per day . They were evaluated after a washout period of three to seven days before the beginning of the study , and again after four weeks of treatment . The major measures of outcome included scores on the pain and disability scales of the Stanford Health Assessment Question naire ( range of possible scores , 0 to 3 ) , scores on the visual-analogue scales for pain at rest and pain while walking , the time needed to walk 50 ft ( 15 m ) , and the physician 's global assessment of the patient 's arthritis . RESULTS Seventy-eight percent of the patients completed four weeks of therapy . No significant differences were noted among the three treatment groups with respect to failure to complete the trial because of noncompliance or adverse events . All three groups had improvement in all major outcome variables , and the groups did not differ significantly in the magnitude of improvement in most variables . The mean improvement ( change ) in the scores on the pain scale of the Health Assessment Question naire was 0.33 with acetaminophen ( 95 percent confidence interval , 0.14 to 0.52 ) , 0.30 with the low dose of ibuprofen ( 95 percent confidence interval , 0.09 to 0.51 ) , and 0.35 with the high dose of ibuprofen ( 95 percent confidence interval , 0.13 to 0.57 ) . Side effects were minor and similar in all three groups . CONCLUSIONS In short-term , symptomatic treatment of osteoarthritis of the knee , the efficacy of acetaminophen was similar to that of ibuprofen , whether the latter was administered in an analgesic or an antiinflammatory dose Twelve patients with rheumatoid arthritis were treated in a r and om double-blind crossover study with Tolmetin ( 1,200 mg/day ) and Paracetamol ( 2,000 mg/day ) . Each drug was administered for 4 days . A three-days wash-out period was fixed between the administrations of the first drug and that of the second one . The efficacy of the treatments was investigated by self-evaluation of the grip strength expressed as mmHg.h during the day .  Tolmetin  proved significantly more effective than  Paracetamol  and induced a significant increase of grip strength , as compared to the baseline values , from the first day of administration . The self-evaluation of the grip strength proved a simple and useful method to evaluate , within an extremely short time and on few groups of patients , the effectiveness of non-steroidal anti-inflammatory drugs in rheumatoid arthritis A double-blind crossover trial of bumadizone calcium ( Eumotol ) , a non-steroidal anti-inflammatory drug , has been carried out in 56 patients with rheumatoid arthritis . On both objective and subjective criteria bumadizone was superior to placebo and paracetamol at a statistically highly significant level ( P less than 0,01 ) . When tested against acetylsalicylic acid , bumadizone was more effective in 13 patients and less effective in 4 patients . Although this does not represent a statistically significant difference it does suggest that its anti-inflammatory and analgesic qualities are at least equal to those of salicylate in high dosages . There were no serious side-effects in the patients who received bumadizone and the drug was better tolerated than either acetylsalicylic acid or paracetamol The usefulness of anti-inflammatory drugs in rheumatoid arthritis ( RA ) is beyond dispute . The role of simple analgesics is less clear and has been disputed . A survey of 21 rheumatologists indicated that a majority sometimes supplemented anti-inflammatory treatment of RA with simple analgesics . A r and om sample of 120 RA patients treated by the same doctors revealed that 47 % ranked pain relief as the most desirable objective of their treatment and 54 % were taking analgesics regularly . Of those receiving analgesics as well as non-steroidal anti-inflammatory drugs 48 % considered the former to be the more effective preparations . Almost half the patients on analgesics were taking drugs without the knowledge of the rheumatologists , who may have underestimated their patients ' desire for pain relief Part I of this report appeared in the previous issue ( Br . J. Cancer ( 1976 ) 34,585 ) , and discussed the design of r and omized clinical trials . Part II now describes efficient methods of analysis of r and omized clinical trials in which we wish to compare the duration of survival ( or the time until some other untoward event first occurs ) among different groups of patients . It is intended to enable physicians without statistical training either to analyse such data themselves using life tables , the logrank test and retrospective stratification , or , when such analyses are presented , to appreciate them more critically , but the discussion may also be of interest to statisticians who have not yet specialized in clinical trial analyses 
    Output:
    
The NSAIDs were preferred more often than paracetamol by the patients or the investigator .
But people with rheumatoid arthritis and the research ers in the study did prefer non-steroidal anti-inflammatory drugs more than acetaminophen/paracetamol .