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Lack of concealment of allocation can increase the effect size observed in randomised controlled trials. (Schulz 1995)

The most secure randomisation method requires the clinician to contact an external randomisation service after obtaining informed consent.However,complexities in the randomisation process may deter general practitioners from recruiting patients. Assessing eligibility, explaining trial, addressing patients' questions and obtaining consent, randomising, and collecting baseline data are time consuming for participating practitioners.(Wilson 1999).The additional workload may lead to some practices suspending recruitment at busy times ( e.g. Monday mornings,holidays, flu season, etc).