Trials cannot address urgent and important questions
fever, swallowing dysfunction, cancer deaths, hyperglycaemia, deaths, acute stroke, strokes
HYPERGLYCAEMIA, ACUTE STROKE, STROKES
Almost every healthcare problem, such as avoidable cancer deaths and strokes or maximising COVID vaccination coverage, demands urgent solutions. The history of medicine is littered with obsolete clinical recommendations based on partial evidence and assumptions, subsequently overturned by rigorous studies [Alternative evaluation designs offer the attraction of faster turnaround times than trials, with shorter planning and follow-up periods. However, time series designs depend upon stable data being available over lengthy periods. Some of the long timelines associated with implementation trials are related to burdensome research regulation and management [Well-conducted trials can overturn conventional wisdom whilst positive quasi-experimental studies may fail to convince. A trial of a multidisciplinary intervention targeting evidence-based management of fever, hyperglycaemia and swallowing dysfunction in acute stroke units found significant reductions in patient deaths or dependency at 90 days [