The Treatment of Acute Infectious Hepatitis. Controlled Studies of the Effects of Diet, Rest, and Physical Reconditioning on the Acute Course of the Disease and on the Incidence of Relapses and Residual Abnormalities 1

Determination of Safe Return to Play for Athletes Recovering from Infectious Mononucleosis

“…14,18 Clinical improvement has been seen with early strenuous activity in other viral illnesses. [19][20][21] Timing of Return to Play Authors are not consistent regarding their recommendations about when athletes with IM may return to competition. 10 Some advocate return to restricted activity based on fever 18 or physical findings, 22,23 whereas others recommend a gradual return to activity after 2 weeks, 14,18,23 3 weeks, 24-27 4 weeks, 28-30 8 weeks, 31 or even 24 weeks.…”

“…46,47 The hepatocellular enzymes do not reach levels seen with viral hepatitis, and chronic hepatitis and cirrhosis are rare sequelae to IM-induced hepatitis. 48,49 Although the use of liver function tests have been suggested as a way to predict return to play in athletes with IM, 19 the enzyme elevations are not specific for IM, and most have resolution back to normal within 4 weeks. 38,50 Although some authors suggest the use of liver enzymes and heterophile titers in the return-to-play decisionmaking process, 30 no correlation has been demonstrated between specific enzyme levels and spleen size.…”

The culture of designing hepato-biliary randomised trials

“…Although randomised trials provide the fairest way to test the effects of interventions [1,[3][4][5][6], over 200 years went before the first hepato-biliary randomised trial was published [7]. Thomas C Chalmers and co-workers conducted their two factorial-designed trials on diet, rest, and physical reconditioning in 460 patients with acute infectious hepatitis in 1955 [7].…”

“…Thomas C Chalmers and co-workers conducted their two factorial-designed trials on diet, rest, and physical reconditioning in 460 patients with acute infectious hepatitis in 1955 [7]. Other trials in liver diseases followed [8] and hepato-biliary randomised trials appeared regularly from the 1970s (Fig.…”

A 1955 clinical trial report that changed my career

“…1 It was then and probably remains one of the most detailed reports of clinical trials ever published: it begins with a Table of Contents and runs on to a further 71 pages of small type. It is a model of how randomized trials should be reported, reflecting Marc Daniels' call for better reporting of clinical trials five years earlier, 2 and anticipating by over four decades the reporting standards agreed and promulgated by the CONSORT Group.…”