410 e-Letters

published between 2015 and 2018

  • Authors' reply to Kumar: Limitation of Results

    Kumar raises concerns about the interpretation of our study examining the cost savings of different repeat prescription durations, and argues monthly dispensing should be maintained. We thank Mr Kumar for his comments and interest in our article and respond below.

    In response to Kumar's first point, our study suggests that with shorter prescription lengths, the cost savings due to reductions in waste are more than offset by the additional dispensing fees; these fees can therefore not be considered "nominal". White1 further highlights the non-nominal impact of additional dispensing fees due to short prescriptions lengths, estimating an additional cost of £700 million if all prescription items issued by the NHS in England were issued as 28-day repeat-dispensing items.

    We are also not aware of any evidence that increased frequency of contact with the community pharmacist (or indeed “indirect contact" with the GP authorising a prescription) due to shorter prescription lengths impacts in a valuable way in terms of patient outcomes as implied, either from a clinical or cost effectiveness perspective. Work by Elliott et al.2 has shown the pharmacy-based New Medicines Service to be cost-effective at improving adherence. However, un-targeted clinical pharmacy services, more generally, lack conclusive evidence of their effect on medication adherence and prescription appropriateness.3 Indeed, in many cases, the contact between patient and pharmacist...

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  • Thank you for your suggestion

    Thank you for your suggestion. We agree with you that parental autistic disorders might increase the risk of ASD in children. In our study, we set all parental psychiatric disorders (ICD-10 codes F00-F99) including autism disorders (ICD-10 codes F84.0 F84.1, F84.5, F84.8 and F84.9) as potential confounding factors, and we adjusted for mother psychiatric disorders (including ASD) in model 1, and father psychiatric disorders (including ASD) in model 2. Besides, we also conducted sibling-matched analyses to control for shared family-related confounding factors like genetic liability for neuropsychiatric conditions.

  • Lack of reliable data confuses discussion on safety of midwife-led and obstetrician-led care

    With interest we read the article of Wiegerinck et al. on intrapartum and neonatal mortality among low-risk women in midwife-led versus obstetrician-led care based on case notes and data from the Dutch national perinatal database (PRN, nowadays called ‘Perined’). In a recent commentary we addressed some important pitfalls associated with the use of register-based data.1 Although the authors acknowledge the methodological challenges of their study, and the limitations of the Perined database, it is important to specify these issues in more detail. Secondly, we want to challenge the interpretation of the findings.
    In this study clinical information regarding the women and babies in the numerators and denominators for intrapartum and neonatal mortality rates were derived from different sources. For the numerators information on women and their babies who died was taken from case notes. For the denominators information was taken from the Perined database, in which information on risk factors is often missing. The authors show in their supplementary file that in a sample of 100 women who started labour in obstetrician-led care no information was recorded for 13% of women on one or more of the eight risk factors which were defined as exclusion criteria in this study. Most women with risk factors will have been removed from the numerator, because information was available in their case notes. On the other hand, an unknown number of women with risk factors were not removed f...

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  • Limitation of Results

    The research result has emphasized that increase medicines waste with longer intervals. Also, increase Prescribing cost for shorterter intervals. These findings should lead to The authors of this article suggesting:
    - Shorter intervals save significant medicines waste in comparison to nominal dispensing fee and offers Very valuable patient contact with a healthcare professional.
    - Authors has totally ignored the e-Repeats and eRDS (EPS most important automation already in place in almost all GP surgeries & Pagrmacies) to save Significant Prescribing cost. That was the main one of the main purpose of EPS; authorities should look into using the existing Tools to savings on both Prescribing cost and reducing costly mesicine waste by keeping Monthly dispensing intervals.

    I hope, authorities use the existing wheels; rather than trying to reinvent / disbalance the existing wheels.

  • Have you considered parental autism as a confounding factor?

    It does not appear that you have considered the possibility of the parents, especially the fathers, being autistic themselves, in this study. We know that around 70% of autistics suffer mental health problems so it would follow that a there is a high likelihood of an autistic parent (who may or may not have a diagnosis themselves) might be on SSRI or other depression medication prior to conception. I would see this as a highly significant potential confounding factor to this study.

  • Addendum to trial design

    In March 2017, the Royal Free Hospital, London, UK was opened as an additional site for recruitment. Hôpitaux Universitairede Genève, Geneva, Switzerland has been screening since the trial opened on March 2015. By January 2017, this site had screened 71 patients and failed to recruit any patients. At the Trial Steering Committee held in January 2017, it was decided to withdraw this site, with mutual consent of the principle investigator, from the trial. The screening data will be reported, as part of the CONSORT diagram, when recruitment is completed and the trial closed. As the primary outcome is cost effectiveness, the Trial Steering Committee has agreed that the data analysis plan is still valid with at least 17 patients to be recruited per country. The removal of Hôpitaux Universitairede Genève, Geneva, Switzerland as a site will not impact on the planned data reporting and the number needed to recruit has not been changed.
    Sites currently screening and recruiting to the trial are:
    Guys and St Thomas NHS Foundation Trust
    Leeds University Hospital
    Royal Brompton and Harefield NHS Foundation Trust
    The Royal Free Hospital
    Centre Hospitalier Universitaire de Grenoble
    Chu-Hôpitaux De Rouen

  • Obesity among Nurses

    There is no mention of nurses ordering take out and all hours of the day and those choices. Plus many bring in food items from home to share with others. How often does that happen and what is brought .
    Blaming the food service is a quick and easy way to blame others versus choices made by nurses.

  • Using Left over Funding in Applied Research in China Is Illegal

    Dear editor,

    As point of Dr. Atif A Baig, this should not be ethical issue but a legal one. After suitable statement of conflict of interest, it is must be no issue. However, Dr. Atif A Baig's conclusion may be obtained without understanding the regulations in China's National Natural Science Foundation (NNSF).

    The newest China's NNSF funded project funding regulation, see http://www.nsfc.gov.cn/publish/portal0/tab229/info48335.htm, has been taken effect in 2015 and now is running. There are clear rules for usage of left over funding in its article 28. First, the left over funding should be returned to NNSF of China in 2 years after the project has been closed. Second, the left over funding can only be used in direct expenditure of basic research. Moreover, article 37 also said that misappropriation of funding is illegal.

    As common sense of scientific research, there are many differences between basic research and applied research, see 1953's annual report of National Science Foundation of US, https://www.nsf.gov/pubs/1953/annualreports/ar_1953_sec6.pdf. In China, the definition of basic research is similar, see http://www.most.gov.cn/kjgh/kjfzgh/200708/t20070824_52690.htm.

    The content of e015983 has cla...

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  • Re: Not a random sample

    Dear Dr Peter,
    Thank you so much for your interest and comment.
    The study population consisted of both new pregnant women and those on follow-up of antenatal care clinic (ANC). Yes, it appears that new pregnant women attended ANC in random order. However, pregnant women who were on ANC follow-up visited the clinic on their schedule date. Thus, we assumed there was some pattern to their attendance of the clinic. In order to increase the chance of including women from different schedule dates and avoid clustered selection, we preferred to use a systematic random sampling than convenient sampling.

  • Role of Ethical and Legal Funding Implications’ from Funding Agencies

    Dear Editor of BMJ.

    I was reading it all and I assume that many times the issues can’t be ethical but are still legal. Being a neutral moiety, I assume just based on a fact to get justification from author or anyone sending a response is not enough for such serious ethical concerns. There is a serious need to look into the legal implications of use of funding. As per usual practice, the report of all grants are submitted to the funding bodies and if the “authors” have explained and mentioned the use of this all funding or “left over funding” in specific time to be used later as per rules and regulations, there must be no issue as far as no “conflict of interest “ is there between the authors and the funding agency. Seems it’s a very minor issue but for me it’s a new issue of its type and thank you for a very positive attitude from BMJ Open editor for facilitating science and honesty not in science but the concern minor issues.