618 e-Letters

  • Finnish fraud to be finished

    Finnish fraud to be finished
    Reply to S. Selinheimio

    Dear Editor,
    Thank you for your response in regards to the publication of Selinheimo S. et al. There remain several important issues of concern which I feel obliged despite a short format to explain explicitly.

    In Finland, in 1995 and later in 2015 the §121 paragraph in the Finnish Employment Accident and Occupational Disease Law 459/2015 was added to the legislation. This paragraph grants insurance institute doctors an exceptional right to write out patient statements without complying with Act on Health Care Professionals 23 § adopted for certified medical statements. Putting it simply that means that a medical doctor from an insurance company does not need to sign patient statements through his/her honor and conscience, like any other health care professional. Due to the adoption of this shameful paragraph the social security of those patients who had accidents or got professional diseases has weakened dramatically. This paragraph has now got nearly 12 000 protests (1). In view of the exceptional rights of doctors working in insurance companies it is therefore difficult to assess their honesty and to know when he/she makes any kind of statements that complies with the accepted norms for medical professionals and when not.

    The constitutional rights of Finnish patients suffering from poor indoor air are violated. FIOH exercises a great deal of psycologization and claims that...

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  • High rate of malformation in cohort

    It seems significant to note the high rate (over 10%) of major congenital malformations among unexposed and exposed pregnancies. It would be interesting to have the authors comment whether this compromises external validity, and possible reasons for such high rates.

  • Authors' Response to Comment by Peter A West

    Peter A West wrote a letter primarily suggesting the use of friction cost method to evaluate the economic impacts of lost PLYs because of diabetes in our paper.
    There is an ongoing debate on which of the two methods (human capital approach or friction cost) is the best method for measuring the economic evaluation of lost productivity. The human capital approach counts any time out of the labour force due to ill health as lost labour productivity because of the reduced work capacity of the individual, whereas the friction cost method takes the employer’s perspective and only counts a portion of the time until a new employee can be hired to take over the job, including undertaking any training required, of the individual who was no longer able to work, with a friction period being typically up to 3 months. We chose to use the human capital approach in our paper for several reasons:
    1. Australia has one of the lowest unemployment rates, currently around 5.7%, among the OECD nations (https://data.oecd.org/australia.htm).
    2. There are numerous areas of the workforce in severe shortage in Australia, making it harder to replace a worker when they leave, let alone an experienced 45-64 years age group worker (https://www.employment.gov.au/occupational-skill-shortages-information).
    3. Finally, Australia has significant barrier...

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  • Selecting code lists to define a disease

    As Tate et al. (2017) have shown, taking a systematic approach to creating a code list is necessary, in the face of significant variation in incidence estimates when different code lists are used. Our group has been working on finding a systematic approach to code list selection for diabetes, by looking at the effect of additional codes on prevalence estimates.

    We have looked at the effects of adding additional codes to a code list, on the number of patients identified with diabetes in CPRD at a single point in time. We looked at a randomised sample of 25,000 patients, downloaded on 7th June 2016, from CPRD. A comprehensive list of 378 diagnostic codes for diabetes was determined by visual inspection of all codes which contained the “diabetes”/”diabetic” keywords. 2334 diabetic patients were identified in our sample using this comprehensive code list. This was defined as the complete cohort.

    All codes in the code list were then ranked, using the following algorithm:

    1. The diabetes code that identified that largest number of patients was ranked highest.

    2. The next ranked code was the one that identified the largest number of new patients.

    3. Repeat (2) until all patients in the cohort are identified.

    Thus, we created a list where codes were ranked according to how useful they were in identifying additional diabetic patients.

    To illustrate, our highest ranked code, ‘Type 2 diabetes mellitus’, identified 1504...

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  • Medicines management across care boundaries

    Phipps and colleagues examine how the work of medicines management during actual or suspected AKI is achieved in practice, especially when patient care crosses care boundaries. We note that there study was undertaken in 2014, which predates the AKI CQUIN introduced for hospital trusts in March 2015. (1) This CQUIN sought to improve the follow up and recovery for individuals who have sustained AKI, reducing the risks of readmission, re-establishing medication for other long term conditions and improving follow up of episodes of AKI.
    As a result of implementing this CQUIN we would argue that some of the challenges they describe can be overcome. As well as our hospital using an electronic prescribing system, we also have access via GURU and the summary care record to assist with medicines reconciliation at admission. This is one of the interventions mentioned by the authors - the provision of shared access between primary and secondary care professionals to a patient record. Patients admitted with suspected AKI now have documented the stage of AKI, evidence of medicines review having been undertaken, and frequency and type of blood tests required on discharge. These tasks are undertaken by the pharmacists. This information, plus additional information on changes to medication, is contemporaneously captured in the patient’s electronic record. When the patient is discharged, this information is assimilated into the e-discharge for the patient’s GP. The additional infor...

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  • Questions about the vitamin D supplementation protocol for patients with myocardial infarction.

    Vitamin D deficiency is increasing worldwide and is considered a public health problem (1-3). Additionally, vitamin D deficiency has been described as frequent in patients with cardiovascular disease (4-11) including myocardial infarction (12-15). Vitamin D deficiency is also associated with intensified cardiac remodeling, impaired cardiovascular outcomes, and increased mortality (16). This aspect has attracted special attention because it is a new easily modifiable risk factor (17). Thus, food fortification and vitamin D supplementation have been indicated by researchers and health professionals (18-20). However, vitamin D administration has also been shown to cause deleterious cardiovascular effects, even in non-hypercalcaemic doses (21-23). Studies have shown that vitamin D exerts a biphasic cardiovascular ‘dose response’ curve with deleterious consequences with both vitamin D deficiency or excess (14, 24, 25). Associations between vitamin D status marker 25OHD (also known as calcidiol) and cardiovascular diseases are generally described as non-linear. These associations have a plateau in serum concentrations between 20 and 30 ng/mL (26, 27) and both low and high calcidiol serum levels are associated with higher cardiovascular mortality (25).
    Specifically in myocardial infarction, vitamin D supplementation may be associated with worse ventricular function and increased mortality. A non-linear U-shaped relationship between calcidiol levels and long-term mortality h...

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  • Updated URL for reboxetine documents

    The URL (link) to studies on reboxetine has changed. They are still housed by the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (Institute for Quality and Efficiency in Healthcare = IQWiG), but now available at: https://www.iqwig.de/en/projects-results/information-on-studies-of-rebox...

  • Table 1 columns interchanged?

    Could it be that the headings in column 1 have been interchanged and that < 150 ug/g should be > 150 ug/g?

  • Table 1 columns interchanged?

    Could it be that the headings in column 1 have been interchanged and that < 150 ug/g should be > 150 ug/g?

  • In answer to inquiry Finnish fraud to be finished

    Dear Editor,

    Tamara Tuuminen has raised concerns that the members of the research team could have had conflicting interests by their affiliations. We did not regard any affiliation to cause conflicts of interest regarding this protocol article. One member of the research group (AV) works part-time as a medical expert in Social Insurance Institute of Finland (KELA) and OP Insurance Ltd, and another (KK) in Varma Mutual Pension Insurance Company. None of these institutions profits financially or non-financially from studying and publishing the methods and results of this intervention study. Moreover, as mentioned in the manuscript, neither the authors' institutions nor the funders have any authority over trial activities or preparing of the manuscript.

    By submitting a protocol paper, our intention was to make our work as transparent as possible. Indoor air associated chronic, non-specific symptoms are perpetuated and exacerbated by various factors. The RCT intervention study compares treatments to reduce symptoms and improve quality of life, regardless of the mechanisms behind the symptoms.

    There is a lack of effective treatments for chronic environment-related symptoms with disability. Thus, our study represents one of the few RCT protocols for these patients. The intention of all stakeholders in Finland is to prevent and reduce disability.

    On behalf of research group,

    Sanna Selinheimo