755 e-Letters

  • Further concerns on methods, results and conclusions
    Julia Hippisley-Cox

    Dear Trish

    I'm afraid we also have many concerns regarding this paper in addition to those already raised by Mary Hawking.

    1. The authors have undertaken a cross-sectional study - this is weakest study design and the results of such studies can only ever signal associations rather than attribute causality. Limited information is provided on the 'adjustments' made in the analyses meaning the reader...

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  • Re:So many concerns, where to begin?
    Evan Kontopantelis

    Dear Mary

    Thank you for your diligent reading and useful comments. To answer the points you raise:

    1) The issue with table 3 has already been identified. Basically the labels for the SHA are wrong. Apologies for this.

    2) In the database from the HSCIC SystmOne was labelled as appears on the paper, ProdSysOneX. Embarrassingly, I did not query the name

    The BMJ has already been notified a...

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  • So many concerns, where to begin?
    Mary Hawking

    There would appear to be a number of inaccuracies in this article which I am very much afraid make the conclusions hard to sustain - and I would urge anyone thinking of using this article to guide their choice of GP IT system at any level to think again!

    Just a few points:- The description of GP computing is wrong: GP systems became 50% reimbursable in 1990 - not 1998 - and the reason was to bring them under DH...

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  • The validity of Carpenter's arguments from a statistical point of view
    Katharina Schueller
    Imputation of missing data
    The REALCOM-IMPUTE imputation method, mentioned in the appendix of the article by Carpenter et al., is based on the assumption that the value of the variable of interest is missing completely at random (MCAR) or that the missing value can be explained by other variables and does not depend on the (unknown) value of the variable of interest itself (MAR, missing at random). Initial an...
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  • Authors' Reply to responses on BMJ Open to Bed sharing when parents do not smoke: Is there a risk of SIDS? An individual level analysis of five major cases-control studies.
    Robert Carpenter

    Dr. O'Hagan's suggestion that SIDS may be due to maternal vitamin C deficiency seems unlikely because baby formula milk includes vitamin C supplement. We would therefore expect on his hypothesis that bottle fed babies would, if anything, be at lower risk than breast fed infants, which is not the case(1,2).

    Professor Byard and Dr Hunsaker are concerned that the possibility of accidental suffocation was not addres...

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  • Grant preparation time: the law of diminishing returns prompts a rethink on the application and review process
    Andrew W. Taylor-Robinson

    Using data from the 2012 Australian National Health and Medical Research Council (NHMRC) application round, Herbert and colleagues provide an estimate of the cost (in dollars and hours) of preparing a research grant. They conclude that more time spent by a chief investigator preparing a proposal does not increase the chance of being awarded a grant and that the relentless polishing of grant text, to the extent of poring o...

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  • Adressing the underestimated risk-problem in primary care's low prevalence sector
    Martin Konitzer

    This article is shedding some light on the underestimated problem of malpractice in primary care. In primary care most encounters finish without diagnoses but with classifications of symptoms. According to RN Braun's "Casugraphy" (1982) we have a biaxial tool describing and hardening results of encounters following a Pareto- or power law distribution. This distribution features two characteristics: 20% of "diagnoses" cou...

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  • Response to 'Does contact with a podiatrist prevent the occurrence of a lower extremity amputation in people with diabetes? A systematic review and meta-analysis.' CM Buckley, IJ Perry, CP Bradley, PM Kearney
    Lawrence Ambrose

    The College of Podiatry and The Society of Chiropodists and Podiatrists wish to provide a response to the recent paper by CM Buckley et al. The basis of the paper is that no evidence is available to show that if a person with diabetes has contact with a podiatrist they are any less likely to have a lower limb amputation than one who has no contact. Leaving aside the fact that podiatrists do not work in isolation and alw...

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  • What medical science cannot explain, it can always conveniently choose to disregard
    Edward J. O'Hagan
    (1) The stated objective of the study was: To resolve uncertainty as to the risk of Sudden Infant Death Syndrome (SIDS) associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed. Comment: How about parental poverty and malnutrition? Hypovitaminosis and more specifically maternal vitamin C deficiency have to be considered. Those aspects motivate this response, not alone by drawing attention...
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  • Is it wise to balance on a high-wire?
    Jan P. Siedentopf

    Based on a large set of data, the authors report on a positive effect of alcohol consumption in pregnancy on the balance ability of exposed children. In their study, information on alcohol consumption was acquired during pregnancy, probably making this data more reliable than other large studies on the effect of prenatal alcohol exposure, eg. the "UK Millennium Cohort Study" reported on by Kelly et al.(1).

    The aut...

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