1446 e-Letters

  • The importance of patient participation

    Firstly, in this response to the earlier comments of Deborah L. Lokken and Beverley H. Johnson of February 24, 2023, we agree that patient participation in patient safety is of huge importance. Sorry that we may be gave you the wrong impression and we would like to apologize for this. We see it as a positive development towards a true partnership in healthcare between patient and professional, however, there can be also concerns or risks if patients participate. We therefore also need the negative effects of patient participation in patient safety to take the next step in the development of patient participation.

    To take the next step in the contribution of patients and their families to patient safety, it is important to examine the full context and see which ‘gaps’ need to be addressed. Even if focusing only on negative effects could lead to a bias, identifying these gaps will us learn which ones there are and therefore also what we need to work on in order to make that positive contribution of patients in patient safety. For that reason, we have also indicated as a recommendation from this study that it is necessary to find the measures that need to be taken to either prevent these negative effects or address them ad hoc as soon as they occur.

    We can understand that the authors have some questions about the initiatives mentioned or about the small sample size. We have included the small sample size as a limitation. However, as also described in our publi...

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  • Author response to the 27.01.23 response

    We would like to thank the previous respondent (27.01.23) for their careful reading of our paper and for sharing their thoughts. Having considered it, the response assumes that our study included a manipulation check which was based on the emotion variable. However, this was not the case. We are not trying to manipulate how uncertain the participants actually feel – we expect them to feel uncertain after receiving conflicting information regardless of whether or not uncertainty is expressed in the vaccine announcement. The point of the paper is that when governments fail to express the uncertainty that people end up encountering, this reduces trust in them. How uncertain participants feel is therefore not a manipulation check as it is not conceptually linked to our manipulation, i.e. uncertainty expressed by the government. If we had wanted to include a manipulation check, it would have been about the perception that the government official is certain about the effectiveness of the vaccine.

    Having said that, the question of experienced uncertainty is still an interesting research question. Although there was some evidence that the manipulation did affect the dynamics of uncertainty (i.e., there was a significantly larger increase in uncertainty in the “certain” than in the “uncertain” condition; F(1,326)=9.27, p=0.003)), this is not required for our conceptual model. Even if we were to use the uncertain emotion variable as a manipulation check, it would not be appr...

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  • Mollicutes and adverse pregnancy outcomes: A challenging research area to navigate

    Axel Skafte-Holm 1, Thomas Roland Pedersen 1 and Jørgen Skov Jensen 1*
    1 Department of Bacteria, Parasites and Fungi, Research Unit for Reproductive Microbiology, Statens Serum Institut, Copenhagen, Denmark

    *Corresponding author
    Jørgen Skov Jensen
    Consultant physician, MD, PhD, DMedSci.
    Statens Serum Institute
    5 Artillerivej
    DK-2300 Copenhagen S
    Research Unit for Reproductive Microbiology.
    Division of Diagnostic Infectious Disease Preparedness
    Telephone +45 3268 3636

    To the Editor,

    We read with interest the systematic review and meta-analysis by Jonduo et al. [1], investigating the association between Mycoplasma (M.) hominis, Ureaplasma (U.) urealyticum and U. parvum colonisation of the genital tract of pregnant women and adverse pregnancy outcomes. This is a highly relevant analysis, as this subject is a matter of ongoing debate, due to the complex interactions with other microbial and non-microbial factors. It is also a subject where enormous taxonomic confusion exists due to the re-classification of the ureaplasmas. We were, consequently, interested in the comprehensive analysis on the relative importance of the two Ureaplasma spp. Unfortunately, we detected some shortcomings, which need to be discussed.
    (I) Culture-based studies. The review excluded articles published before the year 2000 if unspeciated U. urealyticum were re...

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  • Authentic Partnerships in Patient Safety

    For more than 30 years, our organization, the Institute for Patient- and Family-Centered Care (IPFCC) has been a leader in helping other organizations develop and sustain effective partnerships with patients and families to improve the quality, safety, and the experience of care. During that same time, the patient safety movement has affirmed the important roles of patients and their families in safety.

    We are concerned about the recent BMJ Open article, “Explaining the negative effects of patient participation in patient safety,” and the very different message it conveys. Our concerns center on the authors’ misunderstanding of what true partnership means in health care and the inherent bias in the structure of the research. Additionally, there was no patient or partner involvement in the “design, conducting, reporting, or dissemination plans of the research.”

    The questions in the “topic guide” were leading and reflected bias; therefore, they could only elicit negative views from respondents. The sample size of 8 professionals and 8 patients is small in establishing such strong conclusions.

    A patient in labor having the responsibility for checking the accuracy of medications was not an appropriate example of patient participation in safety nor of an understanding of partnership. Authentic partnership would entail a discussion about patient safety as a team responsibility and a determination from the patient on how she wishes to participate on that...

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  • Author's response: Impact of Minimum Unit Pricing on Hospital Discharges for Alcohol-related Liver Disease

    Dear Editor,

    To Prof Forrest and the authors of the Chaudhary et al paper(1): Thank you for your response to our review(2) in which you highlight that there was a significant reduction in alcohol-related liver disease (ALD) discharges following the introduction of minimum unit pricing (MUP) at your unit. This is an important point to highlight as a misrepresentation of the Chaudhary et al study in our review.

    In our review, we reported the outcome measure of mean weekly ALD discharges before and after MUP for 'All hospital episodes' which did not reach pre-defined significance (6.2 versus 5.2; p = 0.123) in the Chaudhary et al study, however the outcomes for 'individual patients' and those 'actively drinking' did indeed reach pre-defined significance and should have been included in our review. These outcomes from the Chaudhary et al study would certainly be consistent with the overall conclusion of our review, adding further support to the impact of MUP reducing alcohol-related hospital burden as you have highlighted.

    We would also like to correct the reference to your study in the main text of our review which should read “Chaudhary et al” and not “Ferguson et al” (found under ‘Results’, subheading ‘Natural experiments’).

    1. Chaudhary S, MacKey W, Duncan K, Forrest EH. Changes in Hospital Discharges with Alcohol-Related Liver Disease in a Gastroenterology and General Medical Unit Following the...

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  • A little confused

    I'm a 68 year old male with parox AF so am very interested in ablation data. I applaud the authors for their work and look forward to the results. One sentence in this paper confused me---" The benefits of ablation may not be fully realised among elderly patients." I wasn't sure what they meant by that. Elderly patients may be unable to appreciate the benefits? There may not be any benefits in elderly patients? Something else?
    Again, very good work, thanks to the authors.
    Declan Fox
    Family physician

  • Serious flaws in article

    Dear Editor,
    The article by Yang et al. (2022) is fundamentally flawed due to a number of serious methodological shortcomings. These deficits are of such crucial relevance that it is in our view highly doubtful whether the conclusions the authors draw from their research are valid.

    1) Data extraction is not transparent and sometimes false:
    We were not able to replicate any of the values included in the main analysis of pain (Figure 4). In at least one study, values were extracted from the wrong group. In two further studies, the given values are incompatible with the values reported in the study. In at least three studies, sample sizes were falsely extracted.
    Only in one of the included studies (Bishop et al., 2016) the values given in Figure 4 (Mean, SD) were found (Table 6, Bishop et al., 2016). However, the values of the control group were extracted from the false group (see below). For all other included studies, the values (Mean, SD) given in Figure 4 were not found. We were not able to find a description of how the authors may have transformed the values to explain the disagreement. In some studies, the given values in Figure 4 are not only not replicable but are incompatible with the values reported in the studies:
    o In Bishop et al. (2016), values were extracted from the false group. Values were taken from standard care group but Yang et al. stated in Table 1 to have used the placebo acupuncture group as control g...

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  • Impact of Minimum Unit Pricing on Hospital Discharges for Alcohol-related Liver Disease

    Dear Editor,
    The recent systematic review by Maharaj et al on the impact of minimum unit pricing on alcohol-related hospital outcomes is a welcome addition to the literature on this subject1. The mirroring of real-world experience of minimum pricing of alcohol with modelling studies provides yet further support for this public health measure.
    As part of their review, the authors cite our study which assessed the impact of minimum pricing of alcohol specifically on alcohol-related liver disease hospital episodes2. In the review it is stated that our study showed ‘no change in ALD hospital discharge rate’ after the introduction of minimum pricing. This conclusion is reiterated in the discussion. However I fear this is a misrepresentation of our study. When we reviewed patients discharged from the specialist Gastroenterology wards at Glasgow Royal Infirmary before and after the introduction of minimum unit pricing, we did find that there was a significant reduction in alcohol-related liver disease discharges. What did not change was the proportion of those patients with specific complications of liver disease such as ascites, hepatic encephalopathy or alcoholic hepatitis. Neither was there any change in mortality. Whilst accepting the limitations of our study as raised in the discussion, these results indicate that minimum unit pricing did reduce the number of hospital episodes with alcohol-related liver disease. However for those fewer patients who did require ho...

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  • Increased risk Frozen Shoulder in Diabetes- A hype

    Most of the studies in the literature propagate that the incidence of frozen shoulder is higher in people with diabetes. According to the American Diabetic Association, the average age of people with frozen shoulder is 52 years. Among people 40 and over, the condition affects 2 to 4 percent of the general population and up to 25 percent of people with diabetes. But no definite pathophysiological mechanism to support the data has been postulated.

    Several questions remain unanswered.
    Do people with diabetes experience worse outcomes from frozen shoulders than those without diabetes?
    Does uncontrolled diabetes have a higher risk or severity of disease?
    Do people with diabetes develop frozen shoulder at an earlier age than non-diabetics?
    Does Diabetes delay the recovery from a frozen shoulder?

    Answers to the above questions may be yes in several studies in scientific literature. However, the certainty in evidence in most such studies is moderate to low. In our experience of more than 30 years, we also don't find any such correlation.

    Frozen shoulder undoubtedly has a higher incidence among patients with Myocardial Infarction, but the incidence, duration of disability, severity of symptoms, and age of onset are not remarkably different from the general population.

    References: 1.https://www.sciencedirect.com/science/article/pii/S259010952100051...

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  • Primary Care Physicians Lead the Call to Eliminate COI in Clinical Practice Guidelines

    This research by Mooghali and team provide valuable and disturbing data on the problem of financial conflicts of interest (COI) in clinical practice guidelines.(1) Failure of authors and committee members to accurately disclose potential COI raises concerns about lack of transparency in the process, bias in the resulting guidelines, and ultimately harm to patients.

    The pioneering work in this area was done by the American Academy of Family Physicians, which published in 1994 the first international call for an explicit declaration of conflicts of interest in the development of clinical practice guidelines.(2) This has been followed by policies on COI by other groups of primary care physicians in the US(3,4), the UK(5,6) and Canada(7,8).

    Primary care physicians have been early champions of evidence-based medicine and explicit clinical practice guidelines. They are also the clinicians working at the point of care, partnering with patients to make shared decisions. The best in care requires the best guidance based on the best evidence. Therefore, potential COIs must be fully disclosed and critically managed by all involved in producing, disseminating, and implementing clinical practice guidelines.
    1.Mooghali M, Glick L, Ramachandran R, et al. Financial conflicts of interest among US physician authors of 2020 clinical practice guidelines: a cross- sectional study. BMJ Open 2023;13:e069115. doi:10.1136/ bmjopen-2022-069115
    2. Phillips...

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