808 e-Letters

  • Editor's Note

    Since publication, BMJ Open has received queries relating to the ethical approval statement in the article along with the reference number provided. We have asked the University of Bristol to investigate the accuracy of the statement and to confirm that the correct approval processes were followed. We are also in contact with the Health Research Authority, who are investigating the project.

    Once we have clarification of the ethical approval process, we will post an update.

  • Antivirals for ILI

    This is a useful study. The participants may not be aware that viruses like cytomegalovirus (CMV) interfere with both influenza vaccination and the immune response to influenza infection especially in the elderly. There is also some evidence that influenza may be interacting with outbreaks of an unknown agent (perhaps CMV?). See relevant references in the sections dealing with deaths and medical admissions and roles for CMV in human health at http://www.hcaf.biz/2010/Publications_Full.pdf

    I hope this is helpful to the study.

  • Women’s prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study

    Dear authors,
    Recently, the work “Women’s prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study” [1] was published in BMJ Open, it aims to study prepregnancy serum lipid levels and the association with the number of children. First, as part of the BMJ Open audiences, we thank for the work was presented to us. But, we think there are some problems on the tables of this study. When we firstly learn scientific knowledge, and the professor will tell us some rules on table and figure in scientific paper, and one of the most important is that table and figure should be “stand-alone” [2], that is, all important information should be presented, including table, figure, title, legend and footnotes etc. We found, although the “BMI” was given measurement unit as “kilogram/ (height in meters)2” in the text, but we did not find it in all of tables. In order to regulate writing rules, we raised the question.

    Conflicts of interest
    We declare that we have no conflicts of interest.
    1. Pirnat A, DeRoo LA, Skjaerven R, et al. Women's prepregnancy lipid levels and number of children: a Norwegian prospective population-based cohort study. BMJ open 2018;8(6): e021188.
    2. Cargill M, O'Connor P. Writing Scientific Research Articles: Strategy and Steps [M] Writing Scientific Research Articles. Wiley John + Sons, 2013:1018.

  • Identifying people with deteriorating health in Scotland for anticipatory care planning

    This is another valuable study using the Scottish public health datasets. It confirms an unplanned hospital admission as an important indicator of deteriorating health that should prompt a review of the patient's overall health and plan of care. Such admissions are key triggers to help identify people whose declining health might otherwise have not been recognised. In our validation study of the SPICT (Supportive and Palliative Care Indicators Tool) in a Scottish acute hospital, unplanned admission was a frequent general indicator.

    We would like to clarify that the Surprise Question is not part of the SPICT tool although some people use both tools. In Scotland, we have now adopted anticipatory care planning as a broader, person-held approach to future care planning and are increasingly moving away from the ‘prognostic paralysis’ associated with considering people for an integrated ‘palliative care approach’ only once they are thought to be in the last year of life.

    Scottish Anticipatory Care Planning Programme: https://ihub.scot/anticipatory-care-planning-toolkit/
    Highet G, Crawford D, Murray SA, Boyd K. Development and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT): a mixed-methods study. (Development & evaluation of SPICT) BMJ Support Palliat Care Published Online First: 25 July 2013 doi:10.1136/bmjspcare-2013-000488.

  • Continuity of Care : What Patients Want

    Patients have long known the benefits to their well being of seeing the same doctor . GPs have described the relevance of continuity in academic studies. The benefits are described in literature (see Berger A Fortunate Man). The current organisation of and future plans envisaged for general practice by policy makers make it increasingly difficult for patients to receive continuity.Fewer GPs work with a personal list, the practise provides the continuity.
    The research by Pereira Gray et al is the first study to give hard evidence that where used by doctors, continuity of cares associated with lower mortality rates. N.A.P.P. representing millions of UK patients in general practice, welcomes this research and hopes it can be replicated in other work.
    Most importantly, patients and their organisations need to lobby policy makers and professionals to ensure that the importance of continuity of care is built into future plans for general practice.

  • Response to the readers’ eLetter

    Dear Dr Lu
    Dear Professor Yang
    Dear Dr Ma

    Thank you for your comment. The sentence “a past systematic review reported that the most frequently cited barriers to abstract publication were a lack of time, although all studies included in that systematic review were conducted outside Japan.” should correctly read: “past studies reported that the most frequently cited barriers to abstract publication were a lack of time, although all studies were conducted outside Japan”.

    Best regards,

    Junpei Komagamine

  • There is a fundamental but overlooked limitation of this study

    The data of such a study are fundamentally biased. As a matter of facts, the Authors do not refer to an essential data: the presence of the CVD Inherited Real Risk of enlisted subjects. To declare the real microvascular outomes in patients with Type 2 Diabetes Mellitus under treatment with SGLT-2, only individuals are to be enrolled, involved by ATS Constitution-Dependent, Inherited Real Risk f CVD. (1-5)

    1) Stagnaro-Neri M., Stagnaro S., Deterministic Chaos, Preconditioning and Myocardial Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of ischaemic Heart Disease even silent. Acta Med. Medit. 13, 109, 1997
    2) Stagnaro Sergio. CAD Inherited Real Risk, Based on Newborn-Pathological, Type I, Subtype B, Aspecific, Coronary Endoarteriolar Blocking Devices. Diagnostic Role of Myocardial Oxygenation and Biophysical-Semeiotic Preconditioning. International Atherosclerosis Society. www.athero.org, 29 April, 2009 http://www.athero.org/commentaries/comm907.asp
    3) Stagnaro Sergio. Role of Coronary Endoarterial Blocking Devices in Myocardial Preconditioning - c007i. Lecture, V Virtual International Congress of Argentine Cardiology. http://www.fac.org.ar/qcvc/llave/c007i/stagnaros.php
    4) Sergio Stagnaro and Simone Caramel. The Inherited R...

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  • Baby-led weaning and iron - looking good but not clear-cut

    It is reassuring to learn that a modified version of the approach to the introduction of solid foods for infants known as ‘baby-led weaning’ does not lead to an increased risk of iron deficiency (Daniels, L., Taylor, R.W., Williams, S.M., Gibson, R.S., Fleming, E.A., Wheeler, B.J., Taylor, B.J., Haszard, J.J. and Heath, A-L.M. (2018) Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial, BMJ Open, 8: e019036). However, before drawing firm conclusions it is important to note that two variables were at play in this trial: One group – the BLISS (‘modified BLW’) group – followed a self-feeding approach and received specific information concerning the method, which included an emphasis on the importance of offering iron-rich foods; the other (control) group spoon-fed their infants and received only standard care, with no extra information regarding iron.

    While it is indeed possible that iron levels in the BLW/BLISS group would have been lower, had the parents not been given additional dietary information – as implied by the authors’ cautious conclusion – it is equally possible that drawing their attention to the need for iron either had no effect, or had a negative impact that was offset by the infant being allowed to feed himself. Without a comparison between a self-feeding group and a spoon-feeding group, where both groups have the same information regarding iron, or between two BLW groups, only one of which is advise...

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  • Response to Peter Kemp

    Thank you for your letter and sharing the results of your work. We agree on the importance of accurate testing for Lyme disease. In our study, we required that participants have a positive IgG Western blot, a lab result only present at least six to eight weeks after infection, as we were interested in studying patients diagnosed in the later stages of disease. However, as we note in our paper, we recognize that this requirement excluded patients with false-negative laboratory results. Thank you for your comment.

  • Study population

    Could you clarify the study population? It is unclear to me whether people who completely stopped smoking during the study period were included in the study population. If, as appears the case, such potential subjects were excluded, this would result in a significant underestimate of the association between e-cigarette and NRT use and average cigarette consumption.