810 e-Letters

  • A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to canc

    Dear Dr. Lu,
    Dear Professor Yang,

    many thanks for this very important remark. Indeed, element #6 in the Appendix table 1: " Search strategy for high-impact journals SRs"" should correctly read: "#6 Search (#4 or #5) Filters: Publication date from 2011/01/01 to 2016/05/31”.

    Best regards,

    Marius Goldkuhle

  • A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer

    Dear Authors,
    Recently, the work “A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer” [1] was published in BMJ Open, it compared cancer-related systematic reviews published in the Cochrane Database of SRs (CDSR) and high-impact journals, we enjoyed it with interest. But we found there was a mistake about #6 in the Appendix table 1: Search strategy for high-impact journals SRs. we cannot find the #7, but it emerged. In our opinion, it should be “#6 Search (#4 or #5) Filters: Publication date from 2011/01/01 to 2016/05/31”. Although this mistake is minor, but it may affect the paper quality and other researchers in the same research field.
    [1] Goldkuhle M, Narayan V M, Weigl A, et al. A systematic assessment of Cochrane reviews and systematic reviews published in high-impact medical journals related to cancer[J]. Bmj Open, 2018, 8(3):e020869.

  • Report of VIRAS Survey on Lyme Disease Testing Delay

    In the UK and other countries, a major obstacle to the treatment of Lyme Borreliosis is the requirement for positive serology tests. This requirement was incorporated in the recent NICE Guidelines for Lyme Disease (National Institute for Clinical and Care Excellence, NG95 for England and Wales: https://www.nice.org.uk/guidance/ng95).

    Although the authors of the guideline claim otherwise, the only concessions which the guideline makes to doctors who wish to treat without positive serology in the absence of a physician diagnosed Erythema Migrans rash, is that they may 'start treatment' whilst awaiting lab results, based on a "high clinical suspicion" - although what form this might take they omit to explain. Neither do they explain what to do when the awaited lab results come back.

    Therefore, with up to 75% of cases requiring positive serology to support a diagnosis and treatment, test accuracy is a critical factor in determining who gets treated and who does not, for a potentially injurious infection which all authorities agree, requires prompt diagnosis and treatment.

    In January 2018, VIRAS conducted a survey to investigate the reasons and extent of delays before people are tested for Lyme disease. The survey was publicised in Facebook support and campaign groups for Lyme patients and collected 330 responses.

    Key points from the survey:

    • 78% of respondents indicate...

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  • Applications in medical training

    I read the paper by Kaimal, Walker, Herres, et al. on the use of art psychotherapy in the management of PTSD in war veterans with interest. I am an Australian emergency physician and retrievalist who ‘retired’ into palliative care practice. I have a longstanding role in the support of junior medical staff, and a more recent informal role in mentoring junior consultant colleagues. The increased risks of developing PTSD in both junior doctors and critical care medical staff is well-recognised but there is still debate in relation to effective prevention and treatment strategies in these cohorts. Recent reports in the general media indicate that some Trusts are beginning to use art therapy to support medical staff (https://www.citymatters.london/art-therapy-st-barts-doctors/) and prevent burn-out and PTSD.

    Over the last 12 months, I completed 180 hours of training in art psychotherapy. Part of this process involved engaging in art psychotherapy myself as ‘the patient’. The branch of art psychotherapy in which I was trained stems from the work conducted by Susan Bach from the 1950s through until her death in the mid-1990s, and uses the creation of an image, clay model or mask as the vehicle to explore non-verbal or suppressed meaning, through interpretation of image structure, colour and composition. As shown by the images of masks in this paper, the process is not one of ‘soothing creativity’,...

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  • Author response to Dr. Wada and Dr. Kataoka

    We thank Dr. Wada and Dr. Kataoka for showing interest in our validation study. Dr. Wada and his colleague raised two important questions: 1) how was the pathologic diagnosis established in our study; and 2) the effect of selection bias (e.g. non-surgically diagnosed patients).
    First, in our study, all pathologic diagnoses were determined by the attending pathologists according to the 2011 lung adenocarcinoma classification described by the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society.1 In our institution, 10% buffered formalin was infused to inflate and fix all surgical specimens containing subsolid nodules (SSNs) via the transpleural and transbronchial approach to precisely measure the invasive adenocarcinoma component.2 Furthermore, pathologic examination was performed independently as a part of routine clinical practice. Thus, pathologic diagnosis was not affected by the predictor variables we collected and vice versa.
    Second, we admit that exclusion of the non-surgically diagnosed patients might have caused selection bias in our study. The current study population comprised solely surgically resected lung nodules. However, this was inevitable given the indolent nature of SSNs and the unique characteristics of SSNs’ definitive diagnosis. SSNs grow slowly and even the SSNs with invasive adenocarcinoma components may remain unchanged over years of CT surveillance. Thus, definitive diagnosis of S...

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  • President & Medical Director - Golden State MD Health & Wellness A Professional Corporation

    As an African American female physician and practice owner with a 37 year professional history I fully concur with the findings of this article. I have commented on other writings on Doximity around the issues of professional attire and efforts to restrict wearing white coats. As a practice owner with locations in San Francisco and Sacramento I travel weekly by Amtrak and this experiences reinforces my opinion that professional attire for a physician can improve patient and public interactions. In the course of my career I have experienced numerous incidents in which I was demeaned, harassed or disrespected as a physician because of my race and gender in areas dominated traditionally by white males. I have authored numerous writings about my experience as the first African American female to train in neurological surgery in the University of California system and my experiences as a flight physician and post doctoral fellow for Stanford Life Flight. I have been mistaken for a custodian, a "girl" and on a good day a pediatrician in my years of training. My white coat and my professional attire make all the difference in the world in how patients relate to me. When I appear without it I am called Miss or Ms. When I have it on I am called Doctor.I will never give up wearing my white coat!

  • Comment on, “Validation of prediction models for risk stratification of incidentally detected pulmonary subsolid nodules: a retrospective cohort study in a Korean tertiary medical center”

    To the Editor:
    We read the recent articles from Kim et al. with great interest and appreciate the authors’ efforts to evaluate the suitability of the two models regarding the prediction of incidentally-detected pulmonary subsolid nodules (SSNs), as well as their reports that there were substantial differences. However, we would like to highlight two concerns that we have regarding their study.

    First, there is a lack of description regarding whether an adequate pathological diagnosis was performed. We would like to know who performed the diagnosis and how it was made. In predictive model research, it is preferable that outcomes are evaluated with masked predictors, as there might be bias in estimating associations between predictors and outcomes. [1]

    Secondly, there might have been a sampling bias before surgery selection. Among patients with SSNs, surgery might be preferentially performed, especially for patients who show a high possibility of lung cancer. Further, additional upper lobes and peripheral nodules, which were difficult to diagnose by bronchoscopy examination, might be selected and resected. Thus, cases of atypical adenomatous hyperplasia (AAH)/ adenocarcinoma in situ (AIS) might comprise a smaller portion of the study cohort, and minimally invasive adenocarcinoma (MIA)/ invasive pulmonary adenocarcinoma (IPA) might be diagnosed more frequently. Clinically, we often struggle to decide whether the nodule is malignant in a case where surgery c...

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  • Error in reference of Calgary Models

    Please note, due to a production error, reference 40 appears incorrectly in the manuscript. It should read:

    Wright, L.M, & Leahey, M. Nurses and Families: A guide to family assessment and intervention. 6th ed. Philadelphia: FA Davis, 2013.

  • Patient Adherence to Self Care Tasks for Chronic Heart Failure

    The statement that our cited study [40] demonstrated an issue of declined patient adherence over time is not entirely accurate. By contrast, our HeartCycle study demonstrated excellent adherence to performing daily tasks of weighing and measuring blood pressure, 90% of the patients were still adherent to these tasks at 6 months and adherence remained stable over time. We recognise however patients were less compliant with completing daily symptom questionnaires long term. There is a behavioural dichotomy therefore between carrying out a daily monitoring task (such as stepping on a weighing scale) and reporting symptoms via questionnaire. Arguably patients perceived the importance of daily weighing, and blood pressure monitoring to be greater than the daily reporting of symptoms such as breathlessness, that they may or may not be experiencing. We look forward to learning of the outcomes of the ITEC-CHF trial.

    [40]. Stut W, Deighan C, Cleland JG, et al. Patient adherence to self-care behaviour in the HeartCycle study. Patient Prefer Adherence 2015;9: 1195-206.

  • Urban-rural differences in factors associated with willingness to receive eldercare among the elderly: a cross-sectional survey in China

    Dear Authors,

    Recently, the work “Urban-rural differences in factors associated with willingness to receive eldercare among the elderly: a cross-sectional survey in China”[1] was published in BMJ Open, it discussed the influencing factors of the eldercare model, and I had the pleasure to enjoy it. But I have a question that in the ninth paragraph in introduction section: “Many other recent studies have examined differences in willingness to receive eldercare between urban and rural areas.” But, there is not a reference, indicating the “many”? Biomedical research waste [2,3] is heatedly discussed recently, and “Towards evidence based research” [4] was published in BMJ and it pointed out that all new research should be based on existing evidence. So, should there be a relevant reference?

    1. Xing YN, Pei RJ, Qu J, et al. Urban-rural differences in factors associated with willingness to receive eldercare among the elderly: a cross-sectional survey in China[J]. BMJ Open 2018;8:e020225.
    2. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence[J]. Lancet, 2009, 374(9692):86-89.
    3. Moher D, Glasziou P, Chalmers I, et al. Increasing value and reducing waste in biomedical research: who's listening?[J]. Lancet, 2015, 387(10027):1573-1586.
    4. Lund H, Brunnhuber K, Juhl C, et al. Towards evidence based research[J]. Bmj, 2016, 355(1):i5440.