Dear Sir,
We read the article titled "Treatment delay affects clinical severity of
tuberculosis: a longitudinal cohort study" published in BMJ open. The
article was interesting as tuberculosis (TB) treatment delay is one of the
important issues in timely case detection and management of TB in
developing countries. The article was well written. However we have few
comments to share which will further facilitate the under...
Dear Sir,
We read the article titled "Treatment delay affects clinical severity of
tuberculosis: a longitudinal cohort study" published in BMJ open. The
article was interesting as tuberculosis (TB) treatment delay is one of the
important issues in timely case detection and management of TB in
developing countries. The article was well written. However we have few
comments to share which will further facilitate the understanding of the
results.
We noticed inconsistency in the information provided in abstract and
main article. In abstract it was mentioned that patients were included 'at
the time of diagnosis' vs 'at the start of treatment in TB treatment
facilities' in the methodology section of the main article. Especially, in
countries like India, we expect some delay in initiation of treatment from
the time of diagnosis.(1) So the information on the stage at which the
patients were recruited into the study is very important. Moreover the
definition of time delay as per the article is "from start of symptom to
initiation of specific anti-TB treatment". Hence the recruitment at time
of diagnosis of TB is not valid, unless the program in Guinea-Bissau is
such that the treatment is started for the TB patient on the same day of
diagnosis. If recruitment was done at TB treatment facilities, whether all
TB treatment facilities in Bissau were considered for study or any
sampling of facilities was done? Time of registration for the study and
place of recruitment will affect the treatment delay and hence internal
validity and generalizability of study results.
The study says all cohorts will be followed for two years duration
for assessment of mortality outcome; in that case data of patient
recruited on 4th June 2010 has to be followed till 4th June 2012. But it
is mentioned data was analyzed during June 2010. It could have been better
if authors have stated that any censoring for the above time period and
the proportion of study population censored. It may be such that data
pertaining to objectives- factors affecting treatment delay and effect of
treatment delay on clinical severity at diagnosis may have been analyzed
during June 2010, but the way it is mentioned in the article is
misleading.
Also in cohort study it is essential to comment on "lost to follow
up" during course of study. In smear negative patients, the lost to follow
up at 12 months (6 months after completion of treatment) was mentioned as
31.4%. Therefore we can expect more percentage of loss to follow up by end
of 24 months. Similarly the information on lost to follow up among smear
positive patients was not mentioned though they were the majority in the
study population. The author had mentioned all-cause mortality only among
smear negative patients that too over 12 months. It would have been better
if the total number of tuberculosis patients died over 24 months was also
mentioned in the article, as mortality is one of the outcome measures.
. In the methodology section authors have stated that they have used
multiple linear regression model to adjust for multiple risk factors in
the treatment delay analysis. It is expected that the outcome variable
for multiple linear regression should be a continuous variable (i.e.
number of days of delay) and the association in linear regression is
expressed in terms of Beta co-efficient. But in table 2 the strength of
association was expressed in terms of relative risk showing risk factors
related to delay in treatment, which cannot be obtained from multiple
linear regression. In case if the association has to be interpreted in
terms of Odds ratio or relative risk, the outcome has to be binary (either
treatment was delayed or not delayed). There are studies where they have
quoted predictor value of factors in terms of either Beta coefficient (2)
or in terms of odds ratio after mentioning cut off for considering patient
was delayed or not in his treatment (3-5). If the outcome was considered
binary and relative risk was obtained using logistic or cox regression,
then there should be some cut-off to define whether patient delayed his
treatment or not ( Ex. Patients with more than 30 days delay are
considered to be delayed in treatment or median cut off).(3-5)
The study interpreted the smear negative TB as the risk factor for
treatment delay. But as per WHO clinical criteria at least two weeks of
follow up with antibiotics was recommended before considering a patient
for anti- TB specific treatment. So the observed difference of 2-3 weeks
in this could be due to the WHO clinical criteria for diagnosing the case
and not necessarily a risk factor for treatment delay.
References
1. Sai Babu B, Satyanarayana AVV, Venkateshwaralu G, Ramakrishna U,
Vikram P, Sahu S, et al. Initial default among diagnosed sputum smear-
positive pulmonary tuberculosis patients in Andhra Pradesh, India. Int J
Tuberc Lung Dis Off J Int Union Tuberc Lung Dis 2008;12(9):1055-8.
2. Ukwaja KN, Alobu I, Nweke CO, Onyenwe EC. Healthcare-seeking
behavior, treatment delays and its determinants among pulmonary
tuberculosis patients in rural Nigeria: a cross-sectional study. BMC
Health Serv Res 2013;13:25.
3. Ngadaya ES, Mfinanga GS, Wandwalo ER, Morkve O. Delay in
Tuberculosis case detection in Pwani region, Tanzania. a cross sectional
study. BMC Health Serv Res 2009;9:196.
4. Yimer S, Bjune G, Alene G. Diagnostic and treatment delay among
pulmonary tuberculosis patients in Ethiopia: a cross sectional study. BMC
Infect Dis 2005;5:112.
5. Needham DM, Foster SD, Tomlinson G, Godfrey-Faussett P. Socio-
economic, gender and health services factors affecting diagnostic delay
for tuberculosis patients in urban Zambia. Trop Med Int Health
2001;6(4):256-9.
The findings of Stranges, et al (2014) that fruit and vegetable
consumption was associated with mental well-being brought to mind some
other findings (1). There could be numerous mechanisms to explain these
results; however, a few jump readily to mind.
It has been asserted that oxidative stress may play a role in anxiety
(2). A diet containing ample amounts of fruits and vegetables, which are
rich in antioxidant...
The findings of Stranges, et al (2014) that fruit and vegetable
consumption was associated with mental well-being brought to mind some
other findings (1). There could be numerous mechanisms to explain these
results; however, a few jump readily to mind.
It has been asserted that oxidative stress may play a role in anxiety
(2). A diet containing ample amounts of fruits and vegetables, which are
rich in antioxidant and anti-inflammatory agents, might promote brain-
health in part by reducing oxidative stress (3).
There is growing evidence that the gastrointestinal microbiota
influence brain function (4). This might be by multiple mechanisms. One
intriguing possibility is that the gut ecosystem might influence the human
epigenome including that of the brain (5). It should be noted that the
epigenome retains some malleability throughout the lifespan and that the
epigenome appears to influence brain function (6, 7). Whole plant foods,
including fruits and vegetables, are believed to promote a health gut
ecosystem (8). In addition, phytochemicals found in fruits and vegetables
also affect the epigenome and might plausibly shape mood by modulating
gene expression (9, 10).
About the author: www.CeliaMRoss.com
1. Stranges S, Samaraweera PC, Taggart F, Kandala NB, Stewart-Brown
S. Major health-related behaviours and mental well-being in the general
population: the Health Survey for England. BMJ Open. 2014 Sep
19;4(9):e005878.
2. Bouayed J, Rammal H, Soulimani R. Oxidative stress and anxiety:
relationship and cellular pathways. Oxid Med Cell Longev. 2009 Apr-
Jun;2(2):63-7.
3. Lau FC, Shukitt-Hale B, Joseph JA. Nutritional intervention in brain
aging: reducing the effects of inflammation and oxidative stress. Subcell
Biochem. 42:299-318.
4. Tillisch K. The effects of gut microbiota on CNS function in humans.
Gut Microbes. 2014 May 16;5(3).
5. Stilling RM, Dinan TG, Cryan JF. Microbial genes, brain & behaviour
- epigenetic regulation of the gut-brain axis. Genes Brain Behav. 2014
Jan;13(1):69-86.
6. Fraga MF, et al. Epigenetic differences arise during the lifetime of
monozygotic twins. Proceeding of the National Academy of Science U S A.
2005 Jul 26;102(30):10604-9.
7. D'Addario C, et al. Selective DNA methylation of BDNF promoter in
bipolar disorder: differences among patients with BDI and BDII.
Neuropsychopharmacology. 2012 Jun;37(7):1647-55.
8. Tuohy KM, Contemo L, Gasperotti M, Viola R. Up-regulating the human
intestinal microbiome using whole plant foods, polyphenols, and/or fiber.
J Agric Food Chem. 2012 Sep 12;60(36):8776-82.
9. Blade C, Baselga-Escudero L, Arola-Amal A MicroRNAs as New Targets of
Dietary Polyphenols. Curr Pharm Biotechnol. 2014 Jul 11. [Epub ahead of
print]
10. Pan MH, Lai CS, Wu JC, Ho CT. Epigenetic and disease targets by
polyphenols. Curr Pharm Des. 2013;19(34):6156-85.
Thanks to Ole Olsen for calling attention to a possible inconsistency
between the data included in our paper and official stillbirth statistics.
We always make our own data retrieval from the raw data in the
National registries, including the birth registry rather than relying on
the official statistics.
First the official statistics often and also in this case are
inconsistent. According to the offic...
Thanks to Ole Olsen for calling attention to a possible inconsistency
between the data included in our paper and official stillbirth statistics.
We always make our own data retrieval from the raw data in the
National registries, including the birth registry rather than relying on
the official statistics.
First the official statistics often and also in this case are
inconsistent. According to the official publication from National Health
Board covering the years 2009-2011 the number of stillbirths in 2010 and
2011 were 255 and 246 respectively (1) whereas according to the official
2013 publication by Statens Serum Institute, the numbers were 270 and 274
in the same two years(2), and finally Statistics of Denmark reports 269
and 262 respectively (3). So what Ole Olsen considers as the truth
actually differs between different official bodies.
Secondly, for scientific purposes it is mandatory to know exactly
which conditions are applied for your data, which data sources you get
your information from, restriction periods for repeated non fatal events
etc.
Our focus was on stillbirths from 37 weeks. Some differences between
dataset may arise from different basic requirements to the dataset. E.g.
we only included women delivering in Denmark with a Danish PIN-code. Thus
women in transit from other countries, but delivering in Denmark, are not
included in our data. Such conditions may explain small differences in
different dataset.
But according to the latest official stillbirth data including the online
statistics which Ole Olsen refer to, the number of stillbirths from 37
weeks was in 2009-2010 247 and in 2011-2012 152, a decrease of 95 (2).
According to our data the number of stillbirths from 37 weeks fell from
198 to 148 or with 50 events from 2009-2010 to 2011-2012. In other words,
the official statistics suggest a fall which is almost twice the fall we
suggested. So if anything, our data were more conservative than the
official statistics.
The reason of focusing on stillbirths from 37 weeks is that a change
in induction practice around and after term is not expected to influence
stillbirths before 37 weeks. Contrary, inclusion of stillbirths before 37
weeks may actually hide the impressing and welcome decrease in stillbirths
from 37 weeks in Denmark through recent years.
We have delivered detailed figures on our data and the conditions and
anticipations we made. We still think we have valid data, which except for
year 2010 are actually very close to the latest official statistics (2).
We have checked data for year 2010, and still find the results that we
published.
Thus, we see no reason to doubt our results and even less to withdraw
our publication.
Grigg and colleagues have published their design for the first-ever
randomised controlled in Plasmodium knowlesi malaria, to be carried out
over a 2-year period in Sabah [1]. We are concerned because one arm of
the trial involves a fixed combination of mefloquine + artesunate.
The authors of the study protocol rightly acknowledge that mefloquine
is associated with neuropsychiatric adverse events (AEs), but go on...
Grigg and colleagues have published their design for the first-ever
randomised controlled in Plasmodium knowlesi malaria, to be carried out
over a 2-year period in Sabah [1]. We are concerned because one arm of
the trial involves a fixed combination of mefloquine + artesunate.
The authors of the study protocol rightly acknowledge that mefloquine
is associated with neuropsychiatric adverse events (AEs), but go on to
state that these are 'self-limiting'. This claim by Grigg et al is
incompatible with published reports of neuropsychiatric AEs from
mefloquine that have persisted for months, or years [2] [3] [4]. Last
year the US Food and Drug Administration strengthened its warning on the
neurological and psychiatric adverse effects of mefloquine to its highest
level (i.e. a 'black box' warning); the change was prompted by the
recognition that the adverse effects of mefloquine can be prolonged and
even, in some patients, permanent [5].
We recommend that the protocol for this trial should include details
of how possible adverse effects of mefloquine will be looked for at and
after the end of the study, and how the authors propose to manage
neuropsychiatric or other AEs that prove to be prolonged, or permanent.
Andrew Herxheimer
Ashley Croft
UK Cochrane Centre, Summertown Pavilion, 18-24 Middle Way, Oxford OX2
7LG, UK
The correct affiliation for Andrew Hayen is: School of Public Health
and Community Medicine, The University of New South Wales, Sydney, New
South Wales, Australia
The 28th reference cited in this article should be corrected as:
28. Xie Y, Ho SC. Prenotification had no additional effect on the
response rate and survey quality: a randomized trial. J Clin Epidemiol
2013;66:1422-6.
"The registry is considered complete through the period" Hedegaard et
al state in their registry study (1) without a supporting reference.
However, there seem to be an issue with the quality of the data as the
number of stillbirths deviate from the published official statistics. The
authors in their online supplement report 539 stillbirths in 2009-10
decreasing to 489 in 2011-12. But according to the published official
s...
"The registry is considered complete through the period" Hedegaard et
al state in their registry study (1) without a supporting reference.
However, there seem to be an issue with the quality of the data as the
number of stillbirths deviate from the published official statistics. The
authors in their online supplement report 539 stillbirths in 2009-10
decreasing to 489 in 2011-12. But according to the published official
statistics the number of stillbirths were 260+255=515 in 2009-10 (2)
decreasing to 274+236=510 in 2011-12 (3). Thus the seemingly dramatic
decrease between the two time periods is reduced from 50 (=539-489) in the
paper to 5 (=515-510) according to the official statistics. Even though we
all hope for miracles, all too often they evaporate into thin air on
closer inspection. I cannot see any other solutions to this conundrum than
either the authors thoroughly document the validity of their data or they
retract their paper.
1) Hedegaard M, Lidegaard O, Skovlund CW, Morch LS, Hedegaard M.
Reduction in stillbirths at term after new birth induction paradigm:
results of a national intervention. BMJ Open. 2014 Aug 14;4(8)
3) Statens Serum Institut. Fodselsstatistikken - tal og analyser,
2012. Available at http://www.ssi.dk/~/media/Indhold/DK%20-
%20dansk/Sundhedsdata%20og%20it/NSF/Registre/Fodselsregisteret/f%C3%B8dselsstatistikken2012_vers%204.ashx.
Accessed September 8th.
Author have come out with an interesting concept of using smart phone
app in medical research. Smart phones are rapidly becoming omnipresent
with greater processing power and memory and now are commonly used as
first device to access information from or off internet. Thousands of
medical apps are available for layman to get information regarding
diseases. Also, several apps are available to physicians to quickly asses
in...
Author have come out with an interesting concept of using smart phone
app in medical research. Smart phones are rapidly becoming omnipresent
with greater processing power and memory and now are commonly used as
first device to access information from or off internet. Thousands of
medical apps are available for layman to get information regarding
diseases. Also, several apps are available to physicians to quickly asses
information from guidelines, algorithms and medical formulas making pocket
books redundant. Increasingly new app are being developed to provide
diagnostics at nominal cost.
I think this is the first serious attempt to use phone app in medical
research, Authors have meticulously prepared protocol and though some
provision like locking the device to one particular group may have got
frown from some ethical committee members but I think that was essential
to have valid randomization.
In my personal view this is well planned study on a very important
socio-medical problem. I shall be very eagerly waiting for the study
results and how this concept per se is taken by medical fraternity.
I read with interest the recent contribution from Baars and Kooreman [1]. The present study is a replication of a previous study, using a different data set, as described by the authors in their introduction. The 2012 study by Kooreman and Baars [2] garnered criticism from me and others [3-5]. Furthermore, the new study was also presented in an earlier form [6], and this also faced criticism [7,8]. Baars and Kooreman provid...
I read with interest the recent contribution from Baars and Kooreman [1]. The present study is a replication of a previous study, using a different data set, as described by the authors in their introduction. The 2012 study by Kooreman and Baars [2] garnered criticism from me and others [3-5]. Furthermore, the new study was also presented in an earlier form [6], and this also faced criticism [7,8]. Baars and Kooreman provided response to both of these at the time [9,10].
The authors have heeded some, if not all, of the criticisms directed at their previous work. In particular, the authors' reporting of their results is somewhat more measured and the limitations of the analysis are more thoroughly presented. It is likely that selection into the two groups at least partially (perhaps fully) explains the observed differences in costs, and the authors are right to identify this as a limitation. The new analysis of mortality data is a welcome improvement.
In addition to the limitations already outlined by critics of the previous publication - and by the authors themselves - it is unfortunate that the new analysis did not account for the hierarchical structure of the data, with patients clustered by GP practice. It appears that the authors were able to identify this source of clustering in their data, so it is disappointing that a multilevel model was not used to account for this potential source of bias (which might also explain part of the observed difference). It is also regrettable that the results of the log-linear regression of costs appear to have been misreported in Table 4 (Appendix 2).
Baars and Kooreman's statement that they intend to carry out further analyses on this or similar data with more appropriate estimation strategies is encouraging. Such analyses are crucial due to the limitations of this study. The implementation of better estimation strategies, such as propensity score matching or (as the authors suggest) use of instrumental variables, will be an important part of this. I look forward to reading these potentially enlightening studies once completed.
References
[1] Baars EW, Kooreman P. A 6-year comparative economic evaluation of healthcare costs and mortality rates of Dutch patients from conventional and CAM GPs. BMJ Open 2014;4:e005332. doi: 10.1136/bmjopen-2014-005332
[2] Kooreman P, Baars EW Patients whose GP knows complementary medicine tend to have lower costs and live longer. European Journal of Health Economics 2012;13(6):769-76. doi: 10.1007/s10198-011-0330-2
[3] Sampson CJ, Whitehurst DGT, Street A. Do patients registered with CAM-trained GPs really use fewer health care resources and live longer? A response to Kooreman and Baars. Eur J Health Econ (2012). 13:769-776. European Journal of Health Economics 2013;14(4):703-5. doi: 10.1007/s10198-013-0466-3
[9] Kooreman P, Baars EW. Do patients registered with CAM-trained GPs really use fewer health care resources and live longer? A reply to Christopher James Sampson. European Journal of Health Economics 2013;14(4):707-8. doi: 10.1007/s10198-013-0475-2
[10] Kooreman P, Baars EW. Reactie op: Complementair werkende huisartsen en de kosten van zorg (Naschrift). Economisch Statistische Berichten 2014;99(4679):125.
This is a very interesting research proposal to evaluate a formula
originated from Chinese traditional medicine, Gan Mai Da Zao (GMDZ)
decoction. The protocol for a systematic review is generally well written;
however, there are several points that need to be addressed from the
standpoint of Japanese traditional Kampo medicine, which incorporated the
Gan Mai Da Zao decoction as kambakutaisoto.
This is a very interesting research proposal to evaluate a formula
originated from Chinese traditional medicine, Gan Mai Da Zao (GMDZ)
decoction. The protocol for a systematic review is generally well written;
however, there are several points that need to be addressed from the
standpoint of Japanese traditional Kampo medicine, which incorporated the
Gan Mai Da Zao decoction as kambakutaisoto.
Kampo medicine originated from ancient Chinese traditional medicine,
but developed distinctively [1]. Kampo medicine was the orthodox medicine
in Japan until the 19th century when modern Western medicine took over.
Nevertheless, some Kampo formulae are still officially registered in the
Japanese Pharmacopoeia [2]. Since 1967, Kampo formulae have been covered
by National Health Insurance, and currently 148 Kampo formulae are
approved for ethical use [3]. Although Kampo extracts are crude drugs
derived from plants, animals, and minerals, their quality is strictly
controlled in accordance with the Japanese Pharmacopoeia by quantitative
analysis of marker components using high-performance liquid
chromatography.
Unlike China and Korea, traditional medicine in Japan is used in a
Western-style medical system, and is prescribed by medical doctors,
educated in Western medicine [3], who are required to have a basic
knowledge of Kampo formulae. Reflecting the needs for establishing
evidence-based medicine in Kampo, the Japan Society for Oriental Medicine
has run a project from 2001 to gather comprehensive data on the randomized
controlled trials (RCTs) of Kampo formulae in Japan, and to compile
structured abstracts with critical appraisal. This report is published
annually as Evidence Reports of Kampo Treatment (EKAT) in Japanese and
English.[4] In the current version EKAT 2013, 402 RCTs of Kampo formulae
are included.
The first point to be addressed is that the systematic review
protocol developed by Dr. Jun et al. lacks searches of articles written in
Japanese; thus, it may result in a biased review. The authors are
encouraged to search in Japanese database, Ichushi [5], although no RCTs
of kambakutaisoto (Japanese name for GMDZ decoction) seem to be reported
in EKAT 2013. Secondary, the authors mention that they include forms of
GMDZ such as extracts, tablets, capsules, pills, powders or injections.
However, unlike Japanese Kampo extracts, the quality and ingredients of
the formulae such as tablets, capsules, or crude powders are not strictly
controlled, especially in the older articles, which may result in a bias.
Thirdly, although the authors are planning to search the Kampo formula by
kambakutaisoto or kam baku tai soto, older articles seem to use the word
kanbaku-taiso-to to express the formula, and this word should be included
in the search. The structured notation of kambakutaisoto is not quite
correct; it should be Kambaku-taiso-To.
1. Matsumoto M, Inoue K, Kajii E. Integrating traditional medicine in
Japan: the case of Kampo medicines. Complement Ther Med 1999;7(4):254-5
2. Kawashima N, Deveaux TE, Yoshida N, et al. Choreito, a formula from
Japanese traditional medicine (Kampo medicine), for massive hemorrhagic
cystitis and clot retention in a pediatric patient with refractory acute
lymphoblastic leukemia. Phytomedicine 2012;19(12):1143-6.
3. Motoo Y, Arai I, Tsutani K. Use of Kampo diagnosis in randomized
controlled trials of kampo products in Japan: a systematic review. PLoS
One 2014;9(8):e104422.
4. Task Force for Evidence Reports/Clinical Practice Guidelines (ER/CPG-
TF) Special Committee for Evidence-based Medicine (EBM), The Japan Society
for Oriental Medicine (JSOM). Evidence Reports of Kampo Treatment (EKAT)
Appendix 2012. Retrieved September 4, 2014, from
http://www.jsom.or.jp/medical/ebm/ere/pdf/EKATE_Appendix_2012.pdf.
5. Tomizawa Y. Ichushi, Japanese medical bibliography. Kyobu Geka
2010;63(7):585-9, in Japanese
Dear Sir, We read the article titled "Treatment delay affects clinical severity of tuberculosis: a longitudinal cohort study" published in BMJ open. The article was interesting as tuberculosis (TB) treatment delay is one of the important issues in timely case detection and management of TB in developing countries. The article was well written. However we have few comments to share which will further facilitate the under...
The findings of Stranges, et al (2014) that fruit and vegetable consumption was associated with mental well-being brought to mind some other findings (1). There could be numerous mechanisms to explain these results; however, a few jump readily to mind.
It has been asserted that oxidative stress may play a role in anxiety (2). A diet containing ample amounts of fruits and vegetables, which are rich in antioxidant...
Thanks to Ole Olsen for calling attention to a possible inconsistency between the data included in our paper and official stillbirth statistics.
We always make our own data retrieval from the raw data in the National registries, including the birth registry rather than relying on the official statistics.
First the official statistics often and also in this case are inconsistent. According to the offic...
Grigg and colleagues have published their design for the first-ever randomised controlled in Plasmodium knowlesi malaria, to be carried out over a 2-year period in Sabah [1]. We are concerned because one arm of the trial involves a fixed combination of mefloquine + artesunate.
The authors of the study protocol rightly acknowledge that mefloquine is associated with neuropsychiatric adverse events (AEs), but go on...
The correct affiliation for Andrew Hayen is: School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
Conflict of Interest:
None declared
The 28th reference cited in this article should be corrected as:
28. Xie Y, Ho SC. Prenotification had no additional effect on the response rate and survey quality: a randomized trial. J Clin Epidemiol 2013;66:1422-6.
Conflict of Interest:
None declared
"The registry is considered complete through the period" Hedegaard et al state in their registry study (1) without a supporting reference. However, there seem to be an issue with the quality of the data as the number of stillbirths deviate from the published official statistics. The authors in their online supplement report 539 stillbirths in 2009-10 decreasing to 489 in 2011-12. But according to the published official s...
Author have come out with an interesting concept of using smart phone app in medical research. Smart phones are rapidly becoming omnipresent with greater processing power and memory and now are commonly used as first device to access information from or off internet. Thousands of medical apps are available for layman to get information regarding diseases. Also, several apps are available to physicians to quickly asses in...
I read with interest the recent contribution from Baars and Kooreman [1]. The present study is a replication of a previous study, using a different data set, as described by the authors in their introduction. The 2012 study by Kooreman and Baars [2] garnered criticism from me and others [3-5]. Furthermore, the new study was also presented in an earlier form [6], and this also faced criticism [7,8]. Baars and Kooreman provid...
This is a very interesting research proposal to evaluate a formula originated from Chinese traditional medicine, Gan Mai Da Zao (GMDZ) decoction. The protocol for a systematic review is generally well written; however, there are several points that need to be addressed from the standpoint of Japanese traditional Kampo medicine, which incorporated the Gan Mai Da Zao decoction as kambakutaisoto.
Kampo medicine ori...
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