1142 e-Letters

  • Needed: guidance for reporting knowledge synthesis studies on measurement properties of outcome measurement instruments in health research

    To the editor:

    Lorente et al. identified significant heterogeneity in the tools, procedures, and definitions used by systematic reviewers to evaluate instrument measurement properties and highlighted key omissions in the reported methodological information in nearly 250 published systematic reviews on quality of life instruments.1 As we encounter with other health outcome measurement instruments used in child health and mental health research, poor compliance with methodological or reporting guidance in published reports impedes appraisal of the quality of the instruments’ measurement properties.2-6 This impairs knowledge users’ (such as policy-makers, other researchers, patients, healthcare providers) comprehensive appraisal of the sufficiency of the instruments that are used in studies or that are recommended to be used, as related to their key measurement properties and to issues of feasibility, burden, and fairness.

    The authors raised important points concerning the current shortcomings of systematic reviews conducted to assess measurement properties of instruments. Lorente et al. concluded that improved adherence to methodological and reporting guidelines for the conduct and dissemination of systematic reviews on measurement properties of instruments is urgently needed. They recommended the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist as the optimal framework to be used to conduct high-quality systemat...

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  • Resistance to evidence other than RCTs is fuelled by senior clinicans' financial self- interest

    There are no case reports anywhere in the world of patients receiving cannabis under medical supervision coming to any significant harm. There is no doubt that cannabis is safe as a medicine. Those opposed to it, usually with vested financial interests, are trying to undermine use of CBPMs with spurious claims of harms caused by smoking cannabis in its most potent form as a recreational drug.

    The senior clinicians responsible for drafting the guidelines, from the Royal Colleges and other professional bodies, are the same people who have failed to provide up-to-date medical education on the endocannabinoid system, through which cannabis exterts its therapeutic effects. These same people are also responsible for running and supervising the clinical trials that pharmaceutical companies use to prove the safety and efficacy of their new products. For this they receive very substantial fees and long-running sponsorship for their institutions. The conflict of interest is obvious, yet is being entirely overlooked.

    I fully support Prof Nutt's analysis but suggest that senior clinicians responsible for drafting guidelines do not wish to consider other forms of evidence as they are not in their financial self-interest.

    In summary there is no evdience of any harm in the medically supervised use of CBPMs and substantial evidence of great benefit. Failing to prescribe in such circumstances is unethical, irresponsible and may actually be 'doing harm...

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  • Media Usage and Sleep Patterns

    I found the results of this study very relatable and thought-provoking. Following and posting on social media is a major past time for many teenagers and young adults. The study found that those who spent the most time on their electronic devices, (five hours or more) also had much later bedtimes. Therefore, it is not surprising that the study links the amount of time spent on social media with poor sleeping patterns. The researchers pointed out as well that the use of social media is a reflection of our current culture and links it to negative effects and behaviors on today’s youth. It was found that very high social media users were more likely to have nightmares, feelings of depression, and anxiety. The researchers make suggestions for parents on how to manage the time that their children spend on media outlets, such as Facebook, Instagram, Snapchat, and Twitter. I thought the research was well balanced as it included a large number of participants aged 13-15 years from the U.K. I think this type of research is important to help parents evaluate how the use of social media is affecting their children’s lives. Adequate sleep is obviously necessary to be healthy, both physically and mentally. The study also links later sleep onset in students to poor academic performance and emotional fluctuations. The emphasis is placed on helping heavy social media users balance their online interactions appropriately. The research inspires parents to become more involved in monitoring...

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  • Epidemiology of lower limb extremity amputations – Do we already have the answer to why there is significant variation in the reporting of incidence, prevalence and number?

    Dear Editor,

    It is interesting to read that Meffen A, et al. (2020) will study the incidence, prevalence and number of major-lower limb amputations in the UK, amongst their objectives. They plan to investigate the reasons for significant variation in the reporting of epidemiology of major lower extremity amputation (LEA). Prevalence of LEA has been evaluated, on numerous occasions in many epidemiological studies (1-14).

    There has been a recent study that has followed similar methods and objectives to Meffen A, et al. (2020), to determine the methodological differences that create the variation of prevalence of LEAs (1). There are also studies that have used robust methodology to report on incidence, prevalence and number of LEAs, which include age standardised, gender, ethnic minority, and regional specific data analysis (6, 13, 14).

    The same systematic searches of peer reviewed journals using PRISMA guidelines, have already been carried out from a comprehensive range of databases: PubMed, Cumulative index to Nursing and Allied Health Literature (CINAHL), ExperptaMedica Database (EMBASE), Medical Literature Analysis and Retrieval Online (MEDLINE), Cochrane database, NHS Digital, Diabetes UK and Healthcare Quality Improvement Partnership (HQIP), of all LEA studies performed in England, over a 30 year period (1988- 2018) (1).

    The variation in prevalence of major LEAs, reported by Davies M, Burdett L, Bowling F, et al. (2019) range from 0.7...

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  • One pharmacist’s perspective on “ Changes over a decade in psychotropic prescribing for people with intellectual disabilities: prospective cohort study”.

    Inequalities and inequities in health and healthcare for people with intellectual disabilities have been of longstanding concern. Medication use is the major therapeutic intervention in this vulnerable population. The use of medication cannot be separated from the environment –physical and social – in which the person with intellectual disabilities lives and is supported.

    There is no ‘one size fits all’ regarding psychotropic medication use in this population group. Those providing direct care are the most important person in the life of an individual with intellectual disabilities and may have a direct influence on medication prescribed or de-prescribed, for problem behaviours etc.

    The social environment, the physical environment and societal preconditions, and their interconnectivity with one another and with individuals in the setting, play an important role in healthy settings for people with intellectual disabilities[1] . Physical, mental, psychological and spiritual well being may all be influenced by the environment. A recent study highlights a health-promoting social network of people with ID as a prerequisite for change [1].

    Pharmacists, as medication experts, in all healthcare environments can make positive contributions to the pharmaceutical care of patients with intellectual disabilities, in collaboration with other healthcare professionals, carers and patients themselves [2,3]. The expertise of specialist and other pharmacists i...

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  • Shift work and burnout in police officers: a risk assessment

    Dear Dr. Kawada,

    Thanks for your comment on our article, Shift work and burnout in police officers: a risk assessment. We appreciate that the risk of burnout may be multi-factorial and the relative contribution of each factor may vary by occupation. We did not examine work-related stress and conflict but appreciate that such factors may contribute to burnout risk in police officers. We maintain, however, our findings that sleepiness, inadequate sleep, irregular schedules, mandatory overtime, long shifts and night shifts are factors associated with elevated burnout risk in this population. We also controlled for age in our analyses and found that age was significant in the adjusted models examining shift work, sleep and their association with Depersonalisation and Personal Accomplishment. We agree that more research into the factors contributing to burnout and programs to mitigate it in safety-sensitive shift working occupations is necessary.

    Scott A Peterson, Alexander P Wolkow, Steven W Lockley, Conor S O'Brien, Salim Qadri, Jason P Sullivan, Charles A Czeisler, Shantha M W Rajaratnam and Laura K Barger

  • Shift work and burnout in police officers: a risk assessment

    Peterson et al. examined associations between shift work and burnout in 3140 police officers with special reference to sleep duration and sleepiness. The Maslach Burnout Inventory, shift schedules (irregular, rotating, fixed), shift characteristics (night, duration, frequency, work hours), sleep duration and sleepiness were used for the analysis. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of long shifts and mandatory overtime for emotional exhaustion were 1.91 (1.35 to 2.72) and 1.37 (1.14 to 1.65), respectively. Adjusted OR (95% CI) of night shifts for depersonalisation was 1.32 (1.05 to 1.66). In addition, Adjusted ORs (95% Cis) of irregular schedules for emotional exhaustion and depersonalisation were 1.91 (1.44 to 2.54) and 1.39 (1.02 to 1.89), respectively. Furthermore, adjusted ORs (95% Cis) of sleeping <6 hours and excessive sleepiness for motional exhaustion were 1.60 (1.33 to 1.93) and 1.81 (1.50 to 2.18), respectively. I have a comment about their study.

    Ogundipe et al. determined factors burnout among 204 medical doctors undergoing residency training. General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI) were used for the analysis. Adjusted OR (95% CI) of call duty as being not stressful for emotional exhaustion was 0.52 (0.29, 0.97). In contrast, adjusted OR (95% CI) of emotional distress, based on GHQ score of ≥3, for emotional exhaustion was 6.97 (3.28, 14.81). In addition, adjusted OR (95% CI) of absence of doc...

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  • Nearness to death and sarcopenia

    Hopefully this will become an invaluable study. Can I alert the authors to the role of nearness to death (the nearness to death effect) in both cognitive and functional decline especially in the last year of life.

  • Multimobidity or Comorbidity?

    In the references you cite, the definition of multimorbidity is showed as the co-existence of two or more chronic conditions, where one is not necessarily more central than the others. But you have defined multi-morbidity comorbidity as the presence of two or more chronic health conditions in an individual. Does your definition indicate comorbidity?

  • Comment on: “Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital: a baseline prospective study.”

    To the editor:
    In response to the article titled “Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital: a baseline prospective study.” published in your esteemed journal, I would like to raise a few points regarding this study. This is a well thought of and written paper which demonstrated that birth weight less than 1.5 kg, confirmed neonatal sepsis, nasogastric tube feeding and poor pupil dilation were independently associated with increased incidence of ROP. ROP screening should be a part of the routine service for premature infants in Ghana. (1)

    Retinopathy of prematurity (ROP) has a prevalence of 6 to 18% as one of the main causes of vision loss in childhood worldwide (2). Early diagnosis is of fundamental importance to avoid sequelae associated with this disease. However, we have a lack of trained professionals for the proper screening and monitoring of this disease. In addition, studies have shown that there may be a discrepancy in the diagnosis of this pathology among the specialists themselves. (3)
    Due to this difficulty in monitoring, new technologies can be developed to assist in early diagnosis and monitoring, avoiding this important cause of childhood blindness. There are devices such as Retcam that can assist in telemedicine monitoring. This device has a high cost that can be compensated with the development of technologies that allow the registration of newborn images with smartphones, facilitating documen...

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