Combination drug therapy for ADHD and one or more of the common co-occurring disorders experienced by 50-60% of patients with ADHD is appropriate on-label use of stimulant plus anti-depressant for instance. 40% of patients with appropriately diagnosed ADHD have clinically significant anxiety as well, 30% have depression. SSRIs have FDA-approved Indications for treating both of these conditions. Stimulants and SSRIs are basically safe when taken together; rare instances of serotonin syndrome are seen. I do not see any evidence that any professional with experience diagnosing and managing patients with these conditions had any input into this "study"; if there had been then the negative value of the report would have been evident. Without correlating diagnoses with the data cited, as noted in the "limitations" section, the data is of no significance whatsoever. As a physician with 18 years of specialty practice in the field of ADHD and 26 years of general Family Medicine prior to that I can attest to the inaccuracy of the biased conclusions reached in this paper. I have no financial interests or benefit from any manufacturer of pharmaceuticals or any other purported treatments for ADHD. I do have a passion for exposing the "myth-information" surrounding ADHD diagnosis and treatment which abounds in the popular press and unfortunately in professional publications as well.
I am writing to draw attention to a commonly overlooked issue that affects the efficacy of antibiotics in tropical countries. It has been observed that many parents fail to store reconstituted antibiotics, such as amoxicillin, in the refrigerator, which can significantly reduce their potency and render them ineffective.
As we know, antibiotics are essential for treating bacterial infections, and their effectiveness is crucial for ensuring good health outcomes. However, in tropical countries where high temperatures and humidity are prevalent, it is especially important to handle these drugs with care to ensure that they retain their potency.
The problem arises when parents fail to store reconstituted antibiotics in the refrigerator, which is necessary to maintain their efficacy. In many cases, this may be due to a lack of awareness about the importance of refrigeration for these drugs. Hence, there is a need for pharmacists and healthcare professionals to provide clear instructions to parents at the time of dispensing the powder form of these drugs.
To address this issue, I suggest that pharmacists and healthcare professionals should educate parents about the need to store reconstituted antibiotics in the refrigerator. This information should be given at the time of dispensing the drug to ensure that parents understand the importance of following the guidelines for optimal efficacy.
I am writing to draw attention to a commonly overlooked issue that affects the efficacy of antibiotics in tropical countries. It has been observed that many parents fail to store reconstituted antibiotics, such as amoxicillin, in the refrigerator, which can significantly reduce their potency and render them ineffective.
As we know, antibiotics are essential for treating bacterial infections, and their effectiveness is crucial for ensuring good health outcomes. However, in tropical countries where high temperatures and humidity are prevalent, it is especially important to handle these drugs with care to ensure that they retain their potency.
The problem arises when parents fail to store reconstituted antibiotics in the refrigerator, which is necessary to maintain their efficacy. In many cases, this may be due to a lack of awareness about the importance of refrigeration for these drugs. Hence, there is a need for pharmacists and healthcare professionals to provide clear instructions to parents at the time of dispensing the powder form of these drugs.
To address this issue, I suggest that pharmacists and healthcare professionals should educate parents about the need to store reconstituted antibiotics in the refrigerator. This information should be given at the time of dispensing the drug to ensure that parents understand the importance of following the guidelines for optimal efficacy.
In conclusion, it is crucial to raise awareness about the importance of proper storage of reconstituted antibiotics among parents in tropical countries. Providing clear instructions at the time of dispensing the powder form of these drugs can go a long way in ensuring that they retain their potency and are effective in treating bacterial infections.
Sincerely,
Dr Pushpendra Magon
Professor
Punjab institute of medical sciences
Jalandhar
India
A major limitation of this article is that it does address relevant previous literature. For half a century I have been publishing in major journals the hypothesis that autism is a variant peripheral audiovestibular disorder. There is no upper limit to the IQ in autism, which alone should sink any primary brain damage hypothesis. As noted by Grandin , who admits to having Meniere's disease, you only have to look around Silicon Valley.
In retrospect, I now place less emphasis on otitis media, and more on inner ear changes known to accompany it, specifically endolymphatic hydrops. I have carefully reviewed the literature on audiosensitivity ("hyperacusis"), prominent in autism and Meniere's disease, and cannot find any other cause for it other than hydrops.
The article says, "The majority of current restaurant meals consumed by American adults—70% of meals consumed from fast-food restaurants and 50% consumed from full-service restaurants—are of poor nutritional quality, and the remainder are only of intermediate nutritional quality, with very few being ideal."
That being the case, perhaps government policy ought to focus on food quality rather than menu calorie labelling. That would have to start back on the farm. Norwegian animal science researchers suggest this approach. In a 2011 article entitled 'Animal products, diseases and drugs: a plea for better integration between agricultural sciences, human nutrition and human pharmacology' the authors wrote, "It is shown how an unnaturally high omega-6/omega-3 fatty acid concentration ratio in meat, offal and eggs (because the omega-6/omega-3 ratio of the animal diet is unnaturally high) directly leads to exacerbation of pain conditions, cardiovascular disease and probably most cancers. It should be technologically easy and fairly inexpensive to produce poultry and pork meat with much more long-chain omega-3 fatty acids and less arachidonic acid than now, at the same time as they could also have a similar selenium concentration as is common in marine fish. The health economic benefits of such products for society as a whole must be expected vastly to outweigh the direct costs for the farming sector."[1]
The article says, "The majority of current restaurant meals consumed by American adults—70% of meals consumed from fast-food restaurants and 50% consumed from full-service restaurants—are of poor nutritional quality, and the remainder are only of intermediate nutritional quality, with very few being ideal."
That being the case, perhaps government policy ought to focus on food quality rather than menu calorie labelling. That would have to start back on the farm. Norwegian animal science researchers suggest this approach. In a 2011 article entitled 'Animal products, diseases and drugs: a plea for better integration between agricultural sciences, human nutrition and human pharmacology' the authors wrote, "It is shown how an unnaturally high omega-6/omega-3 fatty acid concentration ratio in meat, offal and eggs (because the omega-6/omega-3 ratio of the animal diet is unnaturally high) directly leads to exacerbation of pain conditions, cardiovascular disease and probably most cancers. It should be technologically easy and fairly inexpensive to produce poultry and pork meat with much more long-chain omega-3 fatty acids and less arachidonic acid than now, at the same time as they could also have a similar selenium concentration as is common in marine fish. The health economic benefits of such products for society as a whole must be expected vastly to outweigh the direct costs for the farming sector."[1]
Problem is, policy makers and their advisors seem to be unaware of the omega-6/omega-3 fatty acid aspect of food quality. Here is why that aspect is important. "The ω-6 series of fatty acids, which includes arachidonic acid (ARA, C20:4) and its precursor linoleic acid (LA), constitute a growing part of the lipid intake in western diets for the last 40 years. The first cause of this trend is the higher consumption of animal products. White meat especially provides the highest quantities of dietary ARA."[2]
In a 2020 BMJ article entitled 'What role should the commercial food system play in promoting health through better diet?' the authors said, A number of aspects of nutritionally poor processed foods, especially ultra-processed foods, are unhealthy (eg, excess salt or sugar). The mechanisms that lead to associations between processed foods and poor health remain largely unknown. Processed foods have some advantages—for example, their longer shelf life and convenience—and they may not inherently need to be unhealthy. Nevertheless, how to achieve healthier processed foods remains unclear.[3]
Clearly, food policy experts haven't figured out where the hurt is coming from. Canadian animal science researchers offer this insight. "Pork is the most widely eaten meat in the world, but typical feeding practices give it a high omega-6 (n-6) to omega-3 (n-3) fatty acid ratio and make it a poor source of n-3 fatty acids."[4]
In the United States animal science researchers are also trying to rebalance the omega-6/3 fatty acid profile of animal products. "With the incidence of obesity, heart disease and insulin resistance increasing toward epidemic proportions in the United States, people must make changes to improve their health," said Kevin Harvatine, associate professor of nutritional physiology in the Department of Animal Science. "Production of nutritionally enriched eggs and poultry meat will help consumers meet health goals and help egg and poultry producers to increase the value of their products."[5]
It took longer for grain-fed animal products to enter Siberia. Comment by Siberian Federal University researcher. “The dietary value of the Yakutian horse meat is very high precisely due to the ideal balance of polyunsaturated omega-3 and omega-6 acids,” Makhutova explains. “The 1:1 ratio of these acids is ideal for us, but civilization is steadily shifting the balance towards the predominance of omega-6 due to the dominance of vegetable oils, cheap pork and fast food in our daily diet. We also need omega-6 acids, but in combination with the omega-3 partners, which are found mainly in fatty fish. The horse meat we tested is also very good, especially for child nutrition and the diet of people suffering from cardiovascular diseases. If the population of Yakutia starts consuming mass-market products, which are now imported abundantly into the republic, and makes a choice in favor of, let us say, semi-finished pork products, this may drastically affect people’s health. This is just the case when you should not change a time-tested balanced diet.”[6]
In a 1996 Introduction to a symposium on arachidonic acid the authors noted that "Excessive signaling of AA metabolites has been associated with various chronic degenerative or autoimmune diseases, and intervention with the metabolism of AA is widely employed therapeutically in these afflictions. In essence, AA is the most biologically active unsaturated fatty acid in higher animals. Its concentration in membranes and its magnitude of effects depend on its amount, or that of its precursors and analogues, in the diet. The tendency of the field of nutrition to ignore the role of dietary AA will optimistically be reversed in the future."[7]
27 years have elapsed and the field of nutrition continues to ignore the most biologically active unsaturated fatty acid in higher animals. [
Per April 12th 2023, the sample size of the protocol was changed from 84 to 74 participants.
In the original design of the study, sample size was calculated using the following parameters: power 80%, anticipated effect difference 25%, alpha 5%. Sample size was calculated at 32 per group (allocation 1:1). Loss to follow-up was anticipated at 10 participants per group, leading to a sample size of 84 participants.
However, with 57 patients included and 21 patients who have completed follow-up, the researchers see no loss to follow-up. Therefore, the anticipated loss of follow-up of 10 per arm may be more than necessary.
A protocol amendement, anticipating 5 patients loss-to-follow-up per arm, has been proposed to the medical ethics committee, which has approved this change in protocol.
Thank you for this article on PMS - an important public health topic. There is an important typo in the introduction. The article states "Globally, 90% women of reproductive age experience severe premenstrual symptoms" (cited to Chumpalova doi: 10.1186/s12991-019-0255-1). The word 'severe' should be 'several' - an important definition for readers >>> "Globally, 90% of women of reproductive age experience several premenstrual symptoms".
BMJ Open thanks Dr Kilian and colleagues for their rapid response entitled "Serious flaws in article". The authors of the paper have been contacted and have been asked to provide their response.
Cerquera Jaramillo et al. conducted a cross-sectional study to evaluate the risk of primary open-angle glaucoma (POAG) in patients with obstructive sleep apnoea (OSA) (1). There was no dose-response relationship by measuring optic nerve information and the severity of OSA, although OSA contributed to the increased risk of POAG. I recently made comments regarding the increased risk of POAG in patients with OSA by considering the mechanism of association (2). There is a space of summing-up information for preventing POAG, and the understanding of pathophysiology regarding the comorbidity may contribute to new therapeutic approach for POAG (3).
References
1. Cerquera Jaramillo MA, Moreno Mazo SE, Toquica Osorio JE. Primary open-angle glaucoma in patients with obstructive sleep apnoea in a Colombian population: a cross-sectional study. BMJ Open 2023;13(2):e063506.
2. Kawada T. Obstructive sleep apnea and open-angle glaucoma. J Clin Sleep Med 2023 Feb 7. doi: 10.5664/jcsm.10494 [Epub ahead of print]
3. Goyal M, Tiwari US, Jaseja H. Pathophysiology of the comorbidity of glaucoma with obstructive sleep apnea: A postulation. Eur J Ophthalmol 2021;31(5):2776-2780.
I was greatly interested in the article by Peter Chai et al. 1 Additional considerations can be made with regard to STI prevention strategies. Condoms have allowed a massive reduction in the risks of STI, including HIV. In the West, HIV is no longer frightening; due to the advent of antiretroviral drugs, it has changed from a fatal disease to a chronic disease. This paradigm shift has led to a modification of sexual behavior and to the trivialization of condoms. Thus, new strategies are being developed (i.e., PrEP). 2 However, HIV remains a preventable STI in the same manner as gonorrhea, viral hepatitis, syphilis or emergent STI, and these STIs are on the rise with increased costs, antibiotic use and drug resistance. Although the data on PrEP are encouraging (few seroconversions), they are recent, and we do not have sufficient information available to include compliance as a factor limiting these results.3 Moreover, PrEP cannot compete with condoms. 4 All of these elements belong to an evolving sociocultural model, and it is essential to emphasize sexual responsibility (safer sex) to optimize STI prevention strategies.
References
1. Peter Chai, Dikkha De, Hannah Albrechta, Georgia R Goodman, Koki Takabatake, Amy Ben-Arieh, Jasper S Lee, Tiffany R Glynn, Kenneth Mayer, Conall O’Cleirigh, Celia Fisher. Attitudes towards participating in research involving digital pill systems to measure oral HIV pre-exposure chemoprophylaxis: a cross-sectional study among men wh...
I was greatly interested in the article by Peter Chai et al. 1 Additional considerations can be made with regard to STI prevention strategies. Condoms have allowed a massive reduction in the risks of STI, including HIV. In the West, HIV is no longer frightening; due to the advent of antiretroviral drugs, it has changed from a fatal disease to a chronic disease. This paradigm shift has led to a modification of sexual behavior and to the trivialization of condoms. Thus, new strategies are being developed (i.e., PrEP). 2 However, HIV remains a preventable STI in the same manner as gonorrhea, viral hepatitis, syphilis or emergent STI, and these STIs are on the rise with increased costs, antibiotic use and drug resistance. Although the data on PrEP are encouraging (few seroconversions), they are recent, and we do not have sufficient information available to include compliance as a factor limiting these results.3 Moreover, PrEP cannot compete with condoms. 4 All of these elements belong to an evolving sociocultural model, and it is essential to emphasize sexual responsibility (safer sex) to optimize STI prevention strategies.
References
1. Peter Chai, Dikkha De, Hannah Albrechta, Georgia R Goodman, Koki Takabatake, Amy Ben-Arieh, Jasper S Lee, Tiffany R Glynn, Kenneth Mayer, Conall O’Cleirigh, Celia Fisher. Attitudes towards participating in research involving digital pill systems to measure oral HIV pre-exposure chemoprophylaxis: a cross-sectional study among men who have sex with men with substance use. BMJ Open. 2023 Jan 30;13(1):e067549. doi: 10.1136/bmjopen-2022-067549
2. Guillemette Antoni et al. On-demand pre-exposure prophylaxis with tenofovir disoproxil fumarate plus emtricitabine among men who have sex with men with less frequent sexual intercourse: a post-hoc analysis of the ANRS IPERGAY trial. Lancet HIV. 2020 Feb;7(2):e113-e120.
3. Jeanne M Marrazzo et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015 Feb 5;372(6):509-18.
4. Molina et al. On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection. N Engl J Med. 2015 Dec 3;373(23):2237-46.
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...
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 published article, we only reached these conclusion by reaching saturation. The examples of initiatives cited in the research such as the participation in medication safety that you are refer to, are not new initiatives but rather demonstrated initiatives of patient participation in patient safety within an Obstetrics department. In this study, it was decided to offer a new insight based on the respondents from the professional- and patient side. We recognize that in the future it may be interesting to also include the families of pregnant woman in the study, to see and investigate what findings emerge.
Combination drug therapy for ADHD and one or more of the common co-occurring disorders experienced by 50-60% of patients with ADHD is appropriate on-label use of stimulant plus anti-depressant for instance. 40% of patients with appropriately diagnosed ADHD have clinically significant anxiety as well, 30% have depression. SSRIs have FDA-approved Indications for treating both of these conditions. Stimulants and SSRIs are basically safe when taken together; rare instances of serotonin syndrome are seen. I do not see any evidence that any professional with experience diagnosing and managing patients with these conditions had any input into this "study"; if there had been then the negative value of the report would have been evident. Without correlating diagnoses with the data cited, as noted in the "limitations" section, the data is of no significance whatsoever. As a physician with 18 years of specialty practice in the field of ADHD and 26 years of general Family Medicine prior to that I can attest to the inaccuracy of the biased conclusions reached in this paper. I have no financial interests or benefit from any manufacturer of pharmaceuticals or any other purported treatments for ADHD. I do have a passion for exposing the "myth-information" surrounding ADHD diagnosis and treatment which abounds in the popular press and unfortunately in professional publications as well.
Dear Editor,
I am writing to draw attention to a commonly overlooked issue that affects the efficacy of antibiotics in tropical countries. It has been observed that many parents fail to store reconstituted antibiotics, such as amoxicillin, in the refrigerator, which can significantly reduce their potency and render them ineffective.
As we know, antibiotics are essential for treating bacterial infections, and their effectiveness is crucial for ensuring good health outcomes. However, in tropical countries where high temperatures and humidity are prevalent, it is especially important to handle these drugs with care to ensure that they retain their potency.
The problem arises when parents fail to store reconstituted antibiotics in the refrigerator, which is necessary to maintain their efficacy. In many cases, this may be due to a lack of awareness about the importance of refrigeration for these drugs. Hence, there is a need for pharmacists and healthcare professionals to provide clear instructions to parents at the time of dispensing the powder form of these drugs.
To address this issue, I suggest that pharmacists and healthcare professionals should educate parents about the need to store reconstituted antibiotics in the refrigerator. This information should be given at the time of dispensing the drug to ensure that parents understand the importance of following the guidelines for optimal efficacy.
In conclusion, it is crucial to raise awaren...
Show MoreA major limitation of this article is that it does address relevant previous literature. For half a century I have been publishing in major journals the hypothesis that autism is a variant peripheral audiovestibular disorder. There is no upper limit to the IQ in autism, which alone should sink any primary brain damage hypothesis. As noted by Grandin , who admits to having Meniere's disease, you only have to look around Silicon Valley.
In retrospect, I now place less emphasis on otitis media, and more on inner ear changes known to accompany it, specifically endolymphatic hydrops. I have carefully reviewed the literature on audiosensitivity ("hyperacusis"), prominent in autism and Meniere's disease, and cannot find any other cause for it other than hydrops.
The article says, "The majority of current restaurant meals consumed by American adults—70% of meals consumed from fast-food restaurants and 50% consumed from full-service restaurants—are of poor nutritional quality, and the remainder are only of intermediate nutritional quality, with very few being ideal."
That being the case, perhaps government policy ought to focus on food quality rather than menu calorie labelling. That would have to start back on the farm. Norwegian animal science researchers suggest this approach. In a 2011 article entitled 'Animal products, diseases and drugs: a plea for better integration between agricultural sciences, human nutrition and human pharmacology' the authors wrote, "It is shown how an unnaturally high omega-6/omega-3 fatty acid concentration ratio in meat, offal and eggs (because the omega-6/omega-3 ratio of the animal diet is unnaturally high) directly leads to exacerbation of pain conditions, cardiovascular disease and probably most cancers. It should be technologically easy and fairly inexpensive to produce poultry and pork meat with much more long-chain omega-3 fatty acids and less arachidonic acid than now, at the same time as they could also have a similar selenium concentration as is common in marine fish. The health economic benefits of such products for society as a whole must be expected vastly to outweigh the direct costs for the farming sector."[1]
Problem is, policy makers and the...
Show MorePer April 12th 2023, the sample size of the protocol was changed from 84 to 74 participants.
In the original design of the study, sample size was calculated using the following parameters: power 80%, anticipated effect difference 25%, alpha 5%. Sample size was calculated at 32 per group (allocation 1:1). Loss to follow-up was anticipated at 10 participants per group, leading to a sample size of 84 participants.
However, with 57 patients included and 21 patients who have completed follow-up, the researchers see no loss to follow-up. Therefore, the anticipated loss of follow-up of 10 per arm may be more than necessary.
A protocol amendement, anticipating 5 patients loss-to-follow-up per arm, has been proposed to the medical ethics committee, which has approved this change in protocol.
Thank you for this article on PMS - an important public health topic. There is an important typo in the introduction. The article states "Globally, 90% women of reproductive age experience severe premenstrual symptoms" (cited to Chumpalova doi: 10.1186/s12991-019-0255-1). The word 'severe' should be 'several' - an important definition for readers >>> "Globally, 90% of women of reproductive age experience several premenstrual symptoms".
BMJ Open thanks Dr Kilian and colleagues for their rapid response entitled "Serious flaws in article". The authors of the paper have been contacted and have been asked to provide their response.
Cerquera Jaramillo et al. conducted a cross-sectional study to evaluate the risk of primary open-angle glaucoma (POAG) in patients with obstructive sleep apnoea (OSA) (1). There was no dose-response relationship by measuring optic nerve information and the severity of OSA, although OSA contributed to the increased risk of POAG. I recently made comments regarding the increased risk of POAG in patients with OSA by considering the mechanism of association (2). There is a space of summing-up information for preventing POAG, and the understanding of pathophysiology regarding the comorbidity may contribute to new therapeutic approach for POAG (3).
References
1. Cerquera Jaramillo MA, Moreno Mazo SE, Toquica Osorio JE. Primary open-angle glaucoma in patients with obstructive sleep apnoea in a Colombian population: a cross-sectional study. BMJ Open 2023;13(2):e063506.
2. Kawada T. Obstructive sleep apnea and open-angle glaucoma. J Clin Sleep Med 2023 Feb 7. doi: 10.5664/jcsm.10494 [Epub ahead of print]
3. Goyal M, Tiwari US, Jaseja H. Pathophysiology of the comorbidity of glaucoma with obstructive sleep apnea: A postulation. Eur J Ophthalmol 2021;31(5):2776-2780.
I was greatly interested in the article by Peter Chai et al. 1 Additional considerations can be made with regard to STI prevention strategies. Condoms have allowed a massive reduction in the risks of STI, including HIV. In the West, HIV is no longer frightening; due to the advent of antiretroviral drugs, it has changed from a fatal disease to a chronic disease. This paradigm shift has led to a modification of sexual behavior and to the trivialization of condoms. Thus, new strategies are being developed (i.e., PrEP). 2 However, HIV remains a preventable STI in the same manner as gonorrhea, viral hepatitis, syphilis or emergent STI, and these STIs are on the rise with increased costs, antibiotic use and drug resistance. Although the data on PrEP are encouraging (few seroconversions), they are recent, and we do not have sufficient information available to include compliance as a factor limiting these results.3 Moreover, PrEP cannot compete with condoms. 4 All of these elements belong to an evolving sociocultural model, and it is essential to emphasize sexual responsibility (safer sex) to optimize STI prevention strategies.
Show MoreReferences
1. Peter Chai, Dikkha De, Hannah Albrechta, Georgia R Goodman, Koki Takabatake, Amy Ben-Arieh, Jasper S Lee, Tiffany R Glynn, Kenneth Mayer, Conall O’Cleirigh, Celia Fisher. Attitudes towards participating in research involving digital pill systems to measure oral HIV pre-exposure chemoprophylaxis: a cross-sectional study among men wh...
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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