eLetters

12 e-Letters

published between 2003 and 2006

  • Sometimes small things can make a big difference: Dionne et al. respond to Evans and Hadler
    Clermont E. Dionne

    Dear Editor,

    We agree with doctors Evans and Hadler that our clinical decision rule[1] should be validated in another setting and that it should be shown to cause more good than harm before it could be widely used. Our study was a first step in the process of developing a predictive tool for the occupational outcome of back pain. In a next phase of development, not only should the rule be validated in a new group of...

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  • Paediatricians as specialists
    Céline Lemay

    Dear Editor,

    Looking at the effectiveness of actions for well-child care makes us forget that paediatricians are specialists and not primary care givers in our health care system. Specialists are the best professionals to deal with pathology and complex problematic health situations for children. I think that well child should be followed by a family doctor, having time to do prevention by education and screening....

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  • ... but they also present an opportunity to learn more
    Paul Glasziou

    When RCTs are consistent across a variety of populations and settings, we should feel more secure about the applicability of the intervention. If it works in low risk and high risk, young and old, East and West, it will probably work in my patient. However, as Puliyel and Sreenivas point out, RCTs don't always agree, and sometimes diverge widely. When that happens, we would like to know why. It could be any of the PI...

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  • Meta-analysis can be statistically misleading
    Jacob M. Puliyel

    Dear Editor,

    In response to the Editor's invitation calling for short items on EBM related issues, we would like you to consider this statistical problem for possible publication.

    The double-blind Randomised Controlled Trial (RCT) is the basis of good evidence based medicine because it eliminates problems of bias and confounding. However systematic reviews show different RCTs arriving at diametrically op...

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  • Pain
    peggy lreager
    Dear Editor,

    I ran across your site concerning glucomine and sulphate knee cream. I took a cruise to Mexico and bought some cream there with glucomine and sulphate for 6.00. I am 65 and I have rheumatoid-osteoarthritis and am in pain

    That cream worked for me but I cant find it anywhere here. Can you help me find it please?

    Thank you,

    Peggy

  • What is evidence-based medicine?. A note from a developing country
    Luis Huicho

    Dear Editor,

    I read with optimism the note from Dr. Glasziou. It is encouraging to know that systematic reviews on diagnostic tests are being considered as part of national Cochrane movements. We badly need them. We have been involved in this task ever since 1995 and published two systematic reviews [1,2]. Quality of primary studies and methodological problems need to be studied and new tools need to be developed....

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  • The context of the test alters the significance placed upon the result
    David Bossano
    Dear Editor

    I see many results in which potassium falls (a little) above the normal range.[1] I was wondering at what level I should be concerned about sudden death being the presenting symptom.

    I reflected that the context in which the result was found affects my decision making.

    A routine test which identifies a raised value, is less alarming than a test which is done for a reason, such as the presence of s...

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  • Topical chrondroitin and glucoseamine
    Sidha. S Sambandan

    Dear Editor

    Shouldn't the RCT be done in such a way that the placebo also has Camphor and peppermint oil in identical concentration to the actual cream?[1] It is already known that the latter two can have a good effect on osteoarthritis, especially in the elderly.

    Reference

    1. Reginster J-Y. A topical cream containing glucosamine and chondroitin sulphate reduced joint pain in osteoarthritis of...

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  • This article is not about the real cervicogenic headache
    Celio Levyman MD MSc

    Dear Editor

    The paper in question has a strange problem: the definition of cervicogenic headache. Reading the text, one must look to all headaches that origins itself in cervical region, and there we have a conflict with International Classification of Headaches: first described by Ottar Sjaastad in late 1970s, the most correct assumption of cervicogenic headache is a particular syndrome who origins the pain in C...

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  • Pragmatic Criteria for excluding diabetes in borderline patients
    David Bossano

    Dear Editor

    In our primary care practice we are grappling with the diagnostic criteria for (type II) DM.

    We use FPG as our main investigation with the WHO criteria of FPG <7.0 on two occasions defining diabetes.

    In the event of repeated FPGs between 6 and 7 (& presumably a previous RPG 7-11.1) we have previously referred patients for an OGTT. However, we have found that this often does not lead to...

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