eLetters

9 e-Letters

published between 2015 and 2018

  • Re:DPP4is are safe
    Joshua J. Fenton

    Dear Editor,

    Andrea Giaccari asserts that I wrote in my editorial that sitagliptin in the TECOS trial "caused" 20% increase in the secondary outcome of congestive heart failure. That is not what I wrote. I wrote that "the study data remain consistent with" a 20% increase in this adverse outcome. While the wide confidence interval is also consistent with a reduction in heart failure risk, the primary goal of the TECOS tr...

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  • DPP4is are safe
    Andrea Giaccari

    Dear Editor,

    I read with interest the comments of Dr. Fenton. In his editorial (Evid Based Med. 2016 Jun;21(3):81-2) Dr Fenton stated that sitagliptin caused in TECOS "a 20% increase in the secondary outcome of congestive heart failure (intention-to-treat HR 1.00, 95% CI 0.82 to 1.20, p=0.98)". This is really misleading. With exactly the same numbers Dr. Fenton could state that sitagliptin caused an 18% reduction in hos...

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  • Judging evidence in postoperative analgesia
    Andrew Moore

    Dear Editor,

    First, thank you for highlighting our paper. However, I do want to take issue with this commentary.

    Systematic reviews in postop analgesia have been done now for over 20 years, and there is considerable methodological research to substantiate what is done. The results are robust and trustworthy.

    Single trials, however well done, are not trustworthy because while they may be powered t...

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  • 'Cognitive biases plus' and healthcare evidence
    Shashi S. Seshia

    Dear Editor,

    Mazar and Ariely's recent paper [1] reinforces the concepts and suggestions discussed in our recent publications: dishonesty is a human universal, and there is no one-size-fits-all solution [2,3]. Education, moral reminders and changing how researchers are rewarded are important tools [1]. Most importantly, we need to reclaim the integrity, dedication and code of honor Sir Austin Bradford Hill consider...

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  • Re:Inaccurate radiation exposure calculation
    William D. Rogers

    Dear Editor,

    You are correct that protocols and improved technology have led to reductions in radiation exposure from CT scanning at some hospitals. I would suggest though that the resultant reduction in the risk of fatal cancer due to imaging does not affect the conclsion of the paper. If a laparotomy on a healthy young patient carries no risk of death and CT scanning imposes a risk of death the decision to perfor...

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  • Inaccurate radiation exposure calculation
    Nigel D'Souza

    Dear Editor,

    Dr Rogers et al have astutely pointed out the dangers of routine CT assessment of right iliac fossa pain in the paediatric population. I agree wholeheartedly that the role of clinical judgement, alongside observation and serial examination remain critical. Ultrasonography and MRI are additional valuable diagnostic adjuncts that do not incur a radiation dose to patients.

    I would question the da...

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  • Maternal pertussis vaccination
    Elyse O Kharbanda

    Dear Editor,

    We were pleased to read the commentary by Millar and Sanz(1) regarding our publication on Tdap safety in pregnancy from the Vaccine Safety Datalink.(2) We agree that policies regarding routine vaccination should be made after careful review of the risks and benefits of vaccination. For maternal vaccination, evaluations of risk-benefit profiles are complex, as both maternal and infant outcomes must be...

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  • Re:Further research in low dose CT scan for suspected appendicitis.
    William D Rogers

    We share your enthusiasm for the current efforts to reduce radiation exposure associated with the use of CT scanning and agree with your assertion that performance of appendectomy without scanning will inevitably lead to more negative appendectomies. We are confident though based on the NHS laparoscopic appendectomy statistics reviewed by Omar and Clark in the Annals of Surgery that those negative appendectomies are asso...

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  • Further research in low dose CT scan for suspected appendicitis.
    Dr. Paul V Puthussery

    Dear Editor,

    We read with great interest the recent article written by William Rogers et al on the Harms of CT scanning prior to surgery for suspected appendicitis(1). It highlights the radiation risk of cancer while routinely performing an abdominal CT scan on an otherwise healthy patient with symptoms suggestive of appendicitis. This radiation risk of cancer becomes all the more important in patients with 'ne...

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