eLetters

52 e-Letters

  • Antiemetics and arrhythmias.
    Fernando Martins do Vale

    Dear Editor,

    One third of patients who undergo surgery will experience postoperative nausea and vomiting (PONV) which can be very distressing (wound dehiscences and pulmonary complications)[1]. Rawlinson and colleagues [2] have made an excellent systematic review of randomised controlled trials, whose conclusions included the confirmation of intravenous dexamethasone and ondansetron (5-HT3 antagonist) as effective...

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  • Re:Conflicts of interest
    Kazuya Yamazaki

    Disclosure of conflicts of interest in Japanese randomized controlled trials

    Dear Editor,

    Disclosure of potential conflicts of interest (COI) is essential in interpreting randomized controlled trials with less risk of bias. In 2008, the Japanese Ministry of Health, Labour and Welfare issued an ethical guideline for clinical research that endorsed disclosure of potential COI 1. To assess impact of the gu...

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  • Perplexity.
    Piero Baglioni

    Dear Editor,

    As a practicing clinician, who reads Evidence Based Medicine to keep up to date with significant progress in medicine, I cannot help feeling perplexed about the review of Ambrosy and Gheorghiade on the article by Zannad et al (Eplerenone in patients withsystolic heart failure and mild symptoms, NEJM 2011; 364 : 11-21). Throughout their commentary, the reviewers fail to mention that the main conclusion...

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  • Comment on "A qualitative approach to Bayes' theorem" by Medow and Lucey
    Aquiles R. Henriquez

    Dear editor,

    We welcome the publication of Medow and Lucey in the December issue, describing a qualitative approach to Bayes' theorem [1]. Especially because the authors provide a new impulse to the development of clinician-friendly strategies for teaching clinical decision making skills.

    However, the approach proposed by the authors is not new. We reported a didactic model based on a visual representation of B...

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  • Gate control pain modulation theory invalidates the control groups used in these RCTs
    Stavros Saripanidis

    Dear Editors,

    The dorsal horns are not merely passive transmission stations but sites at which dynamic activities (inhibition, excitation and modulation) occur. [18]

    Via a series of filters and amplifiers, the nociceptive message is integrated and analysed in the cerebral cortex, with interconnections with various areas. [1]

    The processing of pain takes place in an integrated matrix throughout...

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  • Accurate, but is it patient-centred?
    Rodger C Charlton

    Although the accuracy of a mercury sphygmomanometer can be debated, automatic and semi-automatic devices which inflate the cuff often do so to well above the systolic pressure and can cause patients considerable discomfort even when an appropriate cuff size has been used. These devices frequently re-inflate for a variety of reasons, but out of control of the operator who is waiting for a reading.

    Anecdotally, I...

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  • Do not discard your mercury sphygmomanometers, yet.
    Yehia Y. Mishriki

    It would not be surprising to find that the "error" rate in blood pressure determinations with the "old fashioned" sphygmomanometer was due, in part, to a faulty technique by the individuals taking the blood pressures. Remarkably, little or no time is spent in teaching medical students the proper technique for blood pressure determination including the appropriate cuff size to use, the various audible phases, etc. One ca...

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  • Qualitative reasoning by elimination
    Huw Llewelyn

    Dear Editor,

    Bayes theorem can only be applied properly when considering a single diagnosis or its absence e.g. the presence or absence of asymptomatic diabetes mellitus, hypothyroidism, hyperlipidaemia, cervical cancer, breast cancer, etc. These asymptomatic situations are very important in the clinical setting and also in the community. It is in these situations that the reasoning described in this paper can be...

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  • What is 'transparent' EBM?
    Huw Llewelyn

    Dear Editor,

    Different individuals have adapted and adopted the principles of EBM to different degrees and in vastly different ways [1]. There is yet another approach to EBM, which goes back a long way in terms of verbal justification on ward rounds but which has not been put in writing and taught in that way until recently [2]. It involves specifying the 'evidence' obtained from the patient that was used for ea...

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  • Editor's reply to "Conflicts of Interest"
    Richard Saitz

    I agree with Dr. Tomedi's assertion that one might question the credibility of a commentary written by someone who has received pharmaceutical industry support, or for a number of other reasons. It is for this reason that BMJ Group policies ask authors to acknowledge and openly state any competing interests (1), and as a result of this policy, Dr. Tomedi could become aware of them and consider them in reading the commenta...

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