I found this article interesting on the debate whether the benfit of
wearing elasticated stockings on long haul flights were useful in
prevention of DVT's in passengers. As you questioned the small amount used
in the study were not significant therefore inconclusive on
recommendations.
I was wondering how the staff, namely the pilots cope who make more
regular long haul flights than the passeng...
I found this article interesting on the debate whether the benfit of
wearing elasticated stockings on long haul flights were useful in
prevention of DVT's in passengers. As you questioned the small amount used
in the study were not significant therefore inconclusive on
recommendations.
I was wondering how the staff, namely the pilots cope who make more
regular long haul flights than the passengers . How do they prevent the
risks of DVT's. As we don't read about them in the press unlike if a
passenger aquires a DVT.
Regarding the article by Michael B Aldous,[1] I was little concerned about the impression I got from the randomized control trial. I ask them to consider the proven fact that immediate hearing improvement that takes place following placement of ventilatory tubes.
Is it not a fact that fluid accumaulation in middle ear results in
profound hearing loss? Does the modern formulas calculating significance and po...
Regarding the article by Michael B Aldous,[1] I was little concerned about the impression I got from the randomized control trial. I ask them to consider the proven fact that immediate hearing improvement that takes place following placement of ventilatory tubes.
Is it not a fact that fluid accumaulation in middle ear results in
profound hearing loss? Does the modern formulas calculating significance and power
of studies simply override the facts and figures.
Reference
(1) MB Aldous. Ventilation tubes did not improve quality of life in persistent otitis media with effusion
Evid Based Med 2001; 6:121.
The question asked in a recent article[1] was “In children with acute
respiratory infection, is tachypnoea accurate for detecting pneumonia?”
The answer obtained was “in children with acute respiratory infection,
tachypnoea had a sensitivity of 74% and specificity of 67%”. Please note
that radiographic determination of pneumonia was the reference standard to
which the finding of tachypnoea was compar...
The question asked in a recent article[1] was “In children with acute
respiratory infection, is tachypnoea accurate for detecting pneumonia?”
The answer obtained was “in children with acute respiratory infection,
tachypnoea had a sensitivity of 74% and specificity of 67%”. Please note
that radiographic determination of pneumonia was the reference standard to
which the finding of tachypnoea was compared.
Radiology has often been used as a “gold-standard” for the diagnosis
of pneumonia. But, is there enough evidence that a Chest X ray is
beneficial in the management of lower respiratory tract infections,
especially in non hospitalised children?
The WHO has advocated an Integrated Management of Childhood Illness
programme in which chest X-ray does not feature in the investigational
aids for the diagnosis of pneumonia. The recent British Thoracic Society
guidelines also suggest “If clinical signs are present, x ray examination
is not necessary to diagnose pneumonia”. [2]
A recent Cochrane systematic review also states, "There is no evidence
that chest radiography improves outcome in ambulatory children with acute
lower respiratory infection. The findings do not exclude a potential
effect of radiography, but the potential benefit needs to be balanced
against the hazards and expense of chest radiography."[3]
It was not very clear how many children in the study were treated as out-
patients. We should judge before we request chest X rays in non-
hospitalised children in this scenario. There are not only biomedical
hazards, but also cost factors where resources are limited.
The other question to ask is with the high mortality and morbidity
associated with acute lower respiratory infections in the developing
countries, is the negative predictive value of the study clinically
acceptable?
References:
(1) Palafox M, Guiscafré H, Reyes H, et al. Diagnostic value of tachypnoea
in pneumonia defined radiologically. Arch Dis Child 2000 Jan;82:41–5
(2) Russell G. Community acquired pneumonia. Arch. Dis. Child. 2001 85:
445-446
(3) Swingler GH, Zwarenstein M. Chest radiograph in acute respiratory
infections in children (Cochrane Review). In: The Cochrane Library, Issue
1, 2002.
Many thanks for your eLetter regarding an abstract appearing in both EBM[1] and EBN[2] with different commentaries. In answer to your queries:
First, when we have the same abstract appearing in both journals we do sometimes use the same commentary as well, however, if we think it doesn't fit our target audience we can require a fresh commentary. The risk is that, like all opinion, diff...
Many thanks for your eLetter regarding an abstract appearing in both EBM[1] and EBN[2] with different commentaries. In answer to your queries:
First, when we have the same abstract appearing in both journals we do sometimes use the same commentary as well, however, if we think it doesn't fit our target audience we can require a fresh commentary. The risk is that, like all opinion, differences in interpretation will occur, hiding such differences would not be our preference. The reason why we provide the details that we do in the abstract is so the reader can judge for
themselves - this is not only a matter of methods of the study, but also local context. Part of the context here is professional perspective. We did have considerable discussion over this particular article because some details such as the precise interventions were not well described in the paper, though Dr Robertson was helpful in supplying these.
Having said this, there isn't much difference in the commentaries, if you look at both of them in toto. They don't in fact disagree. John Robbins isn't saying that nurses can't play an important role in a home-based program for preventing falls, and Nancy Edwards isn't saying that this study is definitive for showing that nurses can only do it, or that the effect will be sustained if they do do it. That the two commentators are taking a somewhat different slant on their interpretations of the application of the results is valid, based on their perspectives.
Second, regarding your suggestion on joint commentaries; having multidisciplinary perspectives presented for each articles would be interesting and potentially informative. But, unfortunately we have to take into consideration obstacles such as the increase in editorial time it would take to prepare a multidisciplinary commentary and the amount of space such text would require. We would need more space for such discourse and would then have less space for other research. The research reports are the "stars" of the publication, so this could be a poor trade-off.
Finally thank you for suggesting this discourse be mounted on the eLetters page, we are keen to get more discussion going on both the websites but we do rely somewhat on our readers prompting appropriate topics.
I hope this answers all your queries.
Yours Sincerely
The Editors
References
(1) Robbins JA, Robertson MC, Campbell AJ (commentator). A home-based, nurse-delivered exercise programme reduced falls and serious injuries in people ³ 80
years of age. Evid Based Med 2001;6:182.
(2) Edwards N. A home based, nurse delivered exercise programme reduced falls and serious injuries in people 80
years of age. Evid Based Nurs 2002;5:22.
The study:
A home-based, nurse-delivered exercise programme reduced falls and serious injuries in people ³ 80 years of age. Robertson et al.
Effectiveness and economic evaluation of a nurse delivered home exercise
programme to prevent falls. 1: randomised controlled trial. [1]
appeared in both Evidence-Based Medicine [2] and in Evidence-Based Nursing.[3]...
The study:
A home-based, nurse-delivered exercise programme reduced falls and serious injuries in people ³ 80 years of age. Robertson et al.
Effectiveness and economic evaluation of a nurse delivered home exercise
programme to prevent falls. 1: randomised controlled trial. [1]
appeared in both Evidence-Based Medicine [2] and in Evidence-Based Nursing.[3]
The commentators differ in their perceptions of this paper. Edwards states that "Study results are promising and suggest that nurses have an important role to play in the
promotion of appropriate exercise that targets fall prevention among seniors."
Whereas Robbins believes "We can be less sure from this study what the actual "treatment" needs to be and who should provide it."
For me several issues are raised:
·Is it necessary to replicate
summaries of studies in both
journals, it seems wasteful of
resources
·What about the possibility of
joint (multidisciplinary)
commentaries
·The eLetters section where issues
such as those I have raised could
be aired still contains no letters
John Platt
References
(1) A home-based, nurse-delivered exercise programme reduced falls and serious injuries in people ³ 80 years of age Robertson MC, Devlin N, Gardner MM, et al.
Effectiveness and economic evaluation of a nurse delivered home exercise
programme to prevent falls. 1: randomised controlled trial. BMJ 2001 Mar 24;322:697-701.
(2) Robbins JA, Robertson MC, Campbell AJ (commentator). A home-based, nurse-delivered exercise programme reduced falls and serious injuries in people ³ 80
years of age. Evid Based Med 2001;6:182.
(3) Edwards N. A home based, nurse delivered exercise programme reduced falls and serious injuries in people 80
years of age. Evid Based Nurs 2002;5:22.
Dear Editor
I found this article interesting on the debate whether the benfit of wearing elasticated stockings on long haul flights were useful in prevention of DVT's in passengers. As you questioned the small amount used in the study were not significant therefore inconclusive on recommendations.
I was wondering how the staff, namely the pilots cope who make more regular long haul flights than the passeng...
Dear Editor
Regarding the article by Michael B Aldous,[1] I was little concerned about the impression I got from the randomized control trial. I ask them to consider the proven fact that immediate hearing improvement that takes place following placement of ventilatory tubes. Is it not a fact that fluid accumaulation in middle ear results in profound hearing loss? Does the modern formulas calculating significance and po...
Dear Editor
The question asked in a recent article[1] was “In children with acute respiratory infection, is tachypnoea accurate for detecting pneumonia?” The answer obtained was “in children with acute respiratory infection, tachypnoea had a sensitivity of 74% and specificity of 67%”. Please note that radiographic determination of pneumonia was the reference standard to which the finding of tachypnoea was compar...
Dear Mr Platt
Many thanks for your eLetter regarding an abstract appearing in both EBM[1] and EBN[2] with different commentaries. In answer to your queries:
First, when we have the same abstract appearing in both journals we do sometimes use the same commentary as well, however, if we think it doesn't fit our target audience we can require a fresh commentary. The risk is that, like all opinion, diff...
Dear Editors
The study:
A home-based, nurse-delivered exercise programme reduced falls and serious injuries in people ³ 80 years of age. Robertson et al. Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls. 1: randomised controlled trial. [1]
appeared in both Evidence-Based Medicine [2] and in Evidence-Based Nursing.[3]...
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