125 e-Letters

  • Authors' Response: Postpartum bleeding is reduced with sublingual powdered misoprostol when compared with oxytocin injection, but a new formulation of misoprostol is unlikely to revolutionise postpartum haemorrhage care
    Mrutyunjaya B. Bellad

    Dear Editor,

    We thank Beverly Winikoff and Jill Durocher for their thoughtful commentary.(1) Winikoff and Durocher note that the incidence of PPH in our study's (2) oxytocin group was higher than expected. This deviance can occur, particularly in studies with relatively small samples such as ours. Regardless, the randomization produced study groups with similar characteristics to each other,(2) although this par...

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  • It is unethical to give placebo
    Neeru Gupta

    Dear Editor, The trial has two arms: magsulf and placebo. In my opinion the subjects should give informed consent and instead of blinding the treatment, the subjects should be able to opt for which arm they would like to participate. And lastly, instead of placebo some other treatment like diazepam or phenytoin should have been given as denying treatment is unethical. Moreover, the magsulf has severe side effects e.g. res...

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  • How should we measure psychological consequences of false-positive screening mammograms adequately?
    John Brodersen

    Dear Editor,

    In this week's EBM, Bond and colleagues report a systematic review entitled: 'Psychological consequences of false-positive screening mammograms in the UK'.(1) Their two main outcomes are self-reported questionnaires, and attendance at the next screening round.

    Together with two colleagues, I conducted a systematic review in 2004 on the adequacy of measurement of short and long-term consequence...

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  • 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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