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Better results when defining frequent attenders proportionally and using Problem diagnoses? (Frans Smits, 01 July 2014)

Dear Madelon and co-... read full comment

Comment on: den Boeft et al. BMC Family Practice, 15:109

Lack of substantiation for claim that patients are often are diagnosed with CLD based on nonstandard interpretations of serology or other testing that has little or no validity (Anthony Murawski, 06 June 2014)

Having read the authors' claims that "[c]hronic Lyme disease is a term that describes a constellation of persistent symptoms in patients with or without evidence of previous Borrelia burgdorferi infection," [emphasis added] and that "patients are often are diagnosed with CLD based on nonstandard interpretations of serology or other testing that has little or no validity....," I am struck by the absence of any discussion or relevant references supporting these claims. For the latter claim, the authors cite only the IDSA and ILADS diagnostic and treatment guidelines for Lyme disease, but make no references to any published evidence concerning the accuracy of the serological testing criteria they endorse or reject. The authors' appear to use the CDC's surveillance criteria for... read full comment

Comment on: Ali et al. BMC Family Practice, 15:79

Reply to comment regarding antiplatelets and anticoagulants. (Sarah Appleton, 29 April 2014)

Although our cardiovascular medicine count included antiplatelets and anticoagulants, we did not conduct any additional analysis on this particular sub-group. An important issue is knowing the clinical indication for the drug, which is not always easy to determine from routine data such as those employed by our study, and specific outcomes related to use of these particular drugs (e.g. bleeding) are not available from our data. We will, however, consider the suggestion made. read full comment

Comment on: Appleton et al. BMC Family Practice, 15:58

New Contact Info for Authors (C. Shawn Tracy, 28 April 2014)

Corresponding Author: Ross Upshur may be contacted at ross.upshur@gmail.com First Author: Shawn Tracy may be contacted at stracy@bridgepointhealth.ca   read full comment

Comment on: Tracy et al. BMC Family Practice, 4:6

Is adequate polypharmacy existing? (Stefan Neuner-jehle, 25 April 2014)

As Sarah Appleton and colleagues are pointing out, polypharmacy is not necessarily negative or the result of an unsufficient "good clinical practice", in spite of its potential to harm. Their finding that a higher number of cardiovascular medicaments per patient do not lead to an increased general hospitalization rate suggests that mostly the indications to prescribe these medicaments are correct and their use beneficial to the... read full comment

Comment on: Appleton et al. BMC Family Practice, 15:58

Complexity rising? (carol sinnott, 16 April 2014)

This interesting study showed that the average number of GP-patient contacts per disease falls with multimorbidity.This suggests that more than one issue is being dealt with in each consultation.
It would be interesting to know what impact this had on consultation length. We know from other work that each additional problem dealt with in a GP-patient consultation not only increases the duration of that consultation but also increases the likelihood of clinical inertia.12 So although it may appear to be a coup for health service delivery, a falling level of consultations per disease may spell greater demands on GP time and more suboptimal... read full comment

Comment on: van Oostrom et al. BMC Family Practice, 15:61

Typing mistake in Methods section (Magdalena Morawska, 03 April 2014)

We would like to apologise for a typing mistake that was introduced in this... read full comment

Comment on: Bayliss et al. BMC Family Practice, 15:44

No evidence that skills have been developed through experience. (Christopher Weatherburn, 01 October 2012)

Interesting study however I do disagree with how the article has ended:

"Our results indicate that the GPs seem to recognise immediately both problems and persons, hence the quintessence of the expert skill of the GP as developed through experience. "

This is an assumption that these relatively senior GPs studied have developed expert skill through experience. There is no control group of less experienced GPs doing the same task. There is a possibility that less senior GPs could have performed better if also studied. read full comment

Comment on: André et al. BMC Family Practice, 13:38

References in tables (Andrew Riordan, 03 March 2012)

The reference numbers in Tables 2 and 3 do not correlate with the reference list in the article.
Is it possible to correct this. read full comment

Comment on: Elshout et al. BMC Family Practice, 12:33

Author error (Sarah Anne Redsell, 27 July 2011)

The authors would like to point out that there is an error in Table 2. Under Gender Male 19 it should read (16.4%). read full comment

Comment on: Redsell et al. BMC Family Practice, 12:54

Grant Acknowledgment (Christopher P. Morley, 17 June 2011)

This project was partially supported by HRSA grant D54HP05462 (Andrea T. Manyon, PI). read full comment

Comment on: Morley BMC Family Practice, 11:11

Patient-Physician Communication: How to Address Hidden Agendas of "Asymptomatic" Patients Who Visit a Doctor for Periodic Health Examinations (Christian T. K.-H. Stadtlander, 17 May 2011)

Hunziker et al. [1] discussed an important issue that relates to patient-physician communication and, in turn, to the development of a trusting relationship. The authors conducted a follow-up study of 66 patients who visited an outpatient clinic for a general, preventive check-up (i.e., a periodic health examination [PHE]), and who initially declared to be "asymptomatic." The authors observed that the majority of the patients had actually "hidden agendas," which means, they mentioned during the consultation specific symptoms, health concerns, or psychosocial problems. It is believed that these initially undisclosed issues were the primary reasons for the patients' requests for routine check-ups.

Communication is an important part for a successful relationship, including the... read full comment

Comment on: Hunziker et al. BMC Family Practice, 12:22

Does provision of free medication represent usual care? (Oliver Frank, 28 March 2011)

This is an important study and a well-designed trial overall, and I look forwards to seeing the findings. I would like to comment on the issue of aiming to have a 'usual care' control group.

The investigators say: "Practices will be allocated to one of three groups 1) Quit with Practice Nurse 2) Quitline Referral 3) usual care control group", but later state: "For patients in all three groups who are on low incomes and therefore eligible for subsidised medicines under the Australian Government Pharmaceutical Benefit Scheme (PBS) the project will fund access to nicotine patches."

The investigators justify this with: "This targeted subsidy will not disrupt the ecological validity of the study as a test of the different modes of cessation support as it will be offered... read full comment

Comment on: Zwar et al. BMC Family Practice, 11:59

Urgent need to get all health care workers certified in palliative care (Michael Hahn, 21 September 2010)

Regarding the statement that "...actual and potential delivery of palliative care by general practitioners and community based nurses has been sorely neglected." The same scenario is true throughout the world.

Although many claim that palliative care is increasing more available in many health care settings, the service is often weak (poorly funded and staffed) and under-utilized.

All health care workers should be required to become certified in palliative care (similar to how advanced life support is trained) so that this vital service can be provided by any clinician in any health care setting. To find out about this, visit the website for the American Society for the Advancement of Palliative Care (ASAP Care) at http://www.asap-care.org .
read full comment

Comment on: Schneider et al. BMC Family Practice, 11:66

Early diagnosis of CFS/ME has been shown to lead to a better prognosis (Tom Kindlon, 06 April 2010)

It was interesting to see the various views expressed by GPs in this paper[1]. However I think a couple of useful points could have been added.

There is much discussion in the paper about whether a label of CFS/ME is useful or not. The authors refer to NICE guidelines which "emphasise the importance of a definitive diagnosis"[2]. However, I think it would have been useful to add some direct evidence on this issue. For example, research published by the Centres for Disease Control and Prevention (CDC) which found that an earlier diagnosis led to a better prognosis[3]. This prompted the CDC to launch a two-pronged awareness drive aimed at both health professionals and the general public - the tag line for the latter was, "Get informed. Get diagnosed. Get help."[4]. A UK... read full comment

Comment on: Chew-Graham et al. BMC Family Practice, 11:16

Burnout and quality of interpersonal care (Ronald Epstein, 15 October 2009)

To the editors,

We take a different interpretation of the findings reported by Zantinge, et al.1 in their recent article documenting a positive cross-sectional association between greater psychosocial orientation observed during clinical interviews and higher levels on two of the three facets of burnout. Their study and analyses were designed with a model of implicit causality, suggesting that burnout would reduce physicians’ psychological availability to patients. Instead, they found that more psychosocially-oriented physicians were also more burned out. An unfortunate conclusion of their negative findings might be that physician burnout increases physicians’ sensitivity to patients’ needs and that attempts to reduce burnout might compromise the quality of... read full comment

Comment on: Zantinge et al. BMC Family Practice, 10:60

Industry sponsorship is associated with a lower probability of publishing data required to calculate trial characteristics (Ronan Conroy, 20 July 2009)

In table 5, Jones and colleagues present odds ratios for the impact of various types of trial funding on the probability that the trial will report the data required to determine the number of patients needed to be screened in order to randomize one participant, a key indicator of the external validity of any study.

However, the associated statistical analysis contrasts each of five funding sources with funding by charities. This has two disadvantages: by disaggregating their data into small groups, the authors' power to detect significant effects is diminished. But, more important, there is no a priori reason to compare each source of funding with charitable funding - why should charities be different?

On the other hand, there are compelling reasons to explore the... read full comment

Comment on: Jones et al. BMC Family Practice, 10:5

Various comments (Tom Kindlon, 16 January 2009)

This paper refers to using a re-attribution programme.I thought I would highlight the results of a trial[1] published last year on the topic.It involved testing practice-based training of GPs in reattribution. The method to test the hypothesis was a "cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual." It found that "Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms". Hardly a ringing endorsement of the method.There has been a lot of hype about the effectiveness of Cognitive Behavioural Therapy (CBT) for Chronic Fatigue Syndrome (CFS). However, a... read full comment

Comment on: Williams et al. BMC Family Practice, 9:30

Physical signs for detecting obstructive airway disease (Eduardo Garcia-Pachon, 31 October 2006)

In their article, the authors stated that 'the diagnostic accuraty of clinical signs [...] was low'. However, they do not evaluate physical signs that have been demonstrate to be useful in detecting OAD, especially Hoover's sign (the paradoxical movement of rib margin during inspiration). Hoover's sign was able to detect OAD with a sensitivity of 58% and a specificity of 86%. (Chest 2002; 122:651-5). read full comment

Comment on: Schneider et al. BMC Family Practice, 7:28

Some key issues neglected in this paper (Angela Kennedy, 22 August 2006)

This paper neglects to discuss some major problems regarding the issue of ‘Chronic Fatigue Syndrome’ and the various interventions claiming efficacy: the fact that such claims to efficacy as well as the nature of ‘CFS’ itself , are contested heavily, especially among those academics and practitioners involved in research and clinical practice, and that there is increasing evidence that baldly contradicts many of the claims present in this paper. Consideration of these should have been included in the literature review and references list at the very least, especially given the topic of the paper.As these important issues were neglected, the paper unfortunately reads as little more than a propaganda piece for two interventions (’CBT’ and ’GET’)... read full comment

Comment on: Thomas et al. BMC Family Practice, 6:49

Gordian knot of migraine: serendipity, empiricism, hope, hype, hokum, and randomized controlled clinical trials (Vinod Gupta, 06 June 2006)

Leiper, Elliott, and Hannaford present a qualitative picture of headache patients’ perspective [1]. The intensity of the quest of many individuals for an increased understanding of their condition and the development of their own explanations for their headaches is in direct proportion to the limitation of definitive knowledge about the origin or genesis of primary or vascular headaches. Migraine (and related idiopathic vascular headaches) is one entity in which technological, taxonomic, methodological (including statistical), and tautological sophistication has failed to offer any insight into disease mechanisms; also, the reductionist nature of ‘hard’ laboratory or epidemiological or clinical trials data has eluded researchers [2][3][4][5][6][7]. Whether... read full comment

Comment on: Leiper et al. BMC Family Practice, 7:27

Bed-Side Prostate Cancer Detecting, even in early stages ("Real Risk" of Cancer). (Sergio Stagnaro, 12 June 2005)

Sirs, I agree with such a statement: “The lack of association between more intensive screening and treatment and lower prostate cancer mortality suggests that trials should continue in order to settle this question”. In my opinion, based on 48 year-long clinical experience, we have to try new and more efficacious screening types for malignancies, easy to perform on very large scale and reliable in ascertain both "real risk" of prostate cancer in a well defined prostate lobe or the “real” initial stage in individuals involved by oncological terrain, of course (1). In fact, nowadays a new bed-side preventive medicine can be applied by all general practitioners around the world in an efficient and practical manner (2)(See my site www.semeioticabiofisica.it, Biophysical-... read full comment

Comment on: Brett et al. BMC Family Practice, 6:24

Metodology and citation (Giedrius Vanagas, 11 February 2004)

Authors of the article “Measuring access to primary care appointments: a review of methods” (1) aimed to search for and compare methods that have been published or are being developed to measure patient access to primary care appointments, with particular focus on finding methods using appointment system data.The methodology of the scientific review well known and informatively described in the Cochrane Reviewers' Handbook (2). It seems that the authors in some extent used this book and review were designed appropriately. Authors highlighted that the retrieval of the literature initially identified total of 1763 citations and 38 articles retrieved for detailed assessment from the Pubmed and the Medline searches (1). Total number of citations highlighted in the Reference section... read full comment

Comment on: Jones et al. BMC Family Practice, 4:8