Title: Physicians’ knowledge, attitude, and prescribing behavior regarding stress ulcer
prophylaxis in China: A multi-center study
Version: 3 Date: 22 Aug 2021
Reviewer:  Muhammad Eid Akkawi
Reviewer's report:
The main comment:
Again, all guidelines including ASHP, DSAICM and EAST DO NOT recommend SUP in major
surgery except for major burn surgery or organ transplantation. However, the authors stated that
major surgery was considered as a risk factor for stress ulcer in these guidelines, which is not
true. For the Chinese guidelines, I could not retrieve it online, so I am not sure whether major
surgery was stated there or not. Anyway, the whole study depends on considering major surgery
as risk factor for SUP and if there is no evidence/guidelines support this assumption, then the
study results are invalid.
Other comments:
Abstract:
“prescribing behavior of the perioperative patients toward surgeons regarding SUP”: Do patients
prescribe medications for surgeons?! Please give it back to the English proof-reader.
Methods: again delete the word ‘national’.
Introduction:
NMJC is the journal where the Chinese guidelines were published. So, it should be used as a
short name of the guidelines!
“attendance at continuing education programs”: what kind of educational programs? are they
related to the use of PPI as SUP?
Methods and results:
Authors agreed with my comments that the response for some statements should be yes/no
instead of Likert scale. The authors just changed it in the questionnaire but in fact that was not
what had been asked to the physicians. Authors need to mention how they handled the answers
using the original questionnaire. For instance, “I agree that SUP is a prescribing habit” the answer
provided for this statement was ‘a. Always b. Usually c. Sometimes d. Rarely e. Never’ as now
we agreed that the answer should be yes or no, what are answers considered yes and what other
choices considered no?
I suggested to add sex, age, education level and years of experience as variables to the logistic
regression. The authors responded that they did it. But I could not see that in tables 3 & 6!
Title: Physicians’ knowledge, attitude, and prescribing behavior regarding stress ulcer
prophylaxis in China: A multi-center study
Version: 3 Date: 22 Aug 2021
Reviewer:  Muhammad Eid Akkawi
Reviewer's report:
The main comment:
Again, all guidelines including ASHP, DSAICM and EAST DO NOT recommend SUP in major
surgery except for major burn surgery or organ transplantation. However, the authors stated that
major surgery was considered as a risk factor for stress ulcer in these guidelines, which is not
true. For the Chinese guidelines, I could not retrieve it online, so I am not sure whether major
surgery was stated there or not. Anyway, the whole study depends on considering major surgery
as risk factor for SUP and if there is no evidence/guidelines support this assumption, then the
study results are invalid.
Other comments:
Abstract:
“prescribing behavior of the perioperative patients toward surgeons regarding SUP”: Do patients
prescribe medications for surgeons?! Please give it back to the English proof-reader.
Methods: again delete the word ‘national’.
Introduction:
NMJC is the journal where the Chinese guidelines were published. So, it should be used as a
short name of the guidelines!
“attendance at continuing education programs”: what kind of educational programs? are they
related to the use of PPI as SUP?
Methods and results:
Authors agreed with my comments that the response for some statements should be yes/no
instead of Likert scale. The authors just changed it in the questionnaire but in fact that was not
what had been asked to the physicians. Authors need to mention how they handled the answers
using the original questionnaire. For instance, “I agree that SUP is a prescribing habit” the answer
provided for this statement was ‘a. Always b. Usually c. Sometimes d. Rarely e. Never’ as now
we agreed that the answer should be yes or no, what are answers considered yes and what other
choices considered no?
I suggested to add sex, age, education level and years of experience as variables to the logistic
regression. The authors responded that they did it. But I could not see that in tables 3 & 6!
Please review this paper.
user
Title: Physicians’ knowledge, attitude, and prescribing behavior regarding stress ulcer
prophylaxis in China: A multi-center study
Version: 3 Date: 22 Aug 2021
Reviewer:  Muhammad Eid Akkawi
Reviewer's report:
The main comment:
Again, all guidelines including ASHP, DSAICM and EAST DO NOT recommend SUP in major
surgery except for major burn surgery or organ transplantation. However, the authors stated that
major surgery was considered as a risk factor for stress ulcer in these guidelines, which is not
true. For the Chinese guidelines, I could not retrieve it online, so I am not sure whether major
surgery was stated there or not. Anyway, the whole study depends on considering major surgery
as risk factor for SUP and if there is no evidence/guidelines support this assumption, then the
study results are invalid.
Other comments:
Abstract:
“prescribing behavior of the perioperative patients toward surgeons regarding SUP”: Do patients
prescribe medications for surgeons?! Please give it back to the English proof-reader.
Methods: again delete the word ‘national’.
Introduction:
NMJC is the journal where the Chinese guidelines were published. So, it should be used as a
short name of the guidelines!
“attendance at continuing education programs”: what kind of educational programs? are they
related to the use of PPI as SUP?
Methods and results:
Authors agreed with my comments that the response for some statements should be yes/no
instead of Likert scale. The authors just changed it in the questionnaire but in fact that was not
what had been asked to the physicians. Authors need to mention how they handled the answers
using the original questionnaire. For instance, “I agree that SUP is a prescribing habit” the answer
provided for this statement was ‘a. Always b. Usually c. Sometimes d. Rarely e. Never’ as now
we agreed that the answer should be yes or no, what are answers considered yes and what other
choices considered no?
I suggested to add sex, age, education level and years of experience as variables to the logistic
regression. The authors responded that they did it. But I could not see that in tables 3 & 6!
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