Reviewer ’s report  
 
Title: Prevalence of medication discrepancies in patients with cirrhosis: a pilot study  
 
 
Version: 0 Date: 10 Feb 2016  
 
 
Reviewer: Vincenzo  Palmieri  
 
 
Reviewer's report:  
 
This is a very interesting paper on a peculiar topic whose results may have some implications in 
the management of these patients.  
 
The study  is well conducted and the results are analyzed and discussed with a correct 
methodological approach.  
 
Nevertheless some corrections or integrations are needed.  
 
1. Criteria of selection of patients: this is not specified (are they consecutive patients? Are they 
enclosed because of the stage of the diseases?).  
 
2. Characteristics of patients: How are the Child Class -Pugh of the patients? In particular, how 
many pati ents have encephalopathy, that the authors themselves at the end of the discussion 
section recognize to have a crucial role in the management of drugs assumptions?  
 
3. The role of carers or family members: In how many cases the carers/family members are 
present to the interview of the patients? We only know that "this person was not always present 
at the time of the interview". I think that this is a crucial point and the authors have to know this 
data and to report it in the paper.In my experience, the numb er of discrepancies could be even 
higher than that reported by the authors if a care giver is absent (whether or not a family 
member).  
 
4. No information about the correlation between the discordance distribution and the stage of the 
disease is avalilable: e.g., how many patients have a decompensated cirrhosis?  
 
From this point of view, the authors let us to know only that "patients with decompensated 
cirrhosis were more likely to be taking diuretics (p<0.01), and to report having been told to 
maintain a low  salt diet (p<0.01)." Since diuretics are taken in 16 cases, is the discrepancy in the 
assumption of this class of drugs represented only in the group of subjects with decompensated 
cirrhosis? This is also the case of the lactulose, main drug in the treatm ent of encephalopathy, for 
which the discordance has a percentage of 60% (3 over 5 cases). The question is relevant as the 
authors themselves underline in the discussion section where they mention the work of Volk and 
colleagues that hypothesized that 22% of 30 -day readmissions among patients with 
decompensated cirrhosis were possibly preventable with improved patient understanding of their 
medications or more frequent outpatient monitoring. On the basis of the data presented in the 
submitted work, we canno t add any new information to this topic since the analysis of data has 
not focused on the stage of the cirrhosis.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the  future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manus cript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://cr eativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the jo urnal  
Reviewer ’s report  
 
Title: Prevalence of medication discrepancies in patients with cirrhosis: a pilot study  
 
 
Version: 0 Date: 10 Feb 2016  
 
 
Reviewer: Vincenzo  Palmieri  
 
 
Reviewer's report:  
 
This is a very interesting paper on a peculiar topic whose results may have some implications in 
the management of these patients.  
 
The study  is well conducted and the results are analyzed and discussed with a correct 
methodological approach.  
 
Nevertheless some corrections or integrations are needed.  
 
1. Criteria of selection of patients: this is not specified (are they consecutive patients? Are they 
enclosed because of the stage of the diseases?).  
 
2. Characteristics of patients: How are the Child Class -Pugh of the patients? In particular, how 
many pati ents have encephalopathy, that the authors themselves at the end of the discussion 
section recognize to have a crucial role in the management of drugs assumptions?  
 
3. The role of carers or family members: In how many cases the carers/family members are 
present to the interview of the patients? We only know that "this person was not always present 
at the time of the interview". I think that this is a crucial point and the authors have to know this 
data and to report it in the paper.In my experience, the numb er of discrepancies could be even 
higher than that reported by the authors if a care giver is absent (whether or not a family 
member).  
 
4. No information about the correlation between the discordance distribution and the stage of the 
disease is avalilable: e.g., how many patients have a decompensated cirrhosis?  
 
From this point of view, the authors let us to know only that "patients with decompensated 
cirrhosis were more likely to be taking diuretics (p<0.01), and to report having been told to 
maintain a low  salt diet (p<0.01)." Since diuretics are taken in 16 cases, is the discrepancy in the 
assumption of this class of drugs represented only in the group of subjects with decompensated 
cirrhosis? This is also the case of the lactulose, main drug in the treatm ent of encephalopathy, for 
which the discordance has a percentage of 60% (3 over 5 cases). The question is relevant as the 
authors themselves underline in the discussion section where they mention the work of Volk and 
colleagues that hypothesized that 22% of 30 -day readmissions among patients with 
decompensated cirrhosis were possibly preventable with improved patient understanding of their 
medications or more frequent outpatient monitoring. On the basis of the data presented in the 
submitted work, we canno t add any new information to this topic since the analysis of data has 
not focused on the stage of the cirrhosis.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the  future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manus cript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://cr eativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the jo urnal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Prevalence of medication discrepancies in patients with cirrhosis: a pilot study  
 
 
Version: 0 Date: 10 Feb 2016  
 
 
Reviewer: Vincenzo  Palmieri  
 
 
Reviewer's report:  
 
This is a very interesting paper on a peculiar topic whose results may have some implications in 
the management of these patients.  
 
The study  is well conducted and the results are analyzed and discussed with a correct 
methodological approach.  
 
Nevertheless some corrections or integrations are needed.  
 
1. Criteria of selection of patients: this is not specified (are they consecutive patients? Are they 
enclosed because of the stage of the diseases?).  
 
2. Characteristics of patients: How are the Child Class -Pugh of the patients? In particular, how 
many pati ents have encephalopathy, that the authors themselves at the end of the discussion 
section recognize to have a crucial role in the management of drugs assumptions?  
 
3. The role of carers or family members: In how many cases the carers/family members are 
present to the interview of the patients? We only know that "this person was not always present 
at the time of the interview". I think that this is a crucial point and the authors have to know this 
data and to report it in the paper.In my experience, the numb er of discrepancies could be even 
higher than that reported by the authors if a care giver is absent (whether or not a family 
member).  
 
4. No information about the correlation between the discordance distribution and the stage of the 
disease is avalilable: e.g., how many patients have a decompensated cirrhosis?  
 
From this point of view, the authors let us to know only that "patients with decompensated 
cirrhosis were more likely to be taking diuretics (p<0.01), and to report having been told to 
maintain a low  salt diet (p<0.01)." Since diuretics are taken in 16 cases, is the discrepancy in the 
assumption of this class of drugs represented only in the group of subjects with decompensated 
cirrhosis? This is also the case of the lactulose, main drug in the treatm ent of encephalopathy, for 
which the discordance has a percentage of 60% (3 over 5 cases). The question is relevant as the 
authors themselves underline in the discussion section where they mention the work of Volk and 
colleagues that hypothesized that 22% of 30 -day readmissions among patients with 
decompensated cirrhosis were possibly preventable with improved patient understanding of their 
medications or more frequent outpatient monitoring. On the basis of the data presented in the 
submitted work, we canno t add any new information to this topic since the analysis of data has 
not focused on the stage of the cirrhosis.  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please spe cify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the  future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I  declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manus cript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://cr eativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the jo urnal  
assistant