Reviewer's report
Title:Helicobacter Pylori Infection: Approach Among Primary Care Physicians Of
Developing Country
Version: 2Date:1 December 2008
Reviewer: Ernst Kuipers
Reviewer's report:
This paper describes the results of a cross-sectional study analysing the
response of 426 primary care physicians based in Karachi, Pakistan, to a
self-designed questionnaire containing 11 items on Helicobacter pylori with focus
on transmission, diagnosis, treatment and follow-up. It turns out that the majority
of the physicians were aware of Helicobacter pylori, and gastric ulcer disease
was the most frequent indication for treatment in this population, with the majority
preferring clarithromycin-based triple therapy. The authors conclude that these
findings contrast with published guidelines for the management of H. pylori
infection and that these internationally published guidelines have little impact on
current practices in their country. They recommend more teaching programs and
frequent interaction between primary care physicians and gastroenterologists.
General comments
1/ The authors make some comparisons with similar studies from other
geographical areas. This is relevant to put their data into a larger perspective.
For that reason, it would be logical and attractive to expand the perspective a
little further adding other studies with similar results, and also if possible to
provide information with respect to the scores of Pakistan gastroenterologists on
the same survey. In other words, are the results from the primary care physicians
very different from those that would be given by gastroenterologists?
2/ The exact questions and their transposal into sentences in the abstract and
discussion do not always perfectly match. As an example; when physicians are
asked about the indications for testing for H. pylori, this is not the same as that
they actually test (and treat) patients with these indications. In that respect, I
propose that the text is once more carefully read with the exactly formulated
questions of the questionnaire in hand. To give a specific example, if 19% of the
primary care physicians knows that gastric maltoma is an indication for H. pylori
testing, this is not the same as “only 19% of phycicians tested for H. pylori in
maltoma” (page 17, line 4 from below).
Specific comments
1/ The presentation of the results can be shortened, in particular the figures are
redundant apart from table listing the proportions of positive answers.
Furthermore, I would list those proportions as full numbers (i.e. 19% instead of
19.40%).
2/ Final recommendation in abstract and both conclusions (page 19: to
recommend more teaching is an obvious step to go for, however, can the authors
provide some data on how this population of physicians is being taught on H.
pylori, and can they present any data that teaching on this topic also increases
the correct response rate as well as changes clinical practice?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Reviewer's report
Title:Helicobacter Pylori Infection: Approach Among Primary Care Physicians Of
Developing Country
Version: 2Date:1 December 2008
Reviewer: Ernst Kuipers
Reviewer's report:
This paper describes the results of a cross-sectional study analysing the
response of 426 primary care physicians based in Karachi, Pakistan, to a
self-designed questionnaire containing 11 items on Helicobacter pylori with focus
on transmission, diagnosis, treatment and follow-up. It turns out that the majority
of the physicians were aware of Helicobacter pylori, and gastric ulcer disease
was the most frequent indication for treatment in this population, with the majority
preferring clarithromycin-based triple therapy. The authors conclude that these
findings contrast with published guidelines for the management of H. pylori
infection and that these internationally published guidelines have little impact on
current practices in their country. They recommend more teaching programs and
frequent interaction between primary care physicians and gastroenterologists.
General comments
1/ The authors make some comparisons with similar studies from other
geographical areas. This is relevant to put their data into a larger perspective.
For that reason, it would be logical and attractive to expand the perspective a
little further adding other studies with similar results, and also if possible to
provide information with respect to the scores of Pakistan gastroenterologists on
the same survey. In other words, are the results from the primary care physicians
very different from those that would be given by gastroenterologists?
2/ The exact questions and their transposal into sentences in the abstract and
discussion do not always perfectly match. As an example; when physicians are
asked about the indications for testing for H. pylori, this is not the same as that
they actually test (and treat) patients with these indications. In that respect, I
propose that the text is once more carefully read with the exactly formulated
questions of the questionnaire in hand. To give a specific example, if 19% of the
primary care physicians knows that gastric maltoma is an indication for H. pylori
testing, this is not the same as “only 19% of phycicians tested for H. pylori in
maltoma” (page 17, line 4 from below).
Specific comments
1/ The presentation of the results can be shortened, in particular the figures are
redundant apart from table listing the proportions of positive answers.
Furthermore, I would list those proportions as full numbers (i.e. 19% instead of
19.40%).
2/ Final recommendation in abstract and both conclusions (page 19: to
recommend more teaching is an obvious step to go for, however, can the authors
provide some data on how this population of physicians is being taught on H.
pylori, and can they present any data that teaching on this topic also increases
the correct response rate as well as changes clinical practice?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Please review this paper.
user
Reviewer's report
Title:Helicobacter Pylori Infection: Approach Among Primary Care Physicians Of
Developing Country
Version: 2Date:1 December 2008
Reviewer: Ernst Kuipers
Reviewer's report:
This paper describes the results of a cross-sectional study analysing the
response of 426 primary care physicians based in Karachi, Pakistan, to a
self-designed questionnaire containing 11 items on Helicobacter pylori with focus
on transmission, diagnosis, treatment and follow-up. It turns out that the majority
of the physicians were aware of Helicobacter pylori, and gastric ulcer disease
was the most frequent indication for treatment in this population, with the majority
preferring clarithromycin-based triple therapy. The authors conclude that these
findings contrast with published guidelines for the management of H. pylori
infection and that these internationally published guidelines have little impact on
current practices in their country. They recommend more teaching programs and
frequent interaction between primary care physicians and gastroenterologists.
General comments
1/ The authors make some comparisons with similar studies from other
geographical areas. This is relevant to put their data into a larger perspective.
For that reason, it would be logical and attractive to expand the perspective a
little further adding other studies with similar results, and also if possible to
provide information with respect to the scores of Pakistan gastroenterologists on
the same survey. In other words, are the results from the primary care physicians
very different from those that would be given by gastroenterologists?
2/ The exact questions and their transposal into sentences in the abstract and
discussion do not always perfectly match. As an example; when physicians are
asked about the indications for testing for H. pylori, this is not the same as that
they actually test (and treat) patients with these indications. In that respect, I
propose that the text is once more carefully read with the exactly formulated
questions of the questionnaire in hand. To give a specific example, if 19% of the
primary care physicians knows that gastric maltoma is an indication for H. pylori
testing, this is not the same as “only 19% of phycicians tested for H. pylori in
maltoma” (page 17, line 4 from below).
Specific comments
1/ The presentation of the results can be shortened, in particular the figures are
redundant apart from table listing the proportions of positive answers.
Furthermore, I would list those proportions as full numbers (i.e. 19% instead of
19.40%).
2/ Final recommendation in abstract and both conclusions (page 19: to
recommend more teaching is an obvious step to go for, however, can the authors
provide some data on how this population of physicians is being taught on H.
pylori, and can they present any data that teaching on this topic also increases
the correct response rate as well as changes clinical practice?
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
assistant