Correspondence: Clinical indications; Iron infusions; Link between; Authorship; Year in review

We think this is a good idea too. More information, including advice about what to do if the patient is concerned about confidentiality, can be found here: http://clinicalindications.com/index

The reference for the BMJ letter is: Masters NJ. Add clinical indications to prescription instructions to avoid problems of polypharmacy. BMJ. 2013;347:f7496. Available from: www.bmj.com/content/347/bmj.f7496?tab=citation

As an additional point, some patient management systems have a field for inserting diagnostic indication for the prescription, however, this is not printed out with the prescribing instructions, but is stored within the PMS.

Iron infusion is usually carried out in secondary care, but increasingly, general practices who have the resources to carry this out (time, skills, resuscitation equipment and anaphylaxis kit), are offering this treatment. Iron infusion may be considered in adults with iron deficiency anaemia if oral treatment is not successful because the patient cannot tolerate the adverse effects (predominantly gastrointestinal) or if the patient is not adherent with treatment, i.e. they are not reliably taking oral medication. It may also be considered in patients where the use of oral iron may be inappropriate such as those with continuing blood loss or patients with gastrointestinal disorders which result in malabsoprtion, e.g. patients with inflammatory bowel disease. Patients with chronic renal failure who are receiving haemodialysis also require intravenous iron administration.

In our recent article on IBS (BPJ 58, Feb, 2014) we mentioned that people with IBS may be more likely to have anxiety, depression, fibromyalgia or restless legs. It raises the question that if you improve the patient’s IBS symptoms, will you also improve their RLS symptoms (or anxiety, depression, fibromyalgia...), or is this simply showing that the same characteristics that predispose a patient to IBS, predispose them to these conditions?

We do not assign individual authorship to our articles as by the time they are published they have been drafted, reviewed, corrected and edited by the entire publications team – the names of whom can be found on the inside cover of each edition of Best Practice Journal and Best Tests. If an article has been contributed by an external author, this is indicated at the start of the article. Almost all articles that appear in Best Practice Journal or Best Tests are written in-house by our publications team, which is made up of medical writers and clinicians. Our Editor (Rebecca) and medical writers (Mark, Gareth and Noni) have post-graduate health sciences-related qualifications and are members of the Australasian Medical Writers Association. Our clinical team is made up of three experienced General Practitioners (Sharyn, Nigel and Hywel) and Pharmacist (Kirsten). Our Editor-in-Chief (Murray) is also an experienced General Practitioner and CEO of bpac^nz. Staff bios for the entire team can be found on our website: www.bpac.org.nz

Our topics are decided on by our clinical advisory group which is made up of representatives from primary and secondary care, and healthcare management (the names of whom can also be found inside the front cover of our publications). The role of the group includes indicating key issues to cover within a topic, highlighting appropriate resources and suggesting expert input if required. The article is scoped and drafted by our publications team, then sent out to review with our clinical advisory group and a subject expert. Final revisions are then made by the clinical and editorial teams before articles are compiled into a publication. Final sign-off of each edition is the responsibility of the Editor-in-Chief.

We base our information on New Zealand guidelines, where available. We then look to guidelines from the United Kingdom’s National Institute for Health and Care Excellence (NICE), Australian, United States and Canadian guidelines, Cochrane systematic reviews, meta-analyses, and where necessary, primary research. This information is then collated, revised and presented in the context of the New Zealand healthcare system, with guidance from selected experts, depending on the topic. The acknowledgements box at the end of an article lists the experts who have reviewed the article and provided written comment. These experts do not write the articles and are not responsible for the final content.

You correctly point out the requirements for submission to peer reviewed journals. However, Best Practice Journal is not, and does not wish to be, a peer reviewed journal – we aim to provide evidence-based, practical guidance for healthcare professionals working in New Zealand. In relation to any conflict of interest, we do declare our funding sources (PHARMAC and DHB Shared Services) and the names of our five shareholders are also inside the front cover of all publications. We also maintain an active conflict of interest register for all staff.

In regards to correspondence items – correspondents have the option to have their letter published anonymously, which some choose to do. If an expert is consulted for a response to a letter, this is acknowledged, otherwise the answers can be assumed to be from the bpac^nz publications team. The purpose of the correspondence section is to reflect on additional questions which have arisen from articles and to promote debate on topical issues; we also publish any feedback on articles or correspondence items online and many people comment directly there. It is certainly not our intention to convey a condescending tone in a response to a correspondence item; we value the wide variety of opinion among the general practice community in New Zealand and appreciate the time people take to write to us and engage with our articles.

We thought this was a good idea too, hence the new insert in this latest BPJ! We would love to hear from our readers as to whether this is a useful tool for personal and/or peer review.