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Errors in a research article published in a Peer-Reviewed Scholarly Journal
LETTERS TO THE EDITOR Errors in a Research Article Published in a Peer-Reviewed Scholarly Journal To the Editor: Research published in scholarly journals is considered sacrosanct and formulates our practice. However, it may “contain methodological errors, report results selectively, and draw unjustified conclusions.”1 Journal editors safeguard themselves against this possibility by having a few (usually three) knowledgeable volunteer reviewers comment on the quality of the article. However, modern research methodology is complex and flaws can sometimes elude even the experts the journal selects to perform such prepublication peer review. Correspondence about the article from a much larger pool of peer reviewers, the journal’s readers worldwide, therefore, remains the “mainstay of holding authors responsible for their work.”2 I illustrate this crucial issue with an example from a recent JAMDA article3 that contains several major and minor errors (Table 1). The authors of that article have apparently mixed up words (traumatic and nontraumatic, fracture and fall) and various numbers making the entire article rather confusing.
Corrections and further information are warranted to maintain the sanctity of our literature. Problems with the quality of medical research have been further discussed elsewhere.4,5 Ghan-Shyam Lohiya, MD, MS, Public Health Officer Fairview Developmental Center Costa Mesa, CA REFERENCES 1. Altman D. Poor quality medical research. JAMA 2002;287:2765–2767. 2. Horton R. Postpublication criticism and the shaping of clinical knowledge. JAMA 2002;287:2843–2847. 3. Toofanny N, Maddens M, Voytas J, Kowalski D. Low bone mass and postfall fracture risk among elderly nursing home men. J Am Med Dir Assoc 2004;5:367–370. 4. Lohiya G. The free lunch and the literature [letter]. J Am Med Dir Assoc 2005;6:88 – 89. 5. Lohiya G. Apropos correspondence [letter]. Ann Emerg Med 2004;43: 533–534.
DOI: 10.1016/j.jamda.2004.12.027
Table 1. Errors in a Published Article: Line Item Listing of Errors With Suggested Corrections Statements in the Published Article
Conflicting Statement in the Same Article Elsewhere
Dr Lohiya’s Comments and Suggested Corrections
Page 367, Abstract, Results: The median age of all participants was 84 years. Page 367, Abstract, Results: About 53% of the subjects who fell (37.2%) sustained a nontraumatic fracture.
Page 368, Results, 4th paragraph, authors state: mean age of 84.
What is 84 years: the mean or the median age? Are both identical?
Page 368, Results, 3rd paragraph: A history of falls was recorded in 64 (37.2%) of the 172 participants. Among these fallers, 34 (53.1%) had a fracture as an outcome.
Page 367, Abstract, Results: About 53% of the subjects who fell sustained a traumatic fracture. Moreover, the original sentence is rather confusing because 37.2% is given inside the parentheses without any raw number outside. In conventional osteoporosis literature, T-score is derived by comparing the observed bone mineral density with that of a young healthy adult of the same gender and race. Were such data available for their Lunar densitometer? If yes, why were they not used? If not available, why, because most densitometer manufacturers provide reference normal data for a wide age range of both genders from a healthy population. Authors should give some explanation about the –1.6 SD cutoff because most densitometers use a –2.5 SD cutoff for diagnosing osteoporosis. Also, these numbers should carry the suffix SD (standard deviation). Ten of the original 212 residents remain unaccounted for.
Pages 367 and 368, Materials and Methods: T scores . . . were reported as the number of standard deviations from the average value for white women aged 60–69 years. (On page 370, the authors have justified this method because of “unavailability of similar large-scale data in men). T-scores . . . below 1.6 for osteoporosis.
Pages 368 and 369, Materials and Methods: Number of study subjects was 172.
LETTERS TO THE EDITOR
Of the 212 residents, 30 were excluded (heel ulcers: 13, poor scans: 8, and steroid therapy: 9). Remaining subjects: 182.
LETTERS TO THE EDITOR 165
Table 1. Continued Statements in the Published Article
Conflicting Statement in the Same Article Elsewhere
Dr Lohiya’s Comments and Suggested Corrections
Page 368, Results, 2nd paragraph: 39 (22.7%) individuals . . . had . . . fracture.
Table 1 (second set of triple rows) shows that 39 individuals had a fall. Fractures actually occurred in 64 individuals (30 without a fall, 34 with a fall: 4th and 6th set of triple rows). Table 1 (second set of triple rows) shows that 39 individuals had a fall. If 39 residents fell per table 1, and of them 34 (87%) had a fracture, this statement will be in conflict with the Abstract (Result) statement “53% . . . sustained a . . . fracture”!
Page 368, Results, 2nd paragraph. 39 (22.7%) individuals . . . had . . . fall.
Page 368, Results, 3rd paragraph: A history of falls was recorded in 64 . . .
Page 368, 4th paragraph: Age quartile groups were formed Page 368, Results, 4th paragraph: The trend revealed a progressive decline in bone mineral density with advancing age. Page 368, Results, last paragraph: Comparing the younger old group with the older old group. Page 368, last paragraph: . . . individuals without a history of a fracture, the mean bone density was similar (P ⫽ .14) between the younger old group (n ⫽ 77 . . .) and the older old group (n ⫽ 56 . . .). Page 369, Discussion, last paragraph: More than one third of the elderly men . . . had a history of at least one fall. Page 370, last paragraph: In conclusion, osteoporosis . . . causing . . . mortality. Table 1.
These data and statements do not match with each other.
What is the age range for each quartile? This statement requires statistical analysis. Statistics is also needed for other data (in the table and the two figures, and others). Authors did not define these age groups: what were their ages and overall sample sizes? Table 1 shows that the total number of residents with a fracture was 103 ⫹ 5 or 108. Total number of residents with a fracture according to the text is 77 ⫹ 56 or 133!
The two numbers about residents with fractures do not agree! What statistical calculation was performed to arrive at a P ⫽ .14?
Table 1 shows that falls occurred in 39 (22.6%, not more than one third) of the 172 residents.
Authors need to clarify this discrepancy and provide data in Results section to support their statement.
Authors gave us no data in this article about any resident dying due to osteoporosis!
Authors’ data do not support making a conclusion about mortality.
Figure 2.
Readability would be enhanced by having a column for row totals. Readability would be enhanced by providing the number of subjects (n) for each bar.
Note. Potentially wrongly used words, along with suggested substitutions, are shown in italics. Words not pertinent to the discussion have been removed, and such removal has been shown by blank space (. . .).
Author’s Reply To the Editor: In reply, we would like to sincerely thank Dr. Ghan-Shyam Lohiya for his criticism of our paper entitled Low Bone Mass and Postfall Fracture Risk Among Elderly Nursing Home Men published in the November 2004 issue of JAMDA,1 giving us a unique opportunity to review the article again and address certain points that were unintentionally overlooked. After reviewing the report, we made the following remarks and changes. Regarding the median/mean age of participants, the mean 166 LETTERS TO THE EDITOR
age was 84.53 years (inadvertently rounded to 84 years), and the median age was 85 years. Dr. Lohiya questions the use of the term nontraumatic. None of these fractures resulted from impact from high velocity external forces such as motor vehicle accidents. We regret that our choice of terminology was confusing. All fractures occurred as a result of “minimal-trauma” as described by Wong and his colleagues2 or occurred spontaneously. About 53% of the subjects who fell sustained a nontraumatic fracture (n ⫽ 34). The 37.2% represents the 64 subjects JAMDA – March/April 2005
Corrections and further information are warranted to maintain the sanctity of our literature. Problems with the quality of medical research have been further discussed elsewhere.4,5 Ghan-Shyam Lohiya, MD, MS, Public Health Officer Fairview Developmental Center Costa Mesa, CA REFERENCES 1. Altman D. Poor quality medical research. JAMA 2002;287:2765–2767. 2. Horton R. Postpublication criticism and the shaping of clinical knowledge. JAMA 2002;287:2843–2847. 3. Toofanny N, Maddens M, Voytas J, Kowalski D. Low bone mass and postfall fracture risk among elderly nursing home men. J Am Med Dir Assoc 2004;5:367–370. 4. Lohiya G. The free lunch and the literature [letter]. J Am Med Dir Assoc 2005;6:88 – 89. 5. Lohiya G. Apropos correspondence [letter]. Ann Emerg Med 2004;43: 533–534.
DOI: 10.1016/j.jamda.2004.12.027
Table 1. Errors in a Published Article: Line Item Listing of Errors With Suggested Corrections Statements in the Published Article
Conflicting Statement in the Same Article Elsewhere
Dr Lohiya’s Comments and Suggested Corrections
Page 367, Abstract, Results: The median age of all participants was 84 years. Page 367, Abstract, Results: About 53% of the subjects who fell (37.2%) sustained a nontraumatic fracture.
Page 368, Results, 4th paragraph, authors state: mean age of 84.
What is 84 years: the mean or the median age? Are both identical?
Page 368, Results, 3rd paragraph: A history of falls was recorded in 64 (37.2%) of the 172 participants. Among these fallers, 34 (53.1%) had a fracture as an outcome.
Page 367, Abstract, Results: About 53% of the subjects who fell sustained a traumatic fracture. Moreover, the original sentence is rather confusing because 37.2% is given inside the parentheses without any raw number outside. In conventional osteoporosis literature, T-score is derived by comparing the observed bone mineral density with that of a young healthy adult of the same gender and race. Were such data available for their Lunar densitometer? If yes, why were they not used? If not available, why, because most densitometer manufacturers provide reference normal data for a wide age range of both genders from a healthy population. Authors should give some explanation about the –1.6 SD cutoff because most densitometers use a –2.5 SD cutoff for diagnosing osteoporosis. Also, these numbers should carry the suffix SD (standard deviation). Ten of the original 212 residents remain unaccounted for.
Pages 367 and 368, Materials and Methods: T scores . . . were reported as the number of standard deviations from the average value for white women aged 60–69 years. (On page 370, the authors have justified this method because of “unavailability of similar large-scale data in men). T-scores . . . below 1.6 for osteoporosis.
Pages 368 and 369, Materials and Methods: Number of study subjects was 172.
LETTERS TO THE EDITOR
Of the 212 residents, 30 were excluded (heel ulcers: 13, poor scans: 8, and steroid therapy: 9). Remaining subjects: 182.
LETTERS TO THE EDITOR 165
Table 1. Continued Statements in the Published Article
Conflicting Statement in the Same Article Elsewhere
Dr Lohiya’s Comments and Suggested Corrections
Page 368, Results, 2nd paragraph: 39 (22.7%) individuals . . . had . . . fracture.
Table 1 (second set of triple rows) shows that 39 individuals had a fall. Fractures actually occurred in 64 individuals (30 without a fall, 34 with a fall: 4th and 6th set of triple rows). Table 1 (second set of triple rows) shows that 39 individuals had a fall. If 39 residents fell per table 1, and of them 34 (87%) had a fracture, this statement will be in conflict with the Abstract (Result) statement “53% . . . sustained a . . . fracture”!
Page 368, Results, 2nd paragraph. 39 (22.7%) individuals . . . had . . . fall.
Page 368, Results, 3rd paragraph: A history of falls was recorded in 64 . . .
Page 368, 4th paragraph: Age quartile groups were formed Page 368, Results, 4th paragraph: The trend revealed a progressive decline in bone mineral density with advancing age. Page 368, Results, last paragraph: Comparing the younger old group with the older old group. Page 368, last paragraph: . . . individuals without a history of a fracture, the mean bone density was similar (P ⫽ .14) between the younger old group (n ⫽ 77 . . .) and the older old group (n ⫽ 56 . . .). Page 369, Discussion, last paragraph: More than one third of the elderly men . . . had a history of at least one fall. Page 370, last paragraph: In conclusion, osteoporosis . . . causing . . . mortality. Table 1.
These data and statements do not match with each other.
What is the age range for each quartile? This statement requires statistical analysis. Statistics is also needed for other data (in the table and the two figures, and others). Authors did not define these age groups: what were their ages and overall sample sizes? Table 1 shows that the total number of residents with a fracture was 103 ⫹ 5 or 108. Total number of residents with a fracture according to the text is 77 ⫹ 56 or 133!
The two numbers about residents with fractures do not agree! What statistical calculation was performed to arrive at a P ⫽ .14?
Table 1 shows that falls occurred in 39 (22.6%, not more than one third) of the 172 residents.
Authors need to clarify this discrepancy and provide data in Results section to support their statement.
Authors gave us no data in this article about any resident dying due to osteoporosis!
Authors’ data do not support making a conclusion about mortality.
Figure 2.
Readability would be enhanced by having a column for row totals. Readability would be enhanced by providing the number of subjects (n) for each bar.
Note. Potentially wrongly used words, along with suggested substitutions, are shown in italics. Words not pertinent to the discussion have been removed, and such removal has been shown by blank space (. . .).
Author’s Reply To the Editor: In reply, we would like to sincerely thank Dr. Ghan-Shyam Lohiya for his criticism of our paper entitled Low Bone Mass and Postfall Fracture Risk Among Elderly Nursing Home Men published in the November 2004 issue of JAMDA,1 giving us a unique opportunity to review the article again and address certain points that were unintentionally overlooked. After reviewing the report, we made the following remarks and changes. Regarding the median/mean age of participants, the mean 166 LETTERS TO THE EDITOR
age was 84.53 years (inadvertently rounded to 84 years), and the median age was 85 years. Dr. Lohiya questions the use of the term nontraumatic. None of these fractures resulted from impact from high velocity external forces such as motor vehicle accidents. We regret that our choice of terminology was confusing. All fractures occurred as a result of “minimal-trauma” as described by Wong and his colleagues2 or occurred spontaneously. About 53% of the subjects who fell sustained a nontraumatic fracture (n ⫽ 34). The 37.2% represents the 64 subjects JAMDA – March/April 2005