- Email: [email protected]
PACE trial clarification
Correspondence
repeat revascularisation. For this reason, there are no patients with repeat revascularisation without control angiography. The rate of non-target-vessel revascularisation was 20% in the drug-eluting stent group and 22% in the bare-metal stent group (p=0·61). Finally, we recommended the same duration of clopidogrel therapy irrespective of the type of stent implanted. JM has received honoraria from Abbott and Terumo. AK has received honoraria from Abbott, Biosensors, Biotronik, Cordis, and Medtronic. All other authors declare that they have no conflicts of interest.
*Julinda Mehilli, Adnan Kastrati, Gert Richardt, Franz-Josef Neumann, Albert Schömig [email protected] Deutsches Herzzentrum, Technische Universität Munich, 80636 Munich, Germany (JM, AK, AS); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (GR); Herz-Zentrum, Bad Krozingen, Germany (F-JN); and Medizinische Klinik, Klinikum rechts der Isar, Technische Universität Munich, Munich, Germany (AS)
The unmet surgical disease burden in the developing world
in need of a surgical consultation or intervention. Additionally, 22% of deaths from the previous 12 months were thought to have been from surgically treatable conditions.3 A full country survey with SOSAS is currently being undertaken in Sierra Leone and will provide detailed data on surgical disease burden for the entire country. Although we agree that a critical look at the possible overuse of surgery in the USA and other highincome countries is warranted, we strongly advocate that more resources be placed into addressing the surgical needs of populations in the developing world.
TC has done consultancy work for insurance companies and has received royalties from Sheldon Press and Constable and Robinson. MS has done voluntary and paid consultancy work for government and for legal and insurance companies, and has received royalties from Oxford University Press. PDW has done voluntary and paid consultancy work for the UK Departments of Health and Work and Pensions and Swiss Re (a reinsurance company).
We declare that we have no conflicts of interest.
3
*Reinou S Groen, Mohamed Samai, Thaim B Kamara, Adam L Kushner
Jenny Matthews/Panos
616
[email protected] Department of Psychological Medicine, King’s College London, London SE5 9RJ, UK 1
2
White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011; 377: 823–36. Chalder T, Berelowitz G, Hirsch S, et al. Development of a fatigue scale. J Psychosom Res 1993; 37: 147–53. Cella M, Chalder T. Measuring fatigue in clinical and community settings. J Psychosom Res 2010; 69: 17–22.
[email protected] Surgeons OverSeas, New York, NY 10003, USA (RSG, TBK, ALK); Royal Tropical Institute, Amsterdam, Netherlands (RSG); Department of Surgery, Connaught Hospital, Freetown, Sierra Leone (TBK); College of Medicine and Allied Health Science (COMAHS), Freetown, Sierra Leone (MS); and Department of Surgery, Columbia University, New York, NY, USA (ALK) 1
2
We commend Alvin Kwok and colleagues (Oct 15, p 1408)1 for highlighting the possible need in the USA for discretion in intervening surgically at the end of life; however, we hope this will not lead to the general idea that too much surgery is undertaken worldwide. As Atul Gawande’s group has pointed out previously,2 only 3·5% of the total surgical procedures done annually occur in the developing world—a statistic suggesting a large unaddressed disease burden. In an effort to shed light on this unmet surgical need, we developed a population-based survey: the Surgeons OverSeas Assessment of Surgical need (SOSAS). A pilot test in Sierra Leone determined that more than 7% of respondents were
*T Chalder, M Sharpe, P D White
3
Kwok AC, Semel ME, Lipsitz SR, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet 2011; 378: 1408–13. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 2008; 372: 139–44. Groen RS, Samai M, Petroze RT. Pilot testing of a population-based surgical survey tool in Sierra Leone. World J Surg (in press).
PACE trial clarification In the PACE trial,1 we stated that we used the Chalder fatigue questionnaire.2 We would like to clarify that we used an updated version of the scale.3 The item “Do you have problems thinking clearly?” was replaced with “Do you find it more difficult to find the correct word?” This updated version has slightly better reliability than the original scale.2,3 In practice, either item can be used without altering the interpretation of the scale.2
Department of Error Baselga J, Bradbury I, Eidtmann H, et al, on behalf of the NeoALTTO study team. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet 2012; 379: 633–40—In the Methods section of the Summary of this Article (published online Jan 17), the loading dose of intravenous trastuzumab should have read 4 mg/kg. This correction has been made to the online version as of Feb 17, and to the printed Article. Johnston C, Saracino M, Kuntz S, et al. Standarddose and high-dose daily antiviral therapy for short episodes of genital HSV-2 reactivation: three randomised, open-label, cross-over trials. Lancet 2012; 379: 641–47—On both page 644, right column, paragraph 1, line 6, and page 645, left column, paragraph 2, line 3 of this Article (published online Jan 5), “data not shown” should have read “webappendix”. New figures and a table have been added to the webappendix. These corrections have been made to the online version as of Feb 17, and to the printed Article.
www.thelancet.com Vol 379 February 18, 2012
repeat revascularisation. For this reason, there are no patients with repeat revascularisation without control angiography. The rate of non-target-vessel revascularisation was 20% in the drug-eluting stent group and 22% in the bare-metal stent group (p=0·61). Finally, we recommended the same duration of clopidogrel therapy irrespective of the type of stent implanted. JM has received honoraria from Abbott and Terumo. AK has received honoraria from Abbott, Biosensors, Biotronik, Cordis, and Medtronic. All other authors declare that they have no conflicts of interest.
*Julinda Mehilli, Adnan Kastrati, Gert Richardt, Franz-Josef Neumann, Albert Schömig [email protected] Deutsches Herzzentrum, Technische Universität Munich, 80636 Munich, Germany (JM, AK, AS); Herzzentrum der Segeberger Kliniken, Bad Segeberg, Germany (GR); Herz-Zentrum, Bad Krozingen, Germany (F-JN); and Medizinische Klinik, Klinikum rechts der Isar, Technische Universität Munich, Munich, Germany (AS)
The unmet surgical disease burden in the developing world
in need of a surgical consultation or intervention. Additionally, 22% of deaths from the previous 12 months were thought to have been from surgically treatable conditions.3 A full country survey with SOSAS is currently being undertaken in Sierra Leone and will provide detailed data on surgical disease burden for the entire country. Although we agree that a critical look at the possible overuse of surgery in the USA and other highincome countries is warranted, we strongly advocate that more resources be placed into addressing the surgical needs of populations in the developing world.
TC has done consultancy work for insurance companies and has received royalties from Sheldon Press and Constable and Robinson. MS has done voluntary and paid consultancy work for government and for legal and insurance companies, and has received royalties from Oxford University Press. PDW has done voluntary and paid consultancy work for the UK Departments of Health and Work and Pensions and Swiss Re (a reinsurance company).
We declare that we have no conflicts of interest.
3
*Reinou S Groen, Mohamed Samai, Thaim B Kamara, Adam L Kushner
Jenny Matthews/Panos
616
[email protected] Department of Psychological Medicine, King’s College London, London SE5 9RJ, UK 1
2
White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet 2011; 377: 823–36. Chalder T, Berelowitz G, Hirsch S, et al. Development of a fatigue scale. J Psychosom Res 1993; 37: 147–53. Cella M, Chalder T. Measuring fatigue in clinical and community settings. J Psychosom Res 2010; 69: 17–22.
[email protected] Surgeons OverSeas, New York, NY 10003, USA (RSG, TBK, ALK); Royal Tropical Institute, Amsterdam, Netherlands (RSG); Department of Surgery, Connaught Hospital, Freetown, Sierra Leone (TBK); College of Medicine and Allied Health Science (COMAHS), Freetown, Sierra Leone (MS); and Department of Surgery, Columbia University, New York, NY, USA (ALK) 1
2
We commend Alvin Kwok and colleagues (Oct 15, p 1408)1 for highlighting the possible need in the USA for discretion in intervening surgically at the end of life; however, we hope this will not lead to the general idea that too much surgery is undertaken worldwide. As Atul Gawande’s group has pointed out previously,2 only 3·5% of the total surgical procedures done annually occur in the developing world—a statistic suggesting a large unaddressed disease burden. In an effort to shed light on this unmet surgical need, we developed a population-based survey: the Surgeons OverSeas Assessment of Surgical need (SOSAS). A pilot test in Sierra Leone determined that more than 7% of respondents were
*T Chalder, M Sharpe, P D White
3
Kwok AC, Semel ME, Lipsitz SR, et al. The intensity and variation of surgical care at the end of life: a retrospective cohort study. Lancet 2011; 378: 1408–13. Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 2008; 372: 139–44. Groen RS, Samai M, Petroze RT. Pilot testing of a population-based surgical survey tool in Sierra Leone. World J Surg (in press).
PACE trial clarification In the PACE trial,1 we stated that we used the Chalder fatigue questionnaire.2 We would like to clarify that we used an updated version of the scale.3 The item “Do you have problems thinking clearly?” was replaced with “Do you find it more difficult to find the correct word?” This updated version has slightly better reliability than the original scale.2,3 In practice, either item can be used without altering the interpretation of the scale.2
Department of Error Baselga J, Bradbury I, Eidtmann H, et al, on behalf of the NeoALTTO study team. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet 2012; 379: 633–40—In the Methods section of the Summary of this Article (published online Jan 17), the loading dose of intravenous trastuzumab should have read 4 mg/kg. This correction has been made to the online version as of Feb 17, and to the printed Article. Johnston C, Saracino M, Kuntz S, et al. Standarddose and high-dose daily antiviral therapy for short episodes of genital HSV-2 reactivation: three randomised, open-label, cross-over trials. Lancet 2012; 379: 641–47—On both page 644, right column, paragraph 1, line 6, and page 645, left column, paragraph 2, line 3 of this Article (published online Jan 5), “data not shown” should have read “webappendix”. New figures and a table have been added to the webappendix. These corrections have been made to the online version as of Feb 17, and to the printed Article.
www.thelancet.com Vol 379 February 18, 2012