May

The new BC Guideline, Atrial Fibrillation—Diagnosis and Management (one of four new guidelines in the Stroke and Atrial Fibrillation series), states: “Patients for whom anticoagulation is recommended for stroke prevention, warfarin, or NOACs are available options. Existing evidence does not provide a definitive ability to recommend one class of OAC over another.”[1]

I would like to thank Dr Cridland for his comments on my article, “Chronic Disease Rates Cut in Half!” Yes indeed, perhaps I did not go far enough. I do believe that doctors are the most influential health professionals in our patients’ lives. To be effective we must walk the talk and be examples of what we tell our patients. However, I don’t believe we can be effective in promoting chronic disease prevention on our own.

I commend Dr Ron Wilson for encouraging doctors to practise health promotion in his article “Chronic-disease rates cut in half!” [BCMJ 2016;58:101]. As much as medical practitioners give lip service to the idea of a healthy lifestyle, few seem to understand the degree to which much, if not most, of the chronic disease we see is not only preventable but reversible through diet and lifestyle changes.

Thank you for the review of our article.

The PROMs used in the study correlated well with the clinical findings, both the Knee Society score and the Harris hip score, and while parts of those assessment tools are subjective there is a significant objective component, which allows some comfort that the two scoring mechanisms, subjective and objective, are measuring results accurately. This is the basis of the argument that the specific PROM test can be used on its own to assess outcomes.

The article by Stanger and colleagues on the use of patient-reported outcome measures (PROMs) in an orthopaedic surgeon’s office [BCMJ 2016;58:82-89] made an unsubstantiated leap from the article’s findings to the applicability of PROMs. Mention was made of PROMs being used both in assessing appropriateness for surgery and in assisting clinicians in their self-assessment.