Review for 10.1186/1471-230X-9-23 (2009)

Reviewer's report
Title:Helicobacter Pylori Infection: Approach Among Primary Care Physicians Of
Developing Country
Version: 2Date:9 November 2008
Reviewer: Andrew S Day
Reviewer's report:
The manuscript authored by Ahmed and colleagues assesses the knowledge
and practice of primary physicians for the detection and management of
Helicobacter pylori infection.
Overall Comment: This area is of great importance around the world, especially
in the developing world. H. pylori remains a significant problem in many areas of
the world, although the infection (and it’s complications) are disappearing in the
western world. Despite the publication of numerous guidelines to the
management of this gastric infection, the use of these guidelines is not universal.
In order to appropriately approach this infection and to ensure consistent and
adequate responses, guidelines need to be widely circulated and followed (and
also need to be updated regularly to reflect current knowledge and
understanding). The authors should be applauded for their study to assess this
pattern in their local primary physician population. The manuscript would be
much stronger and clear with revision of a number of key aspects.
Specific Comments:
1. H. pylori must be given in standard correct format throughout the manuscript,
from the title and at every point thereafter. At times capitals are used
inappropriately, and italics used sparingly.
2. Multiple spelling and grammatical errors occur throughout the manuscript –
these impair the clarity of the results arising from the survey and must be
corrected.
3. Words such as “wild” in the introduction and “ruler” in the Discussion need
correction.
4. The Introduction could be modified to be more clear and precise.
Typographical errors (e.g. educations) need to be corrected.
5. The details of the sample size calculation are unclear. Further, in this type of
survey, it is unclear why a sample size is required (the response rate would be
more helpful). It would be more appropriate to provide the study design clearly
initially, with subsequent details of stats and sample size calculations.
6. It is unclear how many people were samples in this survey? Were practitioners
contacted and sampled until 426 were available? Were all of the primary
practitioners in Karachi asked to participate (i.e. reflecting a return of just around
10%)??
7. How were the participants contacted? By mail, by phone, with direct contact?
8. How was the proforma pretested? These details are not provided.
9. The authors should revise the headings and subheadings through the
manuscript. The Results heading is less than some of the preceding
subheadings and is easily missed.
10. The figures should be in a standard location, along with a figure legends
page (with more details in the legends).
11. Almost all sections of the results require revision to ensure clarity and
enhanced readability.
12. Only one decimal place is required for Figure 2 and elsewhere.
13. In regards to the indications for testing for this gastric pathogen, it is unclear
why primary practitioners would include GU and DU. Endoscopic assessment is
required to make these diagnoses.
14. The remaining sections of the results also require review and modification to
improve the text. There is no need to repeat the denominator in the section
discussing sources of information.
15. The Discussion also requires revisions to improve presentation and clarity.
Some sections appear to merely repeat the results, without good discussion of
the significance of these findings. Several typos also occur in this part of the
manuscript.
16. The Conclusions are appropriate and important.
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests