Reviewer's□report 
□Management□of□Abnormal□Uterine□Bleeding□by□Northern,□Rural□and□Isolated□Primary□Care□ Title: 
Physicians:□PART□I:□How□Are□We□Doing? 
Authors: 
Simone□N□Vigod□( simone.vigod@utoronto.ca )
Donna□E□Stewart□( donna.stewart@uhn.on.ca )
□1□ □6□Sep□2002 Version: Date: 
□Prof□David□H□Barlow Reviewer: 
□A□paper□whose□findings□are□important□to□those□with□closely□related□research□ Level□of□interest: 
interests 
□Other□(see□below) Advice□on□publication: 
Both□papers□are□concerned□with□aspects□of□the□management□of□abnormal□uterine□bleeding□in□the□ 
specific□context□of□Northern□Ontario□where□much□of□the□family□practice□is□in□a□rural□context.□By□ extreme□chance□the□request□to□review□these□papers□has□coincided□with□a□family□holiday□in□Totonto□ 
and□Ontario□so□I□have□just□returned□with□some□insight□into□the□context□in□Northern□Ontario□which□is□ 
certainly□very□different□from□my□usual□perspective□as□a□teaching□hospital□based□academic□ 
gynaecologist□in□the□UK.□This□is□a□rather□specific□context□but□the□findings□are□relevant□to□family□ 
practice□in□many□similar□parts□of□North□America,□and□possibly□wider□afield.□The□papers□highlight□ 
shortcomings□in□the□approaches□to□the□assessment□of□patients□and□to□the□awareness□and□use□of□ 
clinical□guidelines.□This□reveals□scope□for□better□postgraduate□education□and□application□of□ 
guidelines□which□theoretically□should□improve□outcomes□for□women.□ 
I□am□of□the□view□that□both□papers□provide□useful□survey□information□and□are□worthy□of□publication□by□ 
Biomed□Central.□The□questionnaire□process□is□clearly□described□and□the□presentation□of□results□and□ 
conclusions□is□clear.□In□that□I□support□publication□of□the□papers□I□must□consider□the□key□issue□of□ 
whether□they□justify□publication□as□separate□papers.□ 
The□two□paper□format□inevitably□involves□repetition□of□much□descriptive□material.□As□a□journal□Editor□ 
myself□if□I□were□in□an□Editorial□role□here□I□would□request□that□they□be□combined□into□a□single□paper□ since□this□would□abolish□all□of□the□need□for□repetition.□The□pressure□to□require□this□is□likely□to□be□ greater□in□a□print□journal□because□of□the□importance□of□space.□The□combination□into□a□single□paper□ 
would□force□the□authors□to□go□for□particular□clarity□in□order□to□preserve□the□force□of□the□two□types□of□ 
information□they□are□providing.□In□that□process□there□is□always□the□danger□that□the□clarity□of□the□two□ 
aspects□covered□in□the□two□papers□may□be□reduced.□That□is□always□a□risk□in□such□a□process.□If□it□is□ the□case□that□"space"□is□not□quite□such□an□issue□for□online□publishing□as□with□Biomed□Central□then□I□ 
would□be□happy□to□see□the□two□papers□stand□side□by□side,□thus□preserving□the□two□aspects□as□distinct 
topics.□If□this□appears□to□be□suggesting□a□double□standard□then□I□am□sorry□but□I□believe□that□I□am□ 
reflecting□the□true□situation.□One□inherent□aspect□of□online□publishing□is□that□it□can□rethink□how□ papers□are□published□and□need□not□simply□mirror□"print"□journal□methods.□ 
Another□issue□to□be□considered□is□whether□a□split□publication□of□this□one□survey□constitutes□"salami□ 
slicing"□of□the□data□which□is□a□tendency□to□be□discouraged□and□which□in□extreme□forms□is□recognised□ 
as□publishing□misconduct.□My□view□in□this□case□is□that□the□authors□are□not□to□be□criticised□on□this□ 
basis.□ 
Competing□interests: 
None□declared.