Reviewer's□report 
□Management□of□Abnormal□Uterine□Bleeding□by□Northern,□Rural□and□Isolated□Primary□Care□ Title: 
Physicians:□PART□II:□What□Do□We□Need? 
Authors: 
Simone□N□Vigod□( simone.vigod@utoronto.ca )
Donna□E□Stewart□( donna.stewart@uhn.on.ca )
□1□ □3□Sep□2002 Version: Date: 
□Prof□Malcolm□Munro Reviewer: 
□A□paper□of□limited□interest Level□of□interest: 
□Reject Advice□on□publication: 
This□paper□purports□to□describe□the□educational□and□resource□needs□of□family□physicians□in□northern, 
rural□and□isolated□areas□of□Ontario,□Canada□with□respect□to□the□management□of□abnormal□uterine□ 
bleeding,□based□upon□a□survey□instrument.□The□methods□are□far□from□rigorous,□conclusions□are□ made□that□are□not□based□upon□the□data,□and□the□authors□suggest□remedies□that□may□not□be□ 
supported□by□their□data.□At□best,□I□see□this□as□a□preliminary□survey□that□could□be□used□to□design□a□ 
better□instrument□or□better□methodology□for□evaluation□of□the□care□provided□women□with□abnormal□ 
uterine□bleeding□in□this□challenging□environment.□ 
Objectives□ 
There□is□no□clear□objective□delineated□in□this□paper□in□an□appropriate□site.□The□section□entitled□ 
"Background"□is□followed□by□one□entitled□"Methods".□The□apparent□goal□is□contained□in□the□last□ 
sentence□of□the□"Background"□section,□stating□that□the□study□"addresses□the□educational□and□ resource□needs□of□family□physicians....".□ 
Methods□ 
The□paper□is□one□that□is□very□specifically□addressed□to□a□Canadian□health□care□paradigm□with□rural□ primary□care□physicians□practicing□in□remote□locations.□And,□there□is□substantial□heterogeneity□in□the□ 
demographics□of□the□physicians□involved,□that□doesn't□seem□to□be□evaluated□by□the□investigators.□For 
example,□half□of□the□physicians□were□in□rural□or□isolated□locations□while□the□other□half□were□in□"larger□ 
towns...or□small□cities...".□ 
We□do□not□have□a□copy□of□the□survey□instrument.□ 
Results□ 
On□page□5,□the□sentence□stating□that□"Seventeen□responding□physicians□(8.8%)□used□a□CPH□for□AUB 
or□hysterectomy□in□their□practices...".□These□are□primary□care□providers,□not□surgeons.□ 
There□may□be□an□internal□contradiction□in□that□at□the□top□of□the□first□CPG□paragraph□on□page□5□63.3% 
of□91.2%□of□the□population□did□not□know□"that□such□a□guideline□existed..."□while,□in□the□next□sentence□ it□is□stated□that□"...almost□three□quarters□(74.5%)□were□not□familiar□with□any□CPG□for□the□ management□of□AUB.".□ 
Discussion/Conclusion□ 
Many□of□the□CPGs□suggested□are□oriented□to□specialists□in□obstetrics□and□gynecology,□and□may□not□ 
be□applicable□to□the□primary□care□practitioners□who□were□the□subject□of□this□survey.□ 
I□am□unimpressed□with□the□conclusion□that□mailing□hard□copies□of□AUB□CPGs□is□"the□best□option".□ 
While□it□may□be□true,□the□authors□provide□no□quantitative□support.□They□state□that□"many□suggested□ mailed□clinical□practice□guidelines..."□and□conclude,□without□apparent□data□that□"If□these□physicians□ 
do□not□have□the□time,□knowledge□or□the□access□to□resources□to□search□out□guidelines□for□themselves, 
it□is□unlikely□that□non-respondents□do□either".□One□obvious□statement□is□that□if□most□do□not□know□of□ 
the□existence□of□such□guidelines,□why□would□they□search□them□out?□The□fact□that□93%□had□access□to□ 
the□Internet□suggests□that,□for□example,□"mailing"□could□be□accomplished□electronically,□at□least□to□ 
the□31%□who□were□respondents.□ 
Competing□interests: 
None□declared.