Rapid Responses to:

EDITORIALS: Liz Crossan and Tony Delamothe Letters to the editor: the new order BMJ 1998; 316: 1406-1410 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

How to cite an electronic response ?

V M K Bhaskarabhatla   (1 June 1998)

Rapid replies might further enhance the value of rapid responses

Wai-Ching Leung   (3 June 1998)

Reduced osmolarity oral rehydration solution: evidence for increased hyponatraemia

J D F Habbema   (10 August 2001)

How to cite an electronic response ? 1 June 1998
V M K Bhaskarabhatla, Research Associate St Joseph's Hospital & Medical Center, Paterson, New Jersey, U.S.A. Send response to journal: Re: How to cite an electronic response ?	The internet with its limitless space has provided every BMJ reader an opportunity to express one's opinions(1). No doubt, these rapid response electronic letters form part of an active and timely discussion and lead the late appearing paper worthy "Letters to the editor" As this innovative section of the BMJ evolves, important issues surface. One such point is about "how to cite these online electronic BMJ responses in all mainstream articles in BMJ and other journals?" What status do these responses have as campared to the peer-reviewed paper based "Letters to the Editor." Do these electronic letters fit into the conventional published category? Not yet! Have they moved beyond the unpublished class? Only the editors of the scientific journals can come up with the right answer. This clarification would be a timely guideline to all readers and the scientific journals who are most likely to follow this innovative step that the BMJ has taken. Reference: 1 Crossan L & Delamothe T. Letters to the editor: the new order. BMJ 1998; 316: 1406 - 1410 (9 May)
Rapid replies might further enhance the value of rapid responses 3 June 1998
Wai-Ching Leung, Senior Registrar in Public Health Medicine Sunderland Health Authority, Durham Road, Sunderland SR3 4AF Send response to journal: Re: Rapid replies might further enhance the value of rapid responses	Crossan promised to screen all letters to the editor sent electronically through the website and post all accepted responses within 72 hours. (1) It appears that the eBMJ has managed to do so within 24 hours in most cases, and must be congratulated for its efficiency. Whilst authors' replies are not always necessary, the value of the responses which seek clarification may be enhanced by rapid replies from the authors. Unfortunately, there appears to be only one author's reply in the last month. If it is possible for eBMJ to send copies of the responses by computer-generated e-mails to all authors with access to the world wide web and invite them to make rapid replies if they see fit, the value of the rapid responses would be further enhanced. 1) Crossan L. Letters to the editor: the new order. BMJ 1998;316:1406-1410
Reduced osmolarity oral rehydration solution: evidence for increased hyponatraemia 10 August 2001
J D F Habbema, Prof. Medical Decision Sciences Department of Public Health, Erasmus University Rotterdam, The Netherlands Send response to journal: Re: Reduced osmolarity oral rehydration solution: evidence for increased hyponatraemia	Editor- The main worry with using reduced osmolarity oral rehydration solution for treatment of diarrhoea is the risk of hyponatraemia and its associated clinical problems in patients with cholera1. The results of the review by Hahn et al2 with respect to this issue have not been reported carefully. The 95% confidence interval just contains the value of equal chances of hyponatraemia in standard and reduced osmolarity solutions, but the evidence is clearly towards more hyponatraemia in the reduced osmolarity solution group. The estimate of the authors is a somewhat less than 50% increased risk with reduced osmolarity, with a 95% confidence interval (CI) running from about equal risks to more than double risks (odds ratio 1.45. 95% CI: 0.93 - 2.26). This finding is downplayed in the abstract to "no significant difference", without stating the CI, while CI's are given for the other secondary outcomes discussed in the abstract. The short message in the box "What this study adds", even states that "no difference was found in rates of hyponatraemia". This completes the two dangerously misleading steps from "no statistically significant difference" via "no significant difference" to "no difference". In summary the study found a substantial difference in rates of hyponatraemia. The difference is just not statistically significant at the 95% level, but leaves on the other hand a value of a double risk with reduced osmolarity solution open. Thus although the other outcome measures are clearly favourable for the reduced osmolarity solution, a greater caveat than suggested by the formulations by the authors is in place for its use in cholera endemic areas. 1. Fuchs GJ. A better oral rehydration solution? An important step, but not a leap forward. BMJ 2001;323:59-60 2. Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: systematic review. BMJ 2001;323:81-5.