https://orcid.org/0000-0001-6603-341X
Peer Review History
| Original SubmissionFebruary 28, 2020 |
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PONE-D-20-05824 Etiologies and mortality at 12 months of patients with isolated involuntary weight loss in a rapid diagnostic unit PLOS ONE Dear Dr. Aligué, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The manuscript has been evaluated by two reviewers, and their comments are available below. You will see the reviewers have commented on the interest of your study. However, the reviewers have also raised critical concerns and the manuscript will need significant revision before it can be considered for publication – you should anticipate that the reviewers will be re-invited to assess the revised manuscript, so please ensure that your revision is thorough. I have outlined some of the key concerns noted by the reviewers below, but you should respond all concerns mentioned by the reviewers in your response-to-reviewers document. The key concerns noted by the reviewers relate to requests for more information about the rationale for the study design, addition details regarding the diagnoses, clarification about the exclusion criteria, further descriptions of the study population. Additionally, please describe study limitations in the Discussion section. These issues have limitations for the interpretation of the results and should be explored. Please note that novelty is not a requirement for publication in PLOS ONE: https://journals.plos.org/plosone/s/editorial-and-peer-review-process Please submit your revised manuscript by Mar 16 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Danielle Poole Staff Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 2. In the ethics statement in the manuscript and in the online submission form, please provide additional information about the patient records used in your retrospective study, including: a) whether all data were fully anonymized before you accessed them; b) the date range (month and year) during which patients' medical records were accessed; and c) the source of the medical records analyzed in this work (e.g. hospital, institution or medical center name). If patients provided informed written consent to have data from their medical records used in research, please include this information. 3. At this time, we ask that you please discuss any limitations of your study in the Discussion section. 4. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for the opportunity to review this interesting study. 1. I suggest having a native English speaker review content for grammar, style, and spell check. Examples: Line 32: change “visited at” to “presenting to” Line 34: spell out “computed tomography” for the firs t time “CT” is used. Line 40: “… which was higher in the malignant group” is awkward phrasing – suggest “…with the mortality rate being the highest in those with malignancy (61.1%, 95% CI 54.2,68.2) Line 57: pluralize “rapid diagnostic unit”, or, if singular, then on line 56, add “an” before “ambulatory” Line 58: “users”: this should be possessive (“ users’ ”) and, perhaps more importantly, please specify whether this is patient satisfaction, provider satisfaction, or both. Lines 71-72: this is a sentence fragment Line 75, 102, 155; Discussion line 92, and others: Suggest the word “refer” instead of “derive”. Line 82: change “presenting documented” to “presenting with documented” Line 83: Instead of “were included” should state “were eligible or inclusion” (because some were then excluded). Line 91: consider using “rectal bleeding” instead of “rectorrhagia”—not because rectorrhagia is incorrect, but it’s an uncommon term in the US. Line 92: change “cough has” to “cough that has” Line 94-95: change “significant lymph nodes” to “significantly enlarged lymph nodes”, or perhaps simply “lymphadenopathy” Line 107: misspellings: “nauseas” and “vomits” Line 110: misspellings: “glomerular filtrate (GF)” should be “estimated glomerular filtration rate” Lines 108-118: inconsistent capitalizations – some first letters are capitalized, others are not – should be consistent Line 108: “erythrocyte” is misspelled. Missing “)” after “Hb”. Line 107: need comma after “depressive symptoms” Line 119: suggest “primary” instead of “main” outcome (primary matches with secondary outcome, the term used on line 122). Line 124: Instead of “Statistical issues” suggest “Statistical Analysis” Table 1, line 158: suggest “Habits” instead of “Toxic Habits” (“toxic” is a bit judgmental, not used often) Table 2: “Vomiting” instead of “Vomit” Line 160: “Patients with psychiatric disorder” – suggest “Patients with psychiatric disorders” or “Patients with a psychiatric disorder” Table 2: these are not only blood tests, so suggest another title (FOBT are stool tests). Line 171 “GGT i AP” = ? Table 3, column heading: “Psichiatric” is misspelled. Table 3, row heading: “TC” should be “CT” Table 4: “Placed” should read “Place” or “Location”. Is it “not specified” or actually unknown? “Lax Cardia” is an uncommon term – suggest using a more common term. Some typographic errors (period after “Rectum”, small “i” in Alcohol induced Liver Disease; repeated “Benign” in “Benign Colon Polyps” “Enolism” – is this “Embolism”? “Unknonwn” is a misspelling. Discussion Line 60, 62: suggest using the term “depression” instead of “depressive syndrome”. 2. Introduction: Suggest including more information on the specific rationale for this study. For example, were there unanswered questions that previous studies with smaller sample sizes were unable to answer, or were insufficiently powered? Or is the primary aim to determine whether the etiologies of IWL presenting to RDUs is different than those of previous studies in which patients were worked up in a different setting? 3. Methods: General comments: -It would be helpful to know whether RDU providers followed an algorithm. Inclusion criteria were that patients could not have symptoms or signs specific to an organ or system, but then providers made decisions on doing a CT scan of the chest, for example, versus the abdomen, or performed upper versus lower endoscopy—presumably there were then some symptoms or exam findings that led to specific diagnostic choices? However, these patients had apparently negative localizing symptoms in order to be included in the study - was the absence of such symptoms based on referral to the RDU, acceptance to the RDU, or the first intake appointment at the RDU? -Please describe the data extraction – if chart review was required, did multiple investigators review charts for final etiology, and if so, was there agreement (kappa statistic) among reviewers? Or, was all data abstracted from a database? Line 35: “diagnostic-therapeutic process” – it is uncertain what part of the RDU treatment is therapeutic, as this study appears to be focused on diagnoses of the underlying etiology of IWL. Were there treatments involved? Lines 73-76: It would be helpful to have more description of entry referral to RDUs. How are patients referred there? Are there referral criteria or acceptance to an RDU? Presumably these are adults, but is there an age criteria (e.g. over 18)? In the study’s setting, do primary care providers not typically order CT scans or refer for endoscopy? Lines 76-78: Exclusion criteria to the RDU are poorly defined. These should be defined explicitly here or in an appendix of supplementary material. Given that this study hinges on diagnostic etiologies, the exclusion criteria are important: how was “severe functional dependency” defined? For example, was there a rating scale? Were those patients then hospitalized? Why would patients need “family support” to present to an outpatient center? What were the “mild or chronic symptoms”—were these different than the “specific symptoms” starting on line 89? Line 91: “serious rhythm deposition changes” – this is unclear – do you mean an abnormal EKG/ECG? If so, how abnormal? Lines 89-99: These exclusion criteria appear to refer to patients who were seen at the RDU, had IWL, but excluded from the analysis. It would be helpful to specify at what point these patients were excluded – one can infer it is based on their initial history and physical examination, presumably at the first RDU visit, but it is not clear. “Malignant hepatomegaly” should be defined – ie is malignancy somehow known at the initial visit? “Subocclusive crises” should also be defined. Additionally, how is “non-compliance with study criteria for RDU” defined? What is “death during diagnostic process”? Does this mean the patient died before completing the workup? If so, suggest commenting on why these patients should not be analyzed – for example, if they died of malignancy that would be potentially important data, especially if there were autopsy data and mortality is a secondary outcome measure. Lines 106-108: Please explain why some gastrointestinal symptoms merit exclusion (I believe this is what “guide symptoms” are? – line 106 –this term should be defined), but others (abdominal pain, nausea, vomiting) are not—is there precedent from previous studies to define these exclusions? Results: Figure 1: This figure should be labeled. There are misspellings: “Weight loss <5% o not weight loss,” and “Elegibles”. Terminology is inconsistent – “UWL” is presumably “Unintentional Weight Loss” but “Involuntary” is used elsewhere; “Tumoral” hepatomegaly is used in Figure 1 but “malignant” hepatomegaly is used in the text. Table 1: Can report only % male or female (both not needed) unless there were significant nonbinary genders that should be reported. “Phychiatric” is a misspelling (column heading). It is unclear what “n valid” means – presumably this is the n for which the subcategory had valid data. “CCEE” is not defined. “UDR” is presumably “RDU”. The table results should be discussed in the text. For example, there is a p=0.001 for the referral sources, but the clinical significance is not discussed—presumably the exact test was used given the low n in the Unknown origin column and the endoscopic procedures row- however is the intent to show that there is a higher relative percentage of primary healthcare center referrals in the unknown origin group compared to the others? The onset of weight loss is presented as significantly difference (p=0.018), presumably chi-squared or exact test given low n in the Unknown Origin group, but there should be discussion in the text regarding the clinical significance – the test statistic only suggests that the patients are not evenly spread among these groups, but there is no obvious trend (e.g. is the > 6 months trend significant? Do the authors feel that it is reasonable to say that the Unknown group had a higher percentage of patients who had > 6 months of IWL? Ie what is the take-home point, if any, of this part of the table?) Table 2: In methods it was stated that quantitative variables would be reported as mean and SD—however, these variables’ data types are not reported in the Table. It should clearly state mean (SD), or more likely median (IQR) or mean (95%CI) based on the format showing a range. The “FOBT” row should be defined (is this that FOBT was done vs not done?). Table 3: Line 192—it is unclear where the 6.9% figure comes from. Figure 2: suggest the line should be “Mortality” and not “Mortality function” Discussion: Good summary of overall etiologies and literature. Discussion mainly talks about imaging. There are other interesting findings that deserve discussion and context with regard to prior literature as well as clinical significance: for example-- -Lab abnormalities: many were statistically significant, but only some appeared to be different enough to be potentially clinically useful. What do the authors think? -It is interesting that the mean weight loss was not different between groups – is this surprising? How does it compare to previous studies? -Alcohol consumption in Table 1 is shows as being in a significantly greater percentage of patients in the Neoplastic group, but the quantified grams per day was not significant. How do the authors interpret this discrepancy? Is it similar to prior studies? Discussion should include limitations; could there be variability between providers at the RDU in how they conduct the workup? Consider discussing the limitations of the exclusion criteria, including dementia, lack of “family support”,etc, as it affects generalizability. Given the sheer number of statistical tests performed, consider discussing whether the study has a higher chance of type I errors. Line 46-48 – pls clarify – I believe you mean that the differences are due to including hospitalized patients in the other studies, eg “These differences may be due to … with specific symptoms in the other previously published studies.” Line 61 “The two studies” – pls state which two studies you are referring to (Bilbao-Garay and the authors’ study?). Lines 89-92: interesting idea, but could use more justification – are primary care providers not allowed to order CT scans or refer patients for endoscopy? It would help to understand the setting better in terms of generalizability. Similar to lines 66-67--there was endoscopy and CT scanning 10-20 years ago – at least in the US there was no lack of these modalities. Suggest using “yield” instead of “profitable” – the latter implies cost, while here we are really interested in diagnostic yield. References: 5 and 6 are duplicates. Reviewer #2: In this paper the authors reviewed retrospectively patients presented to the rapid diagnostic unit (RDU) for isolated involuntary weight loss (IWL) in a period between 2005 and 2013. The study was a single-center one. Follow up was performed at 1 year. From the 1592 identified patients, 791 (49.7%) met the criteria for enrollment into the study, which is the largest study to date for this group of patients. The main results of the study are that non-malignant organic diseases was the cause for IWL in 44.5%, psychiatric disorders in 29.0%, malignant diseases in 23.6%, and unknown causes in 3.2%. Mortality at 12 months was 18.6% overall, which was much higher in the malignant group 61.1% (95%CI: 54.2-68.2). The authors conclude that malignancy should be ruled out during the first visit for patients presenting with IWL. The manuscript is pretty well written, graphs illustrative, and its findings could be of some interest. The results of the paper are however not novel, add little to the existing data, but the cohort is large, though retrospective. The discussion section could have been constructed in a more attractive way. Besides, I think there are some issues with this paper: Major: 1. The main drawbacks are that it is a single center study with retrospective design. Also, the studied period ended with more than 7 years ago, which is of some concern. Why wasn’t the study period ended sooner, such as in 2019, with follow-up ending in 2020? 2. Materials and methods: the authors state that the study included “patients visited at the RDU between January 2005 and December 2013”, and that the “follow-up of the last patient was done in December 2014”. However, below, the authors state that the follow-up was of 6 months, which is different than the 1-year interval presented above. Please explain the difference. 3. Materials and methods: Please explain why patients with mild or chronic symptoms represented exclusion criteria for being referred to the RDU, because it is not clear, and because I suppose that most of the enrolled patients had some mild and chronic symptoms. 4. Results: Please review the fact that “mean weight loss in the past 12 months was 8.3 Kg (SD 4.7)”, because this would mean that some of the patients lost less than 5kg, which is a non-diagnostic criterion for IWL. See also the data in table 1, in which SD seems to be discordant between the columns of the amounts of weight loss. 5. In the conclusion of the paper, the authors state that “computed tomography is the most profitable complementary test to be performed in addition to complete anamnesis and blood tests for a good diagnostic approximation.” However, there is no discussion throughout the paper about the value of complete anamnesis and of blood tests in establishing the diagnosis in this cohort of patients. Minor: 1. Abstract: please replace “Mortality at 12 months was higher…” with “Mortality at 12 months was much higher…”, as the differences are quite important between the two groups. 2. Introduction: please replace “ambulatory rapid diagnostic unit (RDU) allow us…” by “ambulatory rapid diagnostic units (RDUs) allow us…”. Also, “In these RDU…” by “In these RDUs…”. 3. Introduction: please review the expression “organic or malignant 32 to 51%”; it could be organic or non-malignant, and there could be a mistake. 4. Material and methods: “Ethical Committee number CEIC 15/16” should be integrated into a sentence. 5. Material and methods: it is not clear what it is meant by “serious rhythm deposition changes”. Please rephrase or explain better. 6. Material and methods: The comma after “lymph nodes” should be deleted. 7. Table 1: change “UDR” to “RDU”. 8. Table 2: please rephrase “ESR, GGT i AP”. 9. Table 2: if the values between square brackets represent percentile 25-percentile 75, please state as such: [percentile 25-percentile 75], and not “(percentile 25-percentil75)”. 10. Results: please rephrase “11.9% of thoracoabdominal CTs showed images suspicious for malignancy (which proved to be false positive…” to “11.9% of thoracoabdominal CTs showed images considered suspicious for malignancy (which proved to be false positive…”. 11. Results: please add results of performing upper gastrointestinal endoscopy, not only colonoscopy, especially as below the authors state that “In the neoplastic group, 50% of gastroscopies… were histologically confirmed as malignant.” 12. Table 4: delete repeated word (benign). What do you mean by significant when referring to colon polyps? 13. Table 4: what does enolism stand for? 14. Results: please put “per cent” together. 15. Discussion: please rephrase: “Computed tomography is the most profitable complementary test”; profitable does not seem appropriate for this instance. 16. Figure 3: what do the figures below the graph represent (no. of patients at risk)? Is it the number of patients followed-up at the specific time intervals? It is not clear. ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.
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| Revision 1 |
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PONE-D-20-05824R1 Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit PLOS ONE Dear Dr. Aligué, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Reviewer 2 has raised some minor issues that need to be addressed before your manuscript can be accepted for publication. Please submit your revised manuscript by Jul 23 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jamie Males Staff Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: (No Response) ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes Reviewer #3: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: There are three minor comments: - in the material and methods section, line 111, please change "it was not able" to "it was not possible". - please review again the SD (standard deviations) for the amount of weight loss (kg) in Table 1 (in the first column SD in 4.7, while in all the others it is 0.3 and 0.8, which is somehow odd) - in the discussion section, lines 58-59, please amend this formulation, since gastric, colonic and pancreatic are digestive cancers. Reviewer #3: In this study, the authors use retrospective data collected at a single rapid diagnostic unit from years 2005-2013 of 791 patients presenting with involuntary weight loss above 5%. The cross-sectional visits are linked to diagnostic and mortality outcomes, allowing the authors to draw conclusions about IWL, disease, and mortality. The authors find, for example, that almost a quarter of patients with IWL were later diagnosed with cancer. Thank you for the opportunity to read this interesting manuscript. I joined as a reviewer following the first set of revisions, and can see that both the reviewers and authors have already substantially improved the paper. I have just a few comments. 1. Percentage weight lost. In the list of variables collected, is initial/presenting weight measured/asked? How is % lost calculated? If the variable is available, it should be presented in the descriptive tables. This is especially true in illnesses that occur more in men/women. For example, since women weigh less than men on average, and are more likely to present with psychiatric illness, the % weight lost would be higher in this category. This would be interesting to see. 2. Brief question about “family support”. The phrase is referred to a few times in the manuscript. A brief phrase expanding what is meant by it (and why support is important in predicting RDU usage) would be helpful to the reader. 3. Previous research. While I wouldn’t usually ask an author to refer to my own work when writing a review, I think it could benefit the current manuscript. My co-authors and I are demographers and sociologists, so while the paper uses different survey and analytic methods, the findings could be useful for comparison with this manuscript and encourage cross-discipline dialogue. Though the papers differ--our paper, for example, used a nationally-representative survey that considered people who were diagnosed before retrospective survey, we didn’t exclude based on symptoms, and respondents didn’t need to present to a physician to confirm weight change—we also find evidence of the important role cancer plays in IWL. Vierboom YC, Preston SH, Stokes A (2018) Patterns of weight change associated with disease diagnosis in a national sample. PLoS ONE 13(11): e0207795. https://doi.org/10.1371/journal.pone.0207795 4. Will there be statistical programming code available to readers, alongside the data? It’s becoming customary in my field to make not just the data but also the code that produced the analysis and tables publicly available, to encourage transparency and reproducibility (of course, may be different in the medical field). ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No Reviewer #3: Yes: Yana Vierboom [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
| Revision 2 |
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Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit PONE-D-20-05824R2 Dear Dr. Aligué, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jamie Males Staff Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes Reviewer #3: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: The authors addressed the previous comments in a concise and proper way. I think the manuscript was greatly improved so far. Reviewer #3: Thank you for addressing my comments. I have no further concerns. Thank you for your valuable contribution. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No Reviewer #3: No |
| Formally Accepted |
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PONE-D-20-05824R2 Etiologies and 12-month mortality in patients with isolated involuntary weight loss at a rapid diagnostic unit Dear Dr. Aligué: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr Jamie Males Staff Editor PLOS ONE |
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