Living with Dysphagia

Round 1

Reviewer 1 Report

Peer review comments on manuscript geriatrics-1634743

Thank you for inviting my peer review of this opinion piece entitled “Living with dysphagia” by John Mirams. I found this a moving account which relays the patient perspective of experiencing and living with dysphagia and powerfully points to shortfalls in the clinical care and in clinical research to address the problem of dysphagia.

I have a few minor suggestions for the author’s consideration:

It may help readers without medical background if some of the specialist medical terms could be explained in lay terms also, specifically “Lymphosarcoma in the nasopharynx” in line 8 and “osteoradionecrosis” in line 13.

I noticed that the term “dysphagia” is introduced in line 58. I wonder whether it could be helpful to introduce the term a little earlier in the narrative and also provide a lay explanation. Possibly in line 31, the sentence could read “This showed that I did have some swallowing problems (or, in medical terms, dysphagia), but there was ‘no serious cause’ for them,…”

In line 89, there is a reference to Professor Smithard’s view that dysphagia has been a ‘Sleeping Giant’ within the NHS for many years. As a reader, it seems that this piece is therefore linked, or in a way refers or responds to a piece by Professor Smithard. I wonder whether this could be made apparent, e.g., by inserting an in-text citation at this point; or perhaps by prefacing the entire piece by “in response to ….. by David Smithard”, or similar.

Line 101: There is a small typographical error: “research is desperately needed”.

Lines 101-103: I find the concluding paragraph of this piece provides a very fitting call to action, tying in with the author’s personal experience of dysphagia. In addition to further research into texture modification of food and rehabilitation of dysphagia, I wonder whether the author would also consider that further research is required into how the detection, comprehensive diagnosis and dedicated clinical management of dysphagia could best be implemented and ensured across clinical services? This presents a slightly different but complementary focus of research, as there is already a lot that can be offered in the diagnosis and management of dysphagia, but “getting it to the patient” can be patchy and unreliable.

Finally, I would like to thank the author for sharing his personal story and experiences in this way. Accounts like his very much enrich the academic literature and help remind clinicians and researcher of the reason we are doing our work – thank you.

Author Response

Herewith my revised manuscript for consideration, with the paragraphs containing changes highlighted in blue.

My only comment on the changes, which are based on the suggestions made by the expert referees, is that I believe we now have a clearer and more readable document, especially for non-medical readers, which carries a useful and important message about the ‘Sleeping Giant’.

Thank you for all your help.

Reviewer 2 Report

I herein review an opinion article as submitted by an individual. Quality and content of the article are superb. From my point of view, there are no medical aspects that should be corrected before accepting the manuscript for publication.

Obviously, as is the nature of an opinion article, criteria used to grade an original article such as scientific soundness etc. may not be applied in this case.

Author Response

Thank you for all your comments.