Those referred are mostly healthy individuals; the sample covers a large age span and should be more representative than clinical studies or studies restricted to specific age groups or clinical settings (like pregnant or postpartum women).
Supra-threshold measures, such as pain tolerance and ratings of tonic pain intensity, provide additional information on the pain system, and may be more representative of clinical pain [5, 6].
This study was conducted at multiple sites and can therefore be considered more representative of clinical practice in the US compared to previous studies.
The study sample covers a large age span and both genders, and is considered more representative than clinical studies, often restricted to specific groups.
These data may, however, be more representative of clinical situations where laboratories differ in the sensitivity with which they measure ER expression and cut-off points and scoring systems for ER positivity vary.
Mean age of patients was 76.1 years, 35% of patients had an ejection fraction of >35%, and 37% were women resulting in a unique cohort, far more representative of clinical practice than previous trials.
The use of electronic medical record (EMR) databases allows for the identification of very large-scale patient cohorts in a setting much more representative of clinical practice than prospective studies carried out in selective cohorts.
We therefore believe that, with the current concept of only treating symptomatic and/or severe prolapse and knowing that a percentage of women will opt for conservative measures such as vaginal pessaries, the lifetime surgical risk reported in our study is likely to be more representative of clinical practice in the UK and European countries.
The community-based nature of the study is one of the major strengths of this work, which makes patient typology more representative of daily clinical practice than that of randomized clinical trials.
Since clinical use is now feasible and will probably be approved by regulatory agencies in the near future, it is imperative that the diagnostic performance, added clinical value, and cost-effectiveness of this technique be studied systematically and in populations more representative of real clinical practice.
