Prescrire international
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Lambert-Eaton myasthenic syndrome is a rare neurological syndrome of autoimmune origin. It is usually associated with small-cell lung cancer but may be idiopathic. The main clinical feature is potentially disabling limb muscle weakness. ⋯ Management is generally based on treatment of the underlying malignancy. Immunosuppressants are used in severe disease and in cases not associated with cancer, but they have limited efficacy. Symptomatic treatments are available but their efficacy is poorly documented.
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Prescrire international · Jun 2011
ReviewAcute heart failure with dyspnoea: initial treatment. Furosemide and trinitrine, despite the lack of a proven survival benefit.
For patients with acute heart failure and dyspnoea due to pulmonary congestion, the risk of death in the short term is high. To determine how best to manage these patients, we reviewed the relevant literature using the standard Prescrire methodology. There are few reliable clinical trial data. ⋯ Treatment is mainly based on loop diuretics, nitrate derivatives (when blood pressure is not too low) and non-invasive ventilation. It should be emphasised that these patients are highly unstable and that there is a narrow margin between beneficial and harmful effects of available treatments. Patients receiving treatment should always be closely monitored.
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Prescrire international · Jun 2011
2010 drug packaging review: identifying problems to prevent errors.
Prescrire's analyses showed that the quality of drug packaging in 2010 still left much to be desired. Potentially dangerous packaging remains a significant problem: unclear labelling is source of medication errors; dosing devices for some psychotropic drugs create a risk of overdose; child-proof caps are often lacking; and too many patient information leaflets are misleading or difficult to understand. Everything that is needed for safe drug packaging is available; it is now up to regulatory agencies and drug companies to act responsibly. In the meantime, health professionals can help their patients by learning to identify the pitfalls of drug packaging and providing safe information to help prevent medication errors.
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Prescrire international · May 2011
Autologous chondrocytes. Autologous chondrocyte implantation: more data needed.
There is no standard surgical treatment for young adults with persistent, incapacitating symptoms of knee cartilage damage. ChondroCelect is the first cell therapy product to be authorised in the European Union. It contains a dense suspension of chondrocytes cultured from a biopsy of the patient's knee cartilage for 4 weeks before being reimplanted. ⋯ Autologous chondrocyte implantation is more complex than microfracture. During routine use, there is a risk that one patient will inadvertently receive chondrocytes collected from another patient, leading to a risk of rejection. In practice, this autologous chondrocyte product should only be used by highly specialised teams, and its assessment must continue.