Prescrire international
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Prescrire international · Nov 2010
ReviewAspirin and primary cardiovascular prevention. Uncertain balance between benefits and risks.
Most individuals with no pre-existing cardiovascular disease have a low risk of experiencing arterial thrombosis. Using the standard Prescrire methodology, we reviewed the literature on the risk-benefit balance of aspirin in the primary prevention of cardiovascular events. In the general population, a meta-analysis in 95 456 persons suggests that aspirin has no effect on either total or cardiovascular mortality. ⋯ When the cardiovascular risk is higher than in the general population, for example in patients with risk factors, the weak preventive effects of aspirin on myocardial infarction and ischaemic stroke may outweigh the small extra risk of bleeding. The possible value of aspirin for cardiovascular prevention should be discussed with each individual patient. In general, it is preferable to recommend measures with a proven impact on mortality, such as dietary changes, smoking cessation, or drug therapy for patients with risk factors.
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Prescrire international · Nov 2010
ReviewIcatibant. Attacks of hereditary angioedema: continue to use C1 esterase inhibitor.
Hereditary angioedema is a severe genetic disorder due to C1 esterase inhibitor deficiency, which leads to an excess of bradykinin. It is characterised by attacks of subcutaneous or mucosal oedema, which can carry a risk of asphyxiation if the larynx is involved. The first-choice symptomatic treatment for attacks is intravenous C1 esterase inhibitor administration. ⋯ In practice, in the absence of head-to-head comparisons, it remains to be shown whether or not icatibant has a better risk-benefit balance than C1 esterase inhibitor. Due to inconsistencies between the results and numerous biases in the two main clinical trials, the evidence supporting the efficacy of icatibant is weak. C1 esterase inhibitor remains the first-choice treatment for patients with acute attacks of hereditary angioedema.
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There is no firm evidence that intranasal fentanyl is more effective than buccal fentanyl. The packaging is not entirely safe, thus exposing patients and others to major risks.
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The realisation that an error has been committed, and the courage to discuss it openly, opens the way to a constructive process to improve one's professional practices, in interaction with healthcare organisations. Reporting errors to adverse events programmes is influenced by the impact of errors on healthcare professionals and their fears about the outcome and disclosure. The low rate of spontaneous reporting results from the obstacles encountered by healthcare professionals and reflects their attitudes towards their own errors. ⋯ Reporting an error to a programme such as Prescrire's Preventing the Preventable is a conscious, professional act. It is both lucid and responsible, and part of a commitment to improving professional practice and skills, at the individual and institutional level. Learning from errors in order to prevent them from happening again supports the development of a quality and safety culture that should be encouraged among healthcare professionals.