Prescrire international
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Vaccines against human papillomavirus (HPV) types 6/11/16/18 (Gardasil) and 16/18 (Cervarix) are non-viable vaccines composed of recombinant HPV proteins. As a precaution, they should not be given during pregnancy. However, some women are vaccinated shortly before conceiving or early during an undiagnosed pregnancy. ⋯ There are more, relatively reassuring, data on the HPV 6/11/16/18 vaccine. Women who are vaccinated just before conceiving or early in pregnancy should receive appropriate information. Active pharmacovigilance must continue.
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Prescrire international · May 2012
Review2011 drug packaging review: too many dangers and too many patients overlooked.
Every year, Prescrire's analysis of drug packaging confirms the importance of taking packaging into account in assessing a drug's harm-benefit balance. Safe, tried and true options are available, yet the quality of most of the drug packaging Prescrire examined in 2011 left much to be desired. Few of the packaging items examined help prevent medication errors and many actually increase the risks: misleading and confusing labelling, dosing devices that create a risk of overdose, bottles without a child-proof cap, and inadequate or dangerous patient information leaflets. ⋯ Some patients are at greater risk: the patient leaflets for NSAIDs endanger pregnant women and their unborn babies; children are insufficiently protected by paediatric packaging and are at risk due to the lack of child-proof caps on too many bottles. The raft of regulatory measures taken by the French drug regulatory agency (Afssaps) in the aftermath of the Mediator disaster overlooked the importance of packaging. Until drug regulatory agencies tackle the vast issue of drug packaging, it is up to healthcare professionals to protect patients from harm.
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Prescrire international · Feb 2012
Review Comparative StudyDabigatran and atrial fibrillation: the alternative to warfarin for selected patients.
For patients with atrial fibrillation and a high risk of thrombosis, the standard prophylaxis is warfarin, an anticoagulant, at a dose adjusted to the INR. Warfarin and aspirin are both reasonable choices for patients with a moderate risk of thrombosis. Dabigatran, an oral anticoagulant that inhibits thrombin, has been authorised for patients with atrial fibrillation and a moderate or high risk of thrombosis, without associated valvular abnormalities. ⋯ In practice, warfarin remains the standard drug for patients with atrial fibrillation and a moderate or high risk of thrombosis. Aspirin is an alternative for moderate-risk patients. When the risk is significant and the INR cannot be maintained within the target range despite close monitoring, dabigatran is the alternative to warfarin, provided the patient is closely monitored, especially for changes in renal function.
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Prescrire international · Feb 2012
ReviewPregnancy and alcohol: occasional, light drinking may be safe.
Many pregnant women drink varying quantities of alcohol, although several guidelines recommend total abstinence. What is known of the dangers of alcohol for the outcome of pregnancy and for the unborn child? To answer this question, we conducted a review of the literature using the standard Prescrire methodology. Fetal alcohol syndrome, which combines facial dysmorphism, growth retardation and intellectual disability, occurs in about 5% of children who are regularly exposed to at least five standard units per day (about 50 g of alcohol per day). ⋯ A clinical trial showed that women with at-risk drinking were more likely to reduce their consumption if they were informed of the risks for their pregnancy and their unborn child on several occasions than if they were simply given an information leaflet. In practice, women must be informed of the risks of alcohol consumption during pregnancy, but this must be done tactfully. The risks of minimal alcohol consumption should not be overstated.
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Prescrire international · Nov 2011
ReviewAnalgesia for terminally ill adult patients. Preserve quality of life.
Adequate pain management is crucial in maintaining the best possible quality of life for terminally ill patients. This article examines pain management in the palliative care setting, based on a review of the literature using the standard Prescrire methodology. Accurate pain evaluation, preferably by the patient, is essential for guiding treatment decisions. ⋯ Cannabinoids are another option but have not been adequately assessed. Localised refractory pain may respond to local anaesthesia, chemical neurolysis or surgical ablation. In practice, it is best to allow patients to control their own analgesic consumption, within limits set by their physician to prevent dosing errors.