Prescrire international
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Prescrire international · Dec 2016
Prescrire's Médicaments en Questions: First results of a practice improvement programme.
In 2014, Prescrire launched a new distance-learning practice improve- ment programme for subscribers to our French edition, called M6dicaments en Questions (Medicines in Question). The aim of this programme is to help healthcare professionals take greater account of the harmful effects of drug treatments in their daily practice, manage adverse effects better, and help to reduce their inci- dence and severity. This programme is based on a reflexive approach: participants describe, analyse and compare their practices; update and improve their knowledge base; exchange ideas with other health professionals; and devel- op strategies for improvement. The results of the first session (2014-2015) have been encouraging: participants took greater account of adverse effects, exposed fewer patients to the harms of drugs that have an unfavourable harm-benefit balance, communicated better with other healthcare professionals, found it easier to discuss adverse effects with patients, and were encouraged to report adverse effects to the public pharmacovigilance system.
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Prescrire international · May 2017
ReviewThrombophilia: Testing rarely useful after a venous thromboembolic event.
Some people have coagulation abnormalities, collectively referred to as thrombophilia, which increase the risk of thrombosis. What are the most frequently detected thrombophilia? Does throm- bophilia testing after a venous thromboembolic event enable effective adjustment of the treatment strategy?To answer these questions, we reviewed the available evidence using the standard Prescrire methodology. The best known inherited thrombophilia includes the factorV Leiden mutation and the prothrombin G20210A mutation. ⋯ Clinical guidelines only suggest performing thrombophilia testing after a venous thromboem- bolic event in certain situations, for patients with no identified risk factors for recurrence, when the result might influence the decision to continue or stop anticoagulation: testing for inherited thrombophilia if a close relative had unexplained venous thrombosis at a young age, and antiphospholipid antibody testing. The identification of a thrombophilia can lead to overestimating the risk of thrombosis, and underestimating the risk of bleeding in patients receiving anticoagulation. In practice, thrombophilia testing is rarely useful following venous thromboembolism, except perhaps to clarify the risk of recurrence in some patients in whom the thromboembolic event was unexplained, when deciding whether to discon- tinue anticoagulation.
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Prescrire international · Nov 2015
Review Comparative StudyE-cigarettes and smoking cessation. Similar efficacy to other nicotine delivery devices, but many uncertainties.
E-cigarettes, marketed as an alternative to conventional cigarettes, are designed to transform a solution of variable composition, with or without nicotine, into an aerosol that the user inhales. How effective are e-cigarettes as an aid to smoking cessation, and what are their known adverse effects? To answer these questions, we conducted a review of the literature using the standard Prescrire methodology. A randomised trial involving 657 individuals who wanted to stop smoking compared e-cigarettes (with or without nicotine) with nicotine patches. ⋯ Apart from the effects of nicotine, there are few known adverse effects. However, there are many uncertainties as to the composition of the different e-liquids and the long-term effects of the substances when they are heated and inhaled. There is no reason to discourage smokers from substituting the proven, serious harms of tobacco smoke with the potential and poorly defined harms associated with e-cigarettes.
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Prescrire international · Apr 2016
ReviewIbrutinib (Imbruvica). Relapsed chronic lymphocytic leukaemia and mantle cell lymphoma: uncertain impact on survival.
codynamic interactions are also likely in view of its adverse effect profile. There is no consensus on the treatment of patients with refractory or relapsed mantle cell lymphoma, or for patients with relapsed or possibly refractory chronic lymphocytic leukaemia. Ibrutinib inhibits an enzyme involved in regulating B lymphocyte activity. ⋯ The main adverse effects of ibrutinib were: gastrointestinal disorders such as diarrhoea; life-threatening infections and bleeding disorders; and cardiac disorders, including atrial fibrillation. Ibrutinib carries a risk of multiple pharmacokinetic interactions. Pharmacodynamic interactions are also likely in view of its adverse effect profile.
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Prescrire international · Feb 2016
Review"Weak" opioid analgesics. Codeine, dihydrocodeine and tramadol: no less risky than morphine.
So-called weak opioid analgesics are often used to treat severe pain, or when paracetamol or a nonsteroidal anti-inflammatory drug (NSAID) proves inadequate. But are weak opioids any more effective than paracetamol or NSAIDs on nociceptive pain, and are they better tolerated than morphine? To answer these questions, we conducted a review of literature using the standard Prescrire methodology. The potency of codeine and tramadol is strongly influenced by the cytochrome P450 isoenzyme CYP2D6 genotype, which varies widely from one person to another. ⋯ There is also a sometimes unpredictable risk of serious over-dose. Tramadol has additional adverse effects unrelated to its opioid effects. Weak opioids require at least as much vigilance as morphine, despite the major differences in their reputation and regulation.