Prescrire international
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Without treatment, patients with inoperable or metastatic colorectal cancer have a median life expectancy of about 8 months. The following article is an update of our 2005 review of chemotherapy regimens used in metastatic colorectal cancer, based on the standard Prescrire methodology. In 2005, the de Gramont protocol, based on fluorouracil (always combined with folinic acid) plus either oxaliplatin (Folfox protocol) or irinotecan (Folfiri protocol), was the standard first-line chemotherapy in this setting. ⋯ When the metastases are inoperable and are unlikely to become operable after chemotherapy, it seems best to begin treatment with single-agent fluorouracil (+ folinic acid) or capecitabine. The use of monoclonal antibodies in first-line treatment of patients with colorectal cancer is not justified. Further trials of these drugs are warranted as second-line treatment for patients with KRAS wild-type tumours.
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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.