Prescrire international
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Prescrire international · Dec 2013
ReviewTreatment of ductal carcinoma in situ: an uncertain harm-benefit balance.
Ductal carcinoma in situ develops in the milk ducts without invading the surrounding connective tissue. Progression to invasive carcinoma is slow and infrequent and is thus difficult to predict. Screening mammography has increased the number of women diagnosed with early-stage ductal carcinoma in situ. ⋯ Lumpectomy is associated with a higher risk of recurrence and thus requires closer monitoring. Radiation therapy reduces the risk of recurrence in high-risk situations but has noteworthy adverse effects. Simple clinical monitoring is a valid option for asymptomatic patients: it carries a risk of progression to invasive cancer but avoids exposing many women to the adverse effects of surgery and radiation therapy.
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Prescrire international · Dec 2013
Rivaroxaban and pulmonary embolism: no better than established anticoagulant therapy.
No tangible advantage over heparin therapy followed by a vitamin K antagonist, in an unblinded trial.
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A meningococcal vaccine conjugated to protein CRM 197 (Menveo) is the standard vaccine for immunisation against invasive meningococcal infections caused by serogroups A, C, W135 andY, beginning at age 2 years. Nimenrix, another vaccine against meningococcal groups A, C,W135 and Y, conjugated to tetanus toxoid, was authorised for use in the European Union, starting at age 1 year. The two tetravalent meningococcal conjugate vaccines have not been compared in head-to-head trials. ⋯ In children over 2 years of age, Nimenrix has no advantages over Menveo for vaccination against meningococcal serogroups A, C, W135 andY. In contrast, between the ages of 1 and 2 years, Nimenrix is the only vaccine with established immunogenicity. In addition, it has an acceptable harm-benefit balance.
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About 80% of strokes are ischaemic. Approximately 12% of patients die within 3 months following stroke, and another 20% are institutionalised or become highly dependent. In early 2013, what is the harm-benefit balance of antithrombotic treatments used in the acute phase of ischaemic stroke? To answer this question, we reviewed the available data using the standard Prescrire methodology. ⋯ Rapid intervention and patient selection are both crucial in optimising the harm-benefit balance of intravenous alteplase thrombolysis. This treatment should only be used when management begins within the first hours following stroke symptom onset, and when there are no risk factors for bleeding, especially intracranial bleeding. For other patients, aspirin is the only antithrombotic drug known to reduce, albeit only slightly, the risk of death and sequelae following ischaemic stroke.