Prescrire international
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Prescrire international · Jan 2013
ReviewLocally advanced prostate cancer: effective treatments, but many adverse effects.
Locally advanced prostate tumours, i.e. those that extend beyond the prostate gland but are not metastatic, often carry a poor prognosis: between 10% and 40% of patients die within 5 years after diagnosis. Various treatments are proposed to improve their prognosis. Which treatments have a proven survival benefit, and what are their adverse effects? To answer these questions, we reviewed the literature using the standard Prescrire methodology. ⋯ The adverse effects of gonadorelin agonists often undermine patients' quality of life, due to hot flushes, loss of libido, erectile dysfunction, gynaecomastia, osteoporosis, weight gain, cardiovascular events, and diabetes. In mid-2012, European clinical practice guidelines recommend a combination of radiation therapy and androgen suppression for 2 to 3 years for most patients with locally advanced prostate cancer. Before choosing between therapeutic options, it is crucial to take into account the patient's priorities in terms of treatment efficacy and adverse effects, and reversibility of adverse effects.
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Surgical errors recorded between 2002 and 2008 in a US medical liability insurance database have been analysed. Twenty-five wrong-patient procedures were recorded, resulting in 5 serious adverse events: three unnecessary prostatectomies were performed after prostate biopsy samples were mislabelled; vitrectomy was performed on the wrong patient in an ophthalmology department after confusion between two patients with identical names; and a child scheduled for adenoidectomy received a tympanic drain. There were also 107 wrong-site procedures, with one death resulting from implantation of a pleural drain on the wrong side. ⋯ Final pre-operative checks must be applied methodically and systematically. This includes asking the patient to confirm his/her identity and the intended site of the operation. Healthcare staff must be aware of these measures.
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Prescrire international · Dec 2012
Herpes zoster vaccine. Poorly effective in those who need it most.
The results of a clinical trial suggest that zoster vaccination (Zostavax, Sanofi Pasteur MSD) of 1000 healthy persons aged 60 years or over prevents approximately one case of postherpetic neuralgia each year over the next 3 years. Vaccination is less effective in persons over 70 years of age. The results of another clinical trial suggest that vaccination of 1000 healthy persons aged 50 to 59 years prevents about 5 cases of herpes zoster over the following year. ⋯ In one study, the immune response to the vaccine was lower after simultaneous immunisation with a 23-valent pneumococcal polysaccharide vaccine. This live zoster vaccine is contraindicated in immunocompromised individuals, yet they are at highest risk of severe zoster. In practice, zoster vaccination is not sufficiently effective in the elderly to justify its widespread use.
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Prescrire international · Dec 2012
Comparative StudyFurosemide in acute decompensated heart failure.
In a comparative clinical trial in 308 patients with acute decompensated heart failure, the relief achieved with intravenous furosemide at a dose equivalent to the daily oral dose patients were receiving prior to the acute episode was very similar to that obtained with higher doses of intravenous furosemide. Increasing the dose of intravenous furosemide did not improve the outcome.