Introduction Vulvar lichen sclerosus (LS) is a chronic inflammatory and mutilating disease, which goes often undetected for years. Advanced disease severely affects quality of life like sexual disorders and is also associated with an increased risk of vulvar cancer. Aim To develop and validate a patient-administered symptom score and a physician-administered clinical score for the diagnosis and evaluation of vulvar LS. Methods We included 24 patients with established LS diagnosis and 49 with other vulvar disease. The physician-administered score was based on six clinical features and the patient-administered score was a symptom-based four-item composite score. We determined inter-item correlations and internal consistency of both scores, and estimated sensitivities, specificities, likelihood ratios, and posttest probabilities for different cutoffs of the physician-administered score. Main Outcome Measures Characteristics of patients with and without LS were compared using χ2 and unpaired t-test as required. We then determined Cronbach’s alpha as a measure of the overall consistency of scores and calculated positive and negative likelihoods. Results Lack of redundancy of items (correlation coefficients < 0.90) and internal consistency (Cronbach’s α≥ 0.70) suggested that final composite scores were valid and yielded excellent power to rule in LS. Conclusion Scores may be useful for assessing symptoms of vulvar disorders, to ease diagnosis of LS and to evaluate treatment response over time.

ObjectiveTo compare the effects of antiplatelets and anticoagulants on stroke and death in patients with acute cervical artery dissection.DesignSystematic review with Bayesian meta-analysis.Data SourcesThe reviewers searched MEDLINE and EMBASE from inception to November 2012, checked reference lists, and contacted authors.Study SelectionStudies were eligible if they were randomised, quasi-randomised or observational comparisons of antiplatelets and anticoagulants in patients with cervical artery dissection.Data ExtractionData were extracted by one reviewer and checked by another. Bayesian techniques were used to appropriately account for studies with scarce event data and imbalances in the size of comparison groups.Data SynthesisThirty-seven studies (1991 patients) were included. We found no randomised trial. The primary analysis revealed a large treatment effect in favour of antiplatelets for preventing the primary composite outcome of ischaemic stroke, intracranial haemorrhage or death within the first 3 months after treatment initiation (relative risk 0.32, 95% credibility interval 0.12 to 0.63), while the degree of between-study heterogeneity was moderate (τ2 = 0.18). In an analysis restricted to studies of higher methodological quality, the possible advantage of antiplatelets over anticoagulants was less obvious than in the main analysis (relative risk 0.73, 95% credibility interval 0.17 to 2.30).ConclusionIn view of these results and the safety advantages, easier usage and lower cost of antiplatelets, we conclude that antiplatelets should be given precedence over anticoagulants as a first line treatment in patients with cervical artery dissection unless results of an adequately powered randomised trial suggest the opposite.