Pain is a common complaint, often occurring in conjunction with inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used analgesic agents in ambulatory patients. In ...recent studies, the cyclooxygenase-2 (COX-2) inhibitor rofecoxib demonstrated analgesic effects similar to those of NSAIDs in the treatment of acute pain and primary dysmenorrhea. The present randomized, single-dose, double-blind, doubledummy, placebo- and active-comparator-controlled, parallel-group study was undertaken to compare the analgesic efficacy of the COX-2 inhibitors rofecoxib 50 mg and celecoxib 200 mg with that of ibuprofen 400 mg and placebo in patients with postoperative dental pain. Two hundred and seventy-two patients experiencing pain after the removal of ≥ 2 third molars were randomized according to pain severity (moderate vs severe) to receive a single dose of placebo (n = 45), rofecoxib 50 mg (n = 90), celecoxib 200 mg (n = 91), or ibuprofen 400 mg (n = 46). Using a patient diary, patients recorded pain intensity, pain relief, and global evaluations throughout the 24-hour period after dosing. The overall analgesic effect, onset of action, peak effect, and duration of effect were evaluated, with the primary end point being total pain relief over 8 hours (TOPAR8). The safety profile was assessed on the basis of physical findings, laboratory results, and spontaneous reports of adverse experiences. The results showed that compared with celecoxib, rofecoxib had superior analgesic effects on all measures of analgesic efficacy, including overall analgesic effect (TOPAR8, 18.3 vs 12.5;
P < 0.001), time to onset of effect (30 vs 60 minutes;
P = 0.003), peak pain relief (score, 2.8 vs 2.3;
P < 0.05), and duration of effect (> 24 vs 5.1 hours;
P < 0.001). In addition, rofecoxib's analgesic efficacy was similar to that of ibuprofen (TOPAR8, 18.3 vs 17.0;
P = 0.460), but the duration was longer (
P < 0.05); with ibuprofen, the time to onset was 24 minutes, peak pain relief score was 2.9, and duration of analgesic effect was 8.9 hours. The safety profile was similar across all treatment groups. Thus rofecoxib provided analgesic efficacy superior to that of celecoxib and comparable to that of ibuprofen in the treatment of patients with acute postoperative dental pain.
CONTEXT In vitro studies have shown that celecoxib inhibits cyclooxygenase 2
(COX-2) but not COX-1, suggesting that this drug may have anti-inflammatory
and analgesic activity without adverse upper ...gastrointestinal (GI) tract effects
that result from COX-1 inhibition. OBJECTIVE To test whether celecoxib has efficacy as an anti-inflammatory and analgesic
with reduced GI tract mucosal damage compared with conventional nonsteroidal
anti-inflammatory drugs in patients with rheumatoid arthritis. DESIGN Randomized, multicenter, placebo-controlled, double-blind trial lasting
12 weeks, with follow-up at weeks 2, 6, and 12, from September 1996 thorugh
February 1998. SETTING Seventy-nine clinical sites in the United States and Canada. PATIENTS A total of 1149 patients aged 18 years or older with symptomatic rheumatoid
arthritis who met inclusion criteria were randomized; 688 (60%) of these completed
the study. INTERVENTIONS Patients were randomized to receive celecoxib, 100 mg, 200 mg, or 400
mg twice per day (n = 240, 235, and 218, respectively); naproxen, 500 mg twice
per day (n = 225); or placebo (n = 231). MAIN OUTCOME MEASURES Improvement in signs and symptoms of rheumatoid arthritis as assessed
using standard measures of efficacy and GI tract safety as assessed by upper
GI tract endoscopy before and after treatment, compared among treatment groups. RESULTS All dosages of celecoxib and naproxen significantly improved the signs
and symptoms of arthritis compared with placebo. Maximal anti-inflammatory
and analgesic activity was evident within 2 weeks of initiating treatment
and was sustained throughout the 12 weeks. The incidence of endoscopically
determined gastroduodenal ulcers in placebo-treated patients was 4 (4%) of
99, and the incidences across all dosages of celecoxib were not significantly
different (P>.40): 9 (6%) of 148 with 100 mg twice
per day, 6 (4%) of 145 with 200 mg twice per day, and 8 (6%) of 130 with 400
mg twice per day. In contrast, the incidence with naproxen was 36 (26%) of
137, significantly greater than either placebo or celecoxib (P<.001). The overall incidences of GI tract adverse effects were
19% for placebo; 28%, 25%, and 26% for celecoxib 100 mg, 200 mg, and 400 mg
twice per day, respectively; and 31% for naproxen. CONCLUSION In this study, all dosages of celecoxib were efficacious in the treatment
of rheumatoid arthritis and did not affect COX-1 activity in the GI tract
mucosa as evidenced by less frequent incidence of endoscopic ulcers compared
with naproxen.
The current research tests how comparisons in the moral domain differ from other social comparisons in three ways. First, an initial experience-sampling study shows that people compare downward more ...strongly in the moral domain than in most other domains (Study 1, N = 454), because people like to feel moral and present themselves as moral. Second, the classic threat principle of social comparison holds that people choose downward comparisons to improve their well-being after a threat to their self-esteem. We propose that in the moral domain the threat principle is intensified because morality is a uniquely important and central comparison domain. Across seven experiments (Experiments 2a and 2b, 3a-3c, 4a and 4b), we find that people search for downward comparisons much more than in other domains. This effect is so strong that people are willing to forgo money and incur time costs to avoid upward moral comparisons when threatened. Third, another classic principle of social comparison holds that people only consider comparisons that are diagnostic (i.e., close or similar) and therefore self-relevant, while dismissing extreme or dissimilar comparisons as irrelevant. We propose that this diagnosticity principle is attenuated because morality is a binding code that applies equally to all humans. Across four experiments (Experiments 5a and 5b, 6a and 6b), we find that even the most extreme and dissimilar moral (but not other) comparisons are deemed relevant and potentially threatening. Together, these twelve studies (total N = 5,543) demonstrate how moral comparisons are a ubiquitous but fundamentally distinct form of social comparison with altered basic principles.
Full text
Available for:
CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
4.
Network Meta-Analysis Watt, Jennifer; Del Giovane, Cinzia
Methods in molecular biology (Clifton, N.J.),
2022, Volume:
2345
Journal Article
There are often multiple potential interventions to treat a disease; therefore, we need a method for simultaneously comparing and ranking all of these available interventions. In contrast to pairwise ...meta-analysis, which allows for the comparison of one intervention to another based on head-to-head data from randomized trials, network meta-analysis (NMA) facilitates simultaneous comparison of the efficacy or safety of multiple interventions that may not have been directly compared in a randomized trial. NMAs help researchers study important and previously unanswerable questions, which have contributed to a rapid rise in the number of NMA publications in the biomedical literature. However, the conduct and interpretation of NMAs are more complex than pairwise meta-analyses: there are additional NMA model assumptions (i.e., network connectivity, homogeneity, transitivity, and consistency) and outputs (e.g., network plots and surface under the cumulative ranking curves SUCRAs). In this chapter, we will: (1) explore similarities and differences between pairwise and network meta-analysis; (2) explain the differences between direct, indirect, and mixed treatment comparisons; (3) describe how treatment effects are derived from NMA models; (4) discuss key criteria predicating completion of NMA; (5) interpret NMA outputs; (6) discuss areas of ongoing methodological research in NMA; (7) outline an approach to conducting a systematic review and NMA; (8) describe common problems that researchers encounter when conducting NMAs and potential solutions; and (9) outline an approach to critically appraising a systematic review and NMA.
In this innovative celebration of diversity and affirmation of individuality in animals and humans, Joan Roughgarden challenges accepted wisdom about gender identity and sexual orientation. A ...distinguished evolutionary biologist, Roughgarden takes on the medical establishment, the Bible, social science--and even Darwin himself. She leads the reader through a fascinating discussion of diversity in gender and sexuality among fish, reptiles, amphibians, birds, and mammals, including primates. Evolution's Rainbow explains how this diversity develops from the action of genes and hormones and how people come to differ from each other in all aspects of body and behavior. Roughgarden reconstructs primary science in light of feminist, gay, and transgender criticism and redefines our understanding of sex, gender, and sexuality. Witty, playful, and daring, this book will revolutionize our understanding of sexuality. Roughgarden argues that principal elements of Darwinian sexual selection theory are false and suggests a new theory that emphasizes social inclusion and control of access to resources and mating opportunity. She disputes a range of scientific and medical concepts, including Wilson's genetic determinism of behavior, evolutionary psychology, the existence of a gay gene, the role of parenting in determining gender identity, and Dawkins's "selfish gene" as the driver of natural selection. She dares social science to respect the agency and rationality of diverse people; shows that many cultures across the world and throughout history accommodate people we label today as lesbian, gay, and transgendered; and calls on the Christian religion to acknowledge the Bible's many passages endorsing diversity in gender and sexuality. Evolution's Rainbow concludes with bold recommendations for improving education in biology, psychology, and medicine; for
democratizing genetic engineering and medical practice; and for building a public monument to affirm diversity as one of our nation's defining principles.
Many research questions involve comparing predictions or effects across multiple models. For example, it may be of interest whether an independent variable's effect changes after adding variables to ...a model. Or, it could be important to compare a variable's effect on different outcomes or across different types of models. When doing this, marginal effects are a useful method for quantifying effects because they are in the natural metric of the dependent variable and they avoid identification problems when comparing regression coefficients across logit and probit models. Despite advances that make it possible to compute marginal effects for almost any model, there is no general method for comparing these effects across models. In this article, the authors provide a general framework for comparing predictions and marginal effects across models using seemingly unrelated estimation to combine estimates from multiple models, which allows tests of the equality of predictions and effects across models. The authors illustrate their method to compare nested models, to compare effects on different dependent or independent variables, to compare results from different samples or groups within one sample, and to assess results from different types of models.
Facebook and offline social comparisons have been associated with depressive symptoms, however no study has simultaneously examined comparison tendencies across both settings as predictors of ...depressive symptomology. Accordingly, this study investigated the difference between comparison orientation (tendency to make comparisons) and direction on Facebook and offline, and the predictive utility of these comparisons on depressive symptoms. A convenience sample of 181 young adults aged 18 to 25 years (Mage = 21.90 years, SD = 2.14; 51 males, 130 females) completed an online questionnaire measuring comparisons, depressive symptoms and Facebook use. Paired samples t-tests indicated that participants had higher comparison tendencies offline, CI 1.97, 4.18, d = 0.40, and had more negative comparison tendencies on Facebook, CI −6.37, −2.58, d = 0.25. Hierarchical multiple regression indicated that offline orientation and negative direction predicted significant unique variance in depressive symptoms (2.6% and 9.4% respectively, f2 = 0.33), whilst Facebook orientation and direction did not. Findings indicate that Facebook comparison tendencies may simply reflect offline comparison tendencies, and that depressive symptoms may be a result of a general tendency to compare across both settings.
Jacoby and colleagues used an iterative rhythm reproduction paradigm with listeners from around the world to provide evidence for both rhythm universals (simple-integer ratios 1:1 and 2:1) and ...cross-cultural variation for specific rhythmic categories that can be linked to local music traditions in different regions of the world.
Jacoby and colleagues used an iterative rhythm reproduction paradigm with listeners from around the world to provide evidence for both rhythm universals (simple-integer ratios 1:1 and 2:1) and cross-cultural variation for specific rhythmic categories that can be linked to local music traditions in different regions of the world.
Abstract Despite the great realized or potential value of network meta-analysis of randomized controlled trial evidence to inform health care decision making, many decision makers might not be ...familiar with these techniques. The Task Force developed a consensus-based 26-item questionnaire to help decision makers assess the relevance and credibility of indirect treatment comparisons and network meta-analysis to help inform health care decision making. The relevance domain of the questionnaire (4 questions) calls for assessments about the applicability of network meta-analysis results to the setting of interest to the decision maker. The remaining 22 questions belong to an overall credibility domain and pertain to assessments about whether the network meta-analysis results provide a valid answer to the question they are designed to answer by examining 1) the used evidence base, 2) analysis methods, 3) reporting quality and transparency, 4) interpretation of findings, and 5) conflicts of interest. The questionnaire aims to help readers of network meta-analysis opine about their confidence in the credibility and applicability of the results of a network meta-analysis, and help make decision makers aware of the subtleties involved in the analysis of networks of randomized trial evidence. It is anticipated that user feedback will permit periodic evaluation and modification of the questionnaire.
Financial Management for Health-System Pharmacists, 2nd edition, serves as a guidebook to support the management of enterprise pharmacy finance across business and care continuums. The 2nd edition ...engages the reader with a mix of chapters, some new to this edition, along with a trove of new health-system pharmacy financial business cases. As leaders look to transform their organizations, the principles and practices provided give the reader the knowledge and guidance to craft a new path forward as they look to improve the provision of pharmacy and patient-care services.
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