In patients with RA, rofecoxib demonstrates a greater degree of efficacy than placebo, while having a comparable safety profile. Rofecoxib demonstrates a similar degree of efficacy as naproxen, but with a significantly lower rate of ulceration and gastrointestinal bleeding. Rofecoxib was associated with a greater risk for MI, but the exact significance and pathophysiology of this possible relationship is unclear. Rofecoxib was voluntarily withdrawn from global markets in October 2004. It cannot therefore be prescribed and therefore there are no implications for practice concerning its use. None the less when considering which NSAID to use, it must be borne in mind that the toxicity of NSAIDs is variable amongst patients and drugs and it tends to be dose related and associated with variation in the mode of action, absorption, distribution and metabolism. There remains a number of questions over both the benefits and risks associated with Cox II selective agents and further work is ongoing. It is likely that this issue will not be resolved until research has enabled a fuller understanding of the complex mechanism by which the Cox system operates.
For an individual with RA the potential benefits of celecoxib need to be balanced against the uncertainty that the short-term reduced incidence of upper GI complications are maintained in the long-term and its increased cost in comparison to traditional NSAIDs.
In patients with RA, rofecoxib demonstrates a greater degree of efficacy than placebo, while having a comparable safety profile. Rofecoxib demonstrates a similar degree of efficacy as naproxen, but with a significantly lower rate of ulceration and gastrointestinal bleeding. Rofecoxib was associated with a greater risk for MI, but the exact significance and pathophysiology of this possible relationship is unclear.
No abstract
Background: The Cochrane Library databases are available via different interfaces; evidence in the literature, together with anecdotal evidence, shows interfaces perform differently. To ensure the quality of searches, a study was undertaken to systematically explore the functionality of interfaces. Objectives: To demonstrate differences in functionality when searching the same databases across different interfaces; to discuss the implications this may have on searching; and in a wider context, to suggest a 'best match' for comparable searching. Methods: Detailed cross-comparisons of a selection of search functions including MeSH terms, free text, proximity operators and truncation were undertaken in databases accessed via CRD, Wiley and Ovid. Up to three terms per function were selected and analysed. Results: Differences were identified in the way searches for MeSH headings are executed, which fields are searched, how proximity operators perform, the word order searched and where terms are searched. This adds to a body of evidence demonstrating a lack of consistency in searching across different interfaces. Conclusions: A 'best match' for comparable searching is suggested. Differences between interfaces offering the same database content can have implications for the success of a search, on user education, and on database evaluation and purchasing decisions.
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