A study to determine the efficacy and safety of tenoxicam versus piroxicam, diclofenac and indomethacin in patients with osteoarthritis: a meta-analysis.

OBJECTIVE: To obtain a better quantitative and qualitative estimate of the effect of tenoxicam (Tx) compared to piroxicam (Px), diclofenac (Dcl) and indomethacin (Ind) in the treatment of osteoarthritis (OA). METHODS: Relevant studies were identified using computerized Medline search, manual search of cited references and correspondence with investigators, colleagues and the manufacturer of Tx. Once the studies were selected and chosen on the basis of predetermined methodologic criteria, the required data were extracted by 2 authors, independently. Eighteen studies met the required eligibility criteria. Meta-analyses were undertaken on 12 studies of Tx vs Px, 3 studies of Tx vs Dcl, and 2 studies of Tx vs Ind. Efficacy was measured in 2 ways: (1) physician global rating scale and (2) pain scale. Safety was measured in 3 ways: (1) physician global rating scale, (2) number of patients with adverse events, and (3) dropouts due to adverse events. RESULTS: The following findings of the meta-analysis were statistically significant: In Tx vs Px comparisons, efficacy-(1), safety-(1) and safety-(3) were all better with Tx; in Tx vs Ind comparisons, safety-(1) and safety-(2) were better with Tx. All other findings showed no statistically significant differences between Tx and the comparison drug. CONCLUSIONS: Compared to Px, Tx performs better on physician assessment of efficacy and tolerability, but the other comparisons remain inconclusive. Compared to Dcl, there appears not to be a difference. Compared to Ind, Tx is safer.

Maternal and infant characteristics in abuse: a case control study.

Eighty-six abused children identified by two Children's Aid Societies in Hamilton-Wentworth County, Ontario, were compared with 86 controls born in the same hospital. Three factors were significantly more common in the abused group: (1) low socioeconomic status of the mother, (2) younger age at time of delivery, and (3) indication of a psychosocial problem recorded in the medical chart. The failure to find significant differences between abused children and controls in birthweight, Apgar score, and prematurity contrasts with earlier investigations of infant characteristics and child abuse.

Moving a private community family practice to a hospital-based teaching unit: patients' response.

Patients' response to the relocation of an established practice from the community to a hospital-based teaching unit was measured at the end of one year. Questionnaires were sent to a randomly selected group of adult patients, asking about their impressions of the new clinic or their reasons for switching practices. The major reason cited for changing practices was the change of geographic location, rather than the change from community to teaching practice. Although most patients had been seen by residents, ratings were unrelated to the number of residents or staff administering care.