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Biomedical subjects

Vincent Lo

Publications and source records attributed to Vincent Lo.

12 recordsLinked to original sources
PubMed2006

When should COX-2 selective NSAIDs be used for osteoarthritis and rheumatoid arthritis?

Cyclo-oxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) are as effective as acetaminophen and nonselective NSAIDs in treating of osteoarthritis, and are equally effective in reducing pain and inflammation and improving of joint function for patients with rheumatoid arthritis, when compared with nonselective NSAIDs. The COX-2 selective NSAIDs also have a better gastrointestinal safety profile in short-term (6-12 month) treatment (strength of recommendation [SOR]: A, based on meta-analysis of randomized controlled trials with patient-oriented outcomes). However, with recent growing concern of the cardiovascular safety of COX-2 selective NSAIDs, it is imperative to select appropriate patients by considering benefit vs risks, which include serious gastrointestinal bleeding, history of intolerance to nonselective NSAID, cardiovascular disease or associated risks, renal disease, patient's preference, and cost.

Anti-Ulcer Agents↗
PubMed2006

Clinical inquiries. Which medications can be split without compromising efficacy and safety?

Split tablets of lisinopril are as effective as whole tablets of the same dose for hypertension (strength of recommendation [SOR]: B, based on small randomized crossover study). Similarly, split tablets of atorvastatin, lovastatin, and simvastatin are no less effective for lowering cholesterol (SOR: B, based on retrospective cohort studies). Extended-release, enteric-coated, or tablets that cannot be split accurately are not appropriate for splitting (SOR: C, based on observational studies); the accuracy of splitting also depends on device used and user skill (SOR: C, based on observational study).

Clinical Trials as Topic↗
PubMed2006

Clinical inquiries. What is the best medical therapy for new-onset type 2 diabetes?

Sulfonylureas, metformin, thiazolidinediones, and non-sulfonylurea secretagogues differ little in their ability to decrease glycosylated hemoglobin (Hb A1c) levels when used as initial monotherapy for diabetes mellitus type 2 (strength of recommendation [SOR]: A, based on systematic reviews); alpha-glucosidase inhibitors may also be as effective (SOR: B, based on systematic reviews with inconsistent results). Metformin is generally indicated in obese patients because it improves all-cause mortality and diabetes related outcomes (SOR: B, based on a single high-quality randomized controlled trial [RCT]). Insulin is generally not recommended as an initial agent (SOR: C, expert opinion).

Diabetes Mellitus, Type 2↗
PubMed2006

Clinical inquiries. What is the role of combination therapy (insulin plus oral medication) in type 2 diabetes?

Combination therapy using insulin plus metformin (Glucophage), a sulfonylurea, or both produces glycemic control comparable with using insulin alone, but there is less weight gain when metformin is used (strength of recommendation [SOR]: B, based on systematic review of randomized controlled trials [RCTs] with some heterogeneity). Combination therapy using insulin and pioglitazone (Actos) reduces glycosylated hemoglobin (Hb A1c) more than either insulin alone or adding pioglitazone to a sulfonylurea, but results in more weight gain (SOR: A, based on RCT). Using insulin glargine (Lantus) in combination therapy produces fewer nocturnal hypoglycemic events than using neutral protamine Hagedorn (NPH) insulin, while producing equivalent Hb A1c reduction (SOR: B, based on RCT). When the HbA1c is high (above 9.0% to 9.5%) on 1 or 2 oral agents, beginning combination therapy is more effective than adding another oral agent (SOR: B, based on subpopulation analysis in RCTs).

Diabetes Mellitus, Type 2↗
PubMed2004

The two-minute walk test as a measure of functional capacity in cardiac surgery patients.

OBJECTIVE: To examine construct validity and sensitivity of the two-minute walk test (2MWT) in cardiac surgery patients. DESIGN: Measurements were made in patients preoperatively, during the postoperative in-hospital stay, and 6 to 8 weeks after discharge from hospital. SETTING: Ambulatory and hospitalized care. PARTICIPANTS: Patients (N=122; mean age +/- standard deviation, 63+/-9 y) undergoing coronary artery bypass grafting. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 2MWT, New York Heart Association (NYHA) functional classification for cardiac disease, the Nottingham Extended Activities of Daily Living scale, and the Medical Outcomes Survey 36-Item Short-Form Health Questionnaire (SF-36). RESULTS: Distance walked in 2 minutes decreased significantly postoperatively (from 138+/-26 m to 84+/-33 m, P<.001), but increased again at follow-up (151+/-31 m, P<.0001). Distance walked on the 2MWT correlated significantly to SF-36 (physical function subscale) preoperatively (r=.44) and at follow-up (r=.48) (P<.001). There was a significant difference in distance walked between those with NYHA class I and II compared with those classified as III or IV (P=.04). However, there was no significant difference in distance walked in 2 minutes between those who developed cardiac or pulmonary complications postoperatively (P> or =0.2). CONCLUSIONS: The 2MWT was sensitive to change after cardiac surgery and showed moderate correlation with measures of physical functioning in this population. However, the 2MWT could not identify those who developed complications in the postoperative period.

Activities of Daily Living↗