Hospital practice (1995)
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Hospital practice (1995) · Dec 2009
ReviewIncretin-based therapies: review of the outpatient literature with implications for use in the hospital and after discharge.
A large percentage of critically ill adult inpatients have type 2 diabetes, which may be undiagnosed or uncontrolled during hospitalization. Hyperglycemia complicates the therapeutic management of inpatients and leads to adverse outcomes, and intensive glycemic control with insulin reduces morbidity and mortality. Insulin therapy, however, is labor-intensive and time-consuming. ⋯ Incretin-based therapies offer a potentially useful option for post-discharge therapy, and possibly for inpatient diabetes treatment. Incretins are effective, safe, and well-tolerated; they are easier for patients to use compared with insulin injections (eg, continual glucose monitoring is not required); and they may provide long-term improvement of cardiovascular parameters and beta-cell function. This review examines the challenges to achieving glycemic control in the hospital setting and summarizes clinical data on the efficacy and safety of incretin-based therapies in their use in the hospital and after discharge.
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Hospital practice (1995) · Dec 2009
Comparative StudyAcute ischemic stroke and thrombolysis location: comparing telemedicine and stroke center treatment outcomes.
Telemedicine has been increasingly used as an option for acute ischemic stroke treatment at hospitals where neurological expertise is not available. The aim of this study was to compare the outcome of stroke patients treated with systemic thrombolysis at our academic hub regional stroke centers (hub) versus our spoke hospital telemedicine locations (spoke) ⋯ The hub-and-spoke telemedicine model for acute ischemic stroke treatment seems to carry similar efficacy and safety outcomes at the regional academic hub and spoke centers.
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Hospital practice (1995) · Dec 2009
Randomized Controlled TrialSystemic hypothermia induced within 10 hours after birth improved neurological outcome in newborns with hypoxic-ischemic encephalopathy.
To evaluate the efficacy of systemic hypothermia when applied within 10 hours after birth to neonates with hypoxic-ischemic encephalopathy (HIE). ⋯ Systemic hypothermia reduced the risk of disability in infants with moderate HIE, in accordance with earlier studies. Hypothermia was induced within 6 hours in most infants, but delaying the onset to 6 to 10 hours after birth did not negatively affect primary outcome. Further studies with a large number of patients are needed to confirm that delayed cooling is equally effective.
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Hospital practice (1995) · Dec 2009
ReviewCommon procedures in internal medicine: improving knowledge and minimizing complications.
Internal medicine physicians have long been trained with the skills, knowledge, and attitudes to become proficient at certain medical procedures. Specifically, the lumbar puncture, paracentesis, thoracentesis, and central venous catheter placement are common medical procedures encountered during residency. ⋯ In private practice many internists care for patients requiring these procedures. This review will summarize basic steps followed in these 4 medical procedures and highlight methods to minimize associated complications.
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Over 2.5 million accidental and intentional drug-related poisonings are reported annually in the United States. Early diagnosis and management of patients who present with acute intoxication can significantly reduce both morbidity and mortality. The initial evaluation of patients with suspected or proven intoxications should focus on hemodynamic stability, mental status, and respiratory function. ⋯ Important historical clues are often found in a social history that considers intravenous drug use, alcohol use, and any access or exposure to illicit substances. A patient's medication list should also be scrutinized for psychoactive or sedative medications, such as tricyclic antidepressants or opioids. In this article we present case-based discussions of the specific diagnosis and management of 5 commonly occurring acute intoxication syndromes.