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
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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Acute kidney injury (AKI) is a common clinical syndrome in hospitalized patients associated with high morbidity and mortality rates. Despite several years of improvement in the medical care of the severely ill, there has been little improvement in outcome. ⋯ Although dialysis has been the mainstay of treating AKI for > 40 years, several questions regarding its application remain unsettled, including method (continuous vs intermittent), timing, and dose. The purpose of this review is to summarize recent advances in the epidemiology and treatment of AKI in hospitalized patients.
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Disturbed regional oxygenation is believed to contribute to organ dysfunction, organ failure, and death. Recent techniques such as orthogonal polarization spectral/sidestream darkfield imaging and near infrared spectroscopy have provided insight into the microcirculatory alterations present in critically ill patients. ⋯ Data on the effects of therapeutic interventions on the microcirculation are also being gathered and may help in developing strategies that can influence regional oxygenation and cellular metabolism, and thereby prevent or reverse organ failure. Whether monitoring the microcirculation can be used to guide therapy remains unclear and requires further study, and this is an exciting field of ongoing research.