Cleveland Clinic journal of medicine
-
Hyperglycemia is associated with poor clinical outcomes in critically ill patients. Initial clinical trials of intensive insulin therapy targeting blood glucose levels of 80 to 110 mg/dL showed improved outcomes, but subsequent trials found no benefits and even increased harm with this approach. ⋯ Additionally, the patient's pre existing diabetes status and preadmission diabetic control may modulate the outcomes of stringent glycemic control, with worse outcomes of hyperglycemia being observed in patients without diabetes and in those with well-controlled diabetes. Most medical societies recommend less stringent glucose control in the range of 140 to 180 mg/dL for critically ill patients.
-
Anemia is a well-known complication of chronic kidney disease, and its treatment remains a challenge. Although erythropoiesis-stimulating agents (ESAs) raise hemoglobin levels, their benefits appear to be limited to decreasing the number of blood transfusions needed and perhaps improving quality of life. ⋯ Randomized controlled trials have found these drugs to be at least as effective as ESAs, and the drugs are used in other countries. However, PHIs have yet to be approved in the United States.
-
Capsule endoscopy, also known as wireless capsule endoscopy or video capsule endoscopy, is a noninvasive procedure that uses a swallowed capsule-shaped miniature camera for direct visual and diagnostic evaluation of gastrointestinal (GI) disease. Although originally intended as a tool to examine the small intestine, which is mostly beyond the reach of conventional endoscopy, capsule endoscopy is now also being used to examine the entire length of the GI tract.