ABSTRACT
Objective:To investigate the awareness and attitude towards living wills among community-dwelling elderly in Taiyuan.Methods:A total of 540 residents aged 60 years or older were selected from six communities of Taiyuan city for face-to-face questionnaire survey from November 2018 to March 2019. Chi-square test and logistic regression model were used to analyze the influencing factors for awareness and attitude towards living wills.Results:The awareness rate of living wills in responders was 44.1%(226/513); and the awareness was significantly associated with age (χ 2=11.09, P=0.001), education level (χ 2=7.95, P=0.005), and daily living abilities (χ 2=8.10, P=0.017) of the residents. After the knowledge popularization, 49.9%(256/513) of responders were willing to sign the living order documents. The multivariate logistics analysis showed that residents with age of 60-74 years ( OR=2.151, 95% CI:1.380-2.941), with bachelor degree or above ( OR=3.048, 95% CI:1.571-5.913), with severely impaired activities of daily living ( OR=2.849, 95% CI:1.223-6.638), with multimorbidity ( OR=1.654, 95% CI:1.138-2.404), and with knowledge of living will ( OR=1.596, 95% CI:1.098-2.322) were more likely to sign a living will document. Conclusion:The awareness and acceptance of living wills among the community-dwelling elderly in Taiyuan city is not so high, and it is necessary to further strengthen the promotion of living wills in the city.
ABSTRACT
Objective To investigate the vancomycin trough concentration in elderly patients with severe infection and provide references for clinical use of drugs effectively .Methods According to the Ccr of elderly patients (56 cases), who were ≥65 years old, the patients were divided into two groups , one with Ccr≥50 ml/min, which named group A , the other with Ccr between 20 ml/min and 50 ml/min, which named group B .The use of vancomycin , vancomycin steady-state plasma trough concentration and the differences of renal function were analyzed before and after in both two groups .Results There were 31cases of patients in group A (25 cases of them use vancomycin 1 g,q 12 h;other 6 cases use 0.5 g,q 12 h), 25 cases of patients in group B (15 cases of them use vancomycin 1 g, q 12 h;other 10 cases use 0.5 g,q 12 h) .The percentage that the trough concentration of the patients who use two different scheme of using drugs in group A was between 10 mg/L and 20 mg/L is 12%(3/25) and 66.67%(4/6).The percentage that the trough concen-tration of the patients who used two different scheme of using drugs in group B was between 10 mg/L and 20 mg/L is 20%(3/15) and 60%(6/10).The percentage that trough concentrationis more than 20 mg/L is 73.33%(11/15) and 30%(3/10).The serum creat-inine value of the 15 patients of all cases except for group B of which vancomycin dosage was 1 g, q 12 h had significantly risen after using the drug(P<0.05).The urea nitrogen had no obvious change (P>0.05).The serum creatinine value and urea nitrogen of oth-er patients had no significant change after using the drug (P>0.05).Group B had kidney toxicities observed in 5 patients, the dosage of vancomycin was 1 g, q 12 h, valley concentration >30 mg/L.There was no kidney toxicities observed in group A .Conclusion The use of vancomycin in elderly patients must depend on their Ccr .If the Ccr was larger than 50 ml/min, the use of vancomycin should be 1 g,q 12 h, and the Ccr was between 20 ml/min and 50 ml/min, the use should be 0.5 g.In addition, blood trough concentration need to be paid more attention in elderly patients in order to regulate the regimens according to the individual differences .