RESUMEN
Objective:To investigate the clinical characteristics, preferences for cardiopulmonary resuscitation(CPR)and end-of-life care status in elderly patients with cancer vs.non-cancer diseases under geriatric care, and to provide the basis for different elderly groups to carry out palliative care.Methods:Medical records of deceased residents aged ≥60 years from 2014 to 2017 in the department of geriatrics of our hospital were retrospectively reviewed.Data on clinical characteristics, preferences for CPR, application of life-sustaining treatments and end-of-life care were collected.A total of 129 patients were divided into the cancer death group (n=48) and the non-cancer death group (n=81)according to the cause of death.Clinical characteristics and end-of-life care status were compared between the two groups.Results:A total of 129 cases including 98 males(76.0%)and 31 females(24.0%), with a median age of 87(60~100)years and 110 cases(85.3%)aged 80 years and above, were enrolled in this study.The main causes of death were malignant solid tumors(48 cases, 37.2%)and infectious diseases(47 cases, 36.4%). Compared with the cancer death group(n=48), the proportion of patients aged 80 years and above was higher(n=81)(95.1% or 77 cases vs. 68.7% or 33 cases), the proportion of painkiller utilization(5.0% or 4 cases vs. 29.2% or 14 cases)and Charlson Comorbidity Index scores(5.7±2.3 vs.8.9±2.7)were lower in the non-cancer death group( P<0.01). There was no difference in proportions admitted to the intensive care unit, with moderate and severe disability, or with polypharmacy between the two groups( P>0.05). Compared with the cancer death group, the proportions opting for CPR on admission day(70.9% or 56 cases vs. 39.6% or 19 cases), administration of ventilators(38.3% or 38 cases vs. 16.7% or 8 cases)and respiratory stimulants(71.6% or 58 cases vs. 52.1% or 25 cases)were higher in the non-cancer death group( P<0.05). There was no difference in preference for do-not-resuscitate(DNR), utilization of extracardiac compression, electrical defibrillation, tracheotomy, tracheal intubation or vasoactive drugs utilization( P>0.05). Conclusions:The status of hospitalized elderly patients under geriatrics is complex and the burden of end-of-life care is heavy, so it is urgent to practice geriatric palliative care.In addition to focusing on cancer patients, symptom control, early advance care planning (ALP) plans and avoidance of overuse of life-sustaining treatment (LST) at the end stage of non-cancer diseases also need to be addressed.
RESUMEN
Objective To study the risk factors,auxiliary examinations and severity of disease between elderly female and male pulmonary thromboem bolism(PTE)patients.Methods One hundred and nineteen elderly PTE patients(72females and 47males)admitted to our hospital were included in this study.Their clinical symptoms,past medical history,laboratory testing parameters,imaging data,treatment plan,and risk stratification were compaired between elderly female and male PTE patients.The risk stratification such as PESI,sPESI,and prognosis scores were assessed. Results The rate of past PTE history was significantly higher while that of smoking was significantly lower in female patients than in male patients(P＜0.05,P＜0.01).The serum hemoglobin and creatinine levels and the incidence of AF were significantly lower while the number of lymphocytes was significantly greater,the change of V2and V3lead T-waves was more obvious and the ratio of oral anticoagulation therapy was significantly higher in female patients than in male patients(P＜0.05,P＜0.01).The PESI score was significantly lower in female patients than in male patients(86.5 vs 102.0,P＜0.01).No significant difference was detected in clinical symptoms,sPESI score,prognosis score and risk stratification between female and male PTE patients (P＞0.05).Conclusion No significant difference is detected in clinical symptoms,sPESI score,prognosis score and risk stratification between elderly male and female PTE patients.Changes of V2and V3lead T-waves on ECG are common in female PTE patients.
RESUMEN
Objective To investigate the differences of clinical symptoms,risk factors,plasma D?dimer level and severity of acute pulmonary embolism( APE) between females and males. Methods Clinical data of 153 cases APE patients were analyzed retrospectively. Symptoms,risk factors,electrocardiogram( ECG) findings, plasma D?dimer level and risk classification were analyzed between females and males. Results The proportion of palpitation in females was significantly higher than that in males ( 29. 3%( 24/82 ) vs. 8. 5%( 6/71 ) ,χ2=10. 46,P<0. 01) . The proportion of chest pain in females was significantly lower than that in males ( 4. 9%( 4/82) vs. 25. 4%( 18/71) ,χ2=12. 96,P<0. 01) . The proportion of patients who had three or more symptoms was significantly higher in females than that in males ( 32. 9%( 27/82 ) vs. 7. 0%( 5/71 ) ,χ2 = 15. 41, P<0. 01). D?dimer mean level in females was significantly higher than that in males(334. 00(620. 00) μg/L vs. 528. 00( 812. 75) μg/L,Z=-2. 447,P<0. 05) . The proportion of low risk patients in females was lower than that in males ( 31. 7%( 26/82 ) vs. 53. 3%( 38/71 ) ,χ2 = 7. 44, P<0. 01 ) , while the proportion of the intermediate?high?risk patients was higher ( 34. 1% ( 28/82 ) vs. 14. 1 ( 10/71 )%,χ2 = 8. 20, P<0. 01) . Conclusion The symptoms was more variable in females with the main symptom of palptation. The level of plasma D?dimer is higher in females than that in males. The prognosis of females may be severe than that of males.