The study of auscultation-assisted bedside blind placement of the nasojejunal feeding tube in oldest-old patients / 中国实用护理杂志

Objective:To evaluate the success rate and influencing factors of auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube in oldest-old patients.Methods:A case series study was conducted in those elderly hospitalized patients who met the indications for naso intestinal intubation from January 2019 to May 2021 in China-Japan Friendship Hospital. Auscultation-assisted bedside blind placement of the spiral nasojejunal feeding tube was implemented. In addition, abdominal X-ray imaging was performed to confirm the location of the catheter tip. The primary indicators included were the success rate and the first attempt success rate of nasojejunal tube placement;, while the secondary indicators included were the number of attempts and the time of insertion. The rate of operational-related adverse events was ustreated as to evaluate the indicator of safety. Logistic regression analysis was used to conduct multi factor analysis.Results:The total success rate and the first-attempt success rate of tube implantation reached were 90.1%(73/81) and 85.2%(69/81), respectively. The mean attempt per individual patient was (1.2 ± 0.2) times for each patient. The median length of operation time was 40.0(27.0, 45.0) minutes, more specifically, among which the median length time of nasogastric and gastrojejunal placement was 20.0(15.0, 25.0) and 18.0(12.5, 20.0) minutes, respectively; while the median lengthtime of nasogastric placement was greaterhigher than that of gastrojejunal placement ( Z = -2.78, P<0.05). As suggested by multivariate analysis, indicated that the conscious conditions of patients had a signific antlyimpact affect on the success rate of for tube implantation ( OR = 19.25, 95% CI 1.24-299.63, P<0.05). In addition, the incidence rate of operational-related adverse events was 37.0%(30/81). By contrast, there were no serious adverse events occurring during the study period. Conclusions:The auscultation-assisted bedside blind placement of the nasojejunal feeding tube technique is effective and safe for early nutrition support in oldest-old patients in terms of early nutritionsupport, the success rate of which is significant largely affected by the patients′ conscious conditions of patients.

A study of the application of peer support education in improving the self-management ability of old patients with diabetes / 中国实用护理杂志

Objective To discuss the application effect of peer support education in improving theself-management ability of old patients with diabetes. Methods A total of 160 cases of old patients with type 2 diabetes who were treated and hospitalized from June 2014 to August 2015 were selected, then equally divided into observation group and control group through using random number method.Finally, 76 cases were studiedin observation group, while 75 cases in control group. The health education guidance of conventional diabetes had been used in two groups for six months, and the peer support education was also conducted for the patients in observation group on the basis of conventional education. The self-management ability, insulin standard injection knowledge-belief and attitude-behavior/practice (KAP) and glycosylated hemoglobin (HbA1c) value of old patients with diabetes were observed before intervention, 3 months and 6 months later, respectively. Also,the hypoglycemia frequency in two groups was compared during intervention. Results After three months of intervention, the score of diet, exercise management, glucose monitoring, foot care, pharmaceutical administration and smoke for self-management ability in observation group was 4.63 ± 0.92, 4.18 ± 0.97, 2.86 ± 0.96, 2.35 ± 0.59, 4.01 ± 1.43 and 0.62 ± 0.29, respectively, while that of these indicators in control group was 3.69 ± 0.83, 3.52 ± 0.67, 1.75 ± 0.67, 1.63 ± 0.72, 3.05 ± 1.39 and 0.59 ± 0.38. Except smoke (P > 0.05), the differences between two groups were statistically significant (t=2.987-5.965, P 0.05). Then, the insulin was normally injected in observation group after six months of intervention, the score of knowledge, attitude and behavior was 5.63 ± 1.87, 43.17 ± 6.03 and 16.57 ± 1.59, while that in control group was 3.76 ± 0.83, 23.71 ± 0.59 and 10.16 ± 0.95. The differences between two groups were statistically significant (t= 8.569, 15.623, 6.751, P<0.01). Also, the level of glycosylated hemoglobin was decreased from (8.17 ± 0.32) % to (7.16 ± 0.41) %, and the difference was statistically significant (t=-3.560, P=0.000). Conclusions Peer support education couldenhance the self-management consciousness of old patients with diabetes, standardize the insulin injection, improve the ability of self-management and improve glucose metabolism index so that it is worthy of being clinically popularized and applied.

Effect of HBM-based home visits on blood pressure and health-related behaviors of elderly hypertensive patients / 现代临床护理

Objective To explore the effects of health belief mode (HBM)-based home visits on the blood pressure (BP) and health-related behaviors of elderly hypertensive patients.Methods One-year HBM-based home visits were paid to 114 elderly hypertensive patients over 80 years old chosen from the community.The normalization rate of blood pressure after intervention at 3,6,12 months and health-related behaviors after intervention were also compared with those of pre-intervention.Results The BP after intervention was improved significantly after intervention as compared with that of pre-intervention (P＜0.01).Health-related behaviors after intervention were significantly more than those before pre-intervention (P＜0.01).Conclusions The hypertensions are controlled effectively with the implementation of the HBM-based home visits to the elderly hypertensive patients.The development of disease in elderly hypertensive patients can be slowed down and their life quality can be improved.

Effects of the multi-model analgesia in the old patients / 中国医师杂志

Objective To study the effects of the multi-model analgesia for the old patients who received total hip replacement surgery.Methods Thiry-four patients who would received total hip replacement surgery were randomly divided into 2 group:Group E was the epidural analgesia group and Group M was the multi-model analgesia group.15min before the end of surgery,the load doses were given to the patients in both groups and the electric pumps for postoperative analgesia were connected.The multi-model analgesia was used for Group M:30min before the end of surgery,ropivacaine 7.5mg and morphine 1mg were given via epidural catheter,and at the end of surgery the catheter was pulled out.Intravenous analgesic pumb were used for Group M.Record the following data at different time point (T1 to T5):(1)the pain scores.(2)the scores of sedation and HR,MAP,RR and SpO2.(3)the numbers of the patients who suffered from adverse effects,such as nausea and vomiting and the numbers of patients who needed the rescue medicine were recorded in 48h after surgery.Results Compared to Group E,the scores of pain when the patients turned over in Group M,were lower significantly at T2.At T1 and T2 time point,the sedation scores of Group M were higher than those of Group E significantly.There was significant difference in the SpO2 change between groups at T1.Conclusion The multi-model analgesia of using long-acting local anesthetics and opioids for epidural analgesia once,then using sufentanil and tramadal for intravenous analgesia continuously,was safe and sufficient for the old patients.

Effect and safety analysis of proximal femur locking compression plate for treatment of intertrochanteric frac-ture in 52 cases of old patients / 局解手术学杂志

Objective To investigate the effect and safety of proximal femur locking compression plate for treatment of intertrochanteric fracture in old patients. Methods Clinical data and visit records of 98 cases of intertrochanteric fracture old patients were analysed retro-spectively. According to the treatment of operative methods, these patients were divided into two groups: 46 patients in the control group were given the dynamic hip screw fixation; the other 52 cases in the observation group were given the proximal femur locking compression plate . Compared the therapeutic effect and safety of the two groups. Results The short-term and long-term therapeutic effect of observation group were significantly better than the control group,and the safety of observation group was higher than that of the control group,the differ-ences were statistically significant (P<0. 05). Conclusion Proximal femur locking compression plates is an effective surgical treatment for old patients with intertrochanteric fracture. It can significantly improve the function of hip joint and reduce the risk of postoperative complica-tions. As it is of significant effect and high safety, it is worthy of clinical popularization.

A survey on medical students about the awareness of medical laws and communication between medical students and old patients / 中华医学教育探索杂志

A total of 120 medical students were surveyed to investigate the current status of communication between medical students and old patients and the awareness of medical laws. The questionnaire shows many students don't have enough knowledge of communication skills and medical laws. Furthermore, the most important reason of the medical disputes is the lack of communication between doctors and patients so the cultivation of communication skills and legal knowledge should be strengthened.

The functional alteration of dendritic cells in severe septic old patients / 中华急诊医学杂志

Objective To investigate the functional changes of dendritic cells (DC) in elderly patients with sepsis. Method Elderly patients (n = 20), ages 75 to 86 years, treated in the department of internal medicine for cadres and the medical intensive care unit (MICU), were selected to participate in the study. Patients with ma-ligoant tumors, hematological diseases, immune diseases, or a history of receiving drugs known to interfere with immune functions were excluded. Using the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) definition of sepsis, the patients were categorized into four groups: non-sepsis (group A) (n = 5) ; sepsis (group B) (n = 5) ; severe sepsis (group C) (n = 5) ; and septic shock (group D) (n = 5). The peripheral blood mononuclear cells (PBMCs) of each patient were isolated and cultured with human re-combinant granuloceyte-macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4) in vitro for 10 days. The cells were examined under an inverted microscope, scanning electron microscopy, and flow cytometry. The MTT colorimetric assay was used to observe the abilities of the dendritic cells to stimulale an allogeneic T lym-phocyte response in vitro. Paired t -test was used to compare changes in the surface markers among the different groups, Results The PBMCs in the four groups of patients differentiated into cells with typical dendritic configura-tions after in vitro cuhure with combined cytokines. The CD40, CD80, CD86, and HLA-DR expressions on the cell surfaces increased after culture,with (43.2±12.5)%/(27.3±9.3)%, (31.4 ± 10.1)%/(22.5 ± 8.7)%, (39.3±15.7)%/(21.9±7.7)%, and (75.4±25.6)%/(58.7±16.7)%, respectively. The stimulation index (the abilities of the dendritic cells to stimulale the allogeneic T lymphocyte response in vitro) in the four groups of patients after culture were (23.3±7.9) in group A, (18.9±8.3) in group B,(11.4±5.1) in Group C,and (5.5 ± 3.7) in Group D. Conclusions The immune functions of the dendritic cells of elderly patients with sepsis decrease in a linear manner with the severity of their septic state.

Neumonía adquirida en la comunidad (NAC) y asociada al cuidado crónico de la salud (NACS) en 560 mayores de 65 años / Community-acquired pneumonia and associated chronic health care in 560 older than 65 year

Los mayores de 65 tienden a desarrollar neumonía. Evaluamos la epidemiología, el impacto de los factores de riesgo y las comorbilidades y el pronóstico de NAC y NACS en una cohorte de ancianos. Métodos. Se recolectaron prospectivamente datos en mayores de 65 años no-inmunosuprimidos, atendidos por NAC y NACS. Se definió neumonía por criterios clínicos y radiológicos; considerándose NAC en no internados durante los 15 días previos y NACS si además residían en alguna institución de cuidado crónico o geriátrico. Resultados. De 844 pacientes con NAC, 560 eran mayores de 65 (66.4%), y 100 (el 17.9% de ellos) eran NACS. Mediante análisis univariado se determinó que los portadores de NACS eran mayores, debieron internarse o se habían internado anteriormente por neumonía u otra razón más frecuentemente; también los pacientes con NACS presentaban más frecuentemente comorbilidad neurológica, conciencia alterada, aspiración, uso previo de antibióticos y clase V del PSI (p < 0.001 para todos estos). En análisis multivariado solo la edad mayor de 80 y la comorbilidad neurológica permanecieron más frecuentes en NACS. Los agentes más comunes fueron S. pneumoniae, M. pneumoniae, C. pneumoniae, L. pneumophila, P. aeruginosa, enterobacterias, S. aureus, H. influenzaey virus. No hubo diferencias en etiología entre NAC y NACS. La mortalidad a 30 días fue mayor en los pacientes con NACS (44.5 vs. 33.7%). Conclusión. En mayores de 65 la neumonía es más frecuente, más grave y su etiología es diferente respecto de los menores. La NACS presenta más gravedad y mayor mortalidad.

People older than 65 years are more susceptible to pneumonia. This paper presents an assessment of the impact of risk factors and co-morbidities and the prognosis of community-acquired pneumonia (CAP) and health care associated community-acquised pneumonia (HCAP) in the elderly. Methods. Prospective data collection in immuno-competent patients older than 65 years hospitalized for CAP or HCAP. Pneumonia was defined by radiographic and clinical criteria; CAP was considered in patients who were not hospitalized during the previous 15 days, while HCAP was diagnosed in those who developed pneumonia outside the hospital in a nursing home or long-term health care facility. Results. Out of 844 patients admitted with the diagnosis of pneumonia during 5 years, 560 were older than 65 (66.4%); 460 (54.6%) were classified as CAP and 100 (17.9%) as HCAP. In comparison with the CAP patients, patients with HCAP were older and had more often been admitted in the past for pneumonia or other reason, (p < 0.001). They also presented a higher frequency of neurologic co-morbidity, altered consciousness, aspiration, use of prior antibiotics and high risk pneumonia (risk class V of the Pneumonia Severity Index - PSI) (p < 0.001). In the multivariate analysis, age older than 80 and neurologic co-morbidity were more often significantly associated with HCAP. The more frequent identified microbial agents were S. pneumoniae, M. pneumoniae, C. pneumoniae, L.pneumophila, P. aeruginosa, enteric Gram - negative bacteria, S. aureus, H. influenzae and viruses. The etiology of CAP and HCAP was similar. Thirty - day mortality was higher in HCAP (44.5 vs. 33.7%). Conclusion. In patients older than 65, CAP is more frequent and severe, and the microbial etiology is different than in CAP of younger people. HCAP is even more severe and has higher mortality.

Clinical and Pathologic Characteristics of Gastric Cancer in Old Patients:a Retrospective Study of 671 Patients / 医学研究杂志

60 years)and 126 in the young age group(age≤35 years).The clinical and pathologic parameters for this study included sex,clinical manifestations,gross type,location and histologic type.Results The old patients had a higher percentage of sex ratio,whereas no significant difference was found in the yong age group.In the old age group,large amount of cancers were found in cardiac and fundus of stomach,while those were found in antrum in young group(P

Investigation of Unexpected Injuries during Hospitalization in Old Patients / 中国慢性病预防与控制

Objective To understand the current status and related factors of unexpected injuries during hospitalization in old patients in Shaoxing city. Methods By way of convenient sampling methods, 850 old patients aged over 65 years were chosen from five of grade 3 hospitals in Shaoxing city. The status and consequence of unexpected injuries during their hospitalization in past one year were retrospectively investigated with face to face questionnaire at patients home. Results The occurrence of unexpected injuries in 850 hospitalization old patients were 54(6.35%) during their hospitalization in past one year. The occurrence rate in female (9.27%) was significantly higher than that in male (4.25%) (?2=7.57, P

Relationship between vasoactive substance and blood pressure in old patients with hypertension / 中华急诊医学杂志

Objective To observe the relationship between vasoactive substances and blood pressure in old patients with hypertension.Method Venous blood was drawn from 35 old hypertension patients when blood pressure was normal and abnormal,respectively.Epinephrine(E),norepinephine(NE),endothelins(ET),angiotensin ll (Angll) and ealcitonin-gene-retated peptide were determined by radio-immunity.The above five cytokines were also determined in 33 old healthy people.The cytokines levels were compared between the normal and abnormal blood pressure in hypertension patients and also between the old hypertension patients and healthy persons.The correlation between blood pressure and cytokines were analyzed.Results The level of ET,Angll,E and NE were obviously increased in old hypertension patients when their blood pressure was abnormal,while CGRP obviously decreased.No difference was found in the five cytokines between two groups when the blood pressure were normal.The correlation analysis showed that systolic pressure had positive correlation with ET,AnglI and E(r=0.304,0.337,0.587,P=0.031,0.019,0.036)and negative correlation with CGRP(r=-0.416,P=0.028)in old hypertension patients when the blood pressure was abnormal.And the diastolic pressure had positive correlation with AnglI and E(r=0.357,0.333;P=0.039,0.028).ET had positive correlation with Angll and E(r=0.361,0.315;P=0.041,0.029).Conclusion The levels of vasoaetive substances significantly changed in old hypertension patients with the blood pressure change.Among those cytokines,the substances that contract blood vessel increased most obviously.The vasoactive substances played an important role in the progress of blood pressure rising.

Hospital Fungal Infection in Old Patients with Malignant Tumors:Status and Analysis / 中华医院感染学杂志

OBJECTIVE To investigate and analyze the risk factors,clinical characteristics and prevention countermeasures of hospital fungal incfection in old patients with malignant tumors.METHODS To adopt investigation way to review and analyze the clinical data of hospital fungal infection in 165 cases from the old patients with malignant tumors.RESULTS Among 165 cases the infection occurred predominantly in lower respiratory tract(47.2%),and with urological tract being second(19.0%).Of 165 strains of fungi from 165 patients,the first was Candida albicans(55.8%),and the second was C.tropicalis(23.0%).CONCLUSIONS The causes of hospital fungal infection in old patients with malignant tumors are highly associated with the risk factors such as primary tumor,age,radiotherapy,chemotherapy,antibiotics,hormone,invasive operation,and so on.

Nosocomial Infection: Investigation on 626 Cases / 中华医院感染学杂志

OBJECTIVE To investigate the present situation of the nosocomial infection in our hospital in order to decrease the infection rate. METHODS A total of 40 554 patients were inspected from Oct 2004 to Sept 2005.There were 626 patients with nosocomial infection. RESULTS The nosocomial infection was 1.54%.Old patients were the main components.The longer they were in hosptial,the more risk of infection they had.Elder monitoring department and hematological department were the most common infected units.Respiratory tract was the most common infected site of the body.The entity of disease for the most infection was malignant tumor.Invasive treatment was one of the causes for the infection. CONCLUSIONS The infection rate of our hospital was relatively low.We should establish the system to control the infection.Use the advanced statistical software well be to aid the control and discover the anti-infection deficiency from the statistical view-point.

Effect of comprehensive rehabilitation therapy on ADL of old patients with stroke / 中国康复理论与实践

@# ObjectiveTo study the effect of comprehensive rehabilitation therapy on activity of daily living(ADL) of old patients with stroke.Methods56 old patients with stroke were rehabilitated by the therapy of Bobath,Brunnstrom,Rood,PNF and psychotherapy for 3 months.The Modified Barthel Index (MBI) was applied to measure ADL before and after treatment.ResultsAfter treatment,the MBI of the patients was markedly higher than before(P<0.01),which was relative with the recovery of movement function and the psychology.ConclusionsThe rehabilitation therapy can improve ADL of old patients on stroke.

The Pharmacokinetics Study of Amikacin in Old Patients with Respiratory System Infections / 中国药房

OBJECTIVE:The pharmaceutics of Amikacin(AMK)in old patients with respiratory system infections was studied to provide a basis for clinical use.METHODS:Fluorescence polarizing immunoassay method was employed to detect blood drug concentration.RESULTS:The blood concentration-time curve of AMK fitted in with the two-compartment mod?el.The T 1/2? and AUC of AMK in the healthy volunteers and old patients with respiratory system infections were(2.14?0.81)h and(4.32?1.05)h(P