Willingness to complete advance directives among low‐income older adults living in the USA

This study explored low‐income older adults' willingness to (i) complete advance directives, legal documents, whereby an individual designates decision‐makers in the event that they cannot make their own decisions about end‐of‐life treatment preferences, and (ii) the role of social support and other predictors that impact their willingness. This study was conducted as part of a larger study exploring behaviours of advance care planning among low‐income older adults. Out of a total of 255 participants from the original study, this study included 204 participants who did not complete an advance directive for data analysis. A cross‐sectional study using probability random sampling stratified by ethnicity was used. Older adults residing in two supportive housing facilities or who were members of a senior centre in San Diego, California, USA, were interviewed in person between December 2010 and April 2011. Hierarchical logistic regression analysis revealed that the majority of participants (72.1%) were willing to complete advance directives and the factors significantly predicting willingness to complete included self‐rated health, attitudes towards advance decision‐making and social support. Participants with a poorer health status (OR = 1.43, 95% CI = 1.07–1.90) were more willing to complete advance directives. Conversely, participants with higher positive attitudes (OR = 1.18, 95% CI = 1.00–1.39) and greater social support (OR = 1.07, 95% CI = 1.00–1.15) were also more willing to complete advance directives. The findings suggest the importance of ongoing support from healthcare professionals in end‐of‐life care planning. Healthcare professionals can be a source of support assisting older adults in planning end‐of‐life care. Initiating ongoing communication regarding personal value and preference for end‐of‐life care, providing relevant information and evaluating willingness to complete as well as assisting in the actual completion of advance directives will be necessary.     

琼玉膏的现代研究进展

琼玉膏由人参、生地、茯苓、白蜜组成,具有滋阴润肺、益气健脾的功效,主要用于治疗肺肾阴亏,脾气亦虚所致的劳瘵。现代学者进行了一系列临床及实验研究证实,琼玉膏在治疗肺结核、癌症等各种慢性消耗性疾病,以及抗衰老等方面具有显著疗效,是集治疗与保健为一体的养生名方。     

注射用帕瑞昔布钠超前镇痛对开腹手术病人血清白介素-6的影响

目的：本文旨在探讨在开腹手术中应用帕瑞昔布超前镇痛。测定血清IL--6的变化,以此探讨帕瑞昔布对开腹手术围术期致炎因子IL-6的影响。方法：选择胃癌病人30例,择期行胃癌根治术,随机分为两组：A组（实验组）和B组（对照组）,两组均采用吸入麻醉,A组（实验组）,术前30分钟静脉注射帕瑞昔布20mg,手术结束时静脉注射帕瑞昔布40mg,B组（对照组）不做任何处理。术后接PCA泵,芬太尼1mg＋生理盐水至100ml,每小时2ml,负荷量0．5ml间隔15分钟。分别于入室后（T1）,手术开始后3小时（T2）,术后8小时（T3）和术后24小时（T4）,四个时同点采取末梢静脉血3ml,用IL--6试剂盒采用放免法测定标本中血清IL--6的浓度。结果：A组T2,T3,T4时间点IL--6值与术前相比有显著差异P〈0．05。与B组相比差异有显著性。这说明帕瑞昔布超前镇痛对血清IL-6浓度的升高有-定程度的抑制作用。术后并发征发生率两组间差异显著。帕瑞昔布组显著降低阿片类药物相关不良反应发生率。结论：在开腹手术中,术前静脉给予帕瑞昔布超前镇痛,效果确切,降低了术后疼痛反应,抑制了围术期致炎因子IL-6的升高,对手术创伤后应激时细胞因子反应具有调控作用。     

Pancreatic cancer—A disease in need: Optimizing and integrating supportive care

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy that continues to be challenging to treat. PDAC has the lowest 5-year relative survival rate compared with all other solid tumor malignancies and is expected to become the second-leading cause of cancer-related death in the United States by 2030. Given the high mortality, there is an increasing role for concurrent anticancer and supportive care in the management of patients with PDAC with the aims of maximizing length of life, quality of life, and symptom control. Emerging trends in supportive care that can be integrated into the clinical management of patients with PDAC include standardized supportive care screening, early integration of supportive care into routine cancer care, early implementation of outpatient-based advance care planning, and utilization of electronic patient-reported outcomes for improved symptom management and quality of life. The most common symptoms experienced are nausea, constipation, weight loss, diarrhea, anorexia, and abdominal and back pain. This review article includes current supportive management strategies for these and others. Common disease-related complications include biliary and duodenal obstruction requiring endoscopic procedures and venous thromboembolic events. Patients with PDAC continue to have a poor prognosis. Systemic therapy options are able to palliate the high symptom burden but have a modest impact on overall survival. Early integration of supportive care can lead to improved outcomes.