重症肺炎支原体肺炎老年人血清纤维蛋白原、血小板反应蛋白 -1表达及其与预后的相关性

目的检测重症肺炎支原体肺炎( MPP)病人血清纤维蛋白原( FIB)和血小板反应蛋白 -1(TSP-1)的表达情况，并探究其表达水平与 MPP病人预后的相关性。方法选取 2017年 3月至 2018年 12月在海南医学院第一附属医院收治的 MPP老年人 89例作为研究对象，其中重症 MPP 46例作为重症组，轻症 MPP 43例作为对照组。采用酶联免疫吸附测定( ELISA)检测各组研究对象血清 FIB、TSP-1的表达水平；通过受试者操作特征曲线( ROC曲线)评估血清 FIB、TSP-1表达水平对重症 MPP的诊断价值；分析病人预后不良情况发生率；并采用 logistic回归分析老年人发生预后不良的相关影响因素。结果重症组血清 FIB、TSP-1表达水平分别为( 4.93±1.16)g/L、(375.42±34.13)μg/L，显著高于对照组的( 3.85±0.97)g/L、(316.71±23.05)μg/L(P<0.05)。ROC结果显示，血清 FIB和 TSP-1单独及联合诊断重症 MPP的曲线下面积(AUC)分别为 0.796、0.900、0.926，血清 FIB联合 TSP-1诊断重症 MPP的灵敏度和特异度分别为 84.82%、90.65%。高 FIB组、高 TSP-1组老年人病人预后不良发生率分别为54.55%(12/22)、 55.00%(11/20)，显著高于低 FIB组的 16.67%(4/24)及低 TSP-1组的 19.23%(5/26)(P<0.05)。 logistic回归分析显示，血清 FIB、TSP-1表达水平是影响重症 MPP病人发生预后不良的独立危险因素(均 P<0.05)。结论 FIB和 TSP-1在重症 MPP病人血清中的表达水平明显升高，且其高表达与病人预后不良有关，均可作为重症 MPP的早期诊断及预后评估的潜在生物学指标。     

Medical decision making for older patients during multidisciplinary oncology team meetings

Objectives

Multidisciplinary team meetings aim to facilitate efficient and accurate communication surrounding the complex process of treatment decision making for older patients with cancer. This process is even more complicated for older (≥70?years) patients as the lack of empirical evidence on treatment regimens in patients with age-related problems such as comorbidity and polypharmacy, necessitates a patient-centred approach.This study investigates the decision making process for older patients with cancer during multidisciplinary team meetings and the extent to which geriatric evaluation and geriatric expertise contribute to this process.

Patterns of aged care use among older Australian women: A prospective cohort study using linked data

BackgroundWomen live longer than men and have an increased need for long-term care. The objective of this study was to identify patterns of aged care use among older Australian women and to examine how these patterns were associated with their demographic and health-related characteristics.MethodsThe sample consisted of 8768 women from the 1921–1926 birth cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), who had survived to age 75-80 years. ALSWH survey and linked administrative aged care and death datasets from 2001 to 2011 were utilized. Patterns of aged care use were identified using a repeated measure latent class analysis.ResultsWe identified four patterns of aged care use over time, differentiated by timing of service onset, types of service use and time of death. Approximately 41% of the sample were non-users or using basic home and community care (HACC), while 24% were at high risk of using moderate to high-level HACC/community aged care package (CACP). Only 11% had a greater risk of using residential aged care (RAC) over time. Being widowed, residing in remote/regional areas, having difficulty in managing income, having a chronic condition, reporting poor/fair self-rated health, and lower SF-36 quality of life scores were associated with an increased odds of being a member of the following classes: 1) moderate to high-level HACC/CACP, 2) increasing RAC, and 3) early mortality, compared with the non-user class.ConclusionsDistinct patterns of aged care use were identified. These results will facilitate future capacity planning for aged care systems in Australia.     

Impact on Quality of Life Following the Implantable Miniature Telescope Procedure

The purpose is to examine the impact of the Implantable Miniature Telescope procedure on the level of treatment satisfaction and quality of life of individuals with end-stage age-related macular degeneration. Six individuals who had undergone the Implantable Miniature Telescope procedure were recruited. The participants completed two survey instruments about their overall quality of life and level of treatment satisfaction post intervention. In-depth interviews were also conducted to gain a perspective of the participant’s lived experience. A moderately high quality-of-life and treatment satisfaction rating was reported by participants post intervention. Qualitative themes included loss of independence, realistic perspective about the procedure, importance of rehabilitation following the procedure, and high treatment satisfaction despite lack of improvement in visual functioning. Moderately high quality-of-life ratings and treatment satisfaction were reported despite reports of limited improvements in participants’ visual function and ability to utilize the Implantable Miniature Telescope. However, qualitative responses revealed a negative impact on quality of life in relation to their diagnosis of end-stage age-related macular degeneration, but not in direct relation to the Implantable Miniature Telescope procedure.     

老年难治性心力衰竭患者BNP、hs-CRP水平与心功能的相关性及其临床意义

【摘要】目的：探究老年难治性心力衰竭（心衰）患者BNP、hs-CRP水平与心功能的相关性及其临床意义。方法：以我院心内科近两年收治的61例老年难治性心衰患者为临床研究对象，作为心衰组，另选20例健康志愿者作为对照组。心衰组患者按照NYHA分级的不同，从低到高分成A、B、C三组。对患者进行BNP与hs-CRP测定，并测定患者的心功能LVDD和LVEF。跟踪记录患者的心血管事件发生情况，比较患者BNP、hs-CRP、LVEF、LVDD水平的差异。结果：与对照组相比，心衰组患者的LVDD、BNP与hs-CRP指标显著较高而LVEF指标显著较低；A、B、C三组患者的LVDD、BNP与hs-CRP指标逐渐升高、LVEF水平逐渐下降；与无心血管事件患者相比，出现心血管事件患者的BNP、hs-CRP、LVDD水平显著较高，LVEF指标则显著低。差异均具有统计学意义（P＜0.05）。结论：BNP与hs-CRP指标与老年难治性患者的心功能具有密切的关系，BNP、hs-CRP以及患者的LVEF、LVDD水平是临床诊断老年难治性心衰的重要标志物，具有重要的临床诊断价值。     

老年患者全身麻醉和脊柱麻醉后的诱导、维持和复苏特性分析

目的：比较使用3种全身麻醉方法和脊髓麻醉对老年患者的诱导和复苏特性。方法研究对象为100例接受尿道手术的60岁以上患者，根据麻醉方式不同分为丙泊酚-丙泊酚（ P-P ），丙泊酚-异氟烷（P-I），丙泊酚-地氟烷（P-D）组，每组25例，分别由芬太尼（1～2μg/kg IV）和丙泊酚（1．0～2．0 mg/kg IV）诱导麻醉，并分别用含70％N2 O的氧气同时注射丙泊酚（75～150μg· kg-1· min-1）或异氟烷（呼气0．7％～1．2％）或地氟烷（呼气1％～4％），维持麻醉状态。诱导麻醉后接上通气喉罩，维持自主呼吸。在脊髓麻醉组（S），患者鞘内注射1．5 mL溶于等体积10％葡萄糖注射液中的4％利多卡因（60 mg）麻醉。结果与脊髓麻醉相比（9．3±3．4）min，丙泊酚诱导麻醉的技术方法比较简单并且诱导速度更快（P＜0．01）（P-P，P-I和P-D组麻醉的诱导时间分别为（4．6±1．7）min，（4．7±2．2）min和（3．8±1．4）min。在诱导期内，S组病例的主动脉压和心率更高。3个全身麻醉组患者，在麻醉诱导，拔管和定位时间相近。 S组病例产生疼痛得分更低（P＜0.05），但复苏观察时间更长（P＜0．01）。 P-P和P-D组患者数字符号替换测验（DSST）得分恢复到基础水平的时间比P-I组稍短。麻醉方法不同对于患者术后恶心，嗜睡，焦虑和协调性没有影响。结论老年患者使用丙泊酚和地氟烷诱导全身麻醉可以缩短诱导和复苏时间，且不会产生副作用。因此这种方法适用于老年患者在经尿道手术中使用。     

邢台山区65岁以上老年人骨质疏松症患病情况及其影响因素分析

目的探讨邢台山区65岁以上老年人骨质疏松症（OP）患病情况及其影响因素。 方法调查选取2016年3月至2018年12月邢台山区65岁以上老年人1 207例，采用自制《老年人OP问卷》调查OP患病情况及其影响因素。 结果本次调查的1 207例老年人中，有OP者129例、患病率为10.69%；单因素分析结果显示，有无OP老年人的年龄、体质量指数、运动量、吸烟、奶品摄入、OP家族史比较，差异有统计学意义（P<0.05）；Logistic回归分析结果显示，75~80岁、体质量指数>28 kg/m²、吸烟、OP家族史是老年人OP患病的独立危险因素，经常运动、奶品摄入是老年人OP患病的独立保护因素（P<0.05）。 结论邢台山区65岁以上老年人OP的患病率高，其与多种因素有关，提示应重点关注75~80岁、体质量指数>28 kg/m²、吸烟、OP家族史等老年人群，并应指导老年人进行合理的运动、奶品摄入。     

Multimorbidity and mortality in older adults: A systematic review and meta-analysis

ObjectiveTo review literature and provide a pooled effect for the association between multimorbidity and mortality in older adults.MethodsA systematic review was performed of articles held on the PUBMED database published up until January 2015. Studies which used different diseases and other conditions to define frailty, evaluated multimorbidity related only to mental health or which presented disease homogeneity were not included. A meta-analysis using random effect to obtain a pooled effect of multimorbidity on mortality in older adults was conducted only with studies which reported hazard ratio (HR). Stratified analysis and univariate meta-regression were performed to evaluate sources of heterogeneity.ResultsOut of 5806 identified articles, 26 were included in meta-analysis. Overall, positive association between multimorbidity and mortality [HR: 1.44 (95%CI: 1.34; 1.55)] was detected. The number of morbidities was positively related to risk of death [HR: 1.20 (95%CI: 1.10; 1.30)]. Compared to individuals without multimorbidity, the risk of death was 1.73 (95%CI: 1.41; 2.13) and 2.72 (95%CI: 1.81; 4.08) for people with 2 or more and 3 or more morbidities, respectively. Heterogeneity between studies was high (96.5%). The sample, adjustment and follow-up modified the associations. Only nine estimates performed adjustment which included demographic, socioeconomic and behaviour variables. Disabilities appear to mediate the effect of multimorbidity on mortality.ConclusionsMultimorbidity was associated with an increase in risk of death. Multimorbidity measurement standardization is needed to produce more comparable estimates. Adjusted analysis which includes potential confounders might contribute to better understanding of causal relationships between multimorbidity and mortality.     

侧卧手术体位对老年患者眼压变化的影响及护理观察要点

目的探讨使用有效的测量工具和在适合的测量时间段采集侧卧手术体位老年患者基础数据,找出患者眼压变化随体位变化的规律,旨在制订有效的护理预防措施。方法选取2019年3—6月在首都医科大学附属北京同仁医院中心手术室完成胸科胸腔镜手术的老年患者31例。使用icare回弹式眼压计分别于患者入手术室后、全身麻醉插管后、侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h、翻身拔管、出室前9个时间点测量双眼眼压,同时记录每个时间点患者的血压、心率数据,记录手术过程中液体出入量、特殊用药等。结果患者侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的血压与入室后比较,差异有统计学意义(P<0.05);不同时间点的心率比较,差异无统计学意义(P>0.05)。麻醉插管后患者双眼眼压均低于入室时眼压,差异有统计学意义(P<0.05);侧卧30 min、术中1 h、术中2 h、术中3 h的双眼眼压与入室后眼压比较,差异有统计学意义(P<0.05);侧卧5 min、侧卧30 min、术中1 h、术中2 h、术中3 h的受压侧眼压与非受压侧眼压比较,差异有统计学意义(P<0.05)。Pearson相关分析显示,患者平均动脉压与受压侧眼及非受压侧眼的眼压均无相关性(r值分别为-0.1138、0.0179,P>0.05)。进入手术间时患者测试视力与术后6 h回病房后测试视力比较,差异无统计学意义(P>0.05)。结论胸腔镜手术老年患者的眼压随手术体位变化而波动,从侧卧5 min开始眼压出现变化,2 h内受压侧眼眼压达到高峰,体位恢复平卧位后,眼压随即恢复到入室时水平。本研究未发现血压与眼压变化的相关性。     

Readmissions of Elder Patients Presenting to Hospital for a Fall (RELIEF): A Systematic Review

ObjectivesFalls are an important issue in older adults as they are frequent, deleterious, and often lead to repeated consultations at the emergency department (ED) and unplanned hospitalizations. Our principal objective was to provide an inventory of interventions designed to prevent unplanned readmissions or ED visits of older patients presenting to hospital with a fall.DesignSystematic review performed on February 11, 2019 in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science, without date or language restriction. We manually updated this search in August 1, 2019. Study selection, data extraction and risk of bias assessment were conducted independently by 2 reviewers.Setting and ParticipantsWe included studies reporting interventions to prevent unplanned readmissions or ED visits of older patients (aged 65 years or over) presenting to hospital because of a fall.ResultsWe identified 475 unique citations after removing duplicates and included 6 studies (2 observational and 4 interventional studies). The studies were published between 2012 and 2019; they evaluated heterogeneous interventions that were frequently multifaceted and multidisciplinary. The interventions were shown effective in reducing readmissions or ED revisits compared with control groups in 3 studies (relative risk reductions between 30% and 65%), all of which were multifaceted and 2/3 multidisciplinary.Conclusions and ImplicationsWith 6 articles showing inconsistent results, our study highlights the need to adequately design and evaluate interventions to reduce the burden of hospital readmissions among older fallers. Retrieved studies are recent, which underlines that hospital readmissions are a current concern for researchers and public health authorities [PROSPERO registration number: CRD42019131965].