End-of-life care for older people in subacute care: A retrospective clinical audit

Background

With an ageing population and chronic illness the leading cause of death, challenges exist in meeting the healthcare needs of older people. For older people, care may be provided in subacute care services where, although the focus is on rehabilitation and optimisation of functioning, many older people will die.

老年性痴呆教学体会

老年性痴呆是老年病学中的一个重要内容。在老年性痴呆教学中,首先应提高学生对该疾病重要性的认识,进而在教学方法上下功夫,通过激发学生学习兴趣;发挥多媒体优势;加强教学互动等措施,充分调动学生的学习积极性,提高教学质量。     

对1例老年贫血伴慢性肾功能不全患者的药学监护

1例80岁女性患者,因纳差、全身乏力入院。既往有结肠癌、慢性肾功能不全病史,入院诊断为贫血、慢性肾功能不全。采用口服维生素B12和叶酸、皮下注射促红细胞生成素(EPO)、输血以及静脉补铁等治疗措施。因患者不能耐受口服铁剂,建议静脉给予右旋糖酐铁,结合患者病情计算补铁量,并对输注过程中的不良反应进行监测。为迅速改善和减轻贫血症状,给予一次性输注400mL红细胞悬液,大剂量输血使患者肾功能恶化,建议调整剂量为200mL。出院后回访患者用药情况,因患者隔日服用琥珀酸亚铁片产生轻微胃肠道刺激症状,药师建议换用多糖铁复合物,之后症状缓解。     

老年患者骨科术后感染的治疗和监护

1例75岁男性患者,因股骨颈骨折入院,既往有溃疡性结肠炎病史.患者行关节置换术后发生感染,分泌物培养示阴沟肠杆菌、大肠埃希氏菌、奇异变形杆菌多药耐药,根据药敏结果,临床药师建议选择美罗培南抗生素骨水泥结合全身使用依替米星治疗骨科感染,针对出现的菌群失调及腹泻采用微生态制剂及抗真菌药物对症治疗.最终患者感染得到控制出院.     

舒芬太尼对老年患者全麻诱导应激反应的影响

目的 观察舒芬太尼对老年患者全麻诱导期应激反应的影响.方法 老年全麻患者62例,随机均分两组,舒芬太尼组(SF组)诱导用舒芬太尼0.4 μg/kg;芬太尼组(F组)用芬太尼3μg/kg.比较麻醉诱导各时段的血流动力学及血浆儿茶酚胺浓度.结果 与麻醉诱导前比较,两组在插管前SBP、DBP、HR均明显下降(P<0.05),且F组DBP、HR显著低于SF组(P<0.05).F组插管后肾上腺素浓度升高(P<0.05),明显高于SF组(P<0.05).结论 舒芬太尼对老年患者全麻诱导应激反应的抑制作用强于芬太尼.     

老年病科开展临床药学的体会及经验

目的:探讨临床药师在老年病科患者用药监护中的工作方法和作用。方法:结合实际病例,针对老年病科患者生理、疾病特点,介绍老年病科开展临床药学的体会及经验。结果:临床药师在老年病科开展临床药学能够提高患者的药物治疗效果。结论:临床药师通过参与老年病科查房、监控用药全过程、追踪用药结果,能够全方位服务于患者。     

Second malignancies among elderly survivors of cancer

The U.S. population is aging, life expectancy is increasing, and cancer is a disease associated with aging. Advances in screening and therapeutics have led to a growing number of cancer survivors who are at risk for the development of secondary malignancies. Although the risks for the development of second malignancies following a first diagnosis of cancer are well described for survivors of childhood malignancies, there are fewer data for malignancies common in older adults. With the aging of the U.S. population, and with improving survival statistics in many adult malignancies, there is an increasing need to identify those second malignancies that might develop in the older adult survivor of cancer. In this paper, we describe the types and rates of second malignancies following cancers commonly seen in older adults and review the literature on these malignancies. Comparisons are made between older and younger adults with regard to the risks for developing treatment-related cancers with different modalities. Recommendations for early detection of second malignancies are summarized, though there remains an unmet need for evidence-based guidelines for screening for second malignancies in the older adult in particular.     

老年患者铜绿假单胞菌的感染及耐药性分析

目的了解笔者所在医院老年患者铜绿似单胞菌感染分布和耐药性,为临床合理使用抗菌药物提供依据。方法采用法国生物梅里埃API20NE进行细菌鉴定,K—B法做药敏试验,并用WHONET-5．4软件对药敏结果进行数据分析。结果共分离出病原菌728株,其中铜绿假单胞菌192株占26．4％,以痰液检出率最高占85．9％,其次是尿（9．9％）和创面分泌物（2．1％）。检出的铜绿假单胞菌对所监测的抗菌药物均有不同程度的耐药,活性较好的是阿米卡星（91．4％）、亚胺培南（76．4％）、头孢他啶（74．7％）、头孢哌酮／舒巴坦（64．3％）、环丙沙星（61．4％）;耐药率高的是复方新诺明（98．8％）、庆大霉素（95．5％）、头孢噻肟（88．9％）、头孢曲松（86．9％）、洛美沙星（70．5％）。结论老年患者临床标本中铜绿似单胞菌检出率高,且对抗菌药物耐药现象严重,临床医师应根据药敏结果合理使用抗菌药物,有效控制感染。     

补肾活血法在老年病治疗中的运用

目的:探讨老年病的基本病机和治疗方法.方法:分析老年病基本病因病机及几种常见老年病的病理基础、临床治疗用药.结果:补肾活血法对老年病有很好的治疗效果.结论:肾虚血瘀是老年病的病理基础,补肾活血法当贯穿老年病治疗过程的始终.     

Frailty: an emerging geriatric syndrome

Frailty is a new and emerging syndrome in the field of geriatrics. The study of frailty may provide an explanation for the downward spiral of many elderly patients after an acute illness and hospitalization. The fact that frailty is not present in all elderly persons suggests that it is associated with aging but not an inevitable process of aging and may be prevented or treated. The purpose of this article is to review what is known about frailty, including the definition, epidemiology, and pathophysiology, and to examine potential areas of future research.