Comprehensive geriatric assessment (CGA) conducts comprehensive assessment of many aspects of health and well-being of an older patient including medical,functional,nutritional,psychiatric and behavioral issues and needs as well as family and social support.CGA is typically conducted by a multidisciplinary team led by a geriatrician.Based on the CGA findings,appropriate recommendations are provided to the patient and family.This paper introduces the CGA concept and its content,targeted population,and implementation methods.It will also describe clinical studies focusing on the effectiveness and utility of CGA.

Delirium is a common disorder in aged people.Although it is in poor prognosis,delirium still has been under-recognized and inappropriately evaluated and treated.The clinical aspects of delirium on epidemiology,diagnosis,risk and precipitating factors,prevention and treatment were introduced in this paper.

A total of 115 patients with acute chest pain under the suspicion of acute myocardial infarction (AMI) were selected.By the onset time of chest pain,they were divided into two periods of ＜3 h and 3 -6 h respectively. Heart-type fatty acid binding protein (H-FABP)and such traditional cardiac biochemical markers as cardiac troponin T (cTnT),creatine kinase isoenzyme (CK-MB) and myoglobin (MYO) were tested to compare the sensitivity and specificity in the early diagnosis of AMI.The sensitivity of H-FABP was significantly higher than those of cTnT,CK-MB and MYO (P =0.026,0.005,0.048 ) ; the specificity of H-FABP was lower than those of cTnT,CK-MB in the diagnosis of AMI ( P ＞ 0.05 ).The sensitivities of H-FABP were 81.6％ and 78.1％ in the ST-elevation myocardial infarction (STEMI) and nonST elevation myocardial infarction (NSTEMI) groups respectively ( P =0.095 ).Regardless of the onset of chest pain at ＜ 3 h or 3 -6 h,the combination of H-FABP and cTnT had a higher sensitivity than those of cTnT,CK-MB and MYO in the early diagnosis of AMI (P =0.005,0.028).In the early and rapid diagnosis of AMI patients,H-FABP has a high sensitivity and a poor specificity.And it has some reference value.

OBJECTIVE To investigate the genes of disinfectant-sulfadiazine and antibiotic resistance of Escherichia coli strains in elderly wards.METHODS Polymerase chain reaction and dilution test were used to detect and analyze the disinfectant-sulfadizane drug resistance gene and drug resistance of the E.coli.RESULTS From 30 E.coli strains isolated from elderly patients,21 were detected carrying disinfectant-sulfadizine drug resistance genes,and the positive rate of qacE△1-sulⅠ was 70.0%.CONCLUSIONS The detection rate of disinfectant-sulfadiazine drug resistance gene from E.coli strains isolated from elderly patients,the bacteria detection rates are relatively high.Most of the isolates were resistant to commonly used antibiotics.It suggests that clinical drug-resistant strains may be resistant to disinfectants.This condition should be paid much attention by disinfection wotkers of our country.

Objective To discuss the application effects of CBI teaching method in medical English Teaching of respiration medicine. Methods Dividing 120 students of Grade 2009 in Jining Medical College into two groups including control group (60) and experimental group (60). The tradi-tional teaching method was adopted in the control group and CBI teaching method was adopted in the experimental group. After finishing the courses, medical professional English level test and standard-ized patients test were applied in the two groups. Students' English studying interests and autonomous English learning ability were also investigated by questionnalres. SPSS 17.0 software was used for sta-tistical analysis, and the data were processed by t test and 字2 test, with the level of a test equal to 0.05. Results The medical professional English level test scores, standardized patients test scores and the total average scores of autonomous English learning ability in experimental group were respectively [(81.97±4.91), (80.33±5.85), (3.88±0.38)], and they were significantly higher than those in the control group [(70.40±4.78), (70.48± 4.79), (2.98±0.26), with P values below 0.01]. Satisfaction degrees in the improvement of learning motivation, learning time, learning method, learning attitude and dealing with study difficulties in experimental group were better than those of control group (χ2=13.084, 8.000, 13.297, 11.627, 13.374, P=0.000). Conclusion CBI teaching method is better than traditional teaching method and it transfers English learning into the learning of professional knowledge and skills of respiratory medicine, stirs the interests of students, improves their autonomous English learning ability and strengthens their abilities to learn and apply English language.

Objective To investigate the duration for silicon gastric tube to indwell in stomach of aged patients.Methods One hundred elderly patients needing long-term nutrition support were equally randomized into two groups: control group and observation group.The former had the gastric tubes indwelled in the stomach for 4 weeks and the latter for 3 weeks.The two groups were compared about the used tubes in terms of the color of tube at the length of the first 10cm,the indentation by reflection for 10 seconds at the tube of first 10 cm,the hardness of the tube at the length of the first 10 cm and the springback angle of tube at the first 10cm after reflection.Results The tubes in the observation group were significantly better than those in the control group in terms of color,indentation,hardness and springback angle(all P<0?01).Conclusion The duration of indwelling silicon gastric tubes in stomach can be three weeks for old patients needing long-term nutrition support via indwelling silicon tubes in their stomach.

Based on the ongoing clinical experiences at our outpatient pharmacy and geriatrics multidisciplinary inpatient and outpatient services,we believe that polypharmacy among elderly patients is serious and pervasive in China.This observation is supported by the findings from literature review.To help address this serious issue in senior care,we recommend to gain better understanding of age-related physiological changes of the elderly as well as those in pharmacokinetics and pharmacodynamics,and to conduct prescription review and medication reconciliation.The multi-and interdisciplinary approach employed by modern geriatrics care model,involving doctors,pharmacists and nurses,should further help address this issue and promote rational use of pharmaceuticals in the elderly patients.

Objective:To explore the attitudes of Chinese medical students toward the elderly and their willingness to practice in geriatrics, and to investigate the influence of geriatrics education on their attitudes.Methods:Medical students studying diagnostics in four medical universities were enrolled in a cross-sectional survey and, for the intervention study, graduate trainees from non-geriatrics specialties taking a geriatrics course were interviewed before and after the course.An electronic questionnaire was used to collect general information, the experience of interacting with the elderly, attitudes towards the elderly and the willingness to develop careers in geriatric medicine.Changes in attitudes towards the elderly and their willingness to practice in geriatrics before and after the 40-hour geriatric medicine course were compared.Results:A total of 648 medical students completed the cross-sectional survey, with the highest score in compassion for the elderly(3.54±0.54)and the lowest score for medical services for elderly patients(3.36±0.78). Only 2.2%(14/648)of the students showed strong interest in geriatric medicine.The results of the intervention from 42 graduate trainees showed that the average scores of revised Geriatric Attitude Scale(r-GAS)were 3.80±0.43 and 3.92±0.40 before and after the course, respectively, and the difference was statistically significant( t=2.148, P=0.038). At the end of the course, 7 trainees(16.7%, 7/42)showed great interest in geriatrics, significantly different from 2 trainees(4.8%, 2/42)before the course( χ2=8.211, P=0.025). Conclusions:Chinese medical students show a serious lack of interest in geriatrics, and geriatrics education can improve their attitudes towards the elderly and their willingness to work in geriatrics.With the rapid population aging in China, it is urgent to strengthen the education of geriatric medicine.

Objective To explore the effect of calories supplement or protein supplement on the skeletal muscle in the elderly.Methods The ambulatory elderly (≥65 yrs) with reduced handgrip strength and/or gait speed were enrolled,who did not suffer from any neurological or arthritic disease impairing mobility,or any severe pulmonary or heart disease,or chronic kidney failure.The subjects were recruited with their written informed consent from clinical practices in five hospitals in China.The subjects were randomized to control group(n=26),nutrition supplementation (Nutren 400 kcal/ d) group (n=27) or protein supplementation(Biopro Protein 20 g/d) group (n=21).All the subjects were given healthy lifestyle education.The physical performances i.e.gait speed and handgrip strength were measured at baseline and at 2 and 3 months of followed up.Lean soft tissue mass (muscle mass) was measured by BIA at baseline and at 3 months of follow-up.Results A total of 74 subjects completed the trial,including 26 in controls,27 in Nutren,and 21 in protein group.At the end of the trial,the changes from baseline in appendicular muscle mass were-490.0 g (95％CI:-801.9--245.5,P=0.001)in control group,90.0 g (95％CI:-346.8--442.0,P=0.241) in Nutren group,and 290.0 g (95％CI:-746.6-20.1,P=0.007) in protein group.There were no significant difference in above indices among the three groups (P=0.051),except between Nutren group and control group (P=0.020).The handgrip strength and gait speed in the three groups were improved obviously as compared with those at baseline,but not statistically significant between different groups.Conclusions Caloric supplementation group may have greater effect in maintaining muscle mass than the protein supplement group in the elderly.Both the caloric supplement and the protein supplement produce no additional effect on muscular function as compared with healthy lifestyle education.

Objective To explore the way to evaluate hemodynamics of posterior circulation distal ischemia with PWI. Methods Thirty-two patients with vertebral basilar artery severe stenosis were reviewed and compared with thirty normal persons. Information and data of PWI and MRA were collected and analyzed. Following parameters were observed, index of vascular stenosis, collateral vessels, cerebral blood flow (rCBF), cerebral blood volume (rCBV), and mean transit time (rMTT). Results All the patients had at least one vertebral basilar artery with more than 70% stenosis. There were 17 cases with severe vertebral artery stenosis , 20 cases with severe basal artery stenosis , 8 cases with severe superior cerebellar artery stenosis , 17 cases with posterior cerebral artery stenosis , 22 cases with after the traffic artery open , 11 cases with soft meningeal arteries show and 12 cases with small artery show. The ratio of ROI with frontal white matter was lower than the rCBF and rCBV in the country group. MTT value was extended and P value of the parameters in both groups was less than 0.05, reflecting the statistical difference. Conclusions PWI combined with MRA can effectively evaluate the posterior circulation distal ischemia area and tissue perfusion , as well as the hemodynamic status of ischemia area.