The use of five or more drugs (polypharmacy) is common problem in the elderly,and need to attach importance.Optimization of drug treatment is a major part of medication in older adults,and also is a challenge to clinical physician.Beers Criteria provided by American Geriatrics Society (AGS) is a strong guarantee for improving medication safety in older adults

In April 2016,the American Geriatrics Society(AGS)entered into a cooperative agreement with U.S.Department of Transportation.National Highway Traffic Safety Administration (NHTSA) updates and expands the Clinician's Guide to Assessing and Counseling Older Drivers to the 3rd Edition.The main goal of the Guide is to reduce traffic accidents and injuries to older drivers.According to the workflow of evaluation and management provided by Plan for Older Driver Safety(PODS),clinicians can conduct driving strategies after screening,evaluation and result analysis.The evaluation is done based on the Clinical Assessment of Driving Related Skills(CADReS) by a team including physicians,nurse practitioners,physician assistants,pharmacists,occupational therapists,driving rehabilitation specialists,and social workers.The CADReS including a series of assessment tools are used to evaluate in the key areas,such as vision,cognition,and motor/sensory function related to driving.Some measures will be taken based on the evaluation conclusions to help to explore the potential of driving safely for old adults.

Palliative and hospice care for patients suffering severe or end-stage illness with projected short life expectancy.Such services aim to improve patients' quality of life through prognosticating,prevention and treatment of their ailment.The main components include evaluation and treatment of symptoms,pain control,family care,alleviating and treating patients' psychological burden and depression,and offering comfort and dignity.Hospice and palliative care are different from euthanasia,because they neither hasten nor delay the dying process.Instead,they focus on patients'physical and psychological needs and helping patients to maintain their independence and make their own choice.As a new medical subspecialty,palliative and hospice care are considered one of the important frontier in modern medicine.They employ a multi-disciplinary team approach,and the team members require special skill sets including those in communication and symptom management.

A 64-year old man was admitted on July 2011 with masses both in liver and right kidney.After PET-CT and blood test examination,dual primary advanced cancers were speculated to be co-existed in this patient,which having poor prognosis.By evaluation with comprehensive geriatric assessment,the patient also had hypertension,diabetes and atherosclerosis,liver and renal insufficiency.After multidisciplinary consultation and detailed discussion with the patient,the decision of no surgery and just keep the follow-up was made.The patient has been followed up for 18 months and the functional evaluation is the same as before.It is very important to evaluate the risk/benefit equation and improve the standard of care,and make the decision as patient centered rather than disease-centered in the elderly patients.

Objective To explore the preventive effect of feedforward control on unexpected extubation in patients with cerebral apoplexy.Methods The clinical data of 42 cerebral apoplexy patients during May 2010 and May 2011 were retrospectively reviewed to find out the risk factors of unexpected extubation.The feedforward control was used to manage 49 cerebral apoplexy patients during June 2011 to June 2012 to control the risk factors.The incidence of unexpected extubation was compared between pre-and post-use of feedforward control. Results After application of feedforward control,the incidences of unexpected extubation of gastric tube,deep vein tubes and urinary tubes reduce were significantly decreased compared to pre-use of feedforward control(all P<0.01).Conclusion The feedforward control on patients with cerebral apoplexy is effective in reducing the incidence of unexpected extubation and ensuring the intubation safety.

Purpose To investigate the value of three-dimensional speckle tracking echocardiography in evaluating the cardiac function in breast cancer patients treated with Anthracycline. Materials and Methods Thirty-two breast cancer patients were followed with three-dimensional echocardiography prechemotherapy (group A), 2 cycles (group B) and 4 cycles (group B) postchemotherapy to compare left ventricle global longitudinal strain (GLS), global radial strain (GRS), global circular strain (GCS), global area strain (GAS), early diastolic global area strain rate (EASR), and early diastolic 3D velocity (3DVe). Results GCS, GAS and EASR were signiifcantly lower in group C than group A (t=3.555, 3.692 and 3.590, P<0.01);EASR was lower in group B than group A with statistical significance (t=2.190, P<0.05). GLS, GRS and 3DVe were not significantly different among three groups (F=2.305, 1.957 and 1.205, P>0.05). EASR was negatively correlated with IVRT (r=-0.44, P<0.01); EASR was positively correlated with Em (r=0.49, P<0.01) and Em/Am (r=0.32, P<0.01). GSR was positively correlated with Sm (r=0.21, P<0.05). Conclusion Three-dimensional echocardiography sensitively detects the early changes in diastole function in breast cancer patients treated with Anthracycline.

Objective To observe the effect of Bufalin on controlling ECA109 cells , and to explore its potential anti-tumor mechanism. Method The effect of Bufalin on the proliferation of human esophageal cancer ECA109 cells was evaluated by CCK-8 assay and it effects on apoptosis of esophageal cancer ECA109 cells were determined by flow cytometry (FCM). Protein expressions of NF-κBp65, ERK, PERK1/2 and Caspase-3, Cleaved Caspase-3, PARP, Cleaved PARP in esophageal cancer ECA109 cell were observed through Western blot. Results The proliferation of human esophageal cancer ECA109 cells was significantly inhibited in bufalin group in a time- and concentration-dependent manner. Bufalin can induce the apoptosis in human esophageal ECA109 cells. Results of Western blot showed the protein expressions of apoptosis-related protein Cleaved Caspas-3 and Cleaved PARP in esophageal cancer ECA109 cells could be markedly up-regulated by Bufalin , but p-ERK1/2, NF-κBp65 in esophageal cancer ECA109 cells could be markedly down-regulated by Bufalin. Conclusion Bufalin can potently inhibit the growth of esophageal cancer ECA109 cells and the potential anti-tumor mechanism might be involved in inhibiting ERK/ NF-κB signal pathway.

OBJECTIVE:To investigate the compatible stability of Voriconazole for injection after mixed with Fructose injec-tion or Invert sugar injection. METHODS:Referring to package inserts,Voriconazole for injection 200 mg was dissolved with Wa-ter for injection to 20 mL,and then combined with Fructose injection 250 mL and Invert sugar injection 250 mL,respectively. At room temperature,the appearance of mixtures were observed 0,1,2,3,4,5 h after mixing,and pH value and the number of in-soluble particles were determined;the content of voriconazole was determined by HPLC. RESULTS:Under above condition,the appearance and pH value of mixtures had no significant change within 5 h;the number of particles ≥10 μm and ≥25 μm were all in line with the standard of Chinese Pharmacopoeia (2015 edition);the relative content of voriconazole was decreasing (95.28%-100%),but it changed within ±5%(RSD<2%,n=6). CONCLUSIONS:Voriconazole for injection could keep stable within 5 h after mixed with Fructose injection or Invert sugar injection.

Objective: The aim of this paper is to identify the basic organizational structure and the key elements of integrated healthcare model of patients with Chronic Obstructive Pulmonary Disease (COPD) and propose an appropriate development strategy.Methods: Based on the literature review of research articles about integrated care on patients with COPD, an analysis was conducted with the help of the Chronic Care Model (CCM) which is a chronic disease management model.Results: From of a total 16 articles about 13 case studies were found.An integrated healthcare of COPD was carried out in 10 hospital-based or community-based care programs.Most of the patients were the elderly and health status were moderately severe or more severe.The components of healthcare programs varied from 4 to 12 included at least two CCM dimension.A coordinator or a case manager was appointed in all healthcare programs and a follow-up plan was made as well.Decision making was supported by clinic guideline and specialist resource in 9 integrated healthcare programs which community facilities involved.All programs included self-management with health education and individualized behavioral support was in 10 programs.The action plan was applied in 8 studies.8 studies using a clinical information system connected health care provider and patients.Conclusions: COPD integrated care program can be constructed according to the management model of chronic disease, and it is suggested that we can organize the COPD integrated care program based on CCM and the program comprises 4 organizational components of at least two CCM dimensions.The key elements of COPD integrated healthcare are to appoint a coordinator, to make a follow-up plan, and the necessity of community participation to support decision making, support self-management by education and individualized behavioral management with an action plan.

Objective To investigate clinical value of pubococcygeal line (PCL) determined by dynamic magnetic resonance imaging (MRI) used in evaluating pelvic organ prolapse (POP), and investigate the relationship of pelvic organ prolapse quantitation (POP-Q) stage and pubococcygeal line (PCL) for the patient with POP. Methods Twenty patients with POP were evaluated by POP-Q stage and pelvic dynamic MRI examination simultaneously. Sagittal MRI images were acquired at rest and during maximal Valsalva using a fast gradient echo sequence two-dimensional fast low angle shot (FLASH) T1weighted image. The degree of prolapsed anterior vaginal wall, uterus and posterior vaginal wall were measured by PCL and compared with POP-Q system. Results There were 20 cases with cystocel diagnosed by POP-Q staging system, in which bladder neck or bladder base of 17 patients were under the PCL during maximum Valsalva. The concordance rate was 85% (17/20) between PCL and POP-Q stage. There were 19cases with rectocele diagnosed by POP-Q, in which the anorectal junction of 4 patients' PCL descent below more than 2. 5 cm. The concordance rate was 4/19 between PCL and POP-Q stage. There were 14 cases with uterine prolapse diagnosed by POP-Q staging system, in which uterine cervix of all descent below PCL. The concordance rate was 14/14 between PCL and POP-Q stage. However, it was noted that 5 cases did not reach POP-Q staging and their lowest uteri cervix were below or above PCL but less than 1 cm at maximal Valsalva. Conclusions Compared with POP-Q staging system, the reference line of PCL determined by dynamic MRI could diagnose uterine prolapse accurately and anterior vaginal wall with greater clinical value,however it was limited in diagnosing posterior vaginal wall prolapse effectively. Therefore, the clinical value of PCL should be further studied for evaluating POP.