Palliative medicine deserved to improve quality of life of patients with advanced, incurable diseases. During last 13 years palliative care workers tried to palliate the pain, physical, psychological, spiritual symptoms of suffering, but they never measured the quality of life of palliative care patients. The term quality of life is used to evaluate the general well-being of individuals and societies. 111 countries of the World established Country QOL Index. Quality of life should not be confused with the concept of standard of living, which is based primarily on income, should not be confused with quality of health services, which is based on medical supplies, equipment, quality of medicine, education level of health workers. Health related quality of life (HRQOL) is “The degree to which a person enjoys the important possibilities of his or her life”. Health related quality of life index not established for all medical specialties. Some tools for measuring quality of life established for diabetic patients (DQOL), cancer patients (Ca QOL), HIV patients (HIVQOL), and palliative care patients (Pa QOL). In Mongolia since 2000 started to talk about quality of services and in 2008 started program on quality of health services, but never provided study of health related quality of life of any patientTo provide the study of quality of life index within palliative care patients and compare quality of life index with pain score and score of other physical, psychological, spiritual suffering of palliative care patientsWe provided study of quality of life index within 60 palliative care patients by MISSOULA-VITAS®- 15 quality of life index, pain score by Wong Baker scale, symptoms of suffering by Anderson method, functional activities by Karnofsky performance scale, psychological problems by hospital anxiety scale23.3% of patients were up to 45 years old, 76.6 % were older 45. 70% of palliative care patients in our study were patients with cancer, 30% were palliative care patients with non cancer pathology. The mean Quality of life Index of total palliative care patients was 37.7. They had more common symptoms of suffering, like pain (90%), fatigue (83.3%), weight loss (83.3%), poor appetite (66.6%), thirst (66.6%), nausea (53.3%), constipation (60%)., depression (66.7%) and anxiety (70%). 56.6% of palliative care patients had spiritual suffering because of false hope, lost of meaning, relationship problems, and forgiveness. Increasing the score of symptoms of physical, psychological, spiritual and social suffering correlated to decreasing the quality of life index.We need to develop comprehensive palliative care to improve quality of life palliative care patients.

Background: Many industrialized countries are witnessing a demographic evolution characterized by the aging of their population. For people over aged 65 year, the prevalence of tooth decay, gum disease and oral cancer is higher than for the general population and higher rates for edentulism (missing teeth), few sound teeth and more filled and decayed teeth than the general population. Risk factors for oral diseases include unhealthy diet, tobacco use, harmful alcohol use, and poor oral hygiene. There is no research work concerning the oral health status of the older population aged 65-74 years old. These age group is selected because they were the adult population groups recommended by the WHO for oral health survey. The purpose of this study was to determine prevalence of caries and edentulous of 65-74 years old and living in the Ulanbator. Methods: An epidemiological survey of 365 older people aged 65-74 was carried out in 2008. It followed the WHO methodology to assessing the oral health status and caries lesions, fi llings, missing teeth were recorded using the WHO criteria. Result: The mean age was 68.70.16. The DMFT index at 65-74 years for the Ulanbator population was 19.50.89 DMFT. Caries prevalence was 52.7% among older people. 4.1% were fully dentate, 21.6% were edentulous, 74.2% were partial edentulism, respectively. Mean number of decayed teeth (DT index) was 3.4, fi lling teeth (FT index) was 2.3, missing teeth (MT index) was 18.0. Conclusion: We carried out this study 365 older people aged 65-74. This preliminary study provide evidence in the direction of building the base of knowledge on prevalence of caries and edentulous elderly person in Ulanbator. The planning and implementation of any strategy for oral health status improvement is crucial alongside the countrys infrastructure development.

To study the correlation within psychological and social suffering in palliative care cancer patientsWe provide study within 100 palliative care patients with cancer stage 3-4. Depression was evaluated by San Diego hospice screening method with 3 questions. Anxiety was assessed by Spielberg -Hanin anxiety scale. Spiritual pain was assessed by San Diego hospice questionnaire, which includes main 4 factors of spiritual suffering, like cooperation, meaning of life, hope, forgiveness. Results of study was statistically evaluated by SPSS20 program.19% of patients had depression, 40% had anxiety, 46% patients had insomnia. 18% of patients with depression had spiritual suffering. 33% of patients with anxiety had spiritual pain. 31% of patients with insomnia had spiritual pain. Depression and spiritual suffering had mild correlation (R-0.318), anxiety and spiritual suffering had mild correlation (R-0.330), insomnia and spiritual suffering had very strong correlation (R-0.84). Psychological suffering of palliative care cancer patients increased with spiritual suffering and correlated with spiritual suffering. Especially insomnia had very strong correlation with spiritual suffering (R-0.84).

We conducted cohort study of 170 patients with advanced cancer who admitted to the Palliative care department of NCC, Hope, Green Home and Grace Hospices. Bad news was informed before the hospitalization by Robert Buckman 6 steps. Psychological reactions of patients were observedimmediately after breaking bad news, after 30 minutes, after one day and after a week.Immediate psychological reactions of patients after breaking bad news was different: 25% of patientssat quietly withdraw into themselves and think about something, 24.2% - sighed heavily and stared in disbelief, 21% - cried or had watering eyes, 14.8% - felt mental relief and were thankful for telling truth, 12% - looked very sad and depressed, 9.7%- looked in fear and worrying. Psychological reaction like crying, fear, worrying were more common within female patients, and psychological reactions like withdraw into themselves and think about something were more common for male patients. After 30minutes patients started ask questions, 80% of patients want talk about treatment (asked questions about possibility for treatment abroad, about palliative treatment, and other therapeutic options), 30% of patients asked about prognosis, 29% of patients asked about possible complications, 19% of patients expressed their anger to family members, because they did not tell truth to them, 4 % ofpatients still expressed disbelief to bad news and they told that they are enough strong to fight with disease or they can find other treatment option. After 7 days 85% of patients were psychologicallycomfortable, because they accepted diagnosis and prognosis, 74 % of patients had very good communication with family, and 65% of them experienced psychosocial rehabilitation, 44%- prepared testament, 30% - finished uncompleted job.First several minutes after breaking bad news patients experienced severe psychological reactions, but after several days they came to psychosocial rehabilitation, for this reason we have to inform to patients truth about diagnosis and prognosis.

Introduction: Due to social transition and change of many societal activities in Mongolia, there is an increasing need for pharmaceutical drugs to treat anxiety, stress, fatigue and insomnia. It is considered that medicinal plants used in traditional medicine as sedatives, anti-anxiety and anti-depressive activities could be effective. Our study focuses on exploring optimal methods for preparing tinctures from Paeonia L. genus species, a sedative in Mongolian traditional medicine, and studying their phytochemical compositions. Materials and methods: Root and herb of Paeonia anomala L., grown in Mogod soum in Bulgan province, were used for the study.
Prepared herb and root were chopped and sieved into 1 mm, 2 mm, 3 mm, 4 mm and 5 mm sizes. Then from each size of two samples, a set was created with a 1:1 ratio. Finally 40 % ethanol (1:10 ratio with a set) was applied to prepare tincture through a traditional maceration method. The obtained tincture was analyzed for its color, quantity of biologically active compounds, dry residue, and absorption coefficient using an optimal particle size of samples, volume of the extractive liquid and tincture yield.
Tincture from the set of herb and root of Paeonia anomala L. was prepared using 3 methods, namely, by the traditional maceration; intensified maceration using the ultrasonic bath processing with 45 kHz at an ambient temperature; constant shaking in a heat of 30o-40oC. Conclusion The more optimal and effective method for preparing tincture from Paeonia anomala L. has been found to be the ultrasonic bath processing with 45 kHz for 6 h at an ambient temperature. Crude drug mixture of 2 mm sizes with 40% ethanol (where volume absorption coefficient was accounted to be 2.8) was mixed at a ratio of 1:10. In the obtained tincture, total phenols were determined as 0.58±0.003% in gallic acid equivalent and total monoterpene glycosides as 1.96±0.002% in paeoniflorin, which were the highest compared to other methods, indicating the method is the more optimal one.

Introduction: It is important to standardize a tincture prepared from the herb and root of Paeonia anomala L, which is widely used as a sedative in traditional medicine, based on the results of the studies its chemical composition, biological and pharmacological activities. Moreover, there is a need to carry out a quantitative stability testing in order to establish the ability to maintain quality under certain storage condition, shelf-life and to develop suitable packaging information. Materials and methods: Standardization parameters of prepared Paeonia anomala tincture have been evaluated according to WHO guidelines for the determination of crude drug material, plant preparations and finished products technical parameters, along with the Mongolian National Pharma- copoeian (MNP) and Russian XIV Pharmacopoeian methods for tincture. The color of a tincture, dry residue, special density, alcohol content, and microbiological content were determined according to the methods described in MNP. A qualitative analysis of biological active constituents has been evaluated by thin-layer chromatography, the total phenolic compounds were determined by the reaction with Folin Chicalteu reagent and total monoterpene glycosides by the reaction with hydroxylamine in alkaline solution and ferric (III) chloride following spectrophotometric examination, respectively.
The stability testing study was performed according to the “General requirements for the stability testing study of drug-active compounds” MNS-6439-2014 using the real-time methods for the standardization parameters of the tincture. Conclusions The standardized parameters of tincture prepared from the herb and root of Paeonia anomala L. were approved by the National Reference Laboratory for Food Safety analysis. Consequently, the Mongolian pharmacopoeian article on Paeonia anomala tincture was officially permitted under the number ҮФӨ-0327-2017.
The stability study of tincture was carried out according to the MNS-6439-2014 by real-time tests for 24 months which provided that the changes in tincture quality were within the permitted limits. Consequently, it can conclude that the storage condition and shelf-time of Paeonia anomala tincture are 2 years under not above 25°С.

Introduction: The development of analytical methods for evaluation of quality standard parameters of drugs and other health prophylactic, diagnostic, and therapeutic products is essential from the beginning in the process to release to the market finished product. Validation of developed analytical methods is one crucial part of the analysis.
Quantitative determination methods of the total main active compounds of the tincture prepared from the root and the herb of Paeonia anomala L. were developed. In order to verify whether the analytical procedure is suitable for its intended purpose parameters – accuracy, reproducibility, intermediate precision, and linearity were validated. Materials and methods: The total phenolics in the tincture were determined by the reaction with Folin Chicolteau reagent and total monoterpene glycosides by the reaction with hydroxylamine in alkaline solution and ferric (III) chloride following spectrophotometric examination, respectively. Based on the achieved results of the developed quantitative methods which were validated according to the accepted and pursued technical documents in our country the Eurachem guide “The Fitness for Purpose of Analytical Methods” and Russian Pharmacopoeia 13 “Validation of analytical methodology”, where parameters as accuracy, precision – reproducibility, intermediate precision, and linearity are involved. Conclusions Statistical analysis of total phenolic compounds and total monoterpene glycosides in the Paeonia anomala tincture demonstrated that the bias calculated was for accuracy 0.674% and 0.703%, relative standard deviations were for reproducibility 0.896% and 0.798%, for inter- mediate precision 0.922% and 0.696%, respectively and the linearity – R²=0.9985 and R²=0.9997. All achieved results validated the appropriateness of the developed quantitative methods for the intended purpose.

Background: Pressure ulcer is the worldwide problem which does not depend on age group and any patients could suffer from. Nursing human resource, working load, hospital equipment supply, well-organized training, lack of scientific study are influencing the prevention and nursing care for patients with pressure ulcer although the prevention of ulcer’s depends on continuous nursing care. Therefore, we aimed to improve participation of nurses and evaluate knowledge of nurses on pressure ulcer. Methods: Total of 249 nurses who are working in primary and referral level were chosen as study participants. We used cross-sectional study of analytic study and standard questionnaire with Likert scale. Furthermore, we operated evaluative standard questions of Pieper and Mott (PUKT; 1995), standard questions of pressure ulcer evaluation and nurse’s knowledge. All statistics analysis done by using SPSS 21.0 program. Results: 237 (95.2%) were females, 12 (4,8%) were males were participated in the study and 122 (49,0%) had received Diploma, 125 (50,2%) of them had received bachelor degree and 2 (0,8%) had master degrees. Furthermore, 175 of all participants were nurse practitioners and 74 of them were clinical nurse specialists. The knowledge regarding nursing care on pressure ulcer was evaluated as 2,41% were excellent, 20,88% were with average-knowledge and 76,71% were with poor-knowledge. Nurse’s knowledge regarding Evaluation of pressure ulcer were measured as 65,68% were with poor-knowledge, 33,33% were with average, and 0,8% were with excellent knowledge. Finally, knowledge about nursing care on pressure ulcer, 14,86% were evaluated as average, 85,14% were with poor-knowledge. Conclusion Most of nurse’s knowledge regarding prevention and nursing care for pressure ulcer is inadequate. Therefore, there is a need to improve nurse’s knowledge about prevention and nursing care on pressure ulcer.

Background: The World Health Organization (WHO) estimates that the number of cancerrelated deaths will increase by 45 percent between 2008 and 2030. Following this estimate, many projects and programs have been implemented to improve cancer prevention, diagnosis, and treatment, but the number of new cancer cases and deaths is increasing worldwide. In 2018, 6073 new cancer cases were registered in Mongolia.² As of 2018, there are 19,427 cancer patients under the supervision of aimag and district oncologists. In our country, 78.8 percent of all cancers are diagnosed in stage 3.4 and are transferred to palliative care. However, in our country, there is a lack of research on the family, caregiver burden and quality of life of patients receiving palliative care. Therefore, we aimed to assess the caregivers of burden and quality of life of family of cancer patients in this study. Methods: The survey was conducted between November 2017 and December 2018 using an analytical instantaneous model. The survey data were collected from caregivers of cancer patients at the National Cancer Center, Ulaanbaatar District Health Center, Green Ger, and Iveel Hospice. Quality of life was assessed using the WHO WHOQOL-BREF method. The caregiver burden of cancer patients receiving palliative care was assessed using the Caregiver burden inventory international standard questionnaire. Results: The study involved 180 caregivers aged 20 to 72 years. 82.8 percent of the total guardians are women and 17.2 percent are men. The quality of life of the caregivers surveyed was 65.0 percent. In terms of the quality of life of caregivers, the environment is 59.9 percent, social relations 69.2 percent, psychological 70.8 percent, and physical 64.0 percent. The quality of life of caregivers was rated 69.8 percent for men and 64.0 percent for women, or relatively low for women. A statistically significant indicator is that the quality of life of caregivers decreases as patients spend more time per day (p = 0.013). The average workload score for caregivers is 32.97±11.8 for men and 40.53±14.9 for women, which is a statistically significant difference. The inverse relationship between caregiver quality of life and workload is a statistically significant indicator. / r = - 0.61 /. Conclusions The quality of life of caregivers participating in the study decreased. In addition, 91.7 percent have a caregiver burden level of 2 and more, which indicates that the caregivers of cancer patients are overworked. According to the results of the linear regression analysis, the quality of life decreases by 0.56 units when the caregiver’s workload increases by 1 unit.