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

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.

Myocardial infarction and ischemic stroke share many common risk factors.Their pathophysiological processes are also similar and the 2 diseases often occur at the same time.Coronary artery disease is one of the important causes of embolic stroke in the elderly population.However,there are a few reported stroke events available after myocardial infarction.This article reviews ischenic stroke following acute myocardial infarction.

Objeetive To detect the influence of psychological nursing intervention in 215 Prlmiparas Methods Taking whole course psychological nursing intervention of 215 primiparas who were making appointments on obstetrical outpatient department.Take psychological care,education of in-hospital and person to person care of in-delivery room as experiment group.and choose 205 Primiparas who were delivery in ordinary way at random.Compare the rate of viginal delivmy and the rate of cesarean section and neonatal asphyxia and the rate of postpartum hemorrhage.Evaluate the effect of Psychological nursing intervention to Primiparas.Results The rate of、riginal delivery on experiment group Was higher than the control group.It also shorten the duration of labor,and control the rate of cesarean section,neonatal asphyxia and postpartum hemorrhage effectively.There ale significant difference between two groups(P＜0.05).Conclusion The psychological nursing intervention is positive to the primiparasis in labor.It can increase the of viginal delivery shorten the duration of labor.and decrease the rate of cesarean section neonatal asphyxia and postpartum hemorrhage.

Objective:To evaluate therapeutic effect of olmesartan on patients with mild to moderate essential hyper-tension (EH) and its influence on cardiovascular risk factors .Methods:A total of 150 mild/moderate EH patients were enrolled using opened ,non-control and multi-center method .According to random number table ,they were randomly and equally divided into olmesartan group (received olmesartan 20~40 mg/d) and losartan group (re-ceived losartan 50~100 mg/d) .Changes of systolic blood pressure (SBP) ,diastolic blood pressure (DBP) , levels of risk indexes of cardiovascular diseases ,such as high sensitive C reactive protein (hsCRP) ,urinary albumin/creati-nine ,homocysteine (Hcy) and carotid intima-media thickness (IMT) were observed in two groups before and after treatment .Results:After eight-month treatment , compared with before treatment , all indexes significantly im-proved in both groups;compared with losartan group ,there were significant reductions in SBP [ (145 ± 12) mmHg vs .(132 ± 9) mmHg] and DBP [ (90 ± 7) mmHg vs .(80 ± 5) mmHg] , P<0.01 all;and significant reductions in levels of hsCRP [ (0.54 ± 0.09) mg/L vs .(0.34 ± 0.09) mg/L] ,urinary albumin/creatinine [ (26.5 ± 19.4) mg/g vs .(23.1 ± 18.3) mg/g] ,Hcy [ (13.2 ± 4.8)μmol/L vs .(10.3 ± 4.2)μmol/L] and IMT [ (0.83 ± 0.29) mm vs . (0.74 ± 0.28) mm] in olmesartan group , P< 0.05 all .Conclusion:Besides intensively lowering blood pressure olmesartan can also significantly decrease cardiovascular risk factors in patients with mild to moderate hypertension .

A 27-peptide,a fragment of hepatitis delta antigen(HDAg),was synthesized and used to develop an ELISA method for ihe detection of anti-HD.It was found that positive anti-HD reaction occurred between the coated 27-peptide and a stored sample of serum which was known anti-HD positive.Absorption test revealed that the synthetic peptide competed with natural HDAg for anti-HD,suggesting that the peptide possessed the antigenicity similar to that of natural HDAg.The antigenicity of the synthetic peptide was quite specific wihtout cross reaction with normal human and mouse sera and with anti-HA.anti-HB and anti-HC sera.Among 300 blood donors,there was only 1 case(0.33%)anti-HD positive with an ALT level 2 times higher than normal.In 41 cases of non-B hepatitis and 52 cases of HAV hepatitis,none was anti-HD positive.In 211 cases of various types of HBV hepatitis,21 were(9.95%)anti-HD positive,among whom 2/82(2.5%)werehealthy HBV carriers,6/43(13.95%)were patients with a-cute icteric hepatitis,6/60(10.00%)were patients of chronic active hepatitis,4/18(22.20%)were patients of severe hepatitis,and 3/8(37.50%)were those with liver cirrhosis.These results were consistent with those in our previous reports.

Objective To investigate the clinical significance of tumor necrosis factor-?(TNF-?)and interleukin-6(IL-6)in the ascitic fluid of cirrhotic patients with spontaneous bacterial peritonitis(SBP).Methods TNF-? and IL-6 in the ascitic fluid of 32 cirrhotic patients with SBP were measured by ELISA.The group was compared with the value in transudatory ascites of 30 cirrhotic patients.Results The levels of TNF-? and IL-6 in the ascitic fluid of cirrhotic patients with SBP were much higher than those in transudatory ascites of cirrhotic patients(P

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.

Objective:To investigate the efficiency of CBCT in the diagnosis of impacted maxillary anterior teeth and the treatment effect of different guided eruption methods. Methods:34 impacted maxillary anterior teeth in 30 patients were examined by panoramic films and CBCT, the dental crowns, root, eruption space and other related items were measured and compared between 2 examinations. 20 cases were treated by closed guided eruption and traction( CGET) technique, 10 cases by circumferential supracrestal fibrotomy and exposed traction( CSF-EE) , results were compared. Results: CBCT was more effective than panoramic films in the revelation of tooth root bending, apical pore closure and eruption measurements(P<0. 05). 7-10 d after treatment 5 out off the 10 casses treated by CSF-EE showed different degrees of clinical crown elongation, poor gum appearance and low height of alveolar ridge as insufficient periodontal attachment. However, the treatment of CGET for 26 teeth (76. 47% of all cases) was highly successful and received very satisfactory re-sults, the rest 8 teeth (23. 53% of all cases) showed mediocre satisfaction. Conclusion: CBCT can accurately display the position, shape, relation with adjacent teeth of the impacted teeth. Closed guided eruption and traction is more effective for the treatment.