Pain is a common symptom among populations with life-limiting illnesses. Like all clinicians, family physicians involved in the care of these patients should acquire the skills and knowledge required to provide good pain control in order for the patients and their caregivers to achieve optimal quality of life. This paper is a review and presentation of the definition, classification, assessment and management of pain at the end of life based on available guidelines and evidence.

Objective To investigate the quality of life (QOL) of patients with frequent premature ventricular contractions (PVCs) and the effects of radiofrequency catheter ablation (RFCA) on them.Methods 120 patients with frequent PVCs,100 cases with frequent APCs and 60 healthy persons were assessed by 36-Health survey questionnaire (SF-36) originally.Three months later,the QOL of 48 cases received RFCA and 72 cases with drug therapy were evaluated again by SF-36.Meanwhile,decrease of PVCs were also calculated between these two groups.Results The scores of physiological function and mental health in patients with PVCs were lower than that of cases with APCs,while the score of bodily pain in patients with PVCs was higher (P value:0.0002-0.0380).In addition,the quality of life in patients with frequent PVCs were worse than healthy control(P value:0.0001-0.0915).Three months later,PVCs in 48 cases with frequent PVCs received RFCA were much fewer than that of 72 cases with drug therapy (t=18.8682,P＜0.01),and the quality of life in the former was much better than the latter (F=15.329-39.274,P＜0.01).Conclusion Frequent PVCs can deteriorate the patients' quality of life.RFCA can control or eliminate PVCs in these patients and markedly improve the quality of life of them.

Humans ; Maxillofacial Injuries ; diagnosis ; surgery ; Wounds, Gunshot ; diagnosis ; surgery

Forensic Ballistics ; Humans ; Maxillofacial Injuries ; surgery ; Wounds, Gunshot ; surgery

Bone Transplantation ; Humans ; Mandible ; transplantation ; Transplantation, Homologous

BACKGROUND: Xenograft cortical bone is an easy and inexpensive bone graft material, which has good biocompatibility and bio-mechanical properties. As a bone graft, it can function as biological framework for new bone growth and bio-supporting. Moreover, it can also be processed into internal fixation devices.OBJECTIVE: To review the biological properties, preparation methods and clinical applications of heterogeneous cortical bone for fracture fixation.METHODS: A computer-based online search of Pubmed database (1990-01/2009-05) and CNKI (1990-01/2009-05) was performed for related articles with key words of "Xenograft cortical bone, Bone graft, Fixation" in English and Chinese.RESULTS AND CONCLUSION: A total of 128 articles were collected. Xenograft cortical bone has a good biological performance, in particular, a certain degree of bio-mechanical properties. It is not only able to complete bone filling, bone induction, but also function as internal fixator following processing. However, the traditional preparation process reduces their bio-mechanical properties. Heterogeneous cortical bone can be widely used in intra-articular fractures and cancellous bone fracture fixation, and can be self-absorbed, avoiding the second operation. However, its instability limits its initial mechanical properties of fractures at other sites.

A 65-year-old lady with End-Stage Renal Failure (ESRF) receiving Continuous Ambulatory Peritoneal Dialysis (CAPD) was admitted acutely for altered mental status and neurological symptoms. She presented to the Emergency Department with bilateral upper limb weakness and clumsiness, bilateral lower limb weakness for 1 day’s duration. In addition, her family members reported altered behaviour for the previous 1 day. On examination, the patient had slurred speech, weakness in all limbs and brisk reflexes throughout. Significantly, she had been diagnosed with herpes zoster 2 days earlier by a family physician, for which she was started on oral acyclovir. Our patient was diagnosed as having acyclovir toxicity and commenced on urgent haemodialysis. Her symptoms resolved completely after 2 days. Our case details the uncommon but potentially fatal complication of acyclovir toxicity in patients with renal impairment, reinforces the importance of dose reduction in these patients and demonstrates haemodialysis as a good form of treatment for acyclovir toxicity. Family physicians should be familiar with dose adjustments for common medications prescribed to ESRF patients in the outpatient setting as the burden of chronic kidney disease increases in Singapore.

Objective:To explore the content and model for clinical pharmacists to carry out pharmaceutical care on elderly pa-tients with atrial fibrillation combined with other diseases treated by warfarin. Methods:One case of an elderly atrial fibrillation patient complicated with coronary artery disease and urinary tract infection suffering elevated INR after the use of warfarin was applied as the example. The pharmaceutical care was carried out by clinical pharmacists including analyzing the causes of elevated INR and assisting the doctor to develop the individualized pharmaceutical care plan. Results: After the adjustment of warfarin dose and the other drugs combined with medical education, bleeding and thromboembolic events did not occur during the hospitalization, and finally, satisfactory effect of anticoagulation therapy was achieved. Conclusion: The implementation of pharmaceutical care on anticoagulation in atrial fi-brillation patients with various diseases is helpful to improve the compliance in patients, avoid the occurrence of adverse drug reactions and guarantee the effectiveness and safety of warfarin.

Objective To study the relationship between uric acid and various cognitive functions in Alzheimer's disease (AD).Methods A total of 46 patients with AD and 50 people without cognitive disorder were selected.Plasma uric acid,MOCA,and ADL were measured.Results The mean level of plasma uric acid was (217.93 ± 67.91 )μmol/L in ADs,and (337.02 ± 59.70) μmol/L in controls.The mean level of uric acid was significantly lower in the blood of patients with AD than control with a statistically significant difference ( t =9.142,P ＜0.01 ).Multiple regression analysis revealed that low uric acid,age,educated years,and hypertension were related to cognitive function( P ＜0.01,P ＜0.05 ).Partial correlation analysis revealed uric acid was significantly related to memory ( r =0.457,P =0.002),and attention ( r =0.398,P =0.008).Conclusions Low levels of uric acid may have influence on the occurrence and development of cognitive function impairment in AD.Uric acid may have more influence on the memory and attention in patients with AD.

Objective:Study the effect about cone beam CT(CBCT) image guidance sytem to improve the positioning accuracy and reducing the set-up uncertainty in precise radiotherapy. Methods:Use CBCT system to scan head and neck tumors patients (30 cases) and chest tumor patients (40 cases), including head and neck tumor patients were scaned 90 times, chest tumor patients were scaned 113 times. Setup deviation statistics about anterior and posterior, head and feet, left and right direction. Results:The patients with head and neck cancer, the maximum error of anterior-posterior is 6mm, Three directions errors which greater than 3mm all less than 10%. Patients with chest tumor position error are in the head and foot direction, greater than 5 mm up to 21.51%. Before and after the direction of the error did not exceed 5mm. The left and right direction greater than 5 mm up to 4.53%. Conclusion:It greatly enhances the precision of radiotherapy, improved the curative effect of radiotherapy by using CBCT online image guidance system for the patient position correction. Compared with EPID, patients scaned with CBCT absorb smaller cumulative dose, the image resolution is higher, image matching is more accurate. But compared with the ordinary helical CT,the resolution and scanning range also need to improve.