BACKGROUND: The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China. METHODS: A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables. RESULTS: In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75-84 years (38.1%, 969,809/2,545,430) and ≥85 years (37.9%, 964,718/2,545,430) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196-3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292-927.436 Yuan). CONCLUSIONS The results showed that the use of PIM among older adults was common in China. This study suggests that the use of PIM could be considered as a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.
Humans ; Aged ; Cross-Sectional Studies ; Aged, 80 and over ; Male ; Female ; China ; Inappropriate Prescribing/economics* ; Patient Acceptance of Health Care/statistics & numerical data* ; Potentially Inappropriate Medication List/statistics & numerical data* ; Health Expenditures/statistics & numerical data*

Objective To investigate the learning outcome of clinical scenarios discussion im-plemented in teaching medical students before clinical probation. Methods Using standardized pa-tients (SP) to simulate the clinical common difficult situation, all eight year program clinical medicine students (84) of Grade 2008 who were about to enter the clinical probation were given clinical commu-nication education guidance. Through five classification variables questionnaire and return visit, the teaching effect was evaluate. Epidata 3.0 was used to input data, and the SPSS 15.0 was used to make descriptive analysis of the questionnaire and proportion comparison. Results We found 35.4%(29) and 63.4%(52) of subjects liked and approval this training, respectively;90.2%(74) of the subjects thought the diffi-culty of this train was moderate; 77.3% (65) of subjects believed that it was necessary to set the clinical scenarios discussion before clinical probation. Conclusions The implementation of clinical scenarios discussion before clinical probation was effective on inducing the medical students to pay attention to the doctor-patient communication, and deep thinking about the communication notice mat-ters and cop-ing styles in clinical environment.

Aortic dissection is a common disease which is very dangerous,with high mortality rate.Bypass graft for the treatment of DeBakey Ⅲ dissection has outstanding advantages than the ordinary replacement of thoracic aorta,and some patients will inevitably require the use of the procedure.The purpose of this study was to explore the impact of the subclavian artery-abdominal aorta bypass graft on hemodynamic parameters in the false lumen and the effectiveness of surgical treatment.First of all,the idealized three-dimensional geometric models of DeBakey Ⅲ aortic dissection and its subclavian artery-abdominal aorta bypass graft operation were constructed,respectively.Then the models were imported into ANSYS 11.0 for finite element analysis.Results of numerical simulation showed that both velocity and pressure of the blood flow were reduced after bypass graft at the entrance and in the internal sac of false lumen,which is very favorable for reducing the impact of blood flow on false lumen,slowing down the further expansion of entrance,preventing the breakdown of false lumen,and promoting the healing of dissection.Therefore,the subclavian artery-abdominal aorta bypass graft operation is an effective surgical method for the treatment of DeBakey Ⅲ aortic dissection in some particular cases.This operation is with great prospects for clinical application.

Objective To investigate the levels of IL-18,Th1(IL-2,TNF-?) and Th2(IL-4,IL-10) in patients with lung cancer and their relation to clinical pathological stages.Methods Totally 109 lung cancer patients were of 45 squamous cancer,40 adenocarcinoma,18 small cell lung cancer and 6 large cell carcinoma.Serum levels of IL-18,TNF-?,IL-2,IL-4 and IL-10 were determined by using an ELISA assay in 109 lung cancer patients and in 30 normal people.Results The levels of IL-18,TNF-? and IL-2 were significantly lower and the levels of IL-4 and IL-10 were significantly higher in lung cancer patients than in controls(P