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Objective:To explore the clinical value of the geriatric potentially inappropriate medication(PIM)evaluation system in elderly inpatients.Methods:As a prospective cohort study, 203 elderly inpatients with polypharmacy were randomly divided into the control group and experimental group.Geriatric PIM evaluation system(based on the criteria for judging potential inappropriate drug use in Chinese elderly 2017 edition)on wechat platform was applied to patients of experimental group.During the 6 months, the number of elderly syndromes, types of drugs, the days in hospitalization, readmission rates and all-cause mortality were compared between two groups.Results:The age of 203 elderly inpatients ranged from 60 to 94(77.30±10.34)years, including 121 males and 82 females.The morbidity proportion of top five diseases were 69.95%(142/203)in cerebral infarction(non-acute phase), 62.07%(126/203)in hypertension, 24.14%(49/203)in coronary heart disease, 9.85%(20/203)in atrial fibrillation, and 6.40%(13/203)in cardiac insufficiency.The 97.53%(198/203)of elderly hospitalized patients had at least one senile syndrome, the average was 4.3±2.0.Insomnia, fall and frailty accounted for 32.87%(15/198), 28.45%(56/198)and 13.66%(27/198)respectively.Compared with the control group, the average length of stay in hospital in the experimental group significantly decreased[(16.38±4.29) vs.(21.32±6.10)d, t=2.438、 P=0.025], the number of senile syndrome, the score of fall, weakness and the re-admission rate were also decreased significantly(3.11±2.14 vs.4.32±1.50, t=0.854、 P=0.032; 6.19±1.35 vs.8.61±3.22, t=4.078、 P=0.044; 3.94±1.92 vs.5.65±1.34, t=2.843、 P=0.038; 9.81%(10/102) vs.1.98%(2/101), χ2=4.772、 P=0.029), and the frequency of PIM was significantly different between two groups(417.36±49.21 vs.210.25±38.23, t=2.136、 P=0.034). Conclusions:After making the drug adjustment on the elderly inpatients with multiple drugs, PIM evaluation system for the elderly are able to reduce the incidence of geriatric syndrome, shorten the length of stay in hospital, improve the rational use of drugs, and enhance the quality of life of the elderly patients.
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Objective@#To investigate the correlation between frailty status and anticoagulation therapy in elderly patients with atrial fibrillation.@*Methods@#A total of 131 atrial fibrillation inpatients in our hospital aged 70 years and over with a mean age of(77.4±6.4)years were enrolled from January 2017 to June 2018 in this retrospective study.According to the state of anticoagulation therapy at discharge, patients were divided into the anticoagulation group(n=67)and the non-anticoagulation group(n=64). Data including gender, age, N-terminal pro-brain natriuretic peptide(NT-proBNP), glomerular filtration rate(eGFR), the type of medication, HAS-BLED(Hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), CHA2DS2-VASc scores, Charlson comorbidity index and clinical frailty scores(CFS)were recorded and compared between the two groups.Spearman correlation was used to analyze the correlation between frailty degrees and program of anticoagulant therapy.Two-class Logistic regression models were used to analyze the related factors for programs of anticoagulant therapy.@*Results@#The incidence of the frailty syndrome was 56.49% in 131 elderly patients with atrial fibrillation.Compared with the anticoagulation group, non-anticoagulation group showed that the CFS score[(5.73±1.85)vs.(3.69±2.07), P<0.05], the incidence of the frailty syndrome(67.19% vs.46.27%, P<0.05)and Charlson index[(6.09±2.80)vs.(4.98±2.61), P<0.05]were increased.While, there was no significant difference in HAB-BLED score and CHA2DS2-VASc score between the two groups(P>0.05). The correlation analysis showed that there was a negative correlation between the application of anticoagulants and CFS grade in elderly patients with atrial fibrillation(r=-0.138, P<0.05). Multivariate Logistic regression analysis showed that age, CFS score and the incidence of frailty state were risk factors in elderly atrial fibrillation patients without the anticoagulant therapy(P<0.05).@*Conclusions@#The incidence of frailty state in elderly patients with atrial fibrillation is high, and the proportion of patients receiving the anticoagulant therapy is low.Age and frailty may be the most important influencing factors for anticoagulant therapy.Therefore, it is of great significance to incorporate frailty assessment into the management of anticoagulant therapy in elderly patients with atrial fibrillation.
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Objective To investigate the correlation between frailty status and anticoagulation therapy in elderly patients with atrial fibrillation.Methods A total of 131 atrial fibrillation inpatients in our hospital aged 70 years and over with a mean age of(77.4 ±6.4)years were enrolled from January 2017 to June 2018 in this retrospective study.According to the state of anticoagulation therapy at discharge,patients were divided into the anticoagulation group (n =67) and the non-anticoagulation group (n =64).Data including gender,age,N-terminal pro-brain natriuretic peptide (NT-proBNP),glomerular filtration rate (eGFR),the type of medication,HAS-BLED(Hypertension,abnormal renal/liver function,stroke,bleeding history or predisposition,labile international normalized ratio,elderly,drugs/alcohol concomitantly),CHA2DS2-VASc scores,Charlson comorbidity index and clinical frailty scores(CFS)were recorded and compared between the two groups.Spearman correlation was used to analyze the correlation between frailty degrees and program of anticoagulant therapy.Two-class Logistic regression models were used to analyze the related factors for programs of anticoagulant therapy.Results The incidence of the frailty syndrome was 56.49％ in 131 elderly patients with atrial fibrillation.Compared with the anticoagulation group,non-anticoagulation group showed that the CFS score[(5.73±1.85)vs.(3.69±2.07),P＜0.05],the incidence of the frailty syndrome(67.19％ vs.46.27％,P＜0.05) and Charlson index [(6.09 ± 2.80) vs.(4.98± 2.61),P ＜0.05]were increased.While,there was no significant difference in HAB-BLED score and CHA2DS2-VASc score between the two groups (P ＞ 0.05).The correlation analysis showed that there was a negative correlation between the application of anticoagulants and CFS grade in elderly patients with atrial fibrillation(r =-0.138,P ＜ 0.05).Multivariate Logistic regression analysis showed that age,CFS score and the incidence of frailty state were risk factors in elderly atrial fibrillation patients without the anticoagulant therapy(P＜0.05).Conclusions The incidence of frailty state in elderly patients with atrial fibrillation is high,and the proportion of patients receiving the anticoagulant therapy is low.Age and frailty may be the most important influencing factors for anticoagulant therapy.Therefore,it is of great significance to incorporate frailty assessment into the management of anticoagulant therapy in elderly patients with atrial fibrillation.
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Objective To investigate whether fasting obestatin level is different in patients with impaired glucose tolerance or type 2 diabetes, and to explore the association between obestatin and lipid metabolism. Methods Eighty-four subjects without known diabetes were divided into three groups: normal glucose tolerance(NGT), impaired glucose tolerance (IGT) and type 2 diabetes (DM) Plasma obestatin levels were measured with a radioimmunoassay. The relationship between fasting obestatin levels and metabolic parameters was also analyzed. Results Fasting obestatin levels were lower in DM group [(2.82±0.78)ng/ml] and IGT group [(3.25±0.29)ng/ml] than in NGT group[(3.55±0.57) ng/ml, P＜0.01]. Triglycerides and low density lipoprotein cholesterol levels gradually increased among the three groups (P＜0.05). Multiple linear regression analysis revealed fasting obestatin level was independently associated with waist-to-hip ratio, triglyeride and low density lipoprotein cholesterol. The regression equation was obestatin=6.953-3.412×W/H-0.175×TG-0.123×LDL-C. Conclusions The decreased obestatin may be associated with IGR and T2DM, and obestatin level may be associated with lipid metabolism.
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Objective To observe the correlation between 1-hour postload plasma glucose and carotid intima-media thickness (IMT) in elderly male patients with hypertension.Methods One hundred and twenty six elderly male patients with hypertension were enrolled and divided into four groups: normal glucose tolerance with normal 1 h plasma glucose (1 hPG) group (low-NGT, n=42); normal glucose tolerance with high lh plasma glucose group (high-NGT, n=23);impaired glucose tolerance group (IGT, n=27) and diabetic group (n=84). The differences of blood pressure, blood glucose, blood lipid and intimia-media thickness among groups were analyzed.Results OGTT 1 hPG in high-NGT group was similar with IGT group[(12.0±1.1)mmol/L vs. (11.1±1.8)mrnol/L, P>0. 053 ,but significantly higher than that in Iow-NGT group ((12.0±1.1)mmol/L vs. (9. 1±1.4) mmol/L, P<0.01]. The value of IMT was gradually increased in four groups (P<0.05) and it was (1.02±0. 12) mm in high-NGT group. OGTT 1 hPG was the independent risk factor for IMT(P< 0.01).Conclusions OC-TT 1h plasma glucose is associated with atherosclerosis in elderly male hypertensive people.
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Objective To study the changes of circulating triglyceride (TG) in the obese elderly, and to investigate the effect of hypertriglyceridemia on the development of insulin resistance. Methods A total of 82 subjects were divided into simple obesity group, obesity with IGT group, obesity with T2DM group and normal control group. The body height, body weight, blood pressure, fasting plasma glucose (FPG) and insulin(FPI), circulating TG and total cholesterol (TC) were measured. The homeostasis model assessment-insulin resistance (HOMA-IR) was calculated. Results The levels of serum TG were significantly higher in the simple obesity group ( 1.3 ± 0. 6) mmol/L, obesity with IGT group (1.9 ± 0.9)mmol/L and obesity with T2DM group (2.1±0.7) mmol/L than in the normal controls [(1.0±0.2)mmol/L, all P<0. 05], Furthermore, the levels of TG, FPG, FPI, HOMA-IR and systolic pressure were significantly higher(all P<0. 05) in obesity with IGT group and obesity with T2DM group than in simple obesity group. There were significantly positive correlations between TG and body mass index (BMI), FPG, HOMA-IR, TC, systolic pressure respectively (all P < 0.05). Multiple linear regression analysis indicated that FPG and HOMA-IR were the independent factors affecting TG (both P < 0. 05 ). Conclusions Hypertriglyceridemia may play an important role in the development of insulin resistance.