[The Effectiveness of a Multi-Disciplinary Intervention for Deglutition Disorders in Elderly Inpatients].

BACKGROUND: While many studies have examined multidisciplinary interventions for swallowing disorder, most have focused on acute stroke patients. It is essential to confirm the efficacy of multidisciplinary interventions for all causes of swallowing disorder. PURPOSE: To investigate the efficacy of a nurse-led, multi-disciplinary intervention for hospitalized elderly patients with swallowing disorder. METHODS: One hundred and forty-five elderly patients with swallowing problems from a well-respected affiliate hospital of a university were studied. Patients were randomly allocated using cluster sampling and opaque envelop into either the multi-disciplinary intervention group (n = 73) or the control group (n = 72). The participants were interviewed at baseline and at 30 and 90 days after the intervention. The questionnaires included: a demographics datasheet, Charlson Comorbidity index, Acute Physiology and Chronic Health Evaluation II, short portable mental status questionnaire, Barthel Index, Standardized Swallowing Assessment, Short-form min-nutritional assessment, and aspiration pneumonia. RESULTS: The intervention group showed a significantly higher ratio of SSA (67.1% vs. 44.5%, p < .05), lower aspiration pneumonia (5.5% vs. 23.6%, p <.05), and lower incidence of malnutrition (2.7% vs. 11.1%, p <.05) at 90 days than the intervention group. Moreover, the intervention group showed a significantly higher ADL (activities of daily living) score at 90 days (83.3 ± 22.1 vs. 81.1 ± 22.1, p <.017) than the control group (p <.05). CONCLUSIONS: A nurse-led, multi-disciplinary intervention is a potential option for elderly patients with deglutition disorder to improve swallowing function and ADL and to reduce the incidence of inhaled pneumonia and malnutrition.

An oral controlled release system for ambroxol hydrochloride containing a wax and a water insoluble polymer.

This study was carried out to develop and optimize oral sustained-release formulations for Ambroxol hydrochloride matrix pellets using a combination of wax and water-insoluble polymer, glyceryl behenate (Compritol 888 ATO) and Ethylcellulose (EC(7 FP)). It involved three factors: the content of Compritol 888 ATO (X(1)), EC(7 FP) (X(2)), and the matrix formation methods (X(3)), as independent variables. The drug release percentages at 1, 2 and 4 h were the target responses and were restricted to 15-45% (Y(1)), 45-80% (Y(2)) and 80-100% (Y(3)), respectively. The final blend formulation prepared by extrusion spheronization, was achieved with 27.00% (w/w) Ambroxol hydrochloride, 48.70% (w/w) Compritol 888 ATO, and 24.30% (w/w) EC(7 Fp) with 40 degrees C for 12 h. Comparing the single matrix materials consisting of just the wax or water-insoluble in the complex matrix system containing wax and water-insoluble polymer, the release of the drug can be far more retarded, when the formulations have undergone the process of heat treatment. Furthermore, the combination of the two polymers, with flexible matrix formation methods, will offer a very promising way of producing matrix pellets instead of coated controlled-release pellets to meet various demands of drug release.

Attitudes of Older Chinese Patients Toward Death and Dying.

BACKGROUND: Due to the aging population of China, the need for palliative care will increase. However, one of the barriers to utilization of palliative care is the traditional belief that talking about death and dying is taboo. OBJECTIVE: The aim of this study was to examine to what extent older Chinese patients were willing to answer questions about death and dying by asking them about "fear of death" and their desire to "use advanced life support when dying." DESIGN: Survey questionnaire. SETTING/SUBJECTS: Convenience sample (N = 993 hospitalized patients). RESULTS: Only 215 (21.7%; 95% confidence interval [CI] 16.2%-27.1%) and 99 (9.9%; 95% CI 4.1%-15.8%) patients did not answer the questions related to "fear of death" and "use of advanced life support when dying," respectively, while 439 (44.2%; 95% CI 38.7%-49.7%) answered "yes" and 339 (34.1%; 95% CI 28.7%-39.6%) answered "no" for "fear of death" and 382 (38.5%; 95% CI 32.6%-44.3%) answered "yes" and 512 (51.6%; 95% CI 45.7%-57.4%) answered "no" for "use of advanced life support when dying." In multinomial logistic regression analysis, fear of death was associated with younger age, lowest level of function, and desire to use advanced life support. CONCLUSIONS: The majority of older patients were willing to answer the two questions about death and dying. About one-third of patients were not afraid of death, and older patients were less likely to be afraid of death. More than 50% of patients answered that they would not choose advanced life support when dying. More research in this area is needed to help advance palliative care in China.