Can Primary palliative care education change life-sustaining treatment intensity of older adults at the end of life? A retrospective study
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Abstract Background In recent years, palliative care has gradually developed in mainland China. Since 2018, primary palliative care education has been carried out in the department of geriatrics at Beijing Tongren Hospital. This study aimed to explore the changes to the intensity of end-of-life care in hospitalized older adults before and after the implementation of primary palliative care education. Methods A retrospective study was conducted. 203 decedents were included from Beijing Tongren Hospital’s department of geriatrics between January 1, 2014 to December 31, 2019. Patients were split into two cohorts with regards to the start of palliative care education. Patient demographics and clinical characteristics as well as analgesia use, other medical resources use and provision of life-sustaining treatments were compared between the two groups. We used a chi-square test to compare categorical variables, a t test to compare continuous variables with normal distributions and a Mann–Whitney U test for continuous variables with skewed distributions. Results Of the total participants in the study, 157(77.3%) patients were male. The median age was 88 (interquartile range; Q1-Q3 83–93) and the majority of patients ( N = 172, 84.7%) aged 80 years or older. The top 3 causes of death were malignant solid tumor ( N = 74, 36.5%), infectious disease ( N = 74, 36.5%), and cardiovascular disease ( N = 23, 11.3%). Approximately two thirds died of non-cancer diseases. There was no significant difference in age, gender, cause of death and functional status between the two groups ( p > 0.05). After primary palliative care education, pain controlling drugs were used more ( p < 0.05), fewer patients received electric defibrillation, bag mask ventilation and vasopressors ( p ༜0.05). There was no change in the length of hospitalization, intensive care admissions, polypharmacy, use of broad-spectrum antibiotics, blood infusions, albumin infusions, nasogastric/nasoenteric tubes, parenteral nutrition, renal replacement and mechanical ventilation ( p > 0.05). Conclusions Primary palliative care education promotes symptom control and DNR implementation. In the future, more efforts should be put on education about symptom assessment, prognostication, advance care planning, code status discussion with particular focus on patients with end stage non-cancer diseases.Keywords:
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This paper makes use of the investigation data on time allocation made by Research Center of Leisure Economy of China,Remin University of China in August,2006 and Beijing Statistics Bureau in 1986 to analyze the changes in Beijing citizen' living style during the 20 years.It reports Beijing citizen's living in work and leisure and its changes.
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Beijing Breakfast Program is one of 60 practical matters done by Beijing Municipal Government for Beijing citizens in 2002. Beijing Municipal Bureau of Commerce committed the investigation to Beijing Commercial Information Consultant Center so as to understand deeply the situation of the program in 2002. The investigation combines the method of spot check and questionnaire, and draws the conclusion for management people through analyzing the date.
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Objective To evaluate the performance of diagnosis-related groups,Beijing version (BJ-DRGs) which were locally developed in Beijing.Method A total of 1.3 million inpatient records from 149 hospitals in Beijing in 2008 were drawn from Beijing Public Information Center.Coefficient of variation (CV) was used to measure the performance of DRGs system.Results BJ-DRGs produced the best CV results for expenditure.Conclusions Under Beijing's medical information condition,BJ-DRGs produced good performance.
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Diagnosis-related groups (DRGs) ; Performance evaluation; International comparison
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· AIM: To determine the effect of topical 0.05% cyclosporine A (CsA) on corneal endothelium in patients with dry eye disease. · METHODS: Observational, prospective, case series study. Fifty-five eyes of 29 consecutive patients (9 males and 20 females; median age: 66.8 years, interquartile range: 61 -73.2 years) with moderate -severe dry eye disease were evaluated. All patients were treated with topical 0.05% CsA ophthalmic emulsion twice a day in addition to lubricant eyedrops 5 times a day. The follow- up period was 12 months. Before treatment and at 3 and 12 months post -treatment central corneal specular microscopy was performed. The endothelial cell density (ECD), coefficient of variation of cell size (CoV), and percentage of hexagonal cells (Hex %) were analyzed. ·RESULTS: The median ECDs pre-treatment and at 3 and 12 months post-treatment were 2 352.5/mm 2 (inter- quartile range, 2 178 -2548.5), 2 364/mm 2 (interquartile range, 2 174.25 -2 657.5), and 2 366 cells/mm 2 (inter - quartile range, 2 174.75-2 539.75), respectively (P=0.927, one way ANOVA). The median CoVs pre-treatment and at 3 and 12 months post -treatment were 34.5 (interquartile range, 30 -37), 35 (interquartile range, 30 -38), and 34 (interquartile range, 30.75-38.25), respectively (P=0.7193, one way ANOVA). The median Hex % values pre - treatment and at 3 and 12 months post -treatment were 53 (interquartile range, 47 -58), 54 (interquartile range, 45.75 -59), and 50.5 (interquartile range, 45.75 -58), respectively (P=0.824, one way ANOVA). · CONCLUSION: Treatment of patients with dry eye disease for 12 months with topical 0.05% CsA does not seem to cause substantial changes on corneal endothelium.
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To determine the prevailing hemoglobin levels in PICU patients, and any potential correlates.Post hoc analysis of prospective multicenter observational data.Fifty-nine PICUs in seven countries.PICU patients on four specific days in 2012.None.Patients' hemoglobin and other clinical and institutional data. Two thousand three hundred eighty-nine patients with median age of 1.9 years (interquartile range, 0.3-9.8 yr), weight 11.5 kg (interquartile range, 5.4-29.6 kg), and preceding PICU stay of 4.0 days (interquartile range, 1.0-13.0 d). Their median hemoglobin was 11.0 g/dL (interquartile range, 9.6-12.5 g/dL). The prevalence of transfusion in the 24 hours preceding data collection was 14.2%. Neonates had the highest hemoglobin at 13.1 g/dL (interquartile range, 11.2-15.0 g/dL) compared with other age groups (p < 0.001). The percentage of 31.3 of the patients had hemoglobin of greater than or equal to 12 g/dL, and 1.1% had hemoglobin of less than 7 g/dL. Blacks had lower median hemoglobin (10.5; interquartile range, 9.3-12.1 g/dL) compared with whites (median, 11.1; interquartile range, 9.0-12.6; p < 0.001). Patients in Spain and Portugal had the highest median hemoglobin (11.4; interquartile range, 10.0-12.6) compared with other regions outside of the United States (p < 0.001), and the highest proportion (31.3%) of transfused patients compared with all regions (p < 0.001). Patients in cardiac PICUs had higher median hemoglobin than those in mixed PICUs or noncardiac PICUs (12.3, 11.0, and 10.6 g/dL, respectively; p < 0.001). Cyanotic heart disease patients had the highest median hemoglobin (12.6 g/dL; interquartile range, 11.1-14.5). Multivariable regression analysis within diagnosis groups revealed that hemoglobin levels were significantly associated with the geographic location and history of complex cardiac disease in most of the models. In children with cancer, none of the variables tested correlated with patients' hemoglobin levels.Patients' hemoglobin levels correlated with demographics like age, race, geographic location, and cardiac disease, but none found in cancer patients. Future investigations should account for the effects of these variables.
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세계의 많은 도시들은 국제 행사의 개최를 통해 각 도시의 인지도와 이미지를 제고하려는 노력을 기울이고 있다. 본 연구에서는 대형 스포츠 이벤트인 2008 베이징 올림픽이 베이징 이미지에 미치는 영향에 대해 부산시민 197명에 대한 설문조사를 실시하여 살펴보았다. 수집된 자료의 분석 결과, 주말의 베이징올림픽 시청시간은 베이징에 대한 친밀감, 베이징에 대한 태도와 정적인 상관관계를 갖는 것으로 나타났다. 베이징에 대한 친밀감과 베이징 올림픽 게임 운영에 대한 평가는 베이징에 대한 이미지, 베이징에 대한 태도, 베이징에 대한 방문의도에 유의미한 영향을 미치고, 그 중에서 베이징에 대한 친밀감이 더욱 큰 영향을 미치는 것으로 나타났다. Many cities in the world are trying to enhance city awareness and city image through international events. In this study, the impact of 2008 Beijing Olympic Games on Beijing Image was investigated by survey. According to the result of data analysis, there is a positive correlation between the watching time of Beijing Olympic Games on TV in weekend and familiarity to Beijing. And there is a positive correlation between the watching time of Beijing Olympic Games on TV in weekend and attitude toward Beijing, too. Familiarity to Beijing and Beijing Olympic Games management have an significant impact on Beijing image, attitude toward Beijing and intention to visit Beijing. Familiarity to Beijing than Beijing Olympic Games management has a larger impact on Beijing image and attitude toward Beijing.
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Establishment of Beijing Studies is necessary to objective reality.Genuine Beijing Studies should be a scientific theoretical system,which can bring to light the more deep mysteries about Beijing,based on the respective researches.In future,the main orientation and tasks of Beijing Studies are to strenthen the basic theoretical research on it,develop the applied research widely and deeply,pay great attantion to propaganda for Beijing Studies and strenthen the scientific research conditions and the contingent construction of the Institute of Beijing Studies of Beijing Union University.
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Adopting both questionnaire and interview studies,the paper analyzes the motivation of college volunteers in Beijing Olympic Games and the change of motivations.In this study,the subjects are volunteers in Beijing Olympic Games from 16 departments in Beijing Normal University.Through the study,some suggestions are posed to improve the voluntary work.
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When the Institute of Beijing Studies in Beijing Union University was founded in 1998,Prof.HOU Ren-zhi wrote the inscription for the Institute: Be established in Beijing,Study Beijing,Serve Beijing,which set forth accurately the mission of the Institute.From then on,Prof.HOU has always been having the Beijing Studies at heart.His substantial results from and deep thinking for Beijing historical Geography are the firm base of Beijing Studies and guiding it forward.His academic thoughts and research spirit is influencing,guiding,and promoting the development of Beijing Studies all the time.
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Beijing is the capital of China and a typical super large-sized city. The study of the interrelationship between lifestyles and transport in Beijing is of paramount significance to learning on the interrelationship between lifestyles and transport in China’s super large-sized cities. This chapter analyses Beijing residents’ lifestyle changes in the past 40 years, as well as the connections and interactions between residents’ lifestyles and travel behaviour as it concerns consumption, time use and activities. In addition, based on the Questionnaire Survey on Jobs-Housing Balance in Beijing, residents’ lifestyles are categorised through clustering analysis, and SEM is used to study the impacts of Beijing residents’ lifestyles on their travel behaviour.
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