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Objective To evaluate the efficacy and advantages of individualized stepwise pharmacotherapy in controlling the symptoms of patients with perennial allergic rhinitis (AR). Methods Patients with AR who had received individualized stepwise pharmacotherapy in the Rhinitis Clinic of Minhang Hospital Affiliated to Fudan University were selected for the observation group. Additionally, patients with AR from the general clinic during the same period were randomly sorted to the control group. The visual analogue scale (VAS), total nasal symptom score (TNSS), sino-nasal outcome test 20 (SNOT-20) and rhinitis control assessment test (RCAT) were used to evaluate the symptoms at initial, 2 weeks, 1 month, 3 months, 6 months, 9 months, 12 months after the treatment respectively. SPSS 24.0 statistic soft ware was used to analyze the data between the two groups. Results There were no significant differences in VAS, TNSS, SNOT-20 or RCAT scores between the two groups at the beginning and 1 month after the treatment. The differences in the above indexes between the two groups gradually widened after 1 month, and reached the maximum after 6 months. The stepwise pharmacotherapy group achieved the best efficacy at the end of the third month and maintained until the end point. Conclusions Individualized step-by-step drug strategy could significantly improve the subjective symptoms of patients with perennial AR, especially the nasal symptoms, and has a stable efficacy for a long time. [ABSTRACT FROM AUTHOR]

Objective To summarize the experience of integrative palliative care at Peking Union Medical College Hospital and provide a reference for promoting the integrative palliative care model. Methods Twenty cases receiving integrative palliative care at Peking Union Medical College Hospital were collected.The clinical characteristics,reasons for initiating integrative palliative care,the process of integrative palliative care,and feedback from these cases were summarized. Results Insomnia (11 cases,55%) and pain (9 cases,45%) were the most common symptoms requiring control in the 20 cases.The integrative palliative care team assisted in medical decision-making for 17 cases (85%),prepared end-of-life for 9 cases (45%),assisted in the transfer for 3 cases (15%),and provided comfort care for all the 20 cases (100%). Conclusions The integrative palliative care model can help alleviate suffering in end-of-life patients and provide support to patients' families and the original medical teams.This model is worth further promotion within class A tertiary hospitals.

Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21 500(13 800,37 600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)% for medication,(33.2±18.0)% for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)% of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom control was low.There is a need for further research on the economic impact of hospice and palliative care among terminally ill patients in China.