Continuation of Geriatric Discharge Medication in Primary Care and its Association with Rehospitalizations - A Cohort Study.

Transition of care in geriatric patients is a complex and high risk process, particularly the continuation of discharge medication in primary care. We aimed to determine how general practitioners' management of geriatric patients' discharge medication is associated with rehospitalizations. A prospective monocentric cohort study was done in an acute geriatric inpatient clinic with six-months follow-up. Acutely hospitalized patients ≥ 70 years old with functional impairment and frailty currently taking medications were followed up after hospital discharge and continuation (n=27) or change (n=44) of discharge medication by the General Practitioner was determined. Outcomes were rehospitalizations, days spent at home and time until recurrent rehospitalizations. 71 patients (mean age 82 years, 46 women [65%]) were followed up for six months after hospital discharge. In a negative binomial regression model, the rehospitalization rate after three months was 3.8 times higher in participants whose discharge medication was changed (p = 0.023). The effect did not persist over six months. Patients who were continued on their discharge medication were rehospitalized significantly later and/or less often during the six months observation period, statistically measured by a recurrent events survival model (HR 0.267, p = 0.003). In conclusion, continuation of discharge medication after an acute hospitalization in a specialized geriatric clinic could prevent early rehospitalizations.

[Anesthesia of horses in the standing position]. / Untersuchungen zur Standnarkose des Pferdes.

Painful interventions can be performed on horse in standing position by means of sedative analgesia, also called standing-position anaesthesia. Combinations of anaesthetics are quite often used, in that context, for the purpose of producing analgetic effects stronger and more reliable than those that would be obtainable from one anaesthetic alone. The following combinations were comparatively tested for their analgetic and sedative effects and their effects upon the organism: Chloralhydrate with Ursonarkon (oxazolidone), Chloralhydrate with Rompun (xylazine), Chloralhydrate with morphine hydrochloride, Chloralhydrate with morphine hydrochloride and Ursonarkon, local anaesthesia in conjunction with sedation by Ursonarkon. 50 experiments were conducted on an experimental group of 10 horses under standardised conditions together with complementary tests on 71 horses under field conditions. The experimental methodology used for assessment of analgetic effects was based on defined electrical and thermic stimuli to enable determination of reactive thresholds. An objective comparison was thus possible between the above variants. Local anaesthesia in combination with complementary sedation proved to meet all demands on standing-position anaesthesia, as it was found to eliminate pain and tactile reflexes. Defence movements have to be expected, whenever preparations are used that attack the central nervous system, since while sensations of pain are suppressed, tactile stimuli may be met with reflex responses via the spinal cord and its intrinsic function.

Pituitary adenylate-cyclase-activating peptides relax human coronary arteries by activating K(ATP) and K(Ca) channels in smooth muscle cells.

Pituitary adenylate-cyclase-activating peptides (PACAPs) are potent dilators of arteries, including human coronary arteries. We tested the importance of specific K+ channel regulatory mechanisms in human arterial smooth muscle relaxation induced by PACAPs, using contraction and patch clamp measurements on human coronary artery vascular smooth muscle cells. PACAP27 and PACAP38 produced dose-dependent relaxations of 5 microM PGF2alpha-preconstricted rings, with half-maximal relaxations at 1.0 nM and 2.0 nM, respectively. Both peptides induced complete relaxation at 100 nM. Pretreatment of the vessels with the ATP-dependent K+ (K(ATP)) channel blocker glibenclamide (1 microM) or with the Ca2+-activated K+ (K(Ca)) channel blocker iberiotoxin (100 nM) inhibited PACAP27-induced relaxation in an additive manner. Moreover, in the patch clamp experiments on freshly isolated cells from human coronary arteries, PACAP27 (100 nM) induced a large, nonrectifying, outward (I(K)(ATP)) K+ current in a proportion of cells and a voltage-dependent outward (I(K)(Ca)) K+ current in other cells. The PACAP27-induced I(K)(ATP) was blocked by glibenclamide (3 microM), while the PACAP27-stimulated I(K)(Ca) was blocked by iberiotoxin (100 nM). These findings provide the first evidence that relaxation of arterial smooth muscle cells by PACAPs is mediated by opening of K(ATP) and K(Ca) channels. The data indicate that both K(ATP) and K(Ca) channels in vascular smooth muscle cells may serve as final common pathway to induce vasorelaxation by endogenous vasoactive signals in man.