Implementing a Hospitalist Comanagement Service in Orthopaedic Surgery

➤ Hospitalist comanagement of patients undergoing orthopaedic surgery is a growing trend across the United States, yet its implementation in an academic tertiary care hospital can be complex and even contentious.➤ Hospitalist comanagement services lead to better identification of at-risk patients, optimization of patient care to prevent adverse events, and streamlining of the admission process, thereby enhancing the overall service efficiency.➤ A successful hospitalist comanagement service includes the identification of service stakeholders and leaders; frequent consensus meetings; a well-defined standardized framework, with goals, program metrics, and unified commands; and an occasional satisfaction assessment to update and improve the program.➤ In this article, we establish a step-by-step protocol for the implementation of a comanagement structure between orthopaedic and hospitalist services at a tertiary care center, outlining specific protocols and workflows for patient care and transfer procedures among various departments, particularly in emergency and postoperative situations.

Dynamic Prediction of Post-Acute Care Needs for Hospitalized Medicine Patients

OBJECTIVES

Use patient demographic and clinical characteristics at admission and time-varying in-hospital measures of patient mobility to predict patient post-acute care (PAC) discharge.

DESIGN

Retrospective cohort analysis of electronic medical records.

SETTING AND PARTICIPANTS

Patients admitted to the two participating Hospitals from November 2016 through December 2019 with ≥72 hours in a general medicine service.

METHODS

Discharge location (PAC vs home) was the primary outcome, and 2 time-varying measures of patient mobility, Activity Measure for Post-Acute Care (AM-PAC) Mobility "6-clicks" and Johns Hopkins Highest Level of Mobility, were the primary predictors. Other predictors included demographic and clinical characteristics. For each day of hospitalization, we predicted discharge to PAC using the demographic and clinical characteristics and most recent mobility data within a random forest (RF) for survival, longitudinal, and multivariate (RF-SLAM) data. A regression tree for the daily predicted probabilities of discharge to PAC was constructed to represent a global summary of the RF.

RESULTS

There were 23,090 total patients and compared to PAC, those discharged home were younger (64 vs 71), had shorter length of stay (5 vs 8 days), higher AM-PAC at admission (43 vs 32), and average AM-PAC throughout hospitalization (45 vs 35). AM-PAC was the most important predictor, followed by age, and whether the patient lives alone. The area under the hospital day-specific receiver operating characteristic curve ranged from 0.76 to 0.79 during the first 5 days. The global summary tree explained 75% of the variation in predicted probabilities for PAC from the RF. Sensitivity (75%), specificity (70%), and accuracy (72%) were maximized at a PAC probability threshold of 40%.

CONCLUSIONS AND IMPLICATIONS

Daily assessment of patient mobility should be part of routine practice to help inform care planning by hospital teams. Our prediction model could be used as a valuable tool by multidisciplinary teams in the discharge planning process.

LFA1 and ICAM1 are critical for fusion and spread of murine leukemia virus in vivo

Murine leukemia virus (MLV)-presenting cells form stable intercellular contacts with target cells during infection of lymphoid tissue, indicating a role of cell-cell contacts in retrovirus dissemination. Whether host cell adhesion proteins are required for retrovirus spread in vivo remains unknown. Here, we demonstrate that the lymphocyte-function-associated-antigen-1 (LFA1) and its ligand intercellular-adhesion-molecule-1 (ICAM1) are important for cell-contact-dependent transmission of MLV between leukocytes. Infection experiments in LFA1- and ICAM1-deficient mice demonstrate a defect in MLV spread within lymph nodes. Co-culture of primary leukocytes reveals a specific requirement for ICAM1 on donor cells and LFA1 on target cells for cell-contact-dependent spread through trans- and cis-infection. Importantly, adoptive transfer experiments combined with a newly established MLV-fusion assay confirm that the directed LFA1-ICAM1 interaction is important for retrovirus fusion and transmission in vivo. Taken together, our data provide insights on how retroviruses exploit host proteins and the biology of cell-cell interactions for dissemination.

Selection of Human Cytomegalovirus Mutants with Resistance against PDGFRα-Derived Entry Inhibitors

The human cytomegalovirus (HCMV) infects fibroblasts via an interaction of its envelope glycoprotein gO with the cellular platelet-derived growth factor receptor alpha (PDGFRα), and soluble derivatives of this receptor can inhibit viral entry. We aimed to select mutants with resistance against PDGFRα-Fc and the PDGFRα-derived peptides GT40 and IK40 to gain insight into the underlying mechanisms and determine the genetic barrier to resistance. An error-prone variant of strain AD169 was propagated in the presence of inhibitors, cell cultures were monitored weekly for signs of increased viral growth, and selected viruses were tested regarding their sensitivity to the inhibitor. Resistant virus was analyzed by DNA sequencing, candidate mutations were transferred into AD169 clone pHB5 by seamless mutagenesis, and reconstituted virus was again tested for loss of sensitivity by dose-response analyses. An S48Y mutation in gO was identified that conferred a three-fold loss of sensitivity against PDGFRα-Fc, a combination of mutations in gO, gH, gB and gN reduced sensitivity to GT40 by factor 4, and no loss of sensitivity occurred with IK40. The resistance-conferring mutations support the notion that PDGFRα-Fc and GT40 perturb the interaction of gO with its receptor, but the relatively weak effect indicates a high genetic barrier to resistance.

Production of HD Molecules in Definite Hyperfine Substates

Polarized atomic beam sources have been in operation for many years to produce either nuclear polarized atomic hydrogen or deuterium beams. In recent experiments, such a source was used to polarize both isotopes independently at the same time. By recombination of the atoms, hydrogen-deuterium molecules with all possible nuclear spin combinations can be created. Those spin isomers are useful for further applications, like precision spectroscopy, as polarized targets for laser-particle acceleration, polarized fuel for fusion reactors, or as an option for future measurements of electric dipole moments.

Isotensor Dibaryon in the pp→ppπ^{+}π^{-} Reaction?

Exclusive measurements of the quasifree pp→ppπ^{+}π^{-} reaction have been carried out at WASA@COSY by means of pd collisions at T_{p}=1.2  GeV. Total and differential cross sections have been extracted covering the energy region T_{p}=1.08-1.36  GeV, which is the region of N^{*}(1440) and Δ(1232)Δ(1232) resonance excitations. Calculations describing these excitations by t-channel meson exchange are at variance with the measured differential cross sections and underpredict substantially the experimental total cross section. An isotensor ΔN dibaryon resonance with I(J^{P})=2(1^{+}) produced associatedly with a pion is able to overcome these deficiencies.

Spin Dependence of η Meson Production in Proton-Proton Collisions Close to Threshold

Taking advantage of the high acceptance and axial symmetry of the WASA-at-COSY detector, and the high polarization degree of the proton beam of COSY, the reaction p[over →]p→ppη has been measured close to threshold to explore the analyzing power A_{y}. The angular distribution of A_{y} is determined with the precision improved by more than 1 order of magnitude with respect to previous results, allowing a first accurate comparison with theoretical predictions. The determined analyzing power is consistent with zero for an excess energy of Q=15  MeV, signaling s-wave production with no evidence for higher partial waves. At Q=72  MeV the data reveal strong interference of Ps and Pp partial waves and cancellation of (Pp)^{2} and Ss^{*}Sd contributions. These results rule out the presently available theoretical predictions for the production mechanism of the η meson.

How to Reach a Thousand-Second in-Plane Polarization Lifetime with 0.97-GeV/c Deuterons in a Storage Ring

We observe a deuteron beam polarization lifetime near 1000 s in the horizontal plane of a magnetic storage ring (COSY). This long spin coherence time is maintained through a combination of beam bunching, electron cooling, sextupole field corrections, and the suppression of collective effects through beam current limits. This record lifetime is required for a storage ring search for an intrinsic electric dipole moment on the deuteron at a statistical sensitivity level approaching 10^{-29}  e cm.

[Online self-help for persons with suicidal intentions: budget impact analysis]

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An Epha4/Sipa1l3/Wnt pathway regulates eye development and lens maturation

The signal-induced proliferation associated family of proteins comprises four members, SIPA1 and SIPA1L1-1L3. Mutations of the human SIPA1L3 gene result in congenital cataracts. In Xenopus, loss of Sipa1l3 function led to a severe eye phenotype that was distinguished by smaller eyes and lenses including lens fiber cell maturation defects. We found a direct interaction between Sipa1l3 and Epha4, building a functional platform for proper ocular development. Epha4 deficiency phenocopied loss of Sipa1l3 and rescue experiments demonstrated that Epha4 acts up-stream of Sipa1l3 during eye development. Both, Sipa1l3 and Epha4 are required for early eye specification. The ocular phenotype, upon loss of either Epha4 or Sipa1l3, was partially mediated by rax. We demonstrated that canonical Wnt signaling is inhibited downstream of Epha4/Sipa1l3 during normal eye development. Depletion of either Sipa1l3 or Epha4 resulted in an up-regulation of axin2 expression, a direct Wnt/β-catenin target gene. In line with this, Sipa1l3 or Epha4 depletion could be rescued by blocking Wnt/β-catenin or activating non-canonical Wnt signaling. We therefore conclude that this pathomechanism prevents proper eye development and maturation of lens fiber cells resulting in congenital cataracts.

Production of hyperpolarized H_{2} molecules from H[over →] atoms in gas-storage cells

The preservation of the nuclear polarization of hydrogen atoms during the recombination to molecules was observed on different surface materials in the temperature range from 45 to 100 K and for magnetic fields up to 1 T. On a gold and a fused quartz surface, the expected molecular polarization of about 50% or lower of the atomic polarization was measured, while a surface layer of perfluoropolyether (Fomblin) shows a nearly complete preservation (at least 97%) of the atomic polarization during the recombination process. Further experiments have the possibility of storing polarized deuterium molecules and to use them in nuclear-fusion installations. Another application might be the production of polarized substances for enhanced NMR techniques.

New Method for a Continuous Determination of the Spin Tune in Storage Rings and Implications for Precision Experiments

A new method to determine the spin tune is described and tested. In an ideal planar magnetic ring, the spin tune-defined as the number of spin precessions per turn-is given by ν(s)=γG (γ is the Lorentz factor, G the gyromagnetic anomaly). At 970  MeV/c, the deuteron spins coherently precess at a frequency of ≈120  kHz in the Cooler Synchrotron COSY. The spin tune is deduced from the up-down asymmetry of deuteron-carbon scattering. In a time interval of 2.6 s, the spin tune was determined with a precision of the order 10^{-8}, and to 1×10^{-10} for a continuous 100 s accelerator cycle. This renders the presented method a new precision tool for accelerator physics; controlling the spin motion of particles to high precision is mandatory, in particular, for the measurement of electric dipole moments of charged particles in a storage ring.

Incidence ofFusaria and occurrence of selected Fusarium mycotoxins on Lolium spp. in Germany

Test plantings with varieties ofLolium multiflorum andL perenne were harvested 4 to 7 times a year in 1991 and 1992. Samples were checked for the presence ofFusaria, the mycotoxins zearalenone, T-2 toxin, and diacetoxyscirpenol (DAS). Spectrum of species and the incidence ofFusaria and fusariotoxins are discussed in relation to the influencing factors site, variety ofLolium, harvesting time and year. Depending on these factors, 41 % to 100 % of the samples wereFusarium positive. Differences in infestation with Fusarium among varieties ofLolium perenne were dependent on location and did not correlate with yield. The six species ofFusarium pathogenic toLolium spp. (F. graminearum, F. culmorum, F. avenaceum, F. oxysporum, F. solani, and F. acuminatum) totaled 35.7 % of all the isolated strains. 14 species could be isolated fromLolium samples (descending frequency):F. culmorum, F. sambucinum, F. equiseti, F. acuminatum, F. semitectum, F. oxysporum, F. subglutinans, F. avenaceum, F. sporotrichioides, F. proliferatum, F. tricinctum, F. anthophilum, F. dimerum and F. graminearum. For the detection ofFusaria a promising new immunological method is presented. It is based on the genus specific production of exopolysaccharides byFusarium species.Mycotoxin contents in grass ranged from 0.01 to 4.75 ppm for zearalenone with 67 % positive samples and 0.3 % samples above 1 ppm, 0.04 to 2.78 ppm for T-2 toxin with 25 % positive samples and 2.8 % samples above 1 ppm, and 0.003 to 0.06 for DAS with 21.6 % positive samples. In silages, no T-2 toxin was detectable. IsolatedFusarium strains were checked for the ability to produce the mycotoxins zearalenone, T-2 toxin and DAS in culture. Most of the strains were positive for at least one of the toxins.

[Dopamine and excessive alcohol consumption: how genes interact with their environment]

BACKGROUND

Hereditary factors account for approximately 50% of the risk of developing alcohol dependence. Genes that affect the dopamine function in the brain have been extensively studied as candidate genes.

AIM

To present the results of recent Dutch studies on the interaction between genes and their environment in relation to dopamine function and excessive alcohol use.

METHOD

Two large scale research projects were recently carried out in order to study the relation between dopamine genes and excessive alcohol use in the Netherlands. The first study investigated excessive alcohol use among adolescents. The second studied alcohol dependence among adult males.

RESULTS

Genes that affect the dopamine function in the brain were not directly linked to excessive alcohol use or dependence. Dopamine genes, however, do influence sensitivity to environmental risk factors for excessive alcohol use.

CONCLUSION

These studies show that genetically determined dopamine function increases the risk of excessive alcohol use in the context of an adverse environment. Traumatic experiences and parenting style were both shown to be important environmental factors.

Abashian-Booth-Crowe effect in basic double-pionic fusion: a new resonance?

We report on an exclusive and kinematically complete high-statistics measurement of the basic double-pionic fusion reaction pn→dπ(0)π(0) over the full energy region of the ABC effect, a pronounced low-mass enhancement in the ππ-invariant mass spectrum. The measurements, which cover also the transition region to the conventional t-channel ΔΔ process, were performed with the upgraded WASA detector setup at COSY. The data reveal the Abashian-Booth-Crowe effect to be uniquely correlated with a Lorentzian energy dependence in the integral cross section. The observables are consistent with a narrow resonance with m=2.37  GeV, Γ≈70  MeV and I(J(P))=0(3(+)) in both pn and ΔΔ systems. Necessary further tests of the resonance interpretation are discussed.

[Positive life events and mood disorders: longitudinal evidence for a chaotic life-course hypothesis]

BACKGROUND

In psychiatric research it is often assumed that detrimental effects of negative life events on mental health can be buffered by a number of positive life events. However, there is no convincing empirical evidence that this assumption is correct; it can even be argued that positive life events act as additional stressors rather than as buffers, leading to a continuation of a chaotic life course and an increase in the risk of affective disorders.

AIM

To find out whether positive life events were associated with a higher risk of the occurrence of mood disorders and whether such an association could be explained by a number of negative life events that individuals had experienced.

METHOD

We used data from 4,796 adults, aged 18-64, collected at two measurement moments (i.e. 1997 and 1999) of NEMESIS, a Dutch prospective-epidemiological study. As a basis for our measurements we used dsm-iii-r diagnoses of major depressive disorders and dysthymia and the Life Events and Difficulties Schedules LEDS.

RESULTS

A multivariate (MPlus) path analysis demonstrated that positive life events were not, in themselves, significantly predictive of affective disorders. Positive life events were only related to the risk of mood disorders when they co-occurred with a high number of negative life events.

CONCLUSIONS

In accordance with a chaotic life-course hypothesis, positive events were not found to buffer the detrimental impact of negative life events, but when they are part of an erratic course of life they can pose an extra threat to an individual’s mental health.

Production of a beam of tensor-polarized deuterons using a carbon target

An initially unpolarized beam of deuterons is found to acquire tensor polarization after traversing a foil of spin-zero target nuclei. The effect, called nuclear spin dichroism, has been predicted theoretically, albeit resulting in small values of p(zz) of the order of 0.01 for energies around 10 MeV. The experiment was carried out at the Köln tandem accelerator using carbon targets bombarded by deuterons. The observed polarization is as large as p(zz)=-0.28±0.03 for a beam of 14.8 MeV and a 129  mg/cm2 target. The results allow one to produce tensor-polarized deuterons with p(zz) around -0.30 (or +0.25) from an initially unpolarized beam using a carbon target of appropriate thickness.

Parental communication appears not to be an effective strategy to reduce smoking in a sample of Dutch adolescents

This longitudinal study examined the reciprocal effects of the frequency of parent-adolescent communication on tobacco-related issues (smoking-specific communication), and adolescents' smoking. Participants were 428 Dutch older and younger siblings between 13 and 16 years old. Smoking-specific communication did not affect youth smoking in general; however, among younger, but not older, siblings, smoking-specific communication was associated with a higher likelihood of smoking over time. In addition, when adolescents already smoked parents started to talk more frequently about smoking-related issues with their older and younger adolescents later on. Neither the quality of smoking-specific communication, the quality of parent-adolescent relationship, nor parental smoking moderated these reciprocal effects. In conclusion, prevention campaigns encouraging parents to undertake smoking-specific communication might not be desirable.

Five-year follow up of a randomised controlled trial comparing NovaSure and ThermaChoice endometrial ablation

OBJECTIVE

We have previously reported that NovaSure was more effective than balloon ablation at 12 months follow up in the treatment of menorrhagia. In this paper, we report the 5-year outcome of this study. The objective was to evaluate amenorrhoea rates, hysterectomy rate, and quality of life associated with the bipolar impedance-controlled endometrial ablation technique (NovaSure) in comparison with balloon ablation technique (ThermaChoice) at 5 years after administration.

DESIGN

Double-blind randomised controlled trial, 2:1 randomisation NovaSure versus ThermaChoice.

SETTING

A teaching hospital with 500 beds in The Netherlands.

POPULATION

A total of 126 premenopausal women suffering from menorrhagia with a pictorial blood loss assessment count > or = 150 without intracavitary abnormalities.

METHODS

Women were randomly allocated to bipolar radio-frequency ablation and balloon ablation in a 2:1 ratio.

MAIN OUTCOME MEASURES

The main outcome measures were amenorrhoea rate, hysterectomies, and health-related quality of life (HRQol) as reported at 5 year follow up.

RESULTS

At 5 years of follow up, the total response rate was 96% in the bipolar group and 90% in the balloon group. Amenorrhoea was reported in the bipolar group by 48% of women and in the balloon arm by 32% (relative risk 1.6 [.93-2.6]). There were eight women in the bipolar group (9.8%) and five in the balloon group (12.9%) who had undergone a hysterectomy. Furthermore, there was a significant equal improvement of HRQoL over time in both groups.

CONCLUSIONS

At 5 years follow up, bipolar thermal ablation was superior over balloon ablation in the treatment of menorrhagia.

Challenges to the peer influence paradigm: results for 12-13 year olds from six European countries from the European Smoking Prevention Framework Approach study

OBJECTIVE

To examine whether smoking onset in young adolescents is predicted by peer or parental smoking.

DESIGN

Longitudinal design with one pretest and one follow-up at 12 months.

SETTING

Schools in Finland, Denmark, the Netherlands, the United Kingdom, Spain and Portugal.

PARTICIPANTS

7102 randomly selected adolescents from six countries. Mean age was 12.78 years.

MAIN OUTCOME MEASURES

Smoking behaviour of adolescents, peers and parents.

RESULTS

No support was found for peer smoking as an important predictor of smoking onset in most countries. Support was found for the selection paradigm, implying that adolescents choose friends with similar smoking behaviour. Support for the impact of parents on adolescent behaviour and the choice of friends was also found.

CONCLUSIONS

Smoking uptake in this age cohort may be more strongly influenced by personal and parental influences than initially believed. Hence, social inoculation programmes teaching youngsters to resist the pressures to smoke may be less appropriate if youngsters have a positive attitude towards smoking, associate smoking with various advantages and look for peers with similar values. For this group attitudes towards smoking may thus guide future friend selection.

Sites for interaction between Gal80p and Gal1p in Kluyveromyces lactis: structural model of galactokinase based on homology to the GHMP protein family

The induction of transcription of the galactose genes in yeast involves the galactose-dependent binding of ScGal3p (in Saccharomyces cerevisiae) or KlGal1p (in Kluyveromyces lactis) to Gal80p. This binding abrogates Gal80's inhibitory effect on the activation domain of Gal4p, which can then activate transcription. Here, we describe the isolation and characterization of new interaction mutants of K.lactis GAL1 and GAL80 using a two-hybrid screen. We present the first structural model for Gal1p to be based on the published crystal structures of other proteins belonging to the GHMP (galactokinase, homoserine kinase, mevalonate kinase and phosphomevalonate kinase) kinase family and our own X-ray diffraction data of Gal1p crystals at 3A resolution. The locations of the various mutations in the modelled Gal1p structure identify domains involved in the interaction with Gal80p and provide a structural explanation for the phenotype of constitutive GAL1 mutations.

[Kidney transplant program facilitated by airlift between the Netherlands Antilles and the Netherlands; 1998-2001]

OBJECTIVE

To describe the results of a structured kidney-transplantation programme available to dialysis patients in Curaçao (Dutch Caribbean), involving transplantation in the Netherlands and follow-up in Curaçao.

DESIGN

Descriptive.

METHOD

In 1998, a joint venture was begun with the Academic Medical Center (AMC) in Amsterdam, the Eurotransplant Foundation, the Dutch Transplantation Working Party and the Diagnostic Division of the Sanquin Foundation in Amsterdam, the Netherlands. Its aim was to achieve a structural kidney transplantation programme for patients in the Dutch Caribbean in general and patients in Curaçao in particular. An airlift programme between Curaçao and the AMC was instituted.

RESULTS

Between 1998-2001 19 patients underwent a kidney transplant, three of which failed. In most of the transplants the cold ischaemia time was less than 48 hours; the average cold ischaemia time was 32 hours. All patients returned to the Antilles within 3 months where their treatment was continued. Post-transplantation follow-up was on average 13.9 months (limits 3-36); three patients died.

A cell-culture reactor for the on-line evaluation of radiopharmaceuticals: evaluation of the lumped constant of FDG in human glioma cells

A fluidized-bed cell-culture reactor with on-line radioactivity detection was developed for the in vitro evaluation of radiopharmaceuticals. The technique was applied to measure the dependency of the lumped constant (LC) of FDG on the glucose concentration in the culture medium in a human glioma cell line.

METHODS

Human glioblastoma cells (86HG39) immobilized in open porous microcarriers were cultivated in a continuously operating fluidized-bed bioreactor. At different glucose concentrations in the culture medium, step inputs (0.1 MBq/mL) of FDG were performed and the cellular uptake of FDG was measured on-line and compared with analyzed samples. From these results, the LC of FDG and its dependency on the glucose concentration were calculated.

RESULTS

This fluidized-bed technique enabled precise and reproducible adjustment of all relevant experimental parameters, including radiotracer time-concentration course, medium composition, pH, dissolved oxygen and temperature under steady-state conditions, and an on-line determination of the intracellular radiotracer uptake. The immobilized glioma cells formed stable, 3-dimensional, tumor-like spheroids and were continuously proliferating, as proven by an S-phase portion of 25%-40%. For further examination of the cells, an enzymatic method for detachment from the carriers without cellular destruction was introduced. In the FDG experiments, a significant dependency of the LC on the glucose level was found. For normoglycemic glucose concentrations, the LC was determined to be in the range of 0.7+/-0.1, whereas in hypoglycemia LC increased progressively up to a value of 1.22+/-0.01 at a glucose concentration of 3 mmol/L.

CONCLUSION

The bioreactor represents an improved in vitro model for the on-line evaluation of radiotracers and combines a wide range of experimental setups and 3-dimensional, tissue-like cell cultivation with a technique for on-line radioactivity detection.

Galactose induction in yeast involves association of Gal80p with Gal1p or Gal3p

Gal1p carries out two functions in the galactose pathway of yeast. It activates Gal4p by interacting with Gal80p--a function that can also served by Gal3p--and it catalyzes the formation of galactose-1-phosphate. Recently, we and others have presented biochemical evidence for complex formation between Gal1p and Gal80p. Here, we extend these data and present genetic evidence for an interaction between Gal1p and Gal80p in vivo, using a two-hybrid assay. Interaction between Gal1p and Gal80p depends on the presence of galactose, but not on the catalytic activity of Gal1p. A new class of Kluyveromyces lactis mutants was isolated, designated Klgal1-m, which have lost the derepressing activity but retain galactokinase activity, indicating that the two Gal1p activities are functionally independent. The KlGal1-m proteins are defective in their ability to interact with Gal80p in a two-hybrid assay. The locations of gall-m mutations identify putative interaction sites in Gal1p and Gal80p. A dominant mutation, KlGAL1-d, leads to a high level of constitutive expression of genes of the galactose pathway. The behavior of chimeric proteins consisting of Gal3p and KlGal1p sequences indicates that both the N-terminal and C-terminal halves of KlGal1p are involved in specific interaction with KlGal80p.

[Hypertension and disorders of cognitive function]

In the treatment of hypertension, the aspect of cognitive function is now becoming ever more important. In recent years, the influence of hypertension itself--as well as that of anti-hypertensive treatment--on cognitive functioning has repeatedly been investigated. The results obtained differ too widely to permit any final statement to be made on the relationships involved. The reasons for these differences seem to be due in particular to differences in the methods of investigation and random sampling involved in the studies. More recent studies, however, seem to support a relationship between hypertension and decreased cognitive performance. Improved investigations are expected to produce more detailed results in the future.

[APS-2: comparative study on populations of critical patients in Chile, United States and New Zealand]

Between 1988 and 1991, the Acute Physiologic Score (APS-2) was applied to 1000 critically ill patients admitted to an intensive care unit of a general hospital in Chile. Its predictive capacity was assessed and compared with two series from United States and New Zealand. The mean admission APS-2 in Chilean patients was 12.8 and there was a progressive increase in mortality with elevating scores; no patient with an APS-2 over 30 survived. Admission APS-2 scores in USA and New Zealand were 10.7 and 14.2. Overall mortality in Chilean patients was 28%, compared with 12% in USA and 15% in New Zealand. Within different score ranges, mortality was higher in Chilean patients than those from USA or New Zealand. It is concluded that the assessment of admission APS-2 score underlying diagnosis, physiologic age and previous health status of a patient may help to predict the success of intensive care.