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Anaesthesia care team improves outcomes in surgical patients compared with solo anaesthesiologist: An observational study

BACKGROUND In anaesthesiology, little attention has been drawn to the role of anaesthesia nurses as support personnel on quality of care. OBJECTIVES To compare the impact of anaesthesia by an anaesthesiologist alone (solo anaesthesiologist) or in combination with an anaesthesia nurse (anaesthesia care team) on 30-day postoperative mortality and hospital length of stay. RESULTS Anaesthesia was performed by solo anaesthesiologists in 2832 patients and by an anaesthesia care team in 2842 patients. The two groups were comparable in respect of sex and duration of anaesthesia but differed notably for age, American Society of Anesthesiologists' physical status score and type of surgery. Propensity score matching was performed by logistic regression to adjust for baseline differences between the two groups and 2095 pairs of perfectly matched patients were formed. The latter evidenced a significantly lower 30-day mortality rate for the anaesthesia care team compared with solo anaesthesiologists (0.76 vs. 1.56%, P = 0.0014). Length of hospital stay was also significantly reduced when an anaesthesia nurse was present (4.9 ± 10.1 vs. 5.6 ± 11.5 days, P = 0.0011). CONCLUSION Anaesthesia given by the combination of an anaesthesiologist and an anaesthesia nurse is associated with decreased 30-day postoperative mortality and shorter length of stay when compared with a solo anaesthesiologist. Even if without any demonstration of causality, this emphasises the benefits of the anaesthesia care team model. TRIAL REGISTRATION CCB 325201730849. Correspondence to Patrice Forget, Anaesthesiology and Perioperative Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium Tel: +32 24773058; e-mail: forgetpatrice@yahoo.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Genotype-by-Environment-by-Environment Interactions in the Saccharomyces cerevisiae Transcriptomic Response to Alcohols and Anaerobiosis

Next generation biofuels including longer-chain alcohols such as butanol are attractive as renewable, high-energy fuels. A barrier to microbial production of butanols is the increased toxicity compared to ethanol; however, the cellular targets and microbial defense mechanisms remain poorly understood, especially under anaerobic conditions used frequently in industry. Here we took a comparative approach to understand the response of Saccharomyces cerevisiae to 1-butanol, isobutanol, or ethanol, across three genetic backgrounds of varying tolerance in aerobic and anaerobic conditions. We find that strains have different growth properties and alcohol tolerances with and without oxygen availability, as well as unique and common responses to each of the three alcohols. Our results provide evidence for strain-by-alcohol-by-oxygen interactions that moderate how cells respond to alcohol stress.

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Phonemic fluency improved after inhibitory transcranial magnetic stimulation in a case of chronic aphasia

Twenty-six months after a left hemispheric ischemic stroke an aphasic patient showed a significant improvement in verbal fluency following ten daily sessions of inhibitory 1 Hz repetitive transcranial magnetic stimulation over the right cortex homologous to the Broca's area. No improvement was observed for other linguistic functions or for executive ones. Results confirm the segregation of neural circuitries subtending phonemic and semantic fluency and suggest a selective usefulness of the repetitive transcranial magnetic stimulation treatment. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/1hexVwJ Correspondence to Luigi Tesio, MD, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Via Mercalli 32, 20122 Milan, Italy Tel: +39 025 821 8150; fax: +39 025 821 8155; e-mail: luigi.tesio@unimi.it Received September 15, 2018 Accepted September 17, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Limping on split-belt treadmills implies opposite kinematic and dynamic lower limb asymmetries

Walking on a split-belt treadmill (each of the two belts running at a different speed) has been proposed as an experimental paradigm to investigate the flexibility of the neural control of gait and as a form of therapeutic exercise. However, the scarcity of dynamic investigations challenges the validity of the available findings. The aim of the present study was to investigate the dynamic asymmetries of lower limbs of healthy adults during adaptation to gait on a split-belt treadmill. Ten healthy adults walked on a split-belt treadmill mounted on force sensors, with belts running either at the same speed ('tied' condition) or at different speeds ('split' condition, 0.4 vs. 0.8 or 0.8 vs. 1.2 m/s). The sagittal power and work provided by ankle, knee and hip joints, joint rotations, muscle lengthening, and surface electromyography were recorded simultaneously. Various tied/split walking sequences were requested. In the split condition, a marked asymmetry between the parameters recorded from each of the two lower limbs, in particular from the ankle joint, was recorded. The work provided by the ankle (the main engine of body propulsion) was 4.8 and 2.2 times higher (in the 0.4 vs. 0.8, and 0.8 vs. 1.2 m/s conditions, respectively) compared with the slower side, and 1.2 and 1.1 times higher compared with the same speed in the tied condition. Compared with overground gait in hemiplegia, split gait entails an opposite spatial and dynamic asymmetry. The faster leg mimics the paretic limb temporally, but the unimpaired limb from the spatial and dynamic point of view. These differences challenge the proposed protocols of split gait as forms of therapeutic exercise. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. https://ift.tt/1hexVwJ Correspondence to Luigi Tesio, MD, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca-Polo Capitanio, via Giuseppe Mercalli 30, 20122 Milan, Italy Tel: +39 025 821 8150; fax: +39 025 821 8155; e-mails: luigi.tesio@unimi.it, l.tesio@auxologico.it Received August 1, 2018 Accepted September 12, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Patient Reported Outcomes Following Surgery for Degenerative Spondylolitshtesis: Comparison of a Universal and Multi-Tier Health Care System

Study Design: Retrospective review of results from a prospectively collected Canadian cohort in comparison to published literature.Objectives: (1) To investigate whether patients in a universal health care system (HCS) have different outcomes than those in a multi-tier HCS in surgical management of degenerative spondylolisthesis (DS).(2) To identify independent factors predictive of outcome in surgical DS patients.Summary of Background Data: Canada has a national health insurance program with unique properties.

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