Influence of transactive memory on perceived performance, job satisfaction and identification in anaesthesia teams.

BACKGROUND: There is an increasing awareness in the medical community that human factors are involved in effectiveness of anaesthesia teams. Communication and coordination between physicians and nurses seems to play a crucial role in maintaining a good level of performance under time pressure, particularly for anaesthesia teams, who are confronted with uncertainty, rapid changes in the environment, and multi-tasking. The aim of this study was to examine the relationship between a specific form of implicit coordination--the transactive memory system--and perceptions of team effectiveness and work attitudes such as job satisfaction and team identification. METHODS: A cross-sectional study was conducted among 193 nurse and physician anaesthetists from eight French public hospitals. The questionnaire included some measures of transactive memory system (coordination, specialization, and credibility components), perception of team effectiveness, and work attitudes (Minnesota Job Satisfaction Questionnaire, team identification scale). The questionnaire was designed to be filled anonymously, asking only biographical data relating to sex, age, status, and tenure. RESULTS: Hierarchical multiple regression analyses revealed as predicted that transactive memory system predicted members' perceptions of team effectiveness, and also affective outcomes such as job satisfaction and team identification. Moreover, the results demonstrated that transactive memory processes, and especially the coordination component, were a better predictor of teamwork perceptions than socio-demographic (i.e. gender or status) or contextual variables (i.e. tenure and size of team). CONCLUSIONS: These findings provided empirical evidence of the existence of a transactive memory system among real anaesthesia teams, and highlight the need to investigate whether transactive memory is actually linked with objective measures of performance.

Which DSM validated tools for diagnosing depression are usable in primary care research? A systematic literature review.

INTRODUCTION: Depression occurs frequently in primary care. Its broad clinical variability makes it difficult to diagnose. This makes it essential that family practitioner (FP) researchers have validated tools to minimize bias in studies of everyday practice. Which tools validated against psychiatric examination, according to the major depression criteria of DSM-IV or 5, can be used for research purposes? METHOD: An international FP team conducted a systematic review using the following databases: Pubmed, Cochrane and Embase, from 2000/01/01 to 2015/10/01. RESULTS: The three databases search identified 770 abstracts: 546 abstracts were analyzed after duplicates had been removed (224 duplicates); 50 of the validity studies were eligible and 4 studies were included. In 4 studies, the following tools were found: GDS-5, GDS-15, GDS-30, CESD-R, HADS, PSC-51 and HSCL-25. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value were collected. The Youden index was calculated. DISCUSSION: Using efficiency data alone to compare these studies could be misleading. Additional reliability, reproducibility and ergonomic data will be essential for making comparisons. CONCLUSION: This study selected seven tools, usable in primary care research, for the diagnosis of depression. In order to define the best tools in terms of efficiency, reproducibility, reliability and ergonomics for research in primary care, and for care itself, further research will be essential.

Hemodynamic, gas exchange, and hormonal consequences of LBPP during PEEP ventilation.

Hemodynamic, gas exchange, and hormonal response induced by application of a 25- to 40-mmHg lower body positive pressure (LBPP), during positive end-expiratory pressure (PEEP; 14 +/- 2.5 cmH2O) were studied in nine patients with acute respiratory failure. Compared with PEEP alone, LBPP increased cardiac index (CI) from 3.57 to 4.76 l X min-1 X m-2 (P less than 0.001) in relation to changes in right atrial pressure (RAP) (11 to 16 mmHg; P less than 0.01). Cardiopulmonary blood volume (CPBV) measured in five patients increased during LBPP from 546 +/- 126 to 664 +/- 150 ml (P less than 0.01), with a positive linear relationship between changes in RAP and CPBV (r = 0.88; P less than 0.001). Venous admixture (Qva/QT) decreased with PEEP from 24 to 16% (P less than 0.001) but did not change with LBPP despite the large increase in CI, leading to a marked O2 availability increase (P less than 0.001). Although PEEP induced a significant rise in plasma norepinephrine level (NE) (from 838 +/- 97 to 1008 +/- 139 pg/ml; P less than 0.05), NE was significantly decreased by LBPP to control level (from 1,008 +/- 139 to 794 +/- 124 pg/ml; P less than 0.003). Plasma epinephrine levels were not influenced by PEEP or LBPP. Changes of plasma renin activity (PRA) paralleled those of NE. No change in plasma arginine vasopressin (AVP) was recorded. We concluded that LBPP increases venous return and CPBV and counteracts hemodynamic effects of PEEP ventilation, without significant change in Qva/QT. Mechanical ventilation with PEEP stimulates sympathetic activity and PRA apparently by a reflex neuronal mechanism, at least partially inhibited by the loading of cardiopulmonary low-pressure reflex and high-pressure baroreflex. Finally, AVP does not appear to be involved in the acute cardiovascular adaptation to PEEP.

Standard preoxygenation technique versus two rapid techniques in pregnant patients.

The aim of this study was to compare three different preoxygenation techniques in pregnant women by measuring end-tidal fractional oxygen concentration (FETO2): the traditional technique of 3min tidal volume breathing (VT x 3 min), 8 deep breaths (8 DB) and 4 deep breaths (4 DB). Twenty pregnant volunteers without pulmonary diseases were studied during the third trimester (36-38 weeks' gestation). Women were preoxygentated using a non-rebreathing respiratory circuit with a 3-L reservoir bag and a Capnomac Ultima calibrated before each patient to monitor FETO2 continuously. The three preoxygenation techniques were investigated in random order: VT x 3 min using an oxygen flow of 9 L min-1, 4 DB within 30s using an oxygen flow of 9 L min-1, and 8 DB within one minute using an oxygen flow of 15 L min-1. Between each technique, 5-min room air breathing was allowed to return to baseline FETO2 assessed by the Capnomac Ultima. An FETO2 >/= 90% was achieved more frequently with the VT x 3 min and the 8 DB techniques (76%) than with the 4 DB technique (18%) (P < 0.05). The average time required for obtaining an FETO2 >/= 90% was 107+/-37s. Both the VT x 3 min and the 8 DB techniques are therefore more effective for preoxygenation in pregnant patients than the 4 DB technique. In an acute obstetric emergency before rapid-sequence induction of general anaesthesia, 8 DB preoxygenation technique could be recommended.

Pediatric tonsillectomy: clinical practice guidelines.

OBJECTIVE: This article presents the Clinical Practice Guidelines for Pediatric Tonsillectomy of the French Society of ENT and Head and Neck Surgery (SFORL), entitled "Amygdalectomie de l'enfant : Recommandation pour la pratique clinique" (SFORL, 2009). METHOD: The French Society of ENT (SFORL), in partnership with the French Association for Ambulatory Surgery (AFCA) and French Society for Anaesthesia and Intensive Care (SFAR), set up a representative panel in the fields of anesthesiology, ENT and head-and-neck surgery, pediatrics, sleep medicine and general medicine. Following the literature analysis reported in the Presentation of the Guidelines, recommendations were drawn up taking account of risk/benefit ratios, levels of evidence, feasibility in pediatric tonsillectomy and baseline risk assessment in the relevant population. RESULTS: Around 50,000 pediatric tonsillectomies, with or without associated adenoidectomy, are performed in France each year. Postoperative morbidity and mortality are non-negligible, despite progress in peri-operative management. The present guidelines address the following questions: 1) What are the indications for tonsillectomy, notably in case of obstructive sleep disorder; 2) What pre-operative assessment is required? 3) What are the technical principles involved? 4) What are the selection criteria for ambulatory tonsillectomy? 5) How should postoperative follow-up be organized? 6) How should complications be managed? CONCLUSION: The present Clinical Practice Guidelines for pediatric tonsillectomy in France should improve clinical and organizational practices to enhance patient safety. They seek to ensure optimal conditions of care for all children undergoing tonsillectomy.

[Obstetric epidural analgesia: systemic analysis of an error of syringe rate programming]. / Analgésie péridurale obstétricale : analyse systémique d'une erreur de vitesse de seringue autopousseuse.

We reported an error of syringe rate programming during maintenance of obstetric epidural analgesia and its systemic analysis. The epidural solution included ropivacaine and sufentanil. Despite the 60 mg ropivacaine and the 9.6 microg sufentanil doses infused in 45 minutes, no maternal systemic effect was noted. The systemic analysis of this near-miss has revealed a health care system error.

Effect of nicardipine and verapamil on in vitro albumin transport in rabbit thoracic aorta.

Calcium antagonists have been shown to have an antiatherogenic effect. We investigated the effect of nicardipine and verapamil on the albumin transport across the media of excised rabbit thoracic aorta. The effect of nicardipine was also tested in deendothelialized arteries. The vessels were incubated for 90 minutes in oxygenated Krebs or 80 mM KCl solutions at in vivo length and at a transmural pressure of 70 mm Hg. The transmural concentration profiles of 125I-albumin across the media were measured by a frozen serial sectioning technique. In deendothelialized arteries, K+ decreased the mean medial uptake of labeled albumin, whereas 10(-7) M nicardipine in Krebs increased the uptake and 10(-9) M nicardipine had no effect. In a K+-rich solution, containing 10(-7) or 10(-9) M nicardipine, the medial uptake was lower than, but not significantly different from, that in Krebs. In intact K+-treated vessels, the wall concentrations near the lumen were increased and concentration gradients across the media were observed, possibly due to an increase in endothelial permeability following K+-induced contraction of the endothelial cells. This effect was reversed by the addition of 10(-7) M nicardipine, but not by 10(-7) M verapamil. Nicardipine and verapamil (10(-7) M) in Krebs solution enhanced the albumin uptake by the media of intact arteries. This effect on the permeability of the media may be related to the antiatherogenic effect of calcium antagonists.

Hormonal response to captopril pre-treatment during sodium nitroprusside-induced hypotension in man.

To assess the hormonal response to captopril pre-treatment during sodium nitroprusside (SNP) -induced hypotension, 12 patients were studied during a spinal surgical procedure. Haemodynamic data, plasma-renin activity, aldosterone, adrenaline and noradrenaline levels were measured. Patients were randomly allocated to two groups: Group I, control patients; Group II, 3 mg kg-1 captopril pre-treated patients. SNP requirement for the same level (mean arterial pressure (MAP) = 55 mmHg) and duration of hypotension (88.5 +/- 28.7 vs. 95.2 +/- 22.5 min) was significantly lower in Group II than in Group I (16.5 +/- 14.2 mg vs. 39.3 +/- 16.7 mg; P less than 0.05) and a lower SNP infusion rate was required to induce and to maintain hypotension. In Group II patients, MAP remained significantly lower than the control and Group I values for 30 min after SNP withdrawal. Cardiac index (CI) remained stable in both groups. Heart rate was not modified in Group II during hypotension. Plasma-renin activity rose more dramatically in Group II patients than in Group I both during hypotension (13.9 +/- 7.5 vs. 2.8 +/- 0.9 ng ml-1 h-1; P less than 0.05) and after hypotension (23.4 +/- 15.4 vs. 2.2 +/- 0.8 ng ml-1 h-1; P less than 0.05). Plasma catecholamine levels increased in both groups during hypotension and remained raised in captopril patients after SNP withdrawal. It can be concluded that recovery from hypotension may be delayed when using captopril and that sympathoadrenal activity induced by hypotension is not substantially altered by captopril pre-treatment, suggesting that sympathetic blockade might not be the mechanism by which captopril reduces SNP requirement during controlled hypotension for surgical procedure in man.

Head injury: clonidine decreases plasma catecholamines.

Seven patients who had suffered head injury 3 to 5 days before the study was undertaken received clonidine (2.5 micrograms/kg iv over 10 min). This resulted in a reduction of plasma norepinephrine (p less than .05) and in normalization of plasma epinephrine (p less than .05). Neither common carotid blood flow nor diastolic blood flow as index of global cerebral perfusion as measured by pulsed Doppler changed. The reduction of sympathetic overactivity, probably due to the specific action of clonidine on alpha 2-adrenoceptors within the rostral ventrolateral medulla, may be of interest in the management of head injury because of the maintenance of cephalic hemodynamics.

Role of LDL receptors in the in vitro uptake and degradation of LDL in the media of rabbit thoracic aorta.

The possible role of plasma low-density protein (LDL) receptors in the uptake and degradation of LDL in the whole arterial wall was investigated by comparison of the in vitro uptake of 125I-native LDL (nLDL) and 131I-methylated LDL (mLDL) by the media of deendothelialized rabbit thoracic aorta excised at in vivo length and pressurized to 70 mm Hg, taking the advantage that mLDL is not recognized by the LDL receptor. The distribution of the relative concentrations of nLDL (Cn) and mLDL (Cm) across the wall was obtained using a serial frozen sectioning technique. The aorta was incubated under three different conditions for varying periods of incubation in order to analyze separately the processes of binding, binding-internalization, and degradation. At 39 degrees C, in which binding-internalization and degradation occurred, Cn was significantly higher than Cm at each position across the media. The mean medial Cn/Cm ratio was 1.36 +/- 0.15 (n = 5) after 1 hour of incubation, and decreased to 1.23 +/- 0.22 (n = 7) after 2 hours of incubation and to 1.13 +/- 0.11 (n = 5) after 4 hours of incubation. At 4 degrees C, in which internalization and degradation were blocked, the Cn/Cm ratio reflected the surface nLDL binding alone; the Cn/Cm ratio was 1.47 +/- 0.20 (n = 5) after 4 hours of incubation, higher than the value obtained at 39 degrees C. To investigate whether degradation of nLDL occurred after receptor binding, the interstitial LDL was washed out by an LDL-free solution after 2-hour incubation at 39 degrees C. After 30 minutes of washout, the Cn/Cm ratio decreased to 1.06 +/- 0.20 (n = 5) in the inner media and was unchanged in the outer media. After 1 hour of washout, the ratio declined to 0.57 +/- 0.18 (n = 7) in the inner part of the media and increased progressively to 1 at the media-adventitia boundary. The Cn/Cm ratio, at 0.67 +/- 0.12 (n = 5), was practically constant throughout the media after 2 hours of washout. The nLDL degradation rate across the media was obtained from the comparison of nLDL and mLDL before and after the washout. A steep decreasing gradient in nLDL degradation rate was observed from the luminal to the external surface. The mean medial nLDL degradation rate value was 9.6 +/- 4.5 microliters/cm3 wet tissue/hr. We concluded that functional LDL receptors participate in the uptake and degradation of LDL in the whole aorta.