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Objectives: It is unclear to what extent assessments of work ability differ between disability claimants, their treating physicians, and multidisciplinary medical expert teams., Methods: We compared assessments of work ability for consecutive disability claimants referred to a multidisciplinary assessment center in Switzerland over a 4-year period. Assessments were made for the last job (LJ) prior to claiming a disability benefit and an alternative job (AJ) thought to suit the claimant's physical and mental abilities. Mean differences (MD) in percentage work ability between assessments from claimants, physicians, and experts were then estimated in a linear regression model., Results: The 3562 claims made during the study period were mostly due to musculoskeletal and depressive disorders. Assessments differed little between claimants and physicians [LJ MD 1.3% (95% confidence interval [95% CI] 0.5-2.2%); AJ MD 11% (95% CI 10-12%)]. Experts on average assessed a claimant's work ability higher than either the claimant or physician, particularly in the AJ [MD between expert and claimant 57% (95% CI 56-58%) and between expert and physician 46% (95% CI 45-48%)]., Conclusions: Assessments of work ability differed substantially between experts in multidisciplinary medical teams and both claimants and their treating physicians. A careful evaluation of the disability assessment process is needed in an effort to reduce disagreement between expert teams and treating physicians and so improve acceptance of the process.

Background: Surgical site infections are the most common hospital-acquired infections among surgical patients. The administration of surgical antimicrobial prophylaxis reduces the risk of surgical site infections . The optimal timing of this procedure is still a matter of debate. While most studies suggest that it should be given as close to the incision time as possible, others conclude that this may be too late for optimal prevention of surgical site infections. A large observational study suggests that surgical antimicrobial prophylaxis should be administered 74 to 30 minutes before surgery. The aim of this article is to report the design and protocol of a randomized controlled trial investigating the optimal timing of surgical antimicrobial prophylaxis., Methods/design: In this bi-center randomized controlled trial conducted at two tertiary referral centers in Switzerland, we plan to include 5,000 patients undergoing general, oncologic, vascular and orthopedic trauma procedures. Patients are randomized in a 1:1 ratio into two groups: one receiving surgical antimicrobial prophylaxis in the anesthesia room (75 to 30 minutes before incision) and the other receiving surgical antimicrobial prophylaxis in the operating room (less than 30 minutes before incision). We expect a significantly lower rate of surgical site infections with surgical antimicrobial prophylaxis administered more than 30 minutes before the scheduled incision. The primary outcome is the occurrence of surgical site infections during a 30-day follow-up period (one year with an implant in place). When assuming a 5% surgical site infection risk with administration of surgical antimicrobial prophylaxis in the operating room, the planned sample size has an 80% power to detect a relative risk reduction for surgical site infections of 33% when administering surgical antimicrobial prophylaxis in the anesthesia room (with a two-sided type I error of 5%). We expect the study to be completed within three years., Discussion: The results of this randomized controlled trial will have an important impact on current international guidelines for infection control strategies in the hospital. Moreover, the results of this randomized controlled trial are of significant interest for patient safety and healthcare economics., Trial Registration: This trial is registered on ClinicalTrials.gov under the identifier NCT01790529.

To investigate constraints and preferences for synaptogenesis in the injured mammalian CNS, regenerating retinal ganglion cell (RGC) axons of adult hamsters were guided through a peripheral nerve (PN) graft to a target they do not usually innervate: the cerebellum (Cb). When identified by the presence of HRP anterogradely transported from the retina 2-9 months later, such RGC axons were found to have extended into the cerebellar cortex for up to 650 microns. Most of this growth was in the granule cell layer (GCL) and only a few axons entered the molecular layer. The preference for the GCL could not be explained by the position of the PN graft in the Cb, a selective denervation of the GCL, local damage to other neurons, or the distribution of reactive gliosis in the vicinity of the graft. Furthermore, by EM, more than 95% of the labeled retinocerebellar terminals and synapses were in the GCL. Retinocerebellar terminals were larger and contained more synapses than the regenerated RGC terminals previously studied in the superior colliculus. These results indicate that regenerating axons of CNS neurons can form persistent synapses with novel targets. The preferential synaptogenesis in the GCL suggests that such unusual connections are not formed randomly in the CNS of these adult mammals.