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Background Physiotherapy is a major cornerstone of enhanced rehabilitation after surgery (ERAS) and reduces the development of atelectasis after thoracic surgery. By initiating physiotherapy in the post-anaesthesia care unit (PACU), the aim was to evaluate whether the ultra-early initiation of rehabilitation (in the first hour following tracheal extubation) would improve the outcomes of patients undergoing elective thoracic surgery. Methods A case–control study with a before-and-after design was conducted. From a historical control group, patients were paired at a 3:1 ratio with an intervention group. This group consisted of patients treated with the ultra-early rehabilitation programme after elective thoracic surgery (clear fluids, physiotherapy, and ambulation). The primary outcome was the incidence of postoperative atelectasis and/or pneumonia during the hospital stay. Results After pairing, 675 patients were allocated to the historical control group and 225 patients to the intervention group. A significant decrease in the incidence of postoperative atelectasis and/or pneumonia was found in the latter (11.4 versus 6.7 per cent respectively; P = 0.042) and remained significant on multivariate analysis (OR 0.53, 95 per cent c.i. 0.26 to 0.98; P = 0.045). A subgroup analysis of the intervention group showed that early ambulation during the PACU stay was associated with a further significant decrease in the incidence of postoperative atelectasis and/or pneumonia (2.2 versus 9.5 per cent; P = 0.012). Conclusions Ultra-early rehabilitation in the PACU was associated with a decrease in the incidence of postoperative atelectasis and/or pneumonia after major elective thoracic surgery.

Data on the relationship between antimicrobial resistance and mortality remain scarce, and this relationship needs to be investigated in intensive care units (ICUs). The aim of this study was to compare the ICU mortality rates between patients with ICU-acquired pneumonia due to highly antimicrobial-resistant (HAMR) bacteria and those with ICU-acquired pneumonia due to non-HAMR bacteria. We conducted a multicenter, retrospective cohort study using the French National Surveillance Network for Healthcare Associated Infection in ICUs (“REA-Raisin”) database, gathering data from 200 ICUs from January 2007 to December 2016. We assessed all adult patients who were hospitalized for at least 48 h and presented with ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii. The association between pneumonia caused by HAMR bacteria and ICU mortality was analyzed using the whole sample and using a 1:2 matched sample. Among the 18,497 patients with at least one documented case of ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii, 3081 (16.4%) had HAMR bacteria. The HAMR group was associated with increased ICU mortality (40.3% vs. 30%, odds ratio (OR) 95%, CI 1.57 [1.45–1.70], P P P

Additional file 1. Additional Table 1: Glossary of terms used in the study (supplement material).

Additional file 3: Table S3. Patients outcomes according to treatment with dexamethasone and rescue immunosuppressive therapy.

Additional file 6. Additional Table 5: Propensity score between the two groups (supplement material).

Additional file 7. Additional Table 6: POCUS effect group on in-hospital mortality (logistic regressions, sensitivity analyses) (supplement material).

Additional file 3. Additional Table 3: Summary of patients’ characteristics (supplement material).

Additional file 4. Additional Method: Details of propensity score (supplement material).

Additional file 1: Table S1. Characteristics of recurrent VAP episodes according to dexamethasone treatment.

Additional file 5. Additional Table 4: Summary of senior and resident ICU physicians medical experience between the two groups (supplement material).

Rationnel : les équipes médicales de réponse rapide (EMRR) ont pour but d'améliorer la prise en charge des patients hospitalisés en service conventionnel. Ces patients peuvent développer une insuffisance respiratoire et/ou circulatoire aiguë au cours de leur séjour. Un protocole incluant l'utilisation d'un échographe portatif permettant un examen échographique immédiat au lit du patient (POCUS) peut donc améliorer les performances de ces équipes. L'objectif principal était d'évaluer I’impact de la mise en œuvre du POCUS sur la proportion de diagnostic initial correct par rapport au diagnostic définitif, et l'impact du POCUS sur le délai avant le diagnostic, la pertinence des soins et le devenir des patients.Matériels et méthodes : essai clinique prospectif, monocentrique, quasi-randomisé mené dans un hôpital universitaire. Deux EMRR prenaient en charge alternativement un jour sur deux les patients hospitalisés présentant une insuffisance respiratoire et/ou circulatoire aiguë. Seule une des deux équipes a utilisé un protocole de prise en charge basé sur un examen POCUS au lit du patient, effectué à l'aide d'un échographe portatif (groupe POCUS). Dans les deux groupes, le diagnostic posé au lit du patient était documenté, et orientait la prise en charge du patient. Le diagnostic définitif et le délai avant le premier traitement ont été définis à partir des dossiers médicaux des patients par deux experts en aveugle et ont été jugés par un troisième en cas de désaccord. Le principal critère d'évaluation était le pourcentage de concordance entre le diagnostic initial posé au lit du patient et le diagnostic définitif dans les deux groupes. Pour les critères secondaires, les patients inclus par les deux équipes (avec/sans POCUS) ont été comparés.Résultats : pendant une période de deux ans,83 et 82 patients ont été inclus dans les groupes POCUS et contrôlés respectivement. Le groupe POCUS différait du groupe contrôle sur : la présence plus faible de marbrures (12%versus 27 %, p=0,02), le débit d'oxygène plus faible (6 [2 – 15] versus 12 [5 - 15] l/min, p=0,003)) et une pression artérielle moyenne plus élevée (9 [72 – 113] mmHg versus 82 [70 – 100] mmHg, p=0,02). La proportion de diagnostics immédiats corrects était de 94% dans le groupe POCUS et de 80 % dans le groupe contrôle (p=0,009). Le délai avant le premier traitement était plus court dans le groupe POCUS (15 [10 - 25] min contre 34 [15 - 40] min, p

Africa has been an important focus within Chinese foreign policy for many years. As it continues to grow as an international actor, the Chinese state has found greater necessity in securing and protecting its interests abroad. This study will use qualitative methods, supported by empirical data, to map out China’s positioning in Africa, and aims to conceptualise the implications this will have for global geopolitics. More specifically, this research attempts to take a more focussed approach in security through a strategic outlook rather than examining economic repercussions, which has thus far dominated the discussion in academic literature concerning Sino-African relations. This dissertation argues China has been clearly increasing its security role in Africa, which has led to three important implications: a shift in the balance of power of the Indian Ocean Region, a new maritime dimension to the Sino-Indian relationship, and a greater importance of Africa in Chinese foreign policy.