Attributes of leadership skill development in high-performance pre-hospital medical teams: results of an international multi-service prospective study.

BACKGROUNDS: Team leadership skills of physicians working in high-performing medical teams are directly related to outcome. It is currently unclear how these skills can best be developed. Therefore, in this multi-national cross-sectional prospective study, we explored the development of these skills in relation to physician-, organization- and training characteristics of Helicopter Emergency Medicine Service (HEMS) physicians from services in Europe, the United States of America and Australia. METHODS: Physicians were asked to complete a survey regarding their HEMS service, training, and background as well as a full Leader Behavior Description Questionnaire (LBDQ). Primary outcomes were the 12 leadership subdomain scores as described in the LBDQ. Secondary outcome measures were the association of LBDQ subdomain scores with specific physician-, organization- or training characteristics and self-reported ways to improve leadership skills in HEMS physicians. RESULTS: In total, 120 HEMS physicians completed the questionnaire. Overall, leadership LBDQ subdomain scores were high (10 out of 12 subdomains exceeded 70% of the maximum score). Whereas physician characteristics such as experience or base-specialty were unrelated to leadership qualities, both organization- and training characteristics were important determinants of leadership skill development. Attention to leadership skills during service induction, ongoing leadership training, having standards in place to ensure (regular) scenario training and holding structured mission debriefs each correlated with multiple LBDQ subdomain scores. CONCLUSIONS: Ongoing training of leadership skills should be stimulated and facilitated by organizations as it contributes to higher levels of proficiency, which may translate into a positive effect on patient outcomes. TRIAL REGISTRATION: Not applicable.

[Cerebral amyloid angiopathy: an easily missed diagnosis in patients with transient neurological deficits]. / Cerebrale amyloïdangiopathie.

Cerebral amyloid angiopathy (CAA) is a degenerative neurovascular disease in which the protein amyloid-beta accumulates in the vessel wall of cortical and leptomeningeal arteries. This may lead to acute lobar cerebral haemorrhage, which in case of CAA is fatal in 10-30% of cases. CAA may also present with transient focal neurological episodes (TFNE), the symptoms of which may mimic a transient ischaemic attack (TIA). Distinction between the two has important implications for therapy, as antithrombotics are relatively contra-indicated in CAA, but indicated after a TIA. We describe a patient with transient focal neurological deficits who was initially treated with antithrombotic therapy for a suspected TIA. Eventually, the diagnosis CAA was made and antithrombotic treatment was ceased. This case stresses the importance of considering the diagnosis CAA with TFNE in patients presenting with transient neurological deficits, in order to avoid an unnecessarily increased risk of symptomatic and possibly fatal cerebral haemorrhage.

[Anastomotic leakage after gastro-intestinal surgery: a serious complication that is easily missed]. / Naadlekkage na colonresectie.

Anastomotic leakage is a serious complication of gastro-intestinal surgery. Its prognosis is largely determined by early diagnosis and treatment, yet its symptoms can be aspecific and difficult to recognize in the postoperative phase. Here, we describe a case where recognition of serious anastomotic leakage was significantly delayed. This was due to the incorrect assumption that in the absence of abdominal pain, the deteriorating clinical condition of the patient was caused by aspiration pneumonia. What we learn is that a high index of suspicion of anastomotic leakage is required in the postoperative phase of gastro-intestinal surgery, even in the absence abdominal pain. Hence, CT imaging should be performed when in any doubt.