Health Care as a Team Sport?-Studying Athletics to Improve Interprofessional Collaboration.

Organizations value teamwork and collaboration as they strive to build culture and attain their goals and objectives. Sports provide a useful and easily accessible means to study teamwork. Interprofessional collaborative practice (IPCP) has been identified as a means of improving patient and population health outcomes. Principles of teamwork in sports can inform health professionals and organizations regarding possible improvement strategies and barriers in the optimization of IPCP. Twenty-eight delegates from the 2017 All Together Better Health Conference in Oxford, UK participated in a World Café to discuss the how teamwork in sports can inform IPCP in healthcare and sports medicine. These discussions were captured, transcribed and coded using the domains developed by the Interprofessional Education Collaborative (IPEC) along with extrapersonal or interpersonal loci. Extrapersonal factors regarding structure of leadership, roles and organizational commitment can be positive factors to promote teamwork. However, interpersonal factors affecting communication, values and lack of commitment to collaboration can serve as barriers. Athletic trainers and other sports medicine professionals can serve as valuable members of interprofessional teams and teamwork is essential in the field of sports medicine.

Acute obstruction of a mechanical aortic valve in a young woman: case report and review of the literature.

UNLABELLED: Acute aortic valve obstruction is a medical and surgical emergency necessitating intensive care unit admission. The differential diagnosis includes thrombosis, pannus formation or vegetations. The diagnosis should be obtained as soon as possible, with possible orientation towards the cause. Different diagnostic modalities exist nowadays. Notably, the transesophageal echocardiography (TEE) offers a diagnosis and a guide for management. Surgical treatment remains of choice despite growing evidence about a benefit of combined thrombolytic and anticoagulation line of management. LEARNING POINTS: Acute management and resuscitation of acute valvular obstruction.Differential diagnosis and role of echo in the diagnosis.Management options.

Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness.

OBJECTIVE: To establish the prevalence, clinical characteristics, and electrophysiologic features of residual neuromuscular dysfunction after prolonged critical illness. DESIGN: Prospective follow-up study of survivors of prolonged critical illness. SETTING: A university hospital and two district general hospitals in the UK. PATIENTS: The study occurred for a period of 5 yrs. All patients during that time who were in the intensive care unit for >28 days were entered in the study. MEASUREMENTS AND MAIN RESULTS: At follow-up, length of intensive care unit and hospital stay, duration of mechanical ventilation and admission Acute Physiology and Chronic Health Evaluation II score were recorded from the case notes. A clinical history was obtained, a Barthel Index disability score was calculated, and a full neurologic examination was performed. Nerve conduction studies, needle electromyography, single-fiber electromyography and thermal thresholds were performed. A total of 195 patients were identified. There were 86 survivors, of whom 47 could be contacted and 22 consented to be studied. The median time from intensive care unit discharge to follow-up was 43 months (range, 12-57 months). All gave a clear history of severe weakness and functional impairment after hospital discharge and, in all, recovery was prolonged. Motor or sensory deficits were present on clinical examination in 59% of the patients studied. Common peroneal nerve palsy was present in two patients. A total of 21 of 22 (95%) patients had electromyographic evidence of chronic partial denervation at follow-up, findings indicative of a preceding axonal neuropathy. The single-fiber electromyographic studies were also consistent with a preceding motor neuropathy. CONCLUSION: Severe weakness requiring prolonged rehabilitation and abnormal clinical neurologic findings are extremely common in survivors of protracted critical illness. Neurophysiologic evidence of chronic partial denervation of muscle consistent with previous critical illness polyneuropathy is almost invariable and can be found up to 5 yrs after intensive care unit discharge in >90% of these long-stay patients. Evidence of myopathy is unusual. These findings have important implications for the management and rehabilitation of intensive care survivors.