Expectations and requests regarding team training interventions to promote interdisciplinary collaboration in medical rehabilitation--A qualitative study.

BACKGROUND: Interdisciplinary teamwork and team interventions are highly valued in the rehabilitation sector because they can improve outcomes of care for persons with complex health problems. However, little is known about expectations and requests regarding team interventions, especially in medical rehabilitation. This study aimed to explore how clinical managers and health professionals within multidisciplinary rehabilitation teams describe their expectations and requests regarding team-training interventions in the field of medical rehabilitation. METHODS: Considering the methodology of qualitative research, data were collected using semi-structured interviews and focus groups at five rehabilitation clinics in Germany. We conducted face-to-face interviews with 5 clinical managers and 13 department heads of health care teams as well as five focus groups with a total of 35 members of interdisciplinary rehabilitation teams. Afterwards, the data were analyzed through qualitative content analysis encompassing data coding and using inductive thematic analysis. RESULTS: The exploration of team members' and clinical managers' descriptions showed that, to them, interdisciplinary team training programs should include a wide array of training contents. Seven common core themes emerged from the interviews, including participation of employees, leadership, communication, team meetings, team composition, coordination, and equal esteem. Additionally, 13 themes were identified by either managers or team members. The body of expectations regarding team training content in healthcare spans the continuum of changes on the team and organizational levels. On the organizational level, a number of structural factors were mentioned (e.g. improving the general conditions for team meetings, organized workshops to exchange interdisciplinary experiences, and leadership training), and on the team level, changes in procedural factors were listed (e.g. optimizing the consecutive planning and coordination of patient treatments, clarity with regard to roles and responsibilities of team members, and mutual esteem and appreciation between different professions). CONCLUSIONS: The synthesis underscores that there is meaningful heterogeneity in team training needs; training interventions should be locally adapted for each clinic in terms of training content and training strategies. Tailored team interventions are important for rehabilitation clinics. Future work should evaluate employed team training concepts over time as well as training contents, implementation strategies, and learning outcomes. This includes using robust study designs and evaluating team-training effects.

The use of fluorescent-protein conjugates for staining brain capillaries in hypo- and hyperthermia (26-42 degrees).

The temperature dependency of cerebrocortical capillary diameter (CD), number perfused with fluorescent tracer (CN), and intercapillary distance (ICD) has been investigated for three body temperatures (26, 37, and 42 degrees), in order to analyze the influence of undesired cooling or warming which frequently occurs in animal experiments and humans (freezing, heat disposal, fever, etc.). The capillary bed (Wistar-Frömter rats, N = 92, ketaminxylazin anesthesia) was visualized with a double staining method using serum proteins coupled with either FITC (fluorescein isothiocyanate) or RB-200 (rhodamine-lissamin) injected ia immediately before decapitation. CD (6.1 +/- 0.3 micron, 37 degrees) increased during cooling by about 18%, during warming by about 13%. CN (313 +/- 83/mm2, 37 degrees) showed a 12% increase in response to temperature reduction and 18% after elevation. ICD was characterized by small insignificant changes of the mean values (44.2 +/- 5.5 micron, 37 degrees) at 26 degrees and 42 degrees. Mean cerebrocortical surface PO2 (sPO2) ranging between 15 and 22 mm Hg (37 degrees) increased slightly during warming or decreased during cooling. The sPO2 histogram showed a Gaussian-like shape in the range 0-40 mm Hg at low temperatures (26-34 degrees) and a left-shifted frequency distribution between 34-42 degrees. It was interesting to note that above 38 degrees sporadically high sPO2 values were registered in the range 40-80 mm Hg. Nevertheless, despite pronounced temperature variations, the net effect between O2 transport and consumption was balanced to such an extent that tissue anoxia was not detected within the rat cerebro-cortex.

The influence of moderate hypothermia on cerebral cortex tissue oxygen tension.

The validity of mechanisms balancing oxygen transport and consumption in hypothermia are difficult to analyse because almost any parameter of the transport system is temperature dependent. Two types of experiments have been performed in the rat cerebral cortex to elucidate this problem: PO2 microelectrode study: 32-37 degrees C body temperature, spontaneous respiration. Measurements within the upper tissue layer of 200-500/microgram thickness (N = 15). PO2 surface electrode study: 26-37 degrees C body temperature, artificial respiration. Investigation of the arachnoidal and pial area (N = 46). Mean tissue PO2 (+/- SD) of neo- and archeocortex declined slightly from 27.8 +/- 14.4 mm Hg at 37 degrees C to 25.5 +/- 15.5 mm Hg at 32 degrees C (p less than 0.05, n = 15). Surface PO2 (sPO2) (+/- SD) in response to hypothermia showed a small decrease from 18.1 +/- 4.5 mm Hg (n = 186) at 37 degrees C to 14.7 +/- 4.3 mm Hg (n = 41) at 26 degrees C (p less than 0.05, N = 46). Despite different initial PO2 values at normothermia both groups of experiments are characterized by the same relatively small hypothermia induced PO2 decrease. Oxygen transport and consumption might be balanced under hypothermia and tissue hypoxia does not exist in the temperature range between 26 degrees and 37 degrees C.