What attributes define excellence in a trauma team? A qualitative study

Background: Hospital trauma teams consist of a diverse spectrum of health care professionals who work together to deliver quality care. Although the qualities of a well-performing trauma team are often believed to be self-evident, there is little objective information about the most desirable personal and professional characteristics associated with quality trauma care. The aim of this study was to determine the traits and characteristics deemed of greatest value for a trauma team leader and a trauma team member in the adult trauma care setting. Methods: Semistructured interviews were conducted with trauma team leaders and trauma team members at a tertiary Canadian trauma centre. Standard qualitative research methodology was used. Interviews were recorded, transcribed and analyzed via an inductive analysis approach. Results: Thematic saturation was achieved after 5 interviews, and 6 further interviews were conducted to ensure that a breadth of trauma care disciplines were included. Six attributes were identified to be of greatest value for trauma team leaders: communication, role clarity, experience, anticipation, management and decisiveness. Four attributes were identified to be of greatest value for trauma team members: engagement, efficiency, experience and collaboration. We further characterized the language defining the ranking of performance for each of these attributes. Conclusion: Results of this qualitative study involving an experienced and diverse spectrum of trauma team practitioners provide insight into the characteristics that are critical to establishing a "good" trauma team. These findings can be used to inform future determinations of the quality of trauma teams, the education of trauma practitioners and continuing medical education training and assessment tools.

Contexte: Les équipes de traumatologie des hôpitaux sont formées de professionnels de la santé de divers horizons qui travaillent ensemble pour offrir des soins de qualité. Bien que les attributs d'une bonne équipe de traumatologie soient souvent vus comme étant évidents, il existe peu de données objectives sur les caractéristiques personnelles et professionnelles les plus fortement associées à des soins traumatologiques de qualité. Cette étude avait pour but de déterminer les traits et caractéristiques les plus recherchés chez les chefs et les membres d'équipes de traumatologie pour adultes. Méthodes: Nous avons mené des entrevues semi-structurées auprès de chefs et de membres d'équipes de traumatologie, dans un centre tertiaire de traumatologie canadien. Une méthode de recherche qualitative standard a été utilisée. Les entrevues ont été enregistrées et transcrites, puis analysées selon une approche inductive. Résultats: Le seuil de saturation thématique a été atteint après 5 entrevues, mais nous avons mené 6 entrevues supplémentaires pour garantir une variété dans les disciplines représentées. Six attributs ont été relevés pour les chefs d'équipe de traumatologie : communication, clarté du rôle, expérience, anticipation, gestion et esprit de décision. Quatre attributs ont été relevés pour les membres de l'équipe : engagement, efficacité, expérience et collaboration. Pour chaque attribut, nous avons caractérisé avec précision les termes définissant la qualité des soins prodigués. Conclusion: Les résultats de cette étude qualitative, qui rassemblait des professionnels de la traumatologie expérimentés et d'horizons diversifiés, mettent en lumière les caractéristiques essentielles à la mise en place d'une « bonne ¼ équipe de traumatologie. Ils pourront servir dans l'évaluation des équipes, dans la formation des praticiens et à la création de cours et d'outils d'évaluation pour l'éducation médicale continue.

Platinum-based chemotherapy in triple-negative advanced breast cancer.

The purpose of this study was to evaluate the efficacy of platinum-based chemotherapy (PBC) versus conventional non-PBC regimens in a metastatic triple-negative breast cancer (TNBC) setting. We reviewed the electronic patient records of patients with confirmed metastatic TNBC at four major cancer centres in Canada. All patients were allocated into two groups based on type of chemotherapy received (PBC vs. non-PBC) and line of treatment (first-, second-, or third-line). The primary objective of this study was to evaluate the efficacy of PBC in metastatic TNBC in terms of median duration of overall survival (OS) from diagnosis of distant metastatic disease and compare it with the efficacy of conventional non-platinum-based chemotherapy in metastatic TNBC after controlling for known prognostic factors. A total of 153 metastatic TNBC patients were identified, 58 treated with PBC and 95 with non-PBC. The median time in first-line PBC versus non-PBC was not different between the two groups (2 vs. 2 months, p = 0.9), the median time on treatment in second and third-line therapy was longer for the PBC group compared to the conventional treated group (4 vs. 1 months, p = 0.004; 4 vs. 0.5 months, p = 0.004, respectively). Patients who received PBC had a longer OS compared to those managed conventionally (14.5 vs. 10 months, p = 0.041). This study evaluates the survival outcomes in a homogenous group of TNBC metastatic patients treated with or without PBC. Our results confirmed our hypothesis of a better OS among PBC-treated TNBC patients compared to conventionally managed TNBC patients. Currently ongoing Phase III trials assessing the benefit of PBC versus other chemotherapeutic regimens in advanced TNBC will help define the role of these agents for the management of this breast cancer subtype.

Lats2/Kpm is required for embryonic development, proliferation control and genomic integrity.

The Drosophila melanogaster warts/lats tumour suppressor has two mammalian counterparts LATS1/Warts-1 and LATS2/Kpm. Here, we show that mammalian Lats orthologues exhibit distinct expression profiles according to germ cell layer origin. Lats2(-/-) embryos show overgrowth in restricted tissues of mesodermal lineage; however, lethality ultimately ensues on or before embryonic day 12.5 preceded by defective proliferation. Lats2(-/-) mouse embryonic fibroblasts (MEFs) acquire growth advantages and display a profound defect in contact inhibition of growth, yet exhibit defective cytokinesis. Lats2(-/-) embryos and MEFs display centrosome amplification and genomic instability. Lats2 localizes to centrosomes and overexpression of Lats2 suppresses centrosome overduplication induced in wild-type MEFs and reverses centrosome amplification inherent in Lats2(-/-) MEFs. These findings indicate an essential role of Lats2 in the integrity of processes that govern centrosome duplication, maintenance of mitotic fidelity and genomic stability.