Collaboration and Decision-Making on Trauma Teams: A Survey Assessment.

INTRODUCTION: Leadership, communication, and collaboration are important in well-managed trauma resuscitations. We surveyed resuscitation team members (attendings, fellows, residents, and nurses) in a large urban trauma center regarding their impressions of collaboration among team members and their satisfaction with patient care decisions. METHODS: The Collaboration and Satisfaction About Care Decisions in Trauma (CSACD.T) survey was administered to members of ad hoc trauma teams immediately after resuscitations. Survey respondents self-reported their demographic characteristics; the CSACD.T scores were then compared by gender, occupation, self-identified leader role, and level of training. RESULTS: The study population consisted of 281 respondents from 52 teams; 111 (39.5%) were female, 207 (73.7%) were self-reported White, 78 (27.8%) were nurses, and 140 (49.8%) were physicians. Of the 140 physician respondents, 38 (27.1%) were female, representing 13.5% of the total surveyed population. Nine of the 52 teams had a female leader. Men, physicians (vs nurses), fellows (vs attendings), and self-identified leaders trended toward higher satisfaction across all questions of the CSACD.T. In addition to the comparison groups mentioned, women and general team members (vs non-leaders) gave lower scores. CONCLUSION: Female residents, nurses, general team members, and attendings gave lower CSACD.T scores in this study. Identification of nuances and underlying causes of lower scores from female members of trauma teams is an important next step. Gender-specific training may be necessary to change negative team dynamics in ad hoc trauma teams.

Engineering release kinetics with polyelectrolyte multilayers to modulate TLR signaling and promote immune tolerance.

Autoimmune disorders, such as multiple sclerosis and type 1 diabetes, occur when immune cells fail to recognize "self" molecules. Recently, studies have revealed aberrant inflammatory signaling through pathogen sensing pathways, such as toll-like receptors (TLRs), during autoimmune disease. Therapeutic inhibition of these pathways might attenuate disease development, skewing disease-causing inflammatory cells towards cell types that promote tolerance. Delivering antagonistic ligands to a TLR upstream of an inflammatory signaling cascade, TLR9, has demonstrated exciting potential in a mouse model of MS; however, strategies that enable sustained delivery could reduce the need for repeated administration or enhance therapeutic efficacy. We hypothesized that GpG - an oligonucleotide TLR9 antagonist - which is inherently anionic, could be self-assembled into polyelectrolyte multilayers (PEMs) with a cationic, degradable poly(ß-amino ester) (Poly1). We hypothesized that degradable Poly1/GpG PEMs could promote sustained release of GpG and modulate inflammatory immune cell functions. Here we demonstrate layer-by-layer assembly of degradable PEMs, as well as subsequent degradation and release of GpG. Following assembly and release, GpG maintains the ability to reduce dendritic cell activation and inflammatory cytokine secretion, restrain TLR9 signaling, and polarize myelin specific T cells towards regulatory phenotypes and functions in primarily immune cells. These results indicate that degradable PEMs may be able to promote tolerogenic immune function in the context of autoimmunity.