April Cutting Edge

Editor’s Note

Written by: Shannon Marie Foster, MD, FACS 

Friends and colleagues –

The spring equinox has passed and the days of April are upon us.  Were you the recipient or the instigator of a light joke (or more serious effort of deception) on April 1?  Stemming from medieval oral cautionary tales, an early written example from The Canterbury Tales by Chaucer (Nun’s Priest’s Tale 1392) highlights a tale of chase and flattery.  In the near-death fable of Chauntecleer the vain rooster – we learn not to be out-foxed - as then we would be dinner.  Perhaps unbeknownst, there existed a long divide in early continental Europe and beyond as to the appropriate cycle of the calendar and celebration of the new year – those for winter equinox, those for spring – with separate groups and regions in conflict.  Clearly, the “fools” lost to history.  Over hundreds of years countless misdeeds, bad decisions, or demonstrations of the gullibility of others were henceforward attached to this day, “April fools all”, as a way to enforce frivolity and dismissiveness of the opposite point of view.  As always, history reflects the voice of the majority and those empowered to write about it without repercussion.  Deepest thank you for empowering me and your colleagues represented in these pages. 

 Another important read follows, full of executive updates on the future and strength of the organization and the year ahead.  Please scroll through the entire read as the highlights from the 2023 fall prevention event and the closing piece on Transgender Healthcare Education are a must of collaboration and inclusiveness.

The usual reminder – while the AAST fire wall mandates a log in/sign in – membership is not required to access this digital resource once a sign in is created – so please share!  Additionally, if you wish to participate in the creation of editorial or other content, please contact me at personal email shannonfostermd@gmail.com or Erin Lillis at erinlillisaast@gmail.com.

Feedback and comments are always welcome.  

Thank you for reading!

SMF

President's Message

Written by: Patrick Reilly, MD

 The clocks have been moved forward, the abstracts have been submitted, the lunch sessions have been nominated.  Spring is active in the AAST offices.  Soon Karen Brasel will sequester her Program Committee at the O’Hare Hilton and not come out until the 2024 AAST Annual Meeting Program is selected.  I‘ve scored a number of the abstracts, and the scientific content again looks top notch.  Amy Goldberg will be delivering the Expert Surgeon Lecture, and Mike Rotondo will be serving as the 2024 Fitts Lecturer.  This year the Meeting is also held in conjunction with the World Trauma Congress.  It should be a wonderful week and I hope you will plan on attending next September in Las Vegas. 

I have had the opportunity to meet with each of the committee chairs both during the week of the Clinical Congress and again a few months later.  All of them are hard at work and the product of their labors should be obvious next September.  Please take the time to volunteer for a committee if you haven’t already gotten involved.  Dr. Stewart will be making new appointments in the late summer…now is a perfect time to complete a volunteer form and submit it through the website at the link below:

https://www.aast.org/committee-volunteer-form

 Finally, the Board of Managers continues to work through an 18 – month long strategic planning initiative.  The first two sessions (focusing on member engagement and emergency general surgery) are in the books.  The third and final session in April will focus on research initiatives and will be led by Rosemary Kozar and Ram Nirula.  Afterwards we will develop our overarching plan for the next few years and share it with the AAST community.  

As always, thanks to Sharon Gautschy and the entire AAST staff whom work tirelessly behind the scenes to keep everything moving forward.  All those involved in committee work know we couldn’t do it without them!  Please make an effort to thank them on your next committee call!

Secretary Treasurer's Message

Written by: Clay Cothren Burlew, MD

As I sit (once again) at my kitchen counter to draft this message, I feel I should start with… “Happy Spring!” While the typical sign of spring is the gauntlet called Spring Break for all of the local schools, it is also the sign that the season of waking up to a snowy day is coming to an end…

The AAST Board of Managers had our annual winter meeting in late November 2023. I am immensely thankful to the Board for a lengthy but productive review of our budget. We carefully reviewed expenses, allocated necessary funds, supported important initiatives, cut costs, and were able to create a net positive budget despite a difficult financial climate. By the end of the zoom meeting I felt like I could have joined the banquet’s “silent disco” out of sheer happiness for the careful management of the group’s financial outlook.  

The Research and Education Fund (REF) has continued to grow thanks to your ongoing support and donations.  The market has produced a reasonable return on the REF and we plan to once again fund a total of four research scholarships.  These scholarships are to encourage basic, translational or clinical investigation for four early career faculty.  While the application deadline has passed for this current year, and the Scholarship Committee will meet in April, please keep this opportunity in mind for next year!  In addition to the faculty research scholarships, the REF also supports grants for medical students, residents, and in-training fellows to attend our annual meeting. 

As a reminder, our scholarship awardees from 2023-2024 were: Drs. Letitia Bible (UF), Marissa Boeck (UCSF), Julia Coleman (Ohio State), and Anaar Siletz (USC). These scholarships alone total $200,000 of support for early faculty scientific endeavors. For those who would like to support the REF, simply go to the AAST website, and click on the “Donate” button above the main toolbar or click here: https://www.aast.org/donate

Speaking of fund raising, the Associate Member Council, under the leadership of Dr. Ryan Dumas, has sparked some healthy competition. For those suffering from March Madness to those interested in supporting the cause to those who have no idea what a bracket actually is, consider jumping into the fun: https://one.bidpal.net/marchmadness2024/welcome.  All proceeds will support the REF.  Also, the Associate Member Council, Prevention Committee, and the R&E Fund Committee are once again hosting a Gun Violence Prevention campaign. Get your t-shirt and support gun violence prevention month in June.

Membership applications are now being accepted.  Please encourage your colleagues to consider membership in the AAST – to participate in committee work, meet new friends or connect with old ones, enjoy the annual meeting including scientific presentations, or engage in multicenter trials – the feeling of community and camaraderie is everywhere.  The deadline for applications is July 1, and details can be found on the AAST website at https://www.aast.org/membership/join-aast.

Finally, mark September 11-14 on your calendar for the 83^rd Annual Meeting of the AAST and Clinical Congress of Acute Care Surgery in Las Vegas, NV. My ongoing thanks to the incredible Sharon Gautschy and her central office team at the AAST, for their unwavering dedication to our organization.

Executive Director's Message

Written by: Sharon Gautschy

Welcome to Spring!  Spring means AAST is planning for the 83^rd Annual Meeting of AAST and Clinical Congress of Acute Care Surgery AND this year the 7^th World Trauma Congress is starting!  The hotel block is open and registration will open early June. 

The Program Committee will be meeting in early April so watch your email if you submitted an abstract!  Notifications will begin being sent around April 15^th. 

Do you have a medical student, resident or in-training fellow who has an interest in acute care surgery (trauma, surgical critical care and emergency surgery)?  The application process for annual meeting scholarships is open.  The recipients will receive complimentary registration and four nights of hotel along with a $200 stipend for travel expenses.  If selected for a scholarship they are expected to fund their own travel or receive funding from the department.  Please spread the word.  https://www.aast.org/careers/scholarships

Tools for Acute Care Surgery (TACS) app launched last September and has some great content with more content being added each month.  It is easy to join, click here: https://www.aast.org/tools-for-acute-care-surgery-tacs.  The cost is $10/month for AAST Members and $15 month for non-members.  Are you an AAST Associate Member Resident or In-Training Fellow or ACS Fellow?  Ask us how you can get access for free.  Contact Kaitlyn Sanders at ksanders@aast.org or aast@aast.org.

I hope you have a wonderful Spring and Summer.  See you September 11-14, 2024 in Las Vegas, NV. 

AAST Research and Education Fund

Research and Education Fund Committee Offers Many Ways to Make an Impact  

Written by: Andrew C. Bernard, MD

AAST REF had a banner year in 2023.

• Over 230 donors raised almost $150,000 to fund research and travel scholarships for AAST members, residents, and students.
• 1100 Firearm Violence Awareness T-shirts were sold, each sending an important injury prevention message and contributing to REF scholarships.
• The AAST Auction was another big success, raising over $70,000 for REF.
• AAST trauma team calendars celebrated a dozen trauma centers and trauma teams while contributing to REF through page purchases, sponsorships, and calendar sales. 

And in 2024, you’ll have these and more ways to give:

• Fleece jackets with the AAST logo were available in winter and will be for sale on-site at the annual meeting in Las Vegas.
• For basketball fans, spring brought sponsored March Madness brackets from the Board of Managers.  There is still time to select your bracket from six Board of Managers.  Who will have the winning bracket?  Click here to join in the fun!
• 2024’s Firearm Violence Awareness T-shirts will feature a new design and will be available to every member of your team to raise awareness in June.  Starting in mid-April you will be able to purchase your t-shirt!
• This year’s calendars will feature quarter-pages and many more opportunities to celebrate your team while supporting REF. Calendars purchase will begin in onsite in Las Vegas. Ad sales will begin April 8! Please contact breasanders@aast.org.
• It’s never too early to begin considering your auction donations! AAST members are artists, collectors, and adventurers. Your hobbies and pastimes can become meaningful gifts to the AAST auction and lifelong memories as you host fellow AAST members in your cabin, home, boat, or stadium seats. Contact Brea Sanders, breasanders@aast.org, to donate!

With your support, it’s going to be another great year for AAST and AAST REF! https://www.aast.org/donate

Prevention and Geriatric Trauma Committee

Stop the Falls!  Injury prevention in older adults hosted at the 2023 AAST Annual Meeting

Written by: Prevention Committee

It is a well-known fact that the population is aging. In fact, the number of Americans who are 65 years and older is projected to increase from a high of 58 million in 2022 to 82 million by 2050 (a 47% increase)^[1]. It is clear that the average Acute Care surgeon will encounter older patients in their practice. Injuries sustained and the response to injury is particular to the population experiencing it. Creating specialized programs and standards to address the management and needs of the older patient is essential.

With this increasing burden of injury in the older population, trauma centers should  implement standardized protocols and injury prevention education for that group.  Falls are the leading cause of injury in the elderly with one study citing a single level fall (SLF) as the cause of injury for 61.5% of admitted patients who were 65 and older^[2]. Recognizing the importance of this, members of the Injury Prevention and Geriatric Trauma committees of the AAST joined together to develop the first AAST sponsored “Stop the Falls” event. The program aims to educate the individual on the risks associated with falls and how this can be prevented.  This inaugural event was sponsored by the AAST Board of Managers and held as a pre-session prior to  the 2023 Annual Meeting. In collaboration with the local level 1 trauma center, the University of California at Irvine (UCI), committee members engaged with people in the community and to create a successful memorable occasion.

This event was held at the Anaheim Senior Citizen Center, a government-funded facility near the Annual Meeting venue.  A subcommittee consisting of members of both committees created an itinerary including both didactic education and interactive sessions.  Didactics were administered by the acute care surgeons, a geriatrician, a social worker, and an optometrist.  Interactive sessions included a physical therapy gait and balance activity, Tai Chi, fall-prevention bingo and a question-and-answer session with the local Fire Department Chief which was well-received. The Chair of the Injury Prevention committee, Dr. Thomas Duncan, started the day off with a deeply personal story on how a SLF impacted his family.

Breakfast and lunch were provided to the nearly 60 participants who attended throughout the day.  A handbook with local resources was created in conjunction with the UCI injury prevention team to include information about older adult-specific housing, transportation, food services, in-home services, and local programs such as the Program for All-Inclusive Care (PACE) and the UCI Geriatric Emergency Nurse Initiative Experts (GENIE) program.  One of the highlights of the day was the session by Fire Department Chief Captain David Berry, who provided valuable information on the local triage practices for 911, the local fire alarm distribution, and the replacement program.

Giveaways included important prevention items such as a flashlight, cutting board with grip-technology, a whistle, and additional local resources. Committee members all pitched in to help fill the “SWAG” bags and guide attendees to the nourishment section. Committee member, Dr. Sigrid Burruss, surprised and impressed everyone as part of the Tai Chai demonstration, illustrating the benefit of skill for all ages. The day ended with Dr. Bellal Joseph, Chair of the Geriatric committee, giving closing remarks and thanking all for their participation.

It was a rewarding and enjoyable day, and we look forward to making this an annual event!

Sincere thanks for sponsorship of this event goes to the AAST Board of Managers, who understands the burden of injury associated with falls in older adults.  Future iterations of this event will enable continued collaboration between the AAST and the local trauma center in the annual scientific meeting host location. The AAST can provide a model for these events to be established nationwide.

^[1] U.S. Census Bureau, 2023 National Population Projections Tables: Main Series.

^[2] Cook A, Swindall R, Spencer K, Wadle C, Cage SA, Mohiuddin M, Desai Y, Norwood S. Hospitalization and readmission after single-level fall: a population-based sample. Inj Epidemiol. 2023 Oct 19;10(1):49. doi: 10.1186/s40621-023-00463-4. PMID: 37858271; PMCID: PMC10588028.

Diversity, Equity, and Inclusion Committee

Transgender Healthcare Education

Written by: Ryan Benson, MD; Edited by: Fariha Sheikh, MD and Nicole Goulet, MD

“The invisible minority in healthcare” has been the phrase used to describe transgender and gender diverse (TGD) individuals in the American healthcare system. Not only do TGD people face a multitude of societal disparities, but also are one of the most marginalized groups regarding the current state of healthcare. Approximately 34% of TGD individuals experience poverty and 30% experience homelessness as compared to the general US population (12% and 0.2%, respectively), thus rendering access to healthcare a challenge.^1-3 Furthermore, TGD people are four times as likely to be victims of violence as compared to the cisgender population and TGD households have over twice the amount of property victimization.⁴ A reported 64% of TGD individuals experience sexual violence.⁵ These disparities predispose TGD individuals to sustaining higher rates of violent trauma than the US general population. Even more discouraging is the lack of education in the surgical community regarding transgender healthcare and disparities. 

Medical education associations have been reporting on TGD healthcare disparities for over a decade, however, to date there is no formal training or implemented curriculum on the care of this population within general surgery residency programs nor trauma programs.  In light of this, I sought to initiate change and be a voice for people who struggle to receive one of the most basic rights, access to equitable healthcare. 

With help from both institutional and national mentors, a novel curriculum titled “Transgender Curriculum for the General Surgery Resident” was created. In the form of a live symposium, this curriculum incorporated a background/evolution of transgender healthcare education in the United States, cultural awareness training and communication skills, resources and professionalism, gender affirming health promotion, and special surgical considerations. Lectures were given by professionals in the fields of gender affirming medical and surgical care, along with lectures and first-hand testimonials from TGD volunteers who work in local transgender outreach programs, followed by small group discussions for interactive conversation and skills development. The live symposium was filmed by Rutgers Filmmaking School and has been edited into a video to be distributed to participating institutions and will eventually be published for further use. Although the content was created with specific intention for application to general surgical resident education, all of the content is applicable to any healthcare professional who interacts with patients and can add a great deal of value to the care of the TGD trauma patient.

The specific application for trauma/emergency general surgery lies within both clinical and societal factors regarding patient care. Given the high rates of poverty, homelessness, unemployment, and mental health barriers faced in the TGD population when compared to the general public, it is important to understand these complex issues when preparing disposition plans for an admitted transgender individual. Many lack access to both social and medical resources. It is imperative that practitioners know what resources exist both within their institution and in their local community.

Clinically, there are a multitude of anatomic changes that may or may not exist with any transgender patient. It is imperative that providers are comfortable with initiating these conversations in a professional and respectful manner. Doing so will allow the patient to feel more comfortable disclosing pertinent medical information with their provider. There is a way to go about these difficult and sometimes awkward conversations, and like anything in surgical training, new skills take practice. Just a few examples of pertinent anatomic considerations for specialized or general surgeons are changes in pelvic anatomy when encountering operative pelvic trauma, anorectal cancer, operative diverticulitis, or Fournier’s/necrotizing fasciitis of the perineum, and even considerations for foley placement in an elective general surgery case. There are a multitude of special considerations that should be known in order to provide equitable, quality care to any TGD patient, and this is an area that is currently lacking in the realm of surgical education.

From engaging in culturally sensitive interactions to having knowledge of specific anatomic considerations, this project is a push for practicing and developing a new skillset to be a better provider regarding all aspects of the transgender patient’s surgical encounter. This topic is relatively new to the field of medicine, and as with anything else, will take time and effort to become a part of all medical education. However, with the educational aspects and personal stories told through this curriculum, it will hopefully be a little easier to spread life-changing knowledge that undoubtedly, one day a patient will thank you for possessing.

References:                                                                                          

1. James SE, Herman, J.L., Durso, L.E., & Heng-Lehtinen, R. Early Insights: A Report of the 2022 U.S. Transgender Survey. National Center for Transgender Equality, Washington, DC, 2024.
2. Adkins M. Homelessness in America: Statistics, Analysis, and Trends security.org2024 [updated January 25, 2024. Available from: https://www.security.org/resources/homeless-statistics/ accessed March 13, 2024.
3. Shrider EA, Creamer, J. Poverty in the United States: 2022 U.S. Census Bureau, Current Population Reports, P60-2802023 [updated September 2023. Available from: https://www.census.gov/library/publications/2023/demo/p60-280.html accessed March 13, 2024.
4. Flores AR, Meyer IH, Langton L, Herman JL. Gender Identity Disparities in Criminal Victimization: National Crime Victimization Survey, 2017-2018. Am J Public Health 2021;111(4):726-29. doi: 10.2105/AJPH.2020.306099 [published Online First: 20210218]
5. Grant JM, Mottet, L.A., Tanis, J, Harrison, J, Herman, J.L., Keisling, M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011.

Journal of Trauma and Acute Care Surgery

JTACS Update

Written by: Raul Coimbra, MD, PhD, Editor-in-Chief

The Journal of Trauma and Acute Care Surgery Announces Changes To Color Vs Black And White Figures

With the increase in the number of manuscripts submitted and printed with color figures, starting with Volume 97, Issue 1 (July issue of 2024), only certain figure types will be reproduced in color in JTACS. In addition, members of AAST and affiliated societies will receive 2 complimentary color figures per manuscript.

Only the following image types will be reproduced as color illustrations:

• Surgical Pictures
• Surgical or Research Diagrams
• Heat Maps
• Histology Pictures
• Immunofluorescence Pictures
• Flow Cytometry Graphs
• Selected Radiology Image Reconstructions  

The following figure types should be submitted only in black-and-white or grayscale. Figure legends should be provided for readability in black and white. The figures will be produced only in black-and-white or grayscale (with or without patterns), regardless of affiliated member status:

• Computer Generated Graphs:
  • Bar
  • Column
  • Pie
  • Line
  • Histogram
  • Kaplan-Maier Curves
  • ROC Curves
• Algorithms
• Flow Charts

Color figure billing information will be captured in submission questions for corresponding authors. Full details are included in the Instructions for Authors under the Color Figures section: https://edmgr.ovid.com/jt/accounts/ifauth.htm