EAST 30th Annual Scientific Assembly – Day 3

Today at EAST –

It’s hard to believe that today is Day #3 of the 30th Annual EAST Scientific Assembly. It’s been a fantastic conference.

My favorite part of today was the presentation of six Practice Management Guidelines (PMG’s) in the last plenary session of the conference. Prior to the presentation of the PMG’s, the EAST Guidelines Section discussed the 2012 adoption of the GRADE framework for development of PMG’s. Grading of Recommendation, Assessment, Development, Evaluation provides for a systematic, synchronized process by which outcomes are ranked, meta-analysis is conducted, literature is summarized, and recommendations are generated. The entire process is summarized in a 70 page document such that every PMG published by EAST is held to the same standard. This upcoming year, PMG’s published in years past that require updating will be carefully reviewed by the group in order to update them – facilitating current evidence-based practices are available as resources.

I appreciated the precision and care given to each recommendation mentioned in the PMG’s. If there is insufficient quality data to recommend or strongly recommend a given practice based on the GRADE framework– no matter how popular or “routine” the practice may have become in some venues – EAST is careful to abstain from making a recommendation. If there is considerable data, but the GRADE framework does not yield strong results, EAST may make a “conditional recommendation.” In this circumstance, I learned that the PMG recommendation may be appropriate for some patients, but not for others. The provider’s judgment is required to determine the best course of action for any particular patient. The overarching goal with PMG’s, is not for EAST to create “expert opinions,” but for EAST to make recommendations based on a full body of excellent data. Some of the PMG’s discussed this afternoon were around topics such as antiplatelet therapy for severe TBI patients, use of c-spine immobilization in penetrating trauma, approaches to address diaphragm injuries, and assessment of volume status & endpoints of resuscitation, among others.

One particular PMG for management of renal injuries in pediatric patients is in the early phases of GRADE. No official recommendations have been proposed, but the Guideline Section brought preliminary information forward to the assembly for conceptual feedback & suggestions. I so appreciated the section’s desire to implore the insight of others. At one point during the presentation of another unrelated PMG, I enjoyed observing a lively discussion by several EAST members who felt that the recommendations in a particular PMG were not based on a full body of research. They expressed concern that the PMG was based more on expert opinion than on the literature. As with paper presentations and poster presentations that I observed throughout other portions of the assembly, it was lovely to see the transparency with which the presenters responded to questions and challenges brought forth by the audience. My respect for the men & women of EAST is founded on the characteristics of integrity, honesty, transparency, and humility that I witnessed throughout the meeting. The culture of this “family” – as they call themselves – is one of rich and robust inquiry where one surgeon feels free to ask another how research methods may be improved or about next steps that would lead to further insight on a given topic.

A special highlight: During the awards ceremony today, I was recognized as the 2017 EAST-STN Nurse Fellow. It has been an honor and privilege to have been awarded the opportunity to attend EAST. I have loved every minute of the sessions, the people, the culture… Thank you to EAST and to STN for the collaborative that makes this opportunity possible!

EAST-STN Fellow Recognition. Photo credit to Dr Omar Danner of Grady Memorial Hospital in Atlanta

Finally, in closing this blog, I want to share about the Presidential Address Dr. Stassen delivered today as the outgoing EAST president. Dr. Nicole Stassen is a very special person, and it’s been a pleasure to observe her over the past few days. She leads with ease and with gusto and she shared so beautifully this morning.  Dr. Stassen’s talk, “Pay It Forward,” began with a charge to recognize the challenges faced by surgeons and by healthcare as a whole: “continued optimization of patient care, specialty equipoise, comprehensive education of trainees, resilience/burnout, quality initiatives, firearm injury…” She dove headlong into conversation about conflicting forces and the opposition we face as we fight to accomplish these goals of higher good. She spoke extensively about firearm injury and the challenges of establishing a unified, meaningful response to the weapons injury crisis of today. In so doing she acknowledged that the body of research around this issue and its confounding factors is sorely lacking… She also pointed out that without the proper information, we will not arrive at a helpful, holistic solution. Her charge seemed to be well-received, and it was evident from the rapt attention of the audience, that her leadership is greatly respected. Congratulations to you, Dr. Stassen! I don’t even know you, but I can see that you finished this year strong…and now you’ve passed on the gavel. Thank you for the way you’ve upheld EAST this year, and made this assembly something to write home about! 🙂

Passing of the gavel

In closing, Cheers to you, STN! Thank you for reading this blog… I hope you gained a fun nugget to carry with you… It’s been a pleasure to share.

Just a little about your 2017 EAST-STN Fellow… Sarah Parker heralds from Atlanta, GA where she grew up. A graduate of Emory University, Sarah started her nursing career in Columbus, GA as an ED & Trauma nurse in a busy Level II adult/peds trauma center. It didn’t take long for the “trauma bug” to bite! In 2012 Sarah moved home to be closer to family and to explore the world of pediatric ED and trauma nursing at a metropolitan Level I peds trauma center. A couple of years later, eager for more trauma – and just trauma – she took a position as a Trauma Service Coordinator at Grady Memorial Hospital where she fell in love with trauma data and process improvement. Sarah’s most recent accomplishments include appointment to the ACS TQIP Project Training Team where she has the incredible opportunity to support the development of education for trauma registrars across the country. She also completed the STN Leadership Institute in December 2016, and took on a new position as Trauma Registry Manager at Grady.

Sarah and her incredible husband Lee – although they could be selling SarahLee cakes & pies – instead spend their free time with friends & family, dreaming up home improvement projects, and attempting to keep up with their vivacious, fluffy white golden doodle, Zeus.

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EAST 30th Annual Scientific Assembly – Day 2

A Hollywood morning

Breakfast anyone?

Good morning, Hollywood! Beautiful sunrise this morning at EAST.

Today at EAST for me began with a scientific session around “Hemorrhage” where new and established surgeons gave presentations sharing advancements and research to address hemorrhagic shock. I really appreciated the level of inquiry – as well as inspiration for future research – shared during these various presentations…particularly the presentation about acute traumatic pulmonary thrombus presented by Dr. Matthew Bradley. “De novo” PE’s identified after trauma, are known to be potentially thrombotic and not embolic in nature. The particular retrospective study presented here at EAST looked at blast injuries incurred in military theater. Because the clots were thought to be in response to injury, approximately 48% of the patients were not treated with traditional anticoagulants or other treatments – as long as the patients were not symptomatic with the thrombus. Discussion following the presentation reinforced the concept that studies like this one decouple the DVT/PE concept. In some cases, pulmonary thrombus are isolated incidents from which the body may be able to heal itself. I believe there is much work to be done on this topic, and I’m looking forward to seeing future research – particularly in a civilian population where comorbid conditions are confounding factors.

After a short break we reconvened to hear Dr. Michael Rotondo present “The Shaman in Tribal Warfare” as the Scott B. Frame, MD Memorial Lecture. When I first noticed the title of this lecture on the schedule for today, I wondered how in the world tribal warfare relates to surgery or trauma. However we were in for a treat! In a dimly lit room through the use of story-telling, the sound of drums, and images of the sky, Dr. Rotondo gave a wonderful tribute to the EAST surgeons who came before, and to “the tribal warfare” of surgery. A “shaman” is a healer, and Dr. Rotondo shared how today’s surgeon practices tribal warfare every day under extreme pressure – shouldering the burdens of those who cannot heal themselves.

Though I’m not a surgeon, I found the analogy beautiful and helpful… Truly in healthcare we fight every day – we fight for the healing, the wellness, of those who cannot heal themselves. Throughout the lecture, Dr. Rotondo stressed the importance of the shaman’s capacity to control himself through practices that energize the environment and the body, reduce stress, and engender vision and imagination and creativity. He stressed the importance of understanding people and how to heal them, knowing how to communicate, how to be successful and take action, and finally how to shift levels of energy to handle change. It was an inspiring message that I believe connected and impacted the entire audience.

I’m impressed by the warmth and the rich culture of EAST and its attendees… This is an inclusive, encouraging, inviting group where I have felt so welcomed and so very much a part of the team. It’s beautiful to see and feel these genuine connections and to know that the research and the presentations shared here are just a snippet of the work being done around the country.

The afternoon was filled with poster presentations! I got the opportunity to hear about management of acute V/Q mismatch in hemorrhagic shock in pigs – a very interesting study by a team at Temple University Hospital in Philadelphia. By administering inhaled nitrous oxide to pigs in hemorrhagic shock, the team was able to demonstrate decreased PVR, decreased airway resistance, as well as decreased systemic inflammation. They want to continue their research to determine if the inhaled nitrous oxide also mitigates some lung injury…

Another study conducted at the University of California Irvine investigated the use of antioxidant-rich fluids, as a replacement for traditional normal saline or lactated ringer’s, to decrease inflammatory response in rabbits. This photo is of Dr. Gelbard from Grady presenting her poster on procalcitonin levels as a predictor of enteric fistula formation after damage control laparotomy.

I was thrilled to observe – and I’m thrilled to share! – how established and supportive the relationship between the STN and EAST organizations. STN held a reception Thursday evening where Dr. Nicole Stassen, the current president of EAST, spoke about the collaboration between the two organizations. It’s evident from listening to Dr. Stassen, as well as others that I’ve spoken with during my time here, how valuable these connections have become as we all seek to improve trauma care. I’ve seen here that EAST and STN genuinely regard the contributions each group brings to the table. There is an openness between the leaders and members of both groups, a willingness to share knowledge, and a desire to collaborate on priorities in our field.

Finally, this evening I had the great honor of attending the EAST President’s Reception and Dinner with Joan Pirrung and Betsy Seislove. Thank you, ladies, for everything you’ve done to make this an incredible experience.

Beautiful sunset

President’s Dinner – from left to right: Joan Pirrung, Betsy Seislove, Sarah Parker, Dr Dan Bonville

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