Weekly Member Update - March 19th, 2010

March 19th, 2010

A Message from the ASSH President

A column from President Robert M. Szabo, MD, MPH

Vacancies on AAOS Instructional Course Subcommittess - Apply Now
Resident and Fellow Scholarships
Call for Applicants: Research Division Director - Deadline March 21st
Foundation Announcement - What Is Complus Manus?
Upcoming Research Grant and Award Deadlines
International Traveling Fellow Applications
Sterling Bunnell Traveling Fellowship

ASSH Courses and Meetings

Self-Assessment Exam Registration - Deadline April 2, 2010
2010 Master Skills Series: Trauma of the Elbow, Forearm and Wrist
65th Annual Meeting - Call for Abstracts
General Orthopaedic Review
Comprehensive Review in Hand and Upper Extremity Surgery

Healthcare Reform News

AMA Launches New Tool to Help Physicians Correct Unfair Managed Care Contracts Nationwide - From AMA
Medicare Pay Formula Needs Repair, Sebelius Says - From AMA

A Message from the ASSH President

This week I have asked ASSH member Leo Rozmaryn, MD to share his recent experience volunteering in Haiti.  His eye-opening account serves as both a reminder of how grateful we should be to practice surgery in an advanced country, and also a call to action to better prepare for future disaster, both at home and overseas.  Dr. Rozmaryn’s story is well worth the read. 

Bob Szabo, MD

Dear Folks,

I recently had the opportunity to serve in Haiti, thanks to the AAOS playing an instrumental role in hooking me up with the University of Miami's Project Medishare.  In our 5 days at the field hospital near the airport at Port Au Prince, we had the opportunity to interact with about 150 inpatients and several hundred outpatients through their ER and wound care center. 

Treatment of the outpatients was relatively straightforward and most satisfying.  There were long lines of patients with closed fractures whose time in casts was drawing to a close. Casts were removed and patients were either given instructions for home exercises or referred for PT or OT at the hospital.  Many new, non-earthquake injuries were readily treated; most were released, and some were admitted for further care.
Our inpatient service consisted of earthquake-related injuries or fresh injuries from motor vehicle accidents. 

When we arrived, the departing orthopedists immediately warned us:  "Take all your pre-conceived notions about what you are planning on doing here in the OR and throw it out the window.”  The reasons for the warning was readily apparent when we visited the OR which was situated in the rear of the large pediatric tent, separated by a canvas tarp. (Doors were installed on our last day.)  There were no autoclaves or any means of sterilizing instruments.  After use, instruments were washed with a detergent and soaked in bleach.  Some implant kits and sets were "peel packed" and some were not.  There was no physical separation between OR "theatres,” so a fresh fracture could be operated on next to an infected case. There was free thoroughfare of personnel without restriction between theatres, and insufficient enforcement of the "Hat and Mask" rules. 

The adult and pediatric wards consisted of patients stacked together on long rows of cots in open tents - fresh post-ops next to patients with gaping infected wounds on wound vacs.  It was small wonder that the patients who had had internal fixation of their fractures either with plates, screws, pins or IM rods early on at the facility had a greater than 90% loss of fixation and/or infection with massive skin breakdown in some cases.  It became readily apparent that apart from soft tissue repairs, the only other option available was external fixation.   The external fixation worked well enough for the closed and some of the open tib fibs.  There was a massive daily effort to dress and clean the hundreds of wounds, but there was no possibility to do any kind of coverage procedure, either using regional or free flaps.  There were a great number of external fixators used on femur fractures including subtrochanteric fractures.  These were used as primary treatment or to salvage infected prior internal fixation. 

When we arrived, there were a dozen patients with 5 week old cervical and lumbar burst and shear fractures, some who were frankly dislocated; some had completed neurological deficit; some were partial or were in evolution.  They had been lying on their cots for 5+ weeks since the earthquake without treatment or referral/transfer. 

We were told that the USNS Comfort was not accepting any new patients despite the fact that they had a patient census of only 30 patients and a capacity for hundreds.  Other hospitals in Haiti weren't taking any either.  We were left functioning as a "holding pen" for these poor souls. I even tried to take three patients to St. Damien's Hospital in Port Au Prince after they told our coordinator that I could come over to operate on them in a sterile environment. Upon my arrival, I was denied permission and had to return the patients to base.  After a week of effort, we were finally able to get an American orthopaedic team from Pierre Payen to take some of our subtrochs and spine patients with a promise to take more later.  One night, I found myself having to do a BKA on a young woman who was 24 weeks pregnant with a total degloving injury to her foot, using a non sterile oscillating saw.

I believe that Orthopaedic reconstruction should not be done at a field hospital except under the most hyper-acute circumstances.  I am left wondering whether we were doing these folks a favor with our surgery.   I feel now that for the vast majority of these orthopaedic injuries the emphasis needs to be on performing definitive fixation when possible and managing the thousands of amputees with aggressive rehab and fitting artificial limbs.

Israel has developed a nationwide network of outpatient rehab centers where new and refurbished braces and limbs can be given to patients with the means and training to use them in the context of a comprehensive "return to living" program. I have included a link.

The name of the organization is Yad Sarah. They have been enormously successful in meeting the multiple needs of Israel's disabled for decades.  It is precisely this that Haiti needs.

I also feel that a large, brand new hospital/trauma and rehabilitation center in accordance with California "earthquake code" should be built in Port Au Prince with some of the massive relief funds being sent over and spent. This would be staffed jointly by American, international and Haitian health care providers and could provide world class care.

Just some thoughts,

Leo M. Rozmaryn, MD
Member, American Society for Surgery of the Hand

Photos courtesy of Dr. Rozmaryn (pictured 2nd from the right, below).




Vacancies on AAOS Instructional Course Subcommittees - Apply Now!

The AAOS Presidential Line is urging specialty society members to apply for positions on their Instructional Course Subcommittees that were recently left vacant.  These positions are a wonderful way to become involved while representing hand surgery in the greater orthopaedic community.  Applications are due April 1st, and you can apply through the Committee Appointment Program on the AAOS website

Questions?  Contact AAOS staff liaison Donna Malert via email (malert@aaos.org) or phone (847) 384 - 4044. 

Resident and Fellow Scholarships Now Available!

Through the generosity of the American Foundation for Surgery of the Hand (AFSH) and our corporate partners, Stryker and OsteoMed, Residents and Fellows have the opportunity to win a $1500 scholarship to support the attendance of this year's Residents and Fellows Conference and Annual Meeting.  Learn more on our website.  Please continue to check back regularly as new corporate scholarships are pledged on a weekly basis.

Call for Applicants: Research Division Director  - Deadline is Sunday, March 21, 2010

The application for the Research Division Director position on the ASSH Council is now available.
Qualified candidates will have knowledge of, and commitment to, the ASSH Mission, Vision, Values and Goals as well as availability of time and energy to direct and coordinate the functions of all committees within the Research  Division.  Information about the qualifications, time commitments and specific duties can be found on the ASSH website.

If you are an interested candidate, or know someone well-qualified, please visit the ASSH website to learn more or complete the application.   *Please send all supporting material via email to Alexzandra Wallace at awallace@assh.org, or fax it to (847) 384-1435.  Applications will be accepted until midnight (CDT) Sunday, March 21st.

Foundation Announcement - What is Complus Manus?

Complus Manus, or “many hands,” is an initiative of the American Foundation for Surgery of the Hand (AFSH) to encourage Candidate Members and Young Members (< 3 years) of the ASSH to support their Foundation.  Based on the premise that “many hands make light work,” this initiative is a tremendous opportunity for younger ASSH members to consider the valuable benefits of philanthropic giving to our Foundation while gaining appropriate recognition from their peers and unique opportunities to interact with senior members of the ASSH during several annual functions.  Importantly, a portion of Complus Manus funds will be directed to support the ongoing success of the Adrian E. Flatt Residents and Fellows Conference and the Health Volunteers Overseas Travelling Surgeon programs. 

For additional information, contact Jessica Daniels at the ASSH Central Office (847) 384-8300, or learn more by visiting the AFSH website to find information about Complus Manus.

Upcoming Research Grants and Awards Deadlines

OMeGA Fellowship and Residency Grants - Deadline March 24

2010 Clinician Scientist Development Program - Deadline March 31

AFSH-HVO Young Surgeon Overseas Program - Deadline March 31

Basic Science and Clinical Research Grants - Deadline April 1

The Weiland Medal - Deadline April 1

Military Research Grant - Deadline April 1

Hand Surgeon-Scientist Award - Deadline December 1

International Traveling Fellow Applications
Fellowship Forms are due May 17, 2010

In recent years, the American Society for Surgery of the Hand has welcomed young fellows traveling to the U.S. with the support of their national hand societies.  In support of overseas visiting fellows, the ASSH will provide complimentary registration to the ASSH Annual Meeting in October 2010 for fellows from international societies who are on an academic level equivalent to our Bunnell Fellow.

If your society would like to nominate a fellow to participate in this program, please download the application form from the ASSH website and return to Alexzandra Wallace via email (awallace@assh.org) or fax (847) 384-1435.

Applications Now Available for the Sterling Bunnell Traveling Fellowship in Hand Surgery
Applications are due June 1, 2010 

The Bunnell Fellowship provides scholarship funding for a young Hand Surgeon to pursue an educational or academic goal that:

  • Requires national and international collaboration.
  • Fosters the principles of scholarship of the ASSH.
  • Has a clearly delineated theme in a specific area of clinical interest, a scientific pursuit, or an educational mission.

The Committee will select the Bunnell fellow based on the applicant’s scholarship, ASSH contributions, and the strength of the proposed collaborative project. Learn more about the application process on our Bunnell webpage. For questions, contact Alexzandra Wallace at awallace@assh.org.

ASSH Courses and Meetings

Can’t remember if you’ve already registered for a course? Login at www.assh.org, select "Members" then “My Transactions” in the left column.  If you’ve registered, your registration will appear on this list.  From here, you can also add sessions/tickets to an existing registration.

Self-Assessment Exam
Registration Deadline: April 2, 2010

This examination, a convenient self-education exercise from ASSH, is designed to assist you in your review of the basic principles of hand care and to keep you abreast of new developments and concepts within the specialty.  Cost for members is $155 and cost for nonmembers is $195.

The ASSH designates this educational activity for a maximum of 20.00 AMA PRA Category 1 Credits (TM).  Physicians should only claim credit commensurate with the extent of their participation in the activity. NOTE: Only those who return a completed answer sheet for computer scoring by June 11, 2010 (postmarked) will be eligible for CME.

Registration Deadline                                                                 April 2, 2010
Examination book (Book 1) mailed to registrants                         April 19, 2010
Answer Sheet Deadline                                                                June 11, 2010
Discussion book (Book 2) mailed to registrants                            July 30, 2010

All registrants are confirmed by email. If you have not received email confirmation by April 5, 2010 please contact the ASSH Office via telephone at (847)384-8300 or email ddecker@assh.org.

2010 Master Skills Series: Trauma of the Elbow, Forearm and Wrist
May 21 - 22, 2010
Orthopaedic Learning Center - Rosemont, IL
Registration Deadline: May 6, 2010

The Trauma of the Elbow, Forearm and Wrist course is designed with an emphasis on adult learning with a case-based format, along with a hands-on cadaver workshop to provide you with the most current trends and techniques in trauma.  Learn more about this program and review the registration fees by visiting the Trauma of the Elbow, Forearm and Wrist webpage.  Or register now.

65th Annual Meeting Call for Abstracts
October 7-9 * Boston, MA

Scientific and International Guest Hand Society Poster Abstracts deadline is March 29, 2010. 
Ready to submit? Visit the Abstract Submission Site.  Questions?  Contact Diana Shkap at dshkap@assh.org.  Authors will be notified in May whether or not they have been accepted into the program.

General Orthopaedic Review
July 15, 2010
Renaissance Downtown Hotel - Chicago, IL
Registration Deadline: June 21, 2010

Co-Sponsored by the American Academy of Orthopaedic Surgeons (AAOS) and American Society for Surgery of the Hand (ASSH)

This one-day review course, brought to you by the AAOS and ASSH, prepares you for the general orthopaedic questions on the combined CAQ exam in Hand Surgery. Held just one day prior to the ASSH Comprehensive Review in Hand Surgery course, this is a convenient opportunity to review generally accepted principles of orthopaedics across the specialties and to prepare you to maintain your certification. A skilled faculty of experienced clinicians will focus on what you need to know in all the other specialty areas of orthopaedics for the exam.  Review registration fees and program details on the General Orthopaedic Review webpage.  Get started by registering online today

Comprehensive Review in Hand and Upper Extremity Surgery
July 16-18, 2010
Renaissance Downtown Hotel - Chicago, IL
Registration Deadline: June 21, 2010

The ASSH Comprehensive Review Course is designed as an advanced review course and update for practicing hand surgeons.  The course will review the topical concepts of anatomy, biomechanics and pathology as well as diagnostic and treatment methods relating to hand and elbow surgery.  The faculty are recognized experts in hand surgery and have been selected for their knowledge, expertise and contributions relating to the subject matter they present.  Learn more about this program and review the registration fees by visiting the Comprehensive Review Course webpage.  Or, register online today

Healthcare Reform News

AMA Launches New Tool to Help Physicians Correct Unfair Managed Care Contracts Nationwide - From AMA

Physicians seeking a reasonable alternative to the one-sided contracts offered by some managed care organizations can now rely on a new AMA online resource.  The American Medical Association (AMA) unveiled its new National Managed Care Contract (NMCC) and database to help physicians analyze and negotiate contracts with insurers to provide relief from unfair corporate business practices.

“The concentrated market power of large health insurers gives them an unprecedented advantage in dictating key aspects of health care to physicians,” said AMA President J. James Rohack, MD.  “The AMA’s new resources will be a welcome guide for negotiating fair contracts with health plans angling for an even greater advantage over physicians.”

The NMCC is the first comprehensive managed care contracting resource geared specifically to the needs of physicians. The AMA created the NMCC in an attempt to create model contract language that complies with the managed care laws of all 50 states and the District of Columbia and to comprehensively cover the broad range of physician concerns with managed care contracts. It provides physicians with a valuable frame of reference to compare and evaluate any prospective managed care contract.  Read the rest of this article on the AMA website.

Medicare Pay Formula Needs Repair, Sebelius Says - From AMA

On March 2, Health and Human Services Secretary, Kathleen Sebelius, told a physician audience that the Obama administration strongly supports preventing doctor pay cuts by overhauling Medicare's sustainable growth rate formula.  "We need a permanent fix for the SGR," Sebelius said at the American Medical Association's annual National Advocacy Conference.  But the administration cannot pass laws alone, she noted.  "Congress has to take the next step."

Later that day, the Senate cleared a measure delaying a 21% Medicare doctor pay cut, but only until April 1.  Meanwhile, President Obama followed up his February 25 health reform summit by issuing a plan for enacting a revised version of congressional reform bills, while House Democrats searched for votes to adopt the Senate version.

Sebelius addressed a range of issues of interest to physicians during her hour-long keynote speech, including medical liability reform, care coordination and health IT adoption.  She sidestepped potentially divisive topics, such as a provision in the Senate reform bill that would create an independent Medicare advisory board that could impose additional rate cuts on doctors.  Read the rest of this article on the AMA website.