TopMedTalk

The historical focus in prehabilitation has been on exercise, how can the insights of psychology and behaviour change techniques be applied to the field? Should psychosocial outcomes and behaviour change be factored into your practice?

There's consistent evidence that anxiety around the time of diagnosis is predictive of post operative pain; depression increases the risk of chronic pain; psychological factors also impact on wound healing and functional recovery. Meanwhile low confidence and depression have been shown to effect outcomes.

How can psychological behaviour change techniques be embedded into encouragement to involve themselves in exercise training in advance of their operation?

For more on the Wesfit trial go here: http://www.wesfit.org.uk/

Presented by Chloe Grimmett, National Institute of Health Research (NIHR) post-doctoral Research Fellow and Senior Research Fellow for the Macmillan Survivorship Research Group at the University of Southampton; behavioural science lead for Wessex-Fit-for Surgery (WesFit) trial, a large randomised controlled trial of physical and psychological prehabilitation prior to cancer surgery and is a member of the National Cancer Research Institute clinical studies Lifestyle and Behaviour Change Group and the NIHR Cancer and Nutrition Collaborative.

The UK's fight back is now underway; the 'lockdown' is being largely adhered to and the efforts to support the National Health Service (NHS) from the public, medical students and retired professionals is inspiring to many.

This piece takes a look at the realities of students being given the chance to graduate and practice their skills a little earlier than previously planned.

Presented by Desiree Chappell with her guest, Henry Howe, a medical student at Bristol University, a frequent contributor and partner to TopMedTalk.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"There seems to be a little extra buzz in the cardiac community".

This conversation focuses upon the psychology of change, specifically regarding the leadership role presented within perioperative medicine to anaesthesiologists. How can perfectionism, as a barrier to change, be overcome? How do practitioners build the confidence to make a difference? Furthermore, how do we engage in 'internal marketing' where we promote success within our own institutions?

More information on The Morpheus Consortium here: http://morpheusconsortium.org/

Check out the article here: https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511

Find out more about NorthStar here: https://northstaranesthesia.com/

The "Masters of Scale" podcast is here: https://mastersofscale.com/

This piece was originally released live from "ERAS cardiac: Center of excellence training conference", an Edwards Life Sciences sponsored conference in North Carolina.

Presented by Monty Mythen and Desiree Chappell with their guest Bob Booth, Regional Chief Medical Officer, Vice President of Physician Operations at NorthStar Anesthesia, P.A.

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Brian Woods from NorthStar features on TopMedTalk here: https://www.topmedtalk.com/topmedtalk-the-goal-is-more-important-than-the-role/

"I work in a houshold where my wife was working at a school and my student children have come home so, it's highly likely that I would get COVID 19"; the conversation begins with a discussion about the fact our Editor in Chief Monty Mythen has had some of the symptoms over the last few days. "For us as healthcare workers what we need to do is filter out the true head colds from the COVID 19s"; the symptoms could be caused by a number of factors but until a clear test result is available he is taking precautions.

It underlines the need for practitioners to adhere to distancing guidelines as the conversation moves to an update on the UK's measures to tackle the pandemic and how the global fight continues.

The "Nightingale Hospital" is covered in more detail here: https://www.telegraph.co.uk/global-health/science-and-disease/coronavirus-uk-lockdown-latest-news-non-essential-shops-close/

Presented by Desiree Chappell with Monty Mythen.

How is the fight against COVID 19 going where you are? We are very grateful to everyone who has emailed us since the crisis began. If you would like to reach out to TopMedTalk email [email protected]

The clip of Professor Hugh Montgomery was taken from Coronavirus: How to Isolate Yourself, Channel 4. Find the full programme here: https://www.channel4.com/programmes/coronavirus-how-to-isolate-yourself

The UK Prime Minister's statement is available in full here: https://www.youtube.com/watch?v=iF5gpoj1lwg

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

This piece focuses in upon the important work being done by The Enhanced Recovery After Cardiac Surgery Society, specifically the new guidelines which were published in May 2019. Furthermore, how is the society going to move forward, will it continue to push for a sensible combination of both care providers and academics and what areas of focus are most impactful when it comes to improving care and helping implementation?

The article discussed in this piece "Guidelines for Perioperative Care in Cardiac Surgery, Enhanced Recovery After Surgery Society Recommendations" is here: https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511?guestAccessKey=04f7090d-122c-4e94-a46f-22e49dab7c51

The Enhanced Recovery After Cardiac Surgery website is here: https://www.erascardiac.org/

Presented by Desiree Chappell with her guest Kevin Lobdell, Director of Regional CVT Quality, Education, and Research.

"The guidelines, in fact, I found most useful were the Royal College's guidelines, all those info graphics and all those protocols"

This piece is an emotional conversation with a TopMedTalk favourite; how are things going in New Jersey? Has elective surgery come to a halt yet? What innovations are being deployed by medics are they face a global pandemic? What are the unique pressures which medics are being called upon to deal with in this crisis?

The collaborative resource from the UK https://icmanaesthesiacovid-19.org/

The Royal College of Nursing's webpage regarding Personal Protection Equipment (PPE) is here: https://rcni.com/hosted-content/rcn/first-steps/personal-protective-equipment

Also, the recently released useful conversation about Oxygen shortages Dr Kett mentions - which featured Mike Grocott - can be found here: https://www.topmedtalk.com/covid-19-uk-southampton-and-london-mike-grocott-and-monty/

Presented by Desiree Chappell with Attilla Kett, Chair of Anesthesia at St Peter's University Hospital, New Brunswick, New Jersey.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"The first case of COVID in China was the 8th of December…" this piece looks at the outbreak of the disease from the perspective of healthcare workers in Italy. Focusing on the community health approach to controlling this pandemic, our guest emphasizes the importance of understanding the epidemiology of COVID- 19.

Mirco Nacoti, Department of Anesthesia and Intensive Care, Pediatric Intensive Care Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy, was subsequently featured in the New England Journal of Medicine where he along with Andrea Ciocca and Maurizio Cereda wrote this excellent article: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0080

Please share this information with as many colleagues and friends as you can. TopMedTalk is working with you, our listeners, to raise awareness at this crucial time.

REMINDER: PLEASE stop having in person meetings with administrators and departments to help stop the spread of CV19.

Presented by Monty Mythen and Desiree Chappell.

This podcast was originally released as part of a longer podcast which you can listen to here: https://www.topmedtalk.com/covid-19-you-must-learn-the-epidemiology/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"'The disease is not complicated, the biology is not complicated, the treatment is not that complicated; our behavior patterns and our understanding of what it is truly like to be in a pandemic is the complicated bit' ... 'Yeah, this is not a drill'": the firm message in this piece is clear, use the internet and stop your face to face departmental meetings now.

More broadly we ask; how are things going in North Carolina, Louisville and London? Has elective surgery been cancelled yet? How are people facing the issue of personal protective equipment (PPE)? London practitioners are assuming they themselves have the virus, is this the case everywhere else? How are staff roles being changed in anticipation of the problem?

There's also a very frank conversation about the personal risks practitioners are being asked and deciding to take. Should they acknowledge and talk about their safety for both themselves and their loved ones? We wrap on a conversation about the reported interest in smoking cessation that has grown in the last few days.

Presented by Desiree Chappell and Monty Mythen with TopMedTalk regular and occasional co-host, Sol Aronson, tenured Professor at Duke University.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

This conversation sets the scene for the UK. London now having some hospitals which are overwhelmed, other parts of the UK still in the anticipation period. The conversation moves to the importance of enhanced recovery after surgery and its immediate relevance to the COVID 19 crisis. Then the topic of Personal Protection Equipment (PPE) is raised, possible shortages are discussed. The debate about non invasive ventilation, continuous positive airwave pressure (CPAP) and optiflow techniques. Oxygen economy is one thing to consider, service providers may face issues over this vital resource.

Presented by Monty Mythen with his guest Mike Grocott, occasional TopMedTalk anchor and Professor of Anaesthesia and critical care at the University of Southampton.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

This remarkably prescient conversation was recorded at an Australian National Summit in Adelaide regarding the 'hidden pandemic of postoperative complications'. The dangers presented by them certainly suggest this area needs to be taken more seriously. Although staged in Australia this conversation is of global concern, particularly at a time when the world is realising the benefits of proper perioperative care.

For more about the National Emergency Laparotomy Audit go here: https://www.topmedtalk.com/ebpom-2018-12-the-importance-of-cpet-and-nela/

The article mentioned in this piece is here: https://bjanaesthesia.org/article/S0007-0912(18)30654-8/abstract

There's a good piece about the summit here: http://theleadsouthaustralia.com.au/industries/health-and-medical/summit-targets-post-op-pandemic/

Presented by Monty Mythen and Mike Grocott with their guest Guy Ludbrook Professor of Anaesthesia at the University of Adelaide and Royal Adelaide Hospital.