TopMedTalk

We begin with a question from the audience; 'how do we drive change in our institutions towards enhanced recovery after surgery?' The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned.

This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

The conversation features questioner Paul Hutchings, Consultant Anaesthetist at Norfolk and Norwich University Hospital, alongside Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper, Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for thearaputic purposes.

What is POPS (Proactive care for Older People undergoing Surgery) and how have things gone since this service was introduced to Guy's and St Thomas's back in 2004? How does the team apply the techniques of this programme to the perioperative pathway of a patient? Would a service like this be useful at your practice? Can your institution accommodate a fully comprehensive geriatric assessment and optimisation process?

Furthermore, should a programme like this be rolled out across the UK and could anything similar be considered in the US?

How does having a POPS team facilitate specialist education at the institution? What other opportunities are there for patients and staff as a result of innovations such as this?

Also - what are the drugs that anaesthetists commonly prescribe to patients which people who work on this side of the service aren't so keen on? What are the advantages of being able to safely discharge frail patients who may instead have ended up back in the hospital system?

How do we get undergraduates to learn the skills which simple demographics show are going to become more and more crucial as the trend towards a longer life span continues in the Western world? The Guy's and St Thomas's POPS team offer a fellowship, the final part of this Sunday Special covers both that and the wider issue of getting students and younger practitioners into this growing area of health care.

Desiree Chappell presents, with additional questions thrown in by Monty Mythen, as they speak with their guests; Magda Sbai, specialist registrar at Guy's and St Thomas's, Jason Cross, advanced nurse practitioner and Nursing lead for the POPS team, Claire Gallagher, Deputy clinical nurse specialist, Dr Judith Partridge, consultant geriatricians at Guy's and St Thomas's Hospital in London and Dr Jugdeep Dhesi, Clinical Lead, POPS and Consultant Geriatrician, Guys and St Thomas' NHS Trust.

"Our hospital now has twice the capacity it had" cost of care and efficiency are up. Hear how enhanced recovery after surgery (ERAS) and the power of prehabilitation has dramatically shifted institutions towards better outcomes and a higher value of care.

Also in this piece; what is immunonutrition? How does stress alter our immune responses?

The piece mentioned in the podcast can be found here: https://journals.lww.com/annalsofsurgery/Abstract/2018/10000/Impact_of_a_Novel_Preoperative_Patient_centered.13.aspx

Presented by Desiree Chappell and Monty Mythen with their guest William Wooden, Director of Operative Services at Indiana University of Health.

Originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com

Hear this excellent talk, for free, on this podcast.

If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings

If you have any comments or questions you'd like to send to the team email: [email protected]

Presented by Angela Coulter, a UK based health policy analyst and researcher.

Learn how to inspire a team to act, create change and get things done. How important are financial incentives, emotional connection and the relative ease of change?

Originally streamed live from the hugely successful EBPOM USA Dallas Master's course.

Presented by Michael Englesbe, Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.

Originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com

Hear this excellent talk, for free, on this podcast.

If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings

If you have any comments or questions you'd like to send to the team email: [email protected]

Presented by Sarah Hare, of the National Emergency Laparotomy Audit (NELA).

How is the AANA facilitating the care of patients? How can you make a patient a 'partner in safety'? How do we coordinate so many disaparate systems of information and care?

Patient records and data ownership is discussed, as is Paul Upton's excellent interview on TopMedTalk regarding "My Preop".

The original piece is here: https://www.topmedtalk.com/my-pre-op-empowering-patients-before-surgery/

How do we reach out to patients and inform them about the risks and choices which will be presented to them as part of their surgical pathway? Discussion here moves to the American Association of Retired Persons (AARP) and the incredible work they are doing.

For more on the AARP from TopMedTalk go here: https://www.topmedtalk.com/dont-ask-patients-what-is-the-matter-ask-them-what-matters/

Presented by Desiree Chappell and Monty Mythen with their guest Lynn Reede, CRNA and chief clinical officer at the American Association of Nurse Anesthetists (AANA).

"Leading a large, single group towards excellence" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 on www.topmedtalk.com

Hear this excellent talk, for free, on this podcast.

If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings

If you have any comments or questions you'd like to send to the team email: [email protected]

Presented by Dr Elizabeth Cherot, Vice President of medical affairs at Axia Women's Health, followed by a short break out session with Desiree Chappell, Monty Mythen and Sol Aronson alongside questions from the audience online and the delegates at the conference.

How do the insights of a 'medical linguistic anthropologist' impact upon our understanding of 'shared decision making'? How do patients make decisions about surgery? When, in the perioperative process, do they decide what is best for them?

Does patient autonomy actually even exist?

A bubble bursting conversation with a frequent favourite on TopMedTalk, this podcast is bound to get you thinking!

Presented by Desiree Chappell and Monty Mythen with their guest Dr Lee Fleisher Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania.

What are the big things to watch in 2020? "Renablement, rehabilitation and readmission" from a patient perspective and "training compotence, resillience and 'burn out,'" from the practitioner's point of view, according to one of our contributors on this piece.

What about Enhanced Recovery, is that still set to be big in 2020? Is it methadone we should be thinking about? Is automation something on our collective horizon? What about the "B word", "Brexit"; will political change in the UK bring opportunity?

The ongoing issue in the US of opioid addiction and overuse is discussed. We also ask if the coming year will spread more light on what it really means to be "ready for surgery"? And, how and what should we be thinking about our profession's environmental impact?

Here's a link to the Perioperative Quality Initiative (PQIP) page: https://pqip.org.uk

Presented by Nick Margerrison, with Monty Mythen and Desiree Chappell interviewing our various contributors on this show, appearing in order; Gezz Van Zwanenberg, Nurse and Project Lead North West London Critical Care Network, Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust, Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton, Sol Aronson, Tenured Professor, Duke University and Executive Vice Chairman in the Department of Anesthesiology, Andrew Klein, Cardiothoracic Anaesthetist at Royal Papworth Hospital in Cambridge and Editor in Chief of Anaesthesia, Tom Woodock, author and independent consultant in patient safety, medical law and ethics, Henrik Kehlet, a gastrointestinal surgeon and former professor of surgery, Copenhagen University, and now professor of perioperative therapy and Head of Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University and Matt Wiles, Consultant Anaesthetist & Senior Clinical Lecturer at Sheffield Teaching Hospitals NHS Trust and University of Sheffield.

Follow these links for fuller conversations:

TopMedTalk | Gezz Van Zwanenberg, Live from London Part 2 https://www.topmedtalk.com/topmedtalk-gezz-van-zwanenberg-live-from-london-part-2/

TopMedTalk | Simon Davies's 2020 Vision https://www.topmedtalk.com/topmedtalk-simon-daviess-2020-vision/

TopMedTalk | Andy Klien, Editor in Chief of Anaesthesia https://www.topmedtalk.com/topmedtalk-andy-klien-editor-in-chief-of-anaesthesia/

TopMedTalk | Tom Woodcock https://www.topmedtalk.com/topmedtalk-tom-woodcock/

TopMedTalk | Henrik Kehlet and Nick Scott https://www.topmedtalk.com/topmedtalk-henrik-kehlet-and-nick-scott/

TopMedTalk | Matt Wiles and Marcus Peck, Live from London. https://www.topmedtalk.com/topmedtalk-matt-wiles-and-marcus-peck-live-from-london/