TopMedTalk

This piece focuses on the "Wessex Fit-4-Cancer Surgery Trial"; a unique multi-centre, efficacy pragmatic, factorial design, randomised controlled trial, with patient informed development and process evaluation

"You wouldn't run a marathon without preparing," why would you want an operation where you don't get ready for a physically stressful event such as surgery? Prehabilitation is an obvious advantage, gathering the data which proves that is essential to perioperative medicine because it means we can show the advantages clearly to both patients and practitioners as well as looking at ways of making the process more efficient.

For more on this go here: http://wesfit.org.uk/

Presented by Professor Sandy Jack, PhD, Consultant Clinician Scientist in the Anaesthesia and Critical Care Research Unit at University Hospital Southampton NHS Foundation Trust, Southampton and NIHR Southampton Respiratory Biomedical Research Unit and Integrated Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Honorary Senior Lecturer at the University of Liverpool, University of Southampton and University College London.

How important is it to have a dedicated member of your team focused on starting, maintaining and coordinating your enhanced recovery programme?

Does an enhanced recovery programme which comes from the grassroots need support early on in the process? How do you find the right people to support you once the process has begun? Also, how do you explain that these changes will actually reduce workload?

The conversation moves into managing pain, both the reality of pain and the expectations which can, if handled correctly, help to reduce it.

Finally, what are the three key aptitudes that an enhanced recovery coordinator needs?

Presented by Desiree Chappell with Korey Springman, Anesthesiologist and Perioperative Medicine Fellow at Duke University and Vicki Morton, Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates and Courtney Fossen, Manager of Surgical Services at US Anesthesia Partners (USAP).

This piece builds on last week's look at Fluid Physiology, with reference to the book linked to below.

"We did not have a concensus view on the very basic subject of fluid physiology and I needed to write a book".

The book Fluid Physiology is available now, check out the website here: http://fluidphysiology.org/

Tom's always entertaining twitter feed is here: https://twitter.com/thomaswoodcock

Tom's slightly shorter piece on this book is here: https://www.topmedtalk.com/topmedtalk-tom-woodcock/

Presented by Monty Mythen and Desiree Chappell with their guests Sol Aronson a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and Tom Woodcock author and independent consultant in patient safety, medical law and ethics.

Like this, want more? Tom Woodcock appears frequently on TopMedTalk: https://www.topmedtalk.com/?s=tom+woodcock

This piece looks at The WAVi Headset which allows for a multi-faceted panoramic assessment of brain performance. Hear how this device is used to assess the health of one of our most vital organs.

For more detail check out the website here: https://wavimed.com/

Presented by Desiree Chappell with her guest Rob Martin, Chief Operating Officer at WAVi.

What is "The Brain Health Initiative"? Why is it that so many aspects of brain function are so hard to understand? Why is cognitive dysfunction such a difficult topic to discuss? How far away are we from the days when we will have a biomarker that can help us in this area?

Desiree Chappell presents, with her guests; Dr Lee A. Fleisher Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania and Miles Berger, Neuroanesthesiologist at Duke University Medical Center.

Anaesthesia is the official journal of the Association of Anaesthetists with comprehensive coverage of publications in anaesthesia, ICU and pain. This piece gets into the detail of their hugely popular perioperative care supplement, a collaboration with BJS (formerly the British Journal of Surgery). Surgeons and Anaesthetists around the world are engaging in the debate as a result with thousands of tweets about the subject, after publication only days before the 2020 Winter Scientific Meeting.

Further discussion covers prehabilitation, which aspects are backed up by evidence? What are the big trials we should be looking towards?

The PREVENTT website is here: https://preventt.lshtm.ac.uk/

More detail on Surgery School is covered here: https://www.topmedtalk.com/?s=surgery+school

Anaesthesia's website is here: https://anaesthetists.org

An excellent blog is provided here: https://theanaesthesia.blog/

Anaesthesia tweet here: https://twitter.com/Anaes_Journal

Presented, from the Association of Anaesthetist's Winter Scientific Meeting 2020, by Monty Mythen with Desiree Chappell, Sol Aronson and their guest Andrew Klein, Cardiothoracic Anaesthetist at Royal Papworth Hospital in Cambridge and Editor in Chief of Anaesthesia.

Like this, want more? Andrew Klien's excellent and popular talk on Cardiac Anaesthesia and Anaemia is here: https://www.topmedtalk.com/ebpom-highlight-1-04-cardiac-anaesthesia-and-anaemia/

"It's all about safety and recovery, it's not about speed"; this conversation focuses on enhanced recovery, are we getting it right and where are people getting it wrong? How reliable and well understood is the data behind it? Also, what are the current thoughts on perioperative steroids? How do we refocus and move back to enhanced recovery after surgery rather than "enhanced discharge" after surgery.

Presented by Monty Mythen and Desiree Chappell with Sol Aronson, tenured Professor at Duke University, and their guests 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 Nick Scott, an early proponent of Enhanced Recovery in the UK who has spent the last six years as the Vice Chairman of Anesthesia and Perioperative Medicine at Hamad Medical Corporation in Qatar.

In this piece we're joined by a TopMedTalk favorite for a few predictions regarding the year 2020. Prehabilitation, "the word of the year" for 2019 and now something we expect to see break into the mainstream? How is anesthesia going to develop and what's the future for artificial intelligence in surgery?

PQIP link: https://pqip.org.uk

Multimodal analgesia: https://www.topmedtalk.com/ebpom-usa-part-5-a-perioperative-practicum-with-tj-gan/

TopMedTalk has covered methadone on a couple of occasions recently:

Methadone a forgotten friend: https://www.topmedtalk.com/topmedtalk-methadone-a-forgotten-friend/

Methadone the overlooked opiate: https://www.topmedtalk.com/ebpom-2019-methadone-the-overlooked-opiate/

Artificial intelligence is looked at in more detail here: https://www.topmedtalk.com/topmedtalk-the-ai-doctor-will-see-you-now/

The 13 Minutes To The Moon podcast is here: https://www.bbc.co.uk/programmes/w3csz4dn

Presented by Monty Mythen and Desiree Chappell with their guest Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust.

Like this, want more? Simon also appears on this piece here: https://www.topmedtalk.com/prehab-periop-world-congress-feras-hatib-simon-davies/

This panel discussion and extended question and answer session focuses upon troponin screening. Where is the latest evidence as regards this debate? Is MINS ( Myocardial injury after noncardiac surgery) the most common postoperative complication associated with death and if so why is there a transatlantic divide as regards the evidence? Is there a place for troponin screening preoperatively for risk stratification? What should one do with an asymptomatic post operative patient with raised troponin? Does MINS cause hypotension?

This is part 3 of 3 from The EBPOM 2019 TopMedTalk session which debated the issue.

Chaired by Monty Mythen, TopMedTalk's Editor in Chief, with, Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton and frequent TopMedTalk contributor, Denny Levett, Professor in Perioperative Medicine and Critical Care, Consultant in Perioperative Medicine, Southampton University Hospital NHS Foundation trust (UHS), President of the Perioperative Exercise Testing and Training Society (POETTS) and Duminda Wijeysundera, Professor in the Department of Anaesthesia and the Institute of Health Policy Management and Evaluation at the University of Toronto and a Staff Anesthesiologist at St Michael's Hospital.

To celebrate the launch of his book Fluid Physiology, A Handbook for Anaesthesia and Critical Care Practice: https://books.google.co.uk/books?id=F-m4DwAAQBAJ&printsec=copyright&redir_esc=y#v=onepage&q&f=false

What are Tom's big areas to watch in 2020? Also how are surgical teams similar to the team behind the moon landing and what should we be thinking about the use of steroids in surgery?

Check out Fluid Physiology: www.fluidphysiology.org

The 13 Minutes To The Moon podcast is here: https://www.bbc.co.uk/programmes/w3csz4dn

Presented by Monty Mythen with Desiree Chappell and their guest Tom Woodcock, author and independent consultant in patient safety, medical law and ethics.