TopMedTalk

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Is it fair to say that prehabilitation is the new direction for practitioners of Enhanced Recovery After Surgery (ERAS)?

Discussion expands into patient awareness initiatives; The Macmillan Cancer Support, Principles and guidance for prehabilitation guide mentioned is here: https://www.macmillan.org.uk/about-us/health-professionals/resources/practical-tools-for-professionals/prehabilitation.html

Age care naturally follows as the roundtable discussion continues. This piece gives a truly pan-national perspective with informed comment from prominent perioperative opinion leaders from The UK, Australia and America. How do those different systems work and what can they each learn from the others?

The journal article mentioned in this piece is here: https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511

Presented by Desiree Chappell with Monty Mythen and Lee A. Fleisher, Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania and Ross Kerridge, John Hunter Hospital, Newcastle, Australia, often cited as 'the father of Modern Perioperative Medicine'.

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Smoking is bad for you, there's little debate about that, even among users of the drug. However, further to the widely known consequences, the bottom line in the perioperative period is that smokers are 40% more likely to die after major surgery. Do patients also know this?

Tissue healing, increased risk of infection and increased possiblities of complications with the anaesthetic; with these risks in mind how do we cut through the ubiquitous, but often ignored, government health risk messaging and get patients to understand the increased risk for those undergoing surgery? How do we use smoking cessation techniques in the perioperative setting? How do we manage to start, ideally, six weeks before surgery? What is the latest thinking on the neuro psychiatric consequences of smoking cessation? How useful is the Fagerstrom test of nicotine dependence? What about "vaping", is it better than smoking from a perioperative perspective?

Presented by David Yates, Consultant in Anaesthesia and Critical Care Medicine at York Teaching Hospital, set up one of the UK's first Perioperative Medicine Services in York, Anaesthesia, Perioperative Medicine and Pain Clinical Lead for the Yorkshire & Humber Comprehensive Research Network.

Cancer continues to present a seirous challenge to health care practitioners, particularly with elderly patients. Operations on cancer patients can occur for a variety of reasons, how do we ensure we make decisions that are right for them? Often cancer surgery is both urgent and emergent; the question of 'how long do we have to prepare' is paramount. How do we get patients to a surgical option that may be curative? How do we deal wirth "deconditioned" patients who have been subjected to difficult treatments as part of their cancer care? What are immune checkpoint inhibitors? What is 'targeted chemotherapy'? What are the pulmonary side effects of chemotherapy? Furthermore who do we deal with anemia in cancer Patients?

Finally the talk focuses upon post operative care.

The fuller version of this talk is supported by slides which you can see here: http://www.anzca.edu.au/documents/01-sunil-sahai_periop-evaluation-of-cancer-patient.pdf

Presented by Sunil K. Sahai, MD, FAAP, FACP, Co-Director, The PeriOperative Evaluation & Management Center Section Chief & Professor of Medicine, Section of Consultative Medicine, Department of General Internal Medicine, MD Anderson Cancer Centre.

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Brought to you by the Perioperative Medicine Special Interest Group (SIG) in association with the Australian and New Zealand Society for Geriatric Medicine and the Internal Medicine Society of Australia and New Zealand at the 7th annual Australasian Symposium of Perioperative Medicine.

The Perioperative Medicine Special Interest Group (SIG) has three aims; improve patient safety and outcomes, share knowledge and collaborate with specialty groups, develop the specialty of perioperative medicine with various craft groups.

For more information follow this link here: http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

Can you teach people to be leaders? Should the we be scared of using fear and greed as motivators? Do practitioners sometimes retain the right to clinical freedom to a degree that may not work in the interests of the patient? Can open and transparant institutions and practices exist without provoking a 'culture of blame'? Should risk scoring and funcitonal assesments be used for patients with aortic aneurysms?

Featuring; Dr Ramani Moonesinghe, Professor of Perioperative Medicine at University College London (UCL), Mark Hamilton, Consultant and Honorary Senior Lecturer in Anaesthesia & Critical Care Medicine, clinical lead for the Perioperative Assessment & Planning Unit, at St. George's Hospital and Medical School, member of the Surgical Outcomes Resource Centre at UCL, Co-Director of Evidence Based Perioperative Medicine (EBPOM), Editor in Chief of Perioperative Medicine, he also chairs the System Resilience Group, the Finance and Performance Committee and is a member of the Quality Committee and Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London.

The American Associaton of Retired People (AARP), an organisation with a membership almost equal to the entire voting population of the United Kingdom, are focusing on brain health, in response to the demands of their members.

Further conversation includes how practitioners both explain the risks of surgery and also calm possible misunderstandings or fears regarding them, as well as wider reflections on 'The Brain Health Initiative'.

Presented by Desiree Chappell with Mike Grocott and their guests Lee Fleisher, Professor of Anesthesiology and Critical Care, University of Pennsylvania and Sarah Lock, Senior Vice President for policy at the American Association of Retired People (AARP) and the director of 'The Global Council on Brain Health'.

This panel discussion includes questions such as: In a prehabilitation service what screening tools should we use to assess nutritional risk? What tools are there related to patient self management? What advice would you give a patient about cannabis smoking cessation? Should denial of surgical procedures be used as a motivator for lifestyle change? Can the questions used in interventions sometimes be open to misinterpretation by patients? How do we assess and treat sleep disorders? If not a psychologist, what team members might handle psychological behaviour change? Does immunonutrition work? Are there sensitive approaches to addressing weight loss, physical activity and diet that the panel reccomend?

Panel discussion chaired by Sandy Jack and Daniel Santa Mina, featuring, David Yates, Consultant in Anaesthesia and Critical Care Medicine at York Teaching Hospital, 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, Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University, Chelsia Gillis, Registered Dietitian, Canadian Vanier Scholar, and PhD Candidate in Epidemiology at the University of Calgary, Canada, she is leading the first prehabilitation program for colorectal surgery in Alberta.

How do we develop an agreed curriculum that speaks to what perioperative medicine should be? Once that's in place, how should it be overseen? What sort of official endorsements would it need?

Running in parallel to this are the MOOCs - Massive Online Open Courses - that are being developed.

Developing a broad knowledge of the process is distinct from being a perioperative specialist, how do we develop that even further - without developing a schism? These complicated topics are discussed alongside more detail regarding the future of teaching this speciality.

Presented by Monty Mythen and Mike Grocott with their guests; Joel Symmons, Staff Consultant Anaesthetist in the Department of Anaesthesia and Perioperative Medicine at the Alfred Hospital, Perioperative Medicine Short Course Convenor, and a Senior Lecturer in Anaesthesia at Monash University, and Paul Myles, Head of Alfred Health's and Monash University's Department of Anaesthesia and Perioperative Medicine.

Coming from this year's "21st Current Controversies in Anaesthesia & Peri-Operative Medicine and SIAA Autumn Congress" at the Dingle Skellig Hotel, Ireland, this podcast gives you a chance to learn more about our lead presenter. What have been the highlights of her time working with the TopMedTalk team so far? Why did she become so compelled to advocate Enhanced Recovery and Perioperative Medicine? Also, what is the conference like and why do so many people rave about Dingle, Ireland?

Presented by Vicki Morton, Doctor of Nursing Practice and Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates with her guest Desiree Chappell, lead presenter for TopMedTalk.

What should we think about issues regarding the Perioperative Ischemic Evaluation Study (POISE)? Is it time to treat men and women equally when it comes to haemoglobin levels? What advice should we give to clinicians who are managing change at a hospital? What should our approach to iron be and can interventions make a real difference?

Featuring; Bruce Waxman, Adjunct Associate Professor (Honorary) at Monash University Dept. of Surgery School of Clinical Sciences, Monash Health and Chief Medical Officer, Bass Coast Health, Wonthaggi Hospital, South Gippsland Coast, Victoria, Kate Burbury, Associate Professor, Deputy Chief Medical Officer, Peter MacCallum Cancer Centre and Toby Richards, Academic Professor of Surgery, Vascular Surgeon, University Western Australia.

Prehabilitation represents a real opportunity for practitioners to exploit a 'teachable moment' and realise long term positive behavioural changes. Making patients 'partners in their own care' is an essential part of this, with prehabilitation they have a chance to work with practitioners to increase their functional reserve, increase their rate of recovery and avoid difficult long term outcomes. The longer this partnership lasts the more effective it is. In this respect, how do we manage to emphasise the importance of early access to patients? The evidence of the benefits of exercise is overwhelming, even just two weeks of activity can make a huge difference, how do we articulate this to patients? How much focus should there be on nutrition?

Presented by 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).