TopMedTalk

Adverse outcomes, we all know they happen but how do we handle them, record them and avoid them in the first place? The discussion then moves to (Patient Recorded Outcome Measures) PROMS.

Patient optimisation is then discussed. Exercise, could it be so effective because it works as an anti inflammatory? A deep dive into the research on that is contained in this conversation.

The RELIEF trial is discussed as the team get into a discussion about what a patient sees as a good outcome. How do we communicate the risks, possible benefits and limitations, of surgery to patients?

The "P.R.E.P." website mentioned is here: https://www.prepwell.co.uk/

Desiree Chappell and Joff Lacey are presenting with their guests Dr Mark Edwards, Consultant in Anaesthesia and Perioperative Medicine at The University Hospital Southampton NHS Foundation Trust and Professor Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust.

The International PREHAB trial. This short piece explains the trial's protocol and the scope of the study.

Presented by Charlotte Molenaar, PhD Candidate, multimodal prehabilitation in colorectal cancer care, BIJ Maxima Medisch Centrum, Coordinator of the international PREHAB trial.

Is methadone "the opioid sparing opioid"? This talk looks at where we are at as regards opioids, in the shadow of a national crisis for the USA; is it possible that methapone might offer us answers?

This piece looks at the idea that methadone might be a way to deliver a better more effective, multimodal, opioid sparing, analgesia with a reduced chance of a post operative repiratory events and decreased post-operative pain.

This talk is complimented well by our consersation, live from the conference, which you can find here: https://www.topmedtalk.com/prehab-periop-world-congress-evan-kharasch/

The World Health Organisation's analgesic ladder is here: https://www.who.int/cancer/palliative/painladder/en/

Presented by Evan Kharasch, MD, PhD, Professor and Vice Chair for Innovation in the Department of Anesthesiology at Duke University, Director of Academic Entrepreneurship, Duke University School of Medicine.

What can practitioners do to preoperatively screen for signs that their patients may have issues with post operative delirium? How do we get patients fit for surgery, particularly with regard to delirium? Can you build up mental resilience in the run up to an operation? Do puzzles and mental activity - such as sudoku or a good crossword - help and is there any evidence of that?

Should preoperative sedation be, generally speaking, withheld from people over 60? How do we explain the risks of this procedure to those who need it? Also - are we seeing a rise in post operative delirium and if so why?

Finally - what should we make of the "triple low" story where patients with low blood pressure, a low bispectral index, and a low minimum alveolar concentration of volatile anesthesia are said to face an increased risk of adverse outcomes?

This piece features Monty Mythen and Desiree Chappell in conversation with Dan Cole, professor of clinical anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles and former president of the American Society of Anesthesiologists (ASA).

"Moving as medicine; is it the most underused but proven health promotion and healthcare practice?"

Prehabilitation and population health naturally walk alongside each other. Learn here how Sport England's ambitious strategy to reduce inactivity and improve the nation's physical and mental health is connected to prehabilitation and Enhanced Recovery After Surgery. Should patients be seeking expert condition specific advice before becoming active? How do we improve the quality of conversations between practitioner and patient?

The excellent Moving Medicine website can be found here: http://movingmedicine.ac.uk/

Presented by Sarah Ruane, Sport England's national lead for health, she joined in January 2016 from local government where she oversaw public health, leisure and cultural services.

Thrombosis is the commonest cause of death and disability worldwide, antithrombotic therapy is incredibly beneficial but it promotes bleeding; how then do we manage anticoagulation in the peri-operative period? How do you assess a patient's risk of bleeding? When should you consider bridging? What are we to think as regards the current status of asprin? How do we approach dual anti platelet therapy (DAPT) and does it promote more bleeding?

Lecture slides: http://www.anzca.edu.au/documents/03-harry-gibbs_periop-management-of-antiplatelet.pdf

Presented by Harry Gibbs, FRACP, FCSANZ, The Alfred, Melbourne.

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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

This panel discussion includes questions on; the multidisciplinary aspect of perioperative medicine, the drop off in Enhanced Recovery that some institutions experience, how to lead and coach an institution into an enhanced recovery programme, outcome data, informed decision making, the importance of strategic flexibility and the importance of good shared decision making when resources are stretched.

Chaired by Ramani Moonsinghe this piece features; Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care, University College London; Chair, Evidence Based Perioperative Medicine (EBPOM), Founding Editor-in-Chief of Perioperative Medicine; Editorial Board British Journal of Anaesthesia; Founding Editor-in-Chief TopMedTalk; Founding Board Member Perioperative Quality Initiative (POQI); Fiona Walker, Cardiologist, trained in grown-up congenital heart disease (GUCH) and maternal cardiology in Toronto and at UCLH. She is the Service lead for GUCH (2005 – present) and head of the maternal cardiology programme at University College London Hospitals (UCLH); Jugdeep Dhesi, Clinical Lead, POPS and Consultant Geriatrician, Guys and St Thomas' NHS Trust.

How do you best work a pre-op clinic? Should they be places where you get your problems documented or where you get your problems 'fixed'? How do you convince your practice to optimise patients for life and not just 90 days? How do we encourage population health? How do we get round the fact that we're still in a 'fee for service world'? What is "PBPM"?

Featuring Desiree Chappell, Monty Mythen, Dr Lee A. Fleisher, Chair of Anesthesiology and Critical Care (University of Pennsylvania) and Vicki Morton DNP and Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates University of South Carolina.

What can the experiences of a team who helped to introduce pre-operative assesment and prehabilitation to Barcelona teach us about how to most effectively implement and sustain similar programmes where we are?

How and why is prehabilitation helpful in terms out outcomes and value based care? How long can the benefits of prehabilitation be maintained? What is the value of nutritional consultation, how important is it to asses your patients pre-operative protien intake? Would it help to offer all of your patients mindfullness sessions? How important is it to include patient's partners or carers in sessions?

Also, is it possible for you to tap into and harness the enthusiasm of sporting professionals?

Presented by Graciela Martinez-Palli, Consultant in the Department of Anaesthesia and Perioperative Care at Hospital Clinic, Barcelona. She attends as anaesthesiologist for oncologic digestive surgery and liver transplantation.

Is it still ethically viable to have a standard arm in a prehabilitation trial? Which allied health professionals supervises the exercise part of these trials? What are the biggest reasons for non-adherence to home based exercise programmes? How do you address a possible selection bias with candidates? What is the best time to follow up a study with these patients?

Featuring; Krishna Moorthy Senior Lecturer, Consultant Surgeon, Imperial College London, Academic surgeon, with research interests in patient safety and quality of improvement in surgery, Co-lead of the PREPARE for surgery prehabilitation programme, BMJ Surgical Team of the year and Patient Participation awards 2017, Consultant Surgeon, BMI Healthcare, Consultant Surgeon the Wellington Hospital; Denny Levett, Professor in Perioperative Medicine and Critical Care at the University of Southampton and a Consultant in Perioperative Medicine at Southampton University Hospital NHS Foundation trust; Suzanne Mcdonald, Research Associate at The University of Queensland (Australia), Visiting Researcher at Newcastle University (UK) and registered Chartered Health Psychologist; Charlotte Molenaar, PhD Candidate, multimodal prehabilitation in colorectal cancer care, BIJ Maxima Medisch Centrum, Coordinator of the international PREHAB trial; 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; James Hernon, Consultant Colorectal Surgeon, Norfolk and Norwich University Hospital NHS Foundation Trust, Chair of the Anglia Cancer Colorectal Network, CO-CI for PREPARE ABC a NIHR HTA funded randomised clinical study.