TopMedTalk

Insights and perspectives on the science of prehabilitation from a very different angle. It's often said on TopMedTalk that preparing for an operation is not unlike getting ready for a marathon; how do the insights of professionals who work with elite sports men and women to ensure they are fully prepared to do their physical best, on the world stage? Also, what about the teamwork inherent in such activities as the pitstop of a formula one car? Athletes, coaches and a wide number of different experts come into play ensuring a multidisciplinary team converge with essentially the same end in sight as a perioperative prehabilitation team; optimum performance at a crucial time.

Challenges are similar between the two disciplines; how do we foster a culture of learning and teamwork in a high pressure environment where the bottom line carries enormous life changing consequences?

Regular listeners to TopMedTalk may recall the unofficial preamble to this talk, "Prehab Periop World Congress: Gerard Danjoux, Ken Van Someren": https://www.topmedtalk.com/prehab-periop-world-congress-gerard-danjoux-ken-van-someren/

Presented by Ken Van Someren, Director KvS Performance Ltd.

This piece presents the prehabilitation 'business case'; why it's important to care about costs, how outcomes and value based care can help and why money has to be important in healthcare.

How do we convert health benefits and risk management into something which explains the financial bottom line?

Can we really argue that a process which appears, at the point of practice, to take more time, resources and involve a shorter length of stay for patients, is actually cheaper for institutions in the long run and better value for patients?

Is there in fact more than one 'business case' for a proper perioperative prehabilitation clinic at your practice?

The Fit 4 Surgery website (Netherlands) is here: http://fit4surgery.nl/

Presented by Stefan van Rooijen, surgical resident in Maxima Medical Center, The Netherlands, lecturer at the first Health Innovation School (Ministry of Health, Welfare and Sport and Reshape innovation), Surgical resident, Department of Surgery at Maxima Medical Center (ANIOS).

This piece gives an insight into how the insights of an ex-colorectal surgeon can be blended with the understandings of a medical administrator; how can those two roles work together and understand each other more?

There's a useful Perioperative Coach segment which outlines "Stop Bang" here: https://www.topmedtalk.com/periop-coach-3-02-stop-bang-identifying-obstructive-sleep-apnea/

There's a link to the slides here: http://www.anzca.edu.au/documents/03-bruce-waxman_two-sides-to-the-coin.pdf

Presented by 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.

What is 'knowledge mobilisation'? What's the difference between data used for quality assurance and data used for quality improvement? What's important to patients? Does compettition and publicly reporting data actually help anyone other than those who are already leading in their field? Can league tables lead to a 'culture of blame'? 'We need to spend less time measuring and more time improving'; how do we effectively support practitioners who want to get better?

Presented by Dr Ramani Moonesinghe, Professor of Perioperative Medicine at University College London (UCL).

What is the Enhanced Recovery After Surgery (ERAS) Shared Interest Group (SIG)? How does it relate to the advancement of perioperative medicine?

TopMedTalk was at the American Association of Nurse Anaesthetists (AANA) 2018 conference in Boston, check the podcast timeline for more, or click here: https://www.topmedtalk.com/?s=AANA

Desiree Chappell speaks with her guests, Josh Newman Lead CRNA at Passavant Area Hospital, Springfield, Illinois Area and now Chair of the Enhanced Recovery After Surgery (ERAS) Shared Interest Group (SIG) and Randall Moore, DNP, MBA, CRNA and Chief Executive Officer of the AANA.

This piece is taken from the free papers presentations given at EBPOM 2019. Malnutrition and functional capacity; what is the effect of multimodal prehabilitation? What can the six minute walk test really show us? Does nutritional status predict preoperative change in a six minute walk test in colorectal cancer patients following a prehabilitation programme?

Presented by Lauren Richer, Director, Nutritional Services, Keyto, Registered Dietician, Greene Family Medicine Clinic and Montreal General Hospital, Montreal, Quebec.

How is it the case that some people can lose significant muscle mass while they are being cared for on the Intensive Care Unit (ICU)? What can practitioners do to help avoid this? How do we integrate a dynamic stimulus and react to new research relating to nasogastric feeding?

In this piece you will hear about a randomised controlled pilot study investigating the effect of intermittent versus continuous nasogastric feeding on muscle mass and function in intensive care unit survivors.

Hugh Montgomery presents with his guest, Dr Angela McNelly, clinical researcher at the ISEH and the UCL Centre for Human Health and Performance.

NAP (National Audit Project) 6 is the largest ever prospective study of anaphylaxis related to anaesthesia and surgery. Find out the details behind this intriguing study, how long did it take, how does the data impact upon our day to day practice?

There follows a deep dive into the results and recomendations that NAP 6 has produced. Packed with useful information this podcast is one of the stand out pieces of our coverage of the Royal College of Anaesthetists' annual conference in London.

Joff Lacey sits down with his guest Professor Tim Cook, Consultant in Anaesthesia and ICM, Royal United Hospitals, Bath.

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The Silver Tsunami is coming, are you prepared to assess the elderly patient? Mature patients present unique and interesting opportunities to perioperative practitioners. New ways of thinking and different approaches are always necessary.

The British Geriatric Society's "Fit For Frailty" is here: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty

Presented by Desiree Chappell and Monty Mythen with their guest Houman Javedan, MD. Geriatrician at Brigham and Women's Hospital, assistant program director of the HMS Multi-Campus Fellowship in Geriatric Medicine, and Clinical Director for the Division of Aging in the Department of Medicine.

Can delirium, the most frequent complication in an elderly patient, be tackled with multimodal prehabilitation? This piece explains how that challenge is being investigated at the moment. It was originally one of the EBPOM 2019 Free Papers.

A link to the paper is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564537/

Presented by Ties Lukas Janssen, General Surgery Resident at Amphia Ziekenhuis.