TopMedTalk

This piece gives you information that will empower you when using Warfarin in the perioperative period. How should you sensibly balance bleeding and thrombotic risk? Anti-coagulants are increasing in number, what are the principles behind them which we should learn? An understanding of patient, procedure and type of drug being used is essential, are there other factors that can come into play?

Here is a link to the slides used in this talk: http://www.anzca.edu.au/documents/02-kate-burbury_fast-track-warfarin-reversal.pdf

Presented by Kate Burbury, Associate Professor, Deputy Chief Medical Officer, Peter MacCallum Cancer Centre.

The effectiveness and cost-effectiveness of INSPIRatory musclE training (IMT) for reducing postoperative pulmonary complications (PPC): a sham-controlled randomised controlled trial (RCT) (INSPIRE). This piece is a concise guide to the method and thinking behind the trial.

Presented by Denny Levett, Professor in Perioperative Medicine and Critical Care at the University of Southampton, Consultant in Perioperative Medicine, Southampton University Hospital NHS Foundation trust (UHS), President, Perioperative Exercise Testing and Training Society (POETTS) and biannual chair of the National Perioperative Cardiopulmonary Exercise Testing course, she's also part of the Fit 4 Surgery research group in Southampton, investigating exercise and nutritional optimisation before major surgery and is clinical CI for the multi-centre INSPIRE trial.

A quick surprising poll of perioperative practitioners sets the tone for a robust advocation of the responsibility of surgeons and practitioners to do surgery right; as opposed to being inclined to feeling it must be done "right now!". A data driven approach combined with a patient focused attitude are at the centre of the argument. How do these factors combine to produce a business case which all institutions, practitioners and patients can understand?

In terms of time spent, what do we mean when we say "delay"? How do we overcome a patient's attitudes towards healthcare professionals, if they feel there has already been a delay in 'getting treatment'? How can the pathways from diagnosis to recovery be shortened or made more flexible? Can a case manager help this process? Is eight weeks an acceptable waiting time, can we reasonably expect it to be less than that?

Presented by Gerrit Slooter, MD, PhD, Surgical Oncologist, Maxima Medical Centre, The Netherlands.

The healthcare profession has a mixed history when it comes to messaging around alcohol. Nowadays, from a public health perspective, it is clear that overall it is not helpful for our physiology and well being.

How often do you have alcohol? How many units do you drink? How often do you have a binge? What are the age groups where drinking problems are most apparent? Where is the latest research regarding a perioperative approach to alcohol consumption? How effective is intervention for risky drinkers, should it also be considered for dependent drinkers?

How have studies and evidence been arranged around this topic and where should it lead us? Is there a need for more research?

Presented by Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University, he has recently secured grant funding from the NIAA (RCOA /BJA) to develop prehabilitative training in the elderly surgical patient.

Formed five years ago, the Academic Health Science Networks (AHSNs) in England are driving innovation and speeding up the process of implimenting and discovering improvement in institutions. This piece explains how that occured and what we can all learn from it.

Presented by Natasha Curran, pain medicine University College London Hospital (UCLH) and Medical Director at the Health Innovation Network.

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 Anaesthetists (AANA).

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.

This panel discussion tackles, amongst others, the following questions: How can knowledge and health innovation be moved from the theoretical world and turned into practice? How do we overcome ego in the profession? How do efficient systems improve the experience of staff as well as patients? How can perioperative practitioners truly embed ideas into devolved healthcare systems?

Featuring; Anna Batchellor, Anaesthesia and Intensive Care Medicine (ICM), Newcastle upon Tyne; past President of the Intensive Care Society, past Dean of the Faculty of ICM, past member of Council of the Royal College of Anaesthetists; 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 and Natasha Curran, pain medicine University College London Hospital (UCLH) and Medical Director at the Health Innovation Network.

Should prehabilitation be thought of also as "primary prevention" and used to avoid health problems occuring in the first place? If "exercise is real medicine" how do we change the culture so GPs are comfortable prescribing physical activity to patients? How can we get people to exercise more when the political mood is turning against Government interference and the so-called "nanny state"? What is 'the business case' for prehabilitation?

Co-chaired by Mike Grocott and Stefan van Rooijen and featuring: Graciela Martinez-Palli, Consultant in the Department of Anaesthesia and Perioperative Care at Hospital Clinic, Barcelona; Anna Lowe, Programme manager, National Centre for Sport and Exercise Medicine, Lead Allied Health Physical Activity Clinical Champion at Public Health, England; John Moore, Clinical Head of the Division of Anaesthetics, Peri-operative medicine and Critical Care at Manchester University Hospital NHS Foundation Trust; 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.

What are the results if you apply Enhanced Recovery to obstetrics?

This podcast features Desiree Chappell interviewing Dr Attila Kett, anaesthesiologist and Chairman at St Peter's University Hospital at New Jersey.

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