TopMedTalk

"Enhanced recovery after bariatric surgery" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 on www.topmedtalk.com

Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings

If you have any comments or questions you'd like to send to the team email: [email protected]

Presented by David Voellinger, Lead Physician, Novant Health Bariatric Solutions Charlotte, Medical Director, Novant Health Bariatric Center, Chief, Department of General Surgery, Novant Health Presbyterian Medical Center.

This piece starts with some words from patients; prehabilitation is "a set of actions that can be taken in advance of treatment to ease your passage through cancer". This vital talk explains how prehabilitation can leave cancer patients feeling personally empowered and ready to live well. Living is one thing, how do we get people to enjoy 'living well'? Further to this how do we do that in such a way that respects patient decisions and life choices? How can we get to a position where exercise, nutrition and psychological support are integral to a cancer diagnosis?

Ideally prehabilitation gets to a point where all patients feel like the ones quoted in this talk; "It's a win win situation [...] do that and you'll be healthier".

Presented by June Davis; June has 22 years of experience working in the NHS as a Dietician, service and professional lead, general manager for a number of service areas within the acute setting and senior project lead for several large scale change projects across London; 10 years experience working as Head of Therapies for large acute Trusts. She is also a Director of Allied Health Solutions, Allied Health Professions Advisor (part time) for Macmillan Cancer Support and a professional advisor to the Care Quality Commission.

This piece gets into the detail regarding one of the big talking points in perioperative medicine over the last year or so; what is the impact of intraoperative hypotension on post operative outcomes?

Further discussion encompases the modern uses of a pulmonary artery catheter.

If you enjoyed hearing Andy Shaw's take on these topics further listening can be found here; https://www.topmedtalk.com/hemodynamic-monitoring-and-the-pulmonary-artery-catheter/

Presented by Desiree Chappell with Monty Mythen, Joff Lacey and their guest Dr Andrew Shaw, Chairman, Department of Anesthesiology and Pain Medicine at The University of Alberta, Edmonton, Alberta and Zone Clinical Department Head for Anesthesia, Alberta Health Services Edmonton Zone. He is also a Fellow of the Royal College of Anaesthetists (UK), the American College of Critical Care Medicine and the Faculty of Intensive Care Medicine (UK).

Should we still measure urine output? How useful is permissive oliguria?

Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh.

This panel discussion reacts to various questions from the online audience and those in attendance.

Questions include; Is there any good evidence for the use of wearable tech in prehabilitation? How come, if the evidence is almost there, prehabilitation is not yet included in every pathway? In this respect, is change just around the corner? How do we have patients are partners rather than passive participants? What are the benefits of prehabilitation which can be seen in two weeks? How does one go about setting up a streamlined preoperative service? What would be the most important outcome for any prehabilitation trial? In a usually sedintary patient, how do we engage them in exercise training and prehabilitation?

Featuring; Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton, Franco Carli Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University, Staff anesthesiologist at the McGill University Health Centre and June Davis; June has 22 years of experience working in the NHS as a Dietitian, service and professional lead, general manager for a number of service areas within the acute setting and senior project lead for several large scale change projects across London; 10 years experience working as Head of Therapies for large acute Trusts. She is also a Director of Allied Health Solutions, Allied Health Professions Advisor (part time) for Macmillan Cancer Support and a professional advisor to the Care Quality Commission.

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 screen patients for anaemia before surgery? Has anaemia fallen off the health care agenda? We begin with a conversation about patients who are anaemic and then turn to why this is sometimes not checked enough. Monty Mythen mentions UK University students appear to suffer from the condition more these days and Lori Heller points out that treating the condition, as part of patient optimisation, is something of a revelation for some, even occasionally removing the need for surgery altogether.

Discussion continues regarding haemoglobin levels and the differentiation between men and women. The importance of discovering the condition early on in the pre-habilitation process is also emphasised. Towards the end of the piece Monty makes some time to speak about the "Iron Woman - Iron Therapy for Female athletes" study instigated by Professor Toby Richards. This piece features Professors Monty Mythen and Mike Grocott with guests Lori Heller, Cardiac Anaestheisologist from US Anaesthesia Partners at the Swedish Medical Center in Seattle, and Mike Scott, Professor in the department of Anesthesiology Virginia Commonwealth University Health System in Richmond USA.

Hear how you can transform your practice through team leadership, courage and a finely tuned awareness of the financial aspects of what you are trying to achieve.

How can growth be tempered to suit the long term vision of a company? Why is teambuilding so crucial to large organisations? Can we determine the direction in which healthcare is evolving overall? Is 'population health in the perioperative space', a widely accepted future direction these days?

Presented by Brian Woods, Anesthesiologist and Vice President at NorthStar Anesthesia.

Why does the complex pain patient need 'perioperative pain medicine' to optimize outcomes of surgery? This piece faces the realities behind a perioperative approach which tries to prevent or manage cases of complex regional pain syndrome (CRPS) during surgery and the postoperative period. Should chronic pain be seen as a nervous system disorder? How do we deal with patients who catastrophise their pain? Should we pledge to use a regional analgesia technique wherever possible? Can atypical opioids provide another way?

Lecture slides: http://www.anzca.edu.au/documents/04-stephan-schug_the-complex-pain-patient.pdf

Presented by Stephan A Schug, Anaesthesiology and Pain Medicine, University of Western Australia and Royal Perth Hospital.

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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

The Hypotension Prediction Index (HPI) Monitor takes 2.6 million features from a single waveform which it then applies to 150 million different wave forms looking for factors which can predict hypotension.

It's the first fully approved foray into predictive analyitics for the world of anaesthesia.

This conversation looks at how it works and how it is being adopted in detail.

Presented by Desiree Chappell with Monty Mythen and Feras Hatib Phd, Director, Research and Development, Algorithms and Signal Processing at Edwards Lifesciences and Dr Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust.