The Measurement of Exercise Tolerance before Surgery (METS) trial has both raised, and answered, complicated questions. In the immediate wake of EBPOM 2018, this conversation explores some of the deeper issues and big take home moments from the trial. How will it change practice? Will it alter the use of the Duke Activity Status Index (DASI) for example? Cardiopulmonary Exercise Testing (CPET) clearly predicts major complications and is more predictive than the comparators. Why is this not clear in the abstract? Why is there an obsession with major cardiac events when they are rare?

Presented by Monty Mythen and Desiree Chappell with their guest Professor Mike Grocott of Southampton University and a lead investigator in the METS trial and an author of the paper.

What is pain control for a perioperative patient? What is the 'subacute period' and do you incorporate it into your practice? How do we keep patients 'opioid free' once they leave our care? Furthermore - is the curriculum for medical professionals changing in light of the 'opioid epidemic'?

The tide is undoubtedly turning, the conversation covers lots of good news related to a rising awareness of a very serious problem which includes a need to educate the public.

Desiree Chappell and Vicki Morton presenting, with their guests; Professor Padma Gulur, Anaesthesia and Executive Vice-Chair at Duke University and Dr Natasha Curran, pain medicine University College London Hospital (UCLH) and Medical Director at the Health Innovation Network.

Discussion begins with an explanation of 'Trainees with an Interest in Perioperative Medicine' (TRIPOM), a big hit at the conference this year, then a wider discussion follows which includes thoughts regarding further research and application of the perioperative method as well as where it impacts medicine and care. The importance of a multidisciplinary team based approach is strongly emphasised.

The Getting It Right First Time (GIRFT) initiative is also discussed, more on that here:

http://topmedtalk.libsyn.com/iseh-highlight-getting-it-right-first-time-girft

Further discussion of TRIPOM is here:

https://www.topmedtalk.com/ebpom-2018-10-what-is-tripom/

Presented by Desiree Chappell with her guests; Dr Ramani Moonesinghe, Professor of Perioperative Medicine at University College London (UCL) and Anne-Marie Bougeard perioperative medicine fellow at the Royal College of Anaesthetists (RCoA).

What are the benefits of Cardio Pulmonary Exercise Testing (CPET) in cancer patients? What is the evidence that suggests prehabilitation changes outcomes? Furthermore, what is the National Emergency Laparotomy Audit (NELA) and what are its benefits?

Presented by Joff Lacey and Desiree Chappell with their guests; Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and Improvement lead for the National Emergency Laparotomy Network (NELA.org.uk) and Malcolm West, National Institute for Health Research (NIHR) funded clinical lecturer in surgery and honorary colorectal surgical specialist registrar at the University of Southampton, United Kingdom.

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What are the benefits of Cardio Pulmonary Exercise Testing (CPET) in cancer patients? What is the evidence that suggests prehabilitation changes outcomes? Furthermore, what is the National Emergency Laparotomy Audit (NELA) and what are its benefits?

Presented by Joff Lacey and Desiree Chappell with their guests; Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and Improvement lead for the National Emergency Laparotomy Network (NELA.org.uk) and Malcolm West, National Institute for Health Research (NIHR) funded clinical lecturer in surgery and honorary colorectal surgical specialist registrar at the University of Southampton, United Kingdom.

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After 70 years the NHS still continues to promote debate around the world, here you get expert analysis of the deeper realities of a taxpayer funded national health service.

Also - what is "The Brain Health Initiative"? Why is it that so many aspects of brain function are so hard to understand? Why is cognitive dysfunction such a difficult topic to discuss? How far away are we from the days when we will have a biomarker that can help us in this area?

Desiree Chappell presents, with her guests; Dr Lee A. Fleisher Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania and Miles Berger, Neuroanesthesiologist at Duke University Medical Center.

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Trainees with an Interest in Perioperative Medicine (TRIPOM) is an exciting new collaborative designed to enhance and channel the enthusiasm of its members through various free open access online resources. The aim is to help give trainees a voice in the field of perioperative medicine.

Their website is here: www.tripom.org

Joff Lacey presenting, with his guests; John Whittle, assistant Professor at Duke University Medical Centre and one of the founders of TRIPOM and Sam Bampoe, one of the founders of TRPIPOM and a consultant in Anaesthesia and Perioperative Medicine at University College London NHS Foundation Trust.

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Key messages and big takeaways from a hugely successful meeting, The Second Annual Prehabilitation World Congress, held in Eindhoven, The Netherlands. What was the 'dare to dream' section? How is the business case for prehabilitation being made?

Also - listen out for details of the third World Congress and discover how you can get involved.

Mike Grocott presents with his guests; Sandy Jack, MD, PhD, Senior Researcher, Southampton University Hospital, United Kingdom, Gerrit Slooter, MD, PhD, Surgical Oncologist, Maxima Medical Center, The Netherlands and Gerard Danjoux, Prof, MD, PhD, Consultant Anaesthetist, South Tees Hospitals NHS Hospital, United Kingdom.

Join in the debate: [email protected]

Key messages and big takeaways from a hugely successful meeting, The Second Annual Prehabilitation World Congress, held in Eindhoven, The Netherlands. What was the 'dare to dream' section? How is the business case for prehabilitation being made?

Also - listen out for details of the third World Congress and discover how you can get involved.

Mike Grocott presents with his guests; Sandy Jack, MD, PhD, Senior Researcher, Southampton University Hospital, United Kingdom, Gerrit Slooter, MD, PhD, Surgical Oncologist, Maxima Medical Center, The Netherlands and Gerard Danjoux, Prof, MD, PhD, Consultant Anaesthetist, South Tees Hospitals NHS Hospital, United Kingdom.

Join in the debate: [email protected]

What's the relationship between Enhanced Recovery after Surgery (ERAS) and Prehabilitation? How are randomised trials showing outcome data in a positive way?

Furthermore, according to some of the keynote speakers, what were the highlights and big headlines at this important gathering?

Mike Grocott presents with his guests Olle Ljungqvist, Prof. of Surgery, MD, PhD, Surgeon, Örebro University Hospital & Karolinska Institutet, Sweden and Franco Carli, Prof. MD, PhD, Anesthesiologist, McGill University, Canada.

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