TopMedTalk

This piece focuses on the latest print issue of 'Anesthesia and Analgesia' which is saturated with coverage of the Perioperative Quality Initiative (POQI), the most recent meeting of which was sponsored by the American Society of Enhanced Recovery (ASER).

This conversation acts as an update on where some of the latest thinking is as regards perioperative medicine. It includes a deep dive into gastrointestinal tract dysfunction and allows you to find out the best "whey" to an enhanced recovery alongside information about nutrition screening.

There's also a look at the perioperative medicine calendar, with details on how you can meet Monty and the team at one of the many events we're covering over the next few months.

Monty Mythen is interviewing Dr Tim Miller from Duke University Medical Centre.

Send us your thoughts: contact@topmedtalk

Web links:

- The ASER open source articles mentioned in the piece can be found on the POQI website.

- Also in this piece there is news about, The Morpheus Consortium, there's more information here: http://morpheusconsortium.org

- And finally, the website Dr Tim Miller mentions, is here: https://anesthesiology.duke.edu

 

Most people are familiar with ultrasound these days, next to the stethoscope and thanks largely to baby photographs, it's one of the most frequent public facing technologies in medicine.

New developments in transesophageal echocardiography have brought about huge advancements in its use as a technology; not to mention the incredible images now available from three dimensional echocardiography. As ultrasound becomes more available and more portable this conversation gives you an idea of where, when, why and how you can use this incredible tool. Is it really a piece of bedside assessment equipment which is about to become as ubiquitous as a doctor's thermometer?

It's difficult not to get excited about the ability to take a quick look at a patient's cardiac function, at the bedside, with a handheld piece of kit. Scanning a patient's abdomen, seeing how to apply appropriate measures of care rapidly on the spot, these are just some of the advantages discussed in this piece.

See more here:

Acute Care and Perioperative Ultrasound Workshop Co-sponsored by the Departments of Anesthesiology at Loma Linda and UCLA Medical Centers.

www.pocuseducation.com

Evidence-Based Perioperative Ultrasound Educational Curriculum (created as a free, open-source, platform for point of care ultrasound education)

www.foresightultrasound.com

Professor Monty Mythen is presenting, with his guest, Davinder Ramsingh MD, Director of Research and Perioperative Ultrasound at Loma Linda University Medical Center - Dept. of Anesthesiology.

Most people are familiar with ultrasound these days, next to the stethoscope and thanks largely to baby photographs, it's one of the most frequent public facing technologies in medicine.

New developments in transesophageal echocardiography have brought about huge advancements in its use as a technology; not to mention the incredible images now available from three dimensional echocardiography. As ultrasound becomes more available and more portable this conversation gives you an idea of where, when, why and how you can use this incredible tool. Is it really a piece of bedside assessment equipment which is about to become as ubiquitous as a doctor's thermometer?

It's difficult not to get excited about the ability to take a quick look at a patient's cardiac function, at the bedside, with a handheld piece of kit. Scanning a patient's abdomen, seeing how to apply appropriate measures of care rapidly on the spot, these are just some of the advantages discussed in this piece.

See more here:

Acute Care and Perioperative Ultrasound Workshop Co-sponsored by the Departments of Anesthesiology at Loma Linda and UCLA Medical Centers.

www.pocuseducation.com

Evidence-Based Perioperative Ultrasound Educational Curriculum (created as a free, open-source, platform for point of care ultrasound education)

www.foresightultrasound.com

Professor Monty Mythen is presenting, with his guest, Davinder Ramsingh MD, Director of Research and Perioperative Ultrasound at Loma Linda University Medical Center - Dept. of Anesthesiology.

What is TopMedTalk and how did it come about? Why is perioperative medicine such an inspiration to us? Why is our Editor in Chief such an advocate? What is the opioid crisis?

Broadcaster Nick Margerrison speaks with our Editor in Chief about TopMedTalk and perioperative medicine.

We regularly enjoy reading your feedback: [email protected]

What is TopMedTalk and how did it come about? Why is perioperative medicine such an inspiration to us? Why is our Editor in Chief such an advocate? What is the opioid crisis?

Broadcaster Nick Margerrison speaks with our Editor in Chief about TopMedTalk and perioperative medicine.

We regularly enjoy reading your feedback: [email protected]

The GIRFT (Getting It Right First Time) project. The stated aim is 'to help improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes'. This piece gives you the detail from one of the joint clinical leads. This piece is taken from a longer piece to be found here: https://www.topmedtalk.com/rcoa-13-the-girft-getting-it-right-first-time-project/ Also, if you'd like to hear more about The GIRFT (Getting It Right First Time) project, there's another podcast where we speak about it here: https://www.topmedtalk.com/live-from-the-iseh-part-2/ Presented by Monty Mythen, Joff Lacey and Desiree Chappell with their guest Dr Michael Swart, Consultant in Anaesthesia and Critical Care Medicine at Torbay Hospital and advisor to the UK Department of Health for the Enhanced Recovery Programme.

The GIRFT (Getting It Right First Time) project. The stated aim is 'to help improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes'. This piece gives you the detail from one of the joint clinical leads.   This piece is taken from a longer piece to be found here: https://www.topmedtalk.com/rcoa-13-the-girft-getting-it-right-first-time-project/   Also, if you'd like to hear more about The GIRFT (Getting It Right First Time) project, there's another podcast where we speak about it here: https://www.topmedtalk.com/live-from-the-iseh-part-2/   Presented by Monty Mythen, Joff Lacey and Desiree Chappell with their guest Dr Michael Swart, Consultant in Anaesthesia and Critical Care Medicine at Torbay Hospital and advisor to the UK Department of Health for the Enhanced Recovery Programme.

A Randomized Trial of a Family-Support Intervention in Intensive Care Units

Douglas B. White et al. for the PARTNER Investigators

Surrogate decision makers (e.g. family and friends) for incapacitated, critically ill patients can understandably find it very difficult to make decisions related to goals of care.

Having to make such decisions can cause them psychological distress and may lead to treatment that is not exactly what the patient might have chosen if they could speak for themselves.

In this trial the investigators conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates (folks speaking for them) in five intensive care units (ICUs).

They compared what they term "a multicomponent family-support intervention delivered by the interprofessional ICU team" with usual care.

A total of 1420 patients were enrolled in the trial.

Results

The family-support intervention delivered by the interprofessional ICU team did not significantly reduce the burden of psychological symptoms for the surrogates.

However their ratings of the quality of communication and the patient- and family - centered care were better. Furthermore - the length of stay in the intensive care unit was shorter.

Compelling, in favour of this team approach, but the authors suggest we shouldn't 'dive straight in'; rather that a large replication trial may be conducted, in multiple geographic regions, to establish the findings further.

Thus recognising different health systems have potentially different attitudes and practices regarding care for patients with advanced critical illness.

We will be delving into this excellent paper at greater length in an upcoming journal club.

Link to paper:

The New England Journal of Medicine:

https://www.nejm.org/doi/full/10.1056/NEJMoa1802637

Link to the accompanying editorial by Daniela Lamas, Nurse-Led Communication in the Intensive Care Unit:

https://www.nejm.org/doi/full/10.1056/NEJMe1804576

A Randomized Trial of a Family-Support Intervention in Intensive Care Units

Douglas B. White et al. for the PARTNER Investigators

Surrogate decision makers (e.g. family and friends) for incapacitated, critically ill patients can understandably find it very difficult to make decisions related to goals of care.

Having to make such decisions can cause them psychological distress and may lead to treatment that is not exactly what the patient might have chosen if they could speak for themselves.

In this trial the investigators conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates (folks speaking for them) in five intensive care units (ICUs).

They compared what they term “a multicomponent family-support intervention delivered by the interprofessional ICU team” with usual care.

A total of 1420 patients were enrolled in the trial.

Results

The family-support intervention delivered by the interprofessional ICU team did not significantly reduce the burden of psychological symptoms for the surrogates.

However their ratings of the quality of communication and the patient- and family - centered care were better. Furthermore - the length of stay in the intensive care unit was shorter.

Compelling, in favour of this team approach, but the authors suggest we shouldn’t 'dive straight in'; rather that a large replication trial may be conducted, in multiple geographic regions, to establish the findings further.

Thus recognising different health systems have potentially different attitudes and practices regarding care for patients with advanced critical illness.

We will be delving into this excellent paper at greater length in an upcoming journal club.

Link to paper:

The New England Journal of Medicine:

https://www.nejm.org/doi/full/10.1056/NEJMoa1802637

Link to the accompanying editorial by Daniela Lamas, Nurse-Led Communication in the Intensive Care Unit:

https://www.nejm.org/doi/full/10.1056/NEJMe1804576

Geriatricians naturally fit into the perioperative sphere. Shared decision making is an obvious aspect of this, as is preoperative assessment and the consideration of the risks and benefits of surgery.

Also in this piece; when do you become geriatric?

This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/rcoa-06-geriatric-care-and-the-value-of-teamwork/

Desiree Chappell and Monty Mythen interview their guest Dr Jugdeep Dhesi, Clinical Lead, POPS and Consultant Geriatrician, Guys and St Thomas' NHS Trust.

Join in the debate: [email protected]