TopMedTalk

This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers now. This piece is part two of two.

This piece gets a mention "End of life decision planning in the perioperative setting: the elephant in the room?" https://academic.oup.com/bja/article/115/5/648/230412?login=true

The Global Council on Brain Health is here on the American Association of Retired People's website: https://www.aarp.org/health/brain-health/global-council-on-brain-health/

This is part one of a two part piece, part two features questions from the online conference audience.

Presented by Monty Mythen with Angela Bader, Professor of Anesthesia at Harvard Medical School and Vice Chair for Perioperative Medicine in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital, founding Director of the Weiner Center for Preoperative Evaluation, Sarah Lenz Lock, Senior Vice President for Policy and Brain Health in the American Association of Retired People's (AARP) Policy, Research and International Affairs (PRI), Executive Director of the Global Council on Brain Health, Jeanna Blitz associate professor of Anesthesiology at Duke University School of Medicine, Director of the Preoperative Anesthesia Surgical Screening (PASS) Clinic. There's also a surprise appearance from the EBPOM Chicago 2020 host, Sol Aronson, tenured Professor at Duke University.

This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers.

This piece gets a mention "End of life decision planning in the perioperative setting: the elephant in the room?" https://academic.oup.com/bja/article/115/5/648/230412?login=true

The Global Council on Brain Health is here on the American Association of Retired People's website: https://www.aarp.org/health/brain-health/global-council-on-brain-health/

This is part one of a two part piece, part two features questions from the online conference audience.

Presented by Monty Mythen with Angela Bader, Professor of Anesthesia at Harvard Medical School and Vice Chair for Perioperative Medicine in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital, founding Director of the Weiner Center for Preoperative Evaluation, Sarah Lenz Lock, Senior Vice President for Policy and Brain Health in the American Association of Retired People's (AARP) Policy, Research and International Affairs (PRI), Executive Director of the Global Council on Brain Health, Jeanna Blitz associate professor of Anesthesiology at Duke University School of Medicine, Director of the Preoperative Anesthesia Surgical Screening (PASS) Clinic. There's also a surprise appearance from the EBPOM Chicago 2020 host, Sol Aronson, tenured Professor at Duke University.

"Cognitive testing has been in the news ... there are recommendations for keeping pets mentally sound by implementing nutritional modifications, regular exercise and mental stimulation, we should certainly think about providing the same support to our geriatric patients."

What does the latest research say about this vital issue? How is frailty defined? What's the clinical impact of preoperative cognitive dysfunction?

Presented by Angela Bader, MD, MPH Professor of Anesthesia at Harvard Medical School and Vice Chair for Perioperative Medicine in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital. She is also the founding director of the Weiner Center for Preoperative Evaluation.

For more on this subject check out this piece here: https://www.topmedtalk.com/poet-3-04-is-paternalism-always-bad/

This talk examines the rationale for using methadone in our surgical patient population, reviews clinical trials that assess the effect of intraoperative methadone on post operative outcomes and discusses some unanswered questions related to the administration of this long acting opioid in the perioperative period.

Presented by Glenn Murphy, Jeffery S. Vender Chair of Anesthesiology Research and Education and Director of Cardiac Anesthesia and Clinical Research at NorthShore University HealthSystem, a hospital affiliated with the University of Chicago Pritzker School of Medicine.

For more on the "opioid sparing opioid" go here: https://www.topmedtalk.com/ebpom-2019-methadone-the-overlooked-opiate-2/

"The main challenge around the variability in the perioperative period is nomenclature, definitions and standardized endpoints. Well designed and well conducted randomized control trials determine effectiveness to an unbiased comparison of outcomes, events, or endpoints between intervention groups".

If data is destiny it is to this that we must look if we want to understand what the future may hold for prehabilitation. This piece takes a pragmatic approach toward the task of ensuring information and datasets are widely applicable, as free from bias as possible and ultimately standardised by consistent definitions and terminology alongside a methodology which produces clear outcomes.

Find out more about the Comet Initiative here: https://www.comet-initiative.org/

Find more about the 'Standardised Endpoints in Perioperative Medicine-Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC) Group' here: https://www.comet-initiative.org/Studies/Details/1317

Presented by Malcolm West NIHR funded Clinical Lecturer in Surgery and Honorary colorectal surgical specialist registrar at the University of Southampton.

"In this session, we're going to talk about the importance of fitness, frailty, function and perioperative medicine."

Fitness, frailty and function are overlapping concepts. In the UK, about quarter of patients will be over the age of 65 by 2034. As patients age they may develop comorbidities. These factors combine to present a unique opportunity for the perioperative physician; fitness increases the chances of a positive outcome, time to ensure every patient is "fit for surgery".

The Making Every Contact Count (MECC) campaign is here: https://www.makingeverycontactcount.co.uk/

Presented by Denny Levett, Professor in Perioperative Medicine and Critical Care at Southampton University Hospital NHS Foundation trust and Honorary Associate Professor at the University of Southampton.

"Perhaps assessing functional performance is something that we've overlooked in medicine"

This piece is about the role of functional assessment and status in perioperative medicine.

The Duke Activity Status Index (DASI) can be found here: https://www.mdcalc.com/duke-activity-status-index-dasi

The Mini Cog assessment is here: http://mini-cog.com/wp-content/uploads/2015/12/Mini-Cog-Form-010816.pdf

The video resources mentioned in the piece are here: https://www.youtube.com/channel/UCvOamR8Sb4RXENr56fvRehA/featured

Presented by Daniel Conway, Consultant in Anaesthesia and Critical Care, Group Lead for Perioperative Medicine, Manchester Royal Infirmary, UK and Chair of the Manchester Perioperative Medicine Society.

"I hope to impress upon you that this is a topic that we can and must do better at ... no malnourished patient should ever have elective surgery without having a nutrition assessment done"

This piece is presented in two parts; this is part 2.

Using perioperative nutrition to optimize our patients outcomes; data shows us that nutrition therapy or nutrition optimization is literally life saving. Anyone who uses evidence as their guide know it has to be part of their practice.

Enhanced Recovery After surgery, sometimes called "fast track surgery" is about ensuring we apply the best information we have to the process. This talk focuses on how and why this ties into a sensible attitude towards nutrition and nutritional assessment.

This talk pulls no punches and yet is powerfully optimistic in its message. We implore TopMedTalk listeners to share it with colleagues.

The entertaining audio clips used in this piece are available, with video and in full here: https://www.youtube.com/watch?v=zHEincgSm1k&t=190s

Our speaker kindly shares his email address for further correspondence and questions: [email protected]

Presented by Paul Wischmeyer, Professor of Anaesthesiology and Surgery at Duke Anesthesiology.

"I hope to impress upon you that this is a topic that we can and must do better at ... no malnourished patient should ever have elective surgery without having a nutrition assessment done"

This piece is presented in two parts; this is part 1.

Using perioperative nutrition to optimize our patients outcomes; data shows us that nutrition therapy or nutrition optimization is literally life saving. Anyone who uses evidence as their guide know it has to be part of their practice.

Enhanced Recovery After surgery, sometimes called "fast track surgery" is about ensuring we apply the best information we have to the process. This talk focuses on how and why this ties into a sensible attitude towards nutrition and nutritional assessment.

This talk pulls no punches and yet is powerfully optimistic in its message. We implore TopMedTalk listeners to share it with colleagues.

The entertaining audio clips used in this piece are available, with video and in full here: https://www.youtube.com/watch?v=zHEincgSm1k&t=190s

Our speaker kindly shares his email address for further correspondence and questions: [email protected]

Presented by Paul Wischmeyer, Professor of Anaesthesiology and Surgery at Duke Anesthesiology.

It's widely understood that high value care during, before and immediately after surgery is optimal whereas poor quality care in the perioperative period produces long term difficulties which are compounded by the acute stresses produced during and immediately after a procedure. This talk covers three main areas; surgical care for patients in Greater Manchester, "ERAS+"; prehabilitation for cancer, for the population of Greater Manchester; how Manchester has supported patients during the time of COVID19.

This piece is mentioned in the introduction and serves as a useful compliment to the talk, "Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester's 'Prehab4cancer'": https://www.ejso.com/article/S0748-7983(20)30438-8/fulltext

Find out more about the work in Greater Manchester here: https://gmcancer.org.uk/our-areas-of-work/prehab4cancer-2/

Also the Perioperative Quality Improvement Programme is here: https://pqip.org.uk/content/home

Presented by Dr. John Moore, Clinical Director for Intensive Care at Manchester Royal Infirmary and Medical Lead for Enhanced Recovery After Surgery.