TopMedTalk

This piece considers the need to understand the patient having surgery and the complexity with which they present so we can match our skills to them. Developing these skills requires new approaches; to education and training at undergraduate and postgraduate level; to challenge the old ways of delivering perioperative care. This requires new ways of working, the breaking down of silos, a rethink of the financial support that is required and that we share good practice rather than 'reinventing the wheel'. It also means ensuring that we continue to gain evidence from the real world of clinical medicine, whether that's through original research or through employing quality improvement and implementation science.

More on Proactive care for Older People undergoing Surgery (POPS) here: https://www.guysandstthomas.nhs.uk/our-services/ageing-and-health/specialties/pops/overview.aspx

If you enjoy this piece you'll love our series here: "POPS Part 1| TopMed talk at Guy's and St Thomas's Hospital in Central London" - https://www.topmedtalk.com/pops-part-1-topmed-talk-at-guys-and-st-thomass-hospital-in-central-london/

Presented by Jugdeep Dhesi, Clinical Lead for "Proactive care for Older People undergoing Surgery" (POPS) and Consultant Geriatrician, Guys and St Thomas' NHS Trust.

This piece is the second part of a conversation about leadership in medicine, during times of change. It follows on from the first part where our speaker outlines his thoughts in a short talk. Now questions from the audience are considered and the conversation develops. What have we learned after the recent huge changes we've seen in our profession?

Presented by Desiree Chappell and Monty Mythen with Jeff Vender, Emeritus, Harris Family Foundation Chairman of the Department of Anesthesiology at NorthShore University Health System, Evanston, Illinois and Clinical Professor at the University Of Chicago Pritzker School Of Medicine in Chicago, Illinois.

"I believe most people can be leaders or better leaders. You can create or participate in change and a better future. You can make a difference in your own lives, the lives of others and the life of your organization. If you believe you can."

This piece contains a powerful, inspirational and prescient talk about leadership. Part 1 contains some conversation and the talk, to be followed by questions from the audience in Part 2. Where do leaders come from, what makes them stand out and how do they learn the skills necessary to take what they do to the next level?

Presented by Desiree Chappell and Monty Mythen with Jeff Vender, Emeritus, Harris Family Foundation Chairman of the Department of Anesthesiology at NorthShore University Health System, Evanston, Illinois and Clinical Professor at the University Of Chicago Pritzker School Of Medicine in Chicago, Illinois.

This piece presents an invaluable wealth of first hand experience in setting up various business cases in relation to perioperative medicine in the UK. At University College London (UCL) cardiopulmonary exercise testing (CPET) was set up as a research tool "but then clinicians came, became interested in the results of the tests and started to ask for tests to be done on their patients for clinical evaluation".

An external contractor model, using a charitable organisation, enabled them to charge the NHS for these tests; as the service expanded they were able to expand to other clinical sites connected with UCL, published early data on outcomes and obtained grant funding to look at a robust evaluation model.

Hear how this model was refined and the idea has evolved during its growth within the UK's National Health Service (NHS). Also, consider what other models could apply this thought process; learn how new perioperative care pathways offer interesting opportunities in these areas.

This piece is further enhanced by the discussion we released recently on the same topic: https://www.topmedtalk.com/ebpom-london-2020-the-business-case-for-prehabilitation/

Presented by Kay Mitchell, Senior Research Manager for Critical Care Research, NIHR Biomedical Research Center, University Hospital, Southampton, UK.

"Just having more staff doesn't always equate to better care, especially when the staff do not have the skills required."

Perioperative medicine has the opportunity to lead the way in advanced practice; the extended role of the practitioner within the perioperative pathway can be done with nurses, allied health professionals or physician associates. As we evolve these roles, we must be mindful and recognise not all services will be the same.

How can you tailor your service to your specific needs? How do you construct a business case which provides a better quality of value based care within your institution? Could this help by giving the practitioner role focus and allowing you to measure their effectiveness?

For more information about Guy's and St Thomas's practice we suggest you look at their website, an excellent information resource, here: https://www.guysandstthomas.nhs.uk/our-services/ageing-and-health/specialties/pops/overview.aspx

Presented by Jason Cross, Advanced Nurse Practitioner, Department of Aging and Health, Guy's and St Thomas's, London.

"46% pretty much means every other patient who was getting IV opioids was having some sort of a respiratory depression event"

After a quick round up of COVID news in the contributor's respective areas this piece gets involved in a much needed discussion about the "PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY)" trial.

PRODIGY trial is here:

https://clinicaltrials.gov/ct2/show/NCT02811302

Presented by Desiree Chappell and Monty Mythen with Mike Grocott, and their guests Ashish Khanna, Associate Professor, Section Head for Research, Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine and Roop Kaw, Associate Professor of Medicine at Cleveland Clinic, Founder Member of The Society of Anesthesia and Sleep Medicine.

As mentioned TopMedTalk have been eagerly following the development of this research, you might also enjoy this piece we did here: https://www.topmedtalk.com/ebpom-2020-london-prediction-of-opioid-induced-respiratory-depression-on-the-general-care-floor-does-surveillance-monitoring-help/

More discussion regarding risk factors for opioid-induced respiratory depression in surgical patients here: https://www.topmedtalk.com/topmedtalks-to-paul-grant-2/

Armed with a background in biomedical engineering, doubled with an EMBA in Finance, our guest has spent the past 20 years within the medical device industry. In 2010 he was instrumental in setting up MDoloris Medical Systems, with the mission to provide technologies that allow clinicians a reliable, continuous and non-invasive evaluation of autonomic nervous system (ANS) activity. Based on 23 years of academic research, performed by a French research lab, the technology allows anaesthetists and intensivists to effectively tailor analgesia; more so for patients who are unable to communicate.

The technology is available for adults, paediatrics, neonates as well as animals (specifically horses, cats and dogs), in both standalone and more recently modular format.

Presented by Desiree Chappell and Monty Mythen with their guest Fabian Pagniez, CEO and founder of MDoloris Medical Systems.

For more details on EBPOM please visit www.ebpom.org

Also, if you enjoyed this piece we cover nociception in more detail here: https://www.topmedtalk.com/topmedtalks-to-dan-longrois-on-nociception/

This piece looks at the most recent guidance regarding prehabilitation for cancer, developed and published in 2009 by Macmillan Cancer Care. Extremely well received across the UK, and internationally, here we look at the details and some context in terms of UK national policy.

From an NHS England point of view the desire is to ensure that all patients and participants have personalized care embedded into everyday NHS services. Work around streamlining multidisciplinary team meetings for cancer include the opportunity to discuss the needs of people with cancer and the importance of preparing people in advance and during treatment. Furthermore you will hear elements of the principles of rehabilitation, as well as the importance of earlier and faster diagnosis, the importance of perioperative medicine and prehabilitation before surgery.

Further reading here "Principles and guidance for prehabilitation": https://www.macmillan.org.uk/about-us/health-professionals/resources/practical-tools-for-professionals/prehabilitation.html

Originally part of the hugely successful EBPOM Live from London 2020 conference this piece is nicely complimented by the panel discussion which TopMedTalk has also released free of charge here: https://www.topmedtalk.com/ebpom-london-2020-prehabilitation-update/

Presented by June Davis, Director of Allied Health Solutions, Allied Health Professions Advisor (part time) for Macmillan Cancer Support and a professional advisor to the Care Quality Commission.

"Oxygen is the commonest drug that we give to our patients today during surgery and the general anaesthetic" but what do we really know and understand about it from a perioperative perspective?

This talk illustrates why, even with some of the evidence and background physiology that we have at our fingertips today, the following questions are still perplexing: How much is too little oxygen? How much is too much oxygen? And how much is just the right amount of oxygen?

Presented by Daniel Martin, OBE, Professor of Perioperative and Intensive Care Medicine, University of Plymouth and the Royal Free Hospital, London.

This piece is a listener generated question and answer session from EBPOM 2020. Although it works as a stand alone piece it relates directly to this talk here: https://www.topmedtalk.com/ebpom-2020-london-prediction-of-opioid-induced-respiratory-depression-on-the-general-care-floor-does-surveillance-monitoring-help/

Some of the questions considered include: How much do you think partial / inadequate neuromuscular blockade reversal, contributes to post pulmonary complications, perhaps in combination with opioids? Why as a group would we prefer to save money by avoiding sugammadex to reverse rocuronium to ensure complete reversal? Lack of reversal more than an issue? If you did a pre op sleep study on these patients, would you not find similar frequencies of desaturation? Is it just monitoring sleep? Should all wards have the capability for continuous monitoring?

Presented by Monty Mythen and Desiree Chappell with their guests, Ashish Khanna, Associate Professor, Section Head for Research, Department of Anesthesiology, Section on Critical Care Medicine,Wake Forest School of Medicine, Frank Overdyk, Professor of Anaesthesiology, Charleston, South Carolina, Leif Saager, Executive Vice Chair of the Department of anesthesiology in Germany at the University of Nottingham.

There's more from Frank Overdyk here: https://www.topmedtalk.com/11813-2/