TopMedTalk

"As Anaesthetists the ultimate goal of almost all of our interventions and monitoring is to support cell energy production to provide mitochondria with the oxygen and the fuel they need to produce enough adenosine triphosphate (ATP) to power cell function and integrity".

How human cells produce energy, how this changes in response to stress and how this may influence survival; this piece focuses what we know about how our bodies get the fuel they need to survive surgery and thrive as a result, providing a positive long term outcome. This is not a piece about nutrition, it's a provocative session exploring concepts designed to provide food for thought.

Presented by Helen McKenna, is in the final year of her PhD at University College London, investigating bioenergetic and redox function in critically ill patients.

This piece covers the PREP-WELL project which is a community based prehabilitation program in South Tees, in the North of England:

"We established the following guiding principles; we wanted to provide patient centered care under one roof with facilitated self management; we wanted to work as a cross sector collaborative, by that I mean primary care, secondary care and public health; all working together to try and improve on the fragmented service provision and sign work that we often see in our health care services; we wanted to provide a community based facility for patients; and I'll come to the reasons for this".

See the PREP-WELL team here: https://www.southtees.nhs.uk/services/prepwell-project/meet-the-prepwell-team/

The links mentioned in the talk are here:

Home exercises: https://www.southtees.nhs.uk/services/prepwell-project/home-exercises/

Nutrition: https://www.southtees.nhs.uk/services/prepwell-project/nutrition/

Pdf download: https://bmjopenquality.bmj.com/content/bmjqir/9/1/e000898.full.pdf

We've been following the groundbreaking success of the PREP-WELL project for some time now here on TopMedTalk, why not check out this piece here, the first part in our most recent "P.O.E.T - Perioperative Enhancement Teams" series; https://www.topmedtalk.com/poet-2-01-the-uks-prepwell-initiative/

This piece was originally part of EBPOM 2020 - Live from London, our groundbreaking virtual conference; find out more about Evidence Based Perioperative Medicine (EBPOM) here: www.ebpom.org

Presented by Gerard Danjoux, consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust.

"We have to create the culture of learning; the culture of having a safe space, the culture of wanting to do better and learning those conditions in which we do do better"

This powerful talk looks directly at how a clear approach to patient safety really can improve the standard of care where you work. What is the culture of quality and safety that you're trying to embed, can you actually do better? Learn why it's important to focus on psychological safety; "if people start being scared, everyone gets scared then it expands".

Learn how an evidence based approach can allow us to tackle these issues rather than shy away from them; "what factors are maintaining safety? How do we get to good outcomes? What are the things working well? How do we understand human variation?".

Presented by Lee Fleisher, Emeritus Professor of Anesthesiology and Critical Care, University of Pennsylvania.

Pain is a subjective experience that affects all segments of the population. However, there are inter-individual differences in pain. The biopsychosocial model proposes that the intersection of biological, psychological, and social factors create a pain experience and pain outcomes that differ by sex, race, and socioeconomic status.

"The minority stress theory ... the idea that for racial minorities, especially blacks, they are exposed to chronic stress; the stress of daily racism"

Could epigenetics hold the key to understanding how social factors compound differences between patients? How does this impact on you and your practice?

Further reading is to be found here: https://pubmed.ncbi.nlm.nih.gov/19411059/

https://pubmed.ncbi.nlm.nih.gov/32487870/

https://pubmed.ncbi.nlm.nih.gov/30863142/

Presented by Desiree Chappell and Monty Mythen with Edwin N. Aroke, Ph.D., CRNA, Assistant Professor, Associate Scientist, Minority Health and Health Disparities Research Center, Associate Scientist, Comprehensive Arthritis, Musculoskeletal, Bone, & Autoimmunity Center, The University of Alabama, Birmingham, US.

This piece was recorded at the start of the year, to celebrate the launch of Tom Woodcock's book Fluid Physiology, A Handbook for Anaesthesia and Critical Care Practice: https://books.google.co.uk/books?id=F-m4DwAAQBAJ&printsec=copyright&redir_esc=y#v=onepage&q&f=false

The editorial team here at TopMedTalk recently (08/12/2020) reflected upon the fact that Tom's 'big areas to watch in 2020' have proven to be remarkably prescient.

The 13 Minutes To The Moon podcast is here: https://www.bbc.co.uk/programmes/w3csz4dn

Presented by Monty Mythen with Desiree Chappell and their guest Tom Woodcock, author and independent consultant in patient safety, medical law and ethics.

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 looks at some of the advantages to having a perioperative interdisciplinary team reducing complications, understanding and discussing risk, facilitating better shared decision making and increased patient satisfaction, even among those who - as part of this process - decide not to go ahead with an operation.

It also incorporates evidence regarding what we know about COVID-19; "The risks ... of the COVID-19 virus is that if people contract it during or after their surgery, they have a much worse result with perhaps 51% pulmonary complications or 24% mortality".

The World Health Organisation report mentioned in this piece, "Smoking greatly increases risk of complications after surgery", is here: https://www.who.int/news/item/20-01-2020-smoking-greatly-increases-risk-of-complications-after-surgery

The Montgomery ruling is covered on a previous TopMedTalk in more detail in "Sunday Special | Being on the right side of the law" here: https://www.topmedtalk.com/sunday-special-being-on-the-right-side-of-the-law-2/

The Centre for Perioperative Care website is an excellent resource, here is the section specifically for your patients: https://www.cpoc.org.uk/patients

The Royal College of Surgeons is here: https://www.rcseng.ac.uk/

Our presenter has a website dedicated to her work here: http://www.scarlettmcnally.co.uk/

And she maintains a twitter feed - focused on medical issues - here: https://twitter.com/scarlettmcnally

Presented by Scarlett McNally, Deputy Director of The Centre for Perioperative Care (CPOC) consultant Orthopaedic Surgeon, Eastbourne DGH, UK.

"We did not have a concensus view on the very basic subject of fluid physiology and I needed to write a book".

Recorded at the start of the year this piece builds on our previous look at Fluid Physiology, which you can find here: https://www.topmedtalk.com/topmedtalk-tom-woodcock/

We also make reference to the book "Fluid Physiology" which is available now, check out the website here: http://fluidphysiology.org/

Tom's always entertaining twitter feed is here: https://twitter.com/thomaswoodcock

Presented by Monty Mythen and Desiree Chappell with their guests Sol Aronson a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and Tom Woodcock author and independent consultant in patient safety, medical law and ethics.

Like this, want more? Tom Woodcock appears frequently on TopMedTalk: https://www.topmedtalk.com/?s=tom+woodcock

"We, who physically will be elsewhere in the world, for example, in London and in Southampton, are going to - within what we're allowed to do - get together in a bubble probably at work, and set aside the time to watch the meeting together, and to share some food and maybe share some diet coke and talk about what we've been looking at what we've been learning. So that's the start of the hybrid events - and we hope that by the time we get to the World Congress of Perioperative Care, which used to be known as the London meeting, we are going to have 10's if not hundreds, if not 1000's of hybrid venues around the world..."

Listen to the end to find out more about the ambitious plans for COVID conscious "hybrid meetings" in 2021. Email us if you think you can help arrange a hybrid zone breakout space: [email protected]

Recollections regarding Evidence Based Perioperative Medicine's (EBPOM) Chicago virtual meeting begin the piece, as the TopMedTalk team look back over the final part of the year.

The Toby Richards piece mentioned is here: https://www.topmedtalk.com/topmedtalk-iron-man-vs-anemia/

The entertaining discussion between Angela Bader and Gina Blitz will be available in a forthcoming episode of TopMedTalk. It has been heard already by EBPOM Chicago attendees under the title: "Brain Health: Frailty, Delirium, POCD". This talk will be available for free in full on TopMedTalk in the future.

For more details of the next EBPOM 'hybrid' meeting please visit www.ebpom.org

The music of Jeremy Sassoon - part of the EBPOM Chicago entertainment offering - is available to enjoy here: https://www.youtube.com/watch?v=D_baYCXTdY8

The Dingle lectures will also form part of TopMedTalk's programming next year, make sure you hit the subscribe button on whichever platform you receive us on.

Presented by Desiree Chappell and Monty Mythen with TopMedTalk producer Nick Margerrison.

The team enjoy reflecting on 2020 as we appreciate the fact that there were the green shoots of hope during the middle part of the year.

The patient facing Macmillan Cancer Care podcasts are here: https://www.topmedtalk.com/?s=topmedtalk+%26+macmillan

The POCAPALOOZA is here: https://www.topmedtalk.com/?s=pocapalooza

Find out more about the African Surgical Outcomes Study (ASOS) and the African Perioperative Research Group (APORG) here: https://www.topmedtalk.com/pocapalooza-cape-town/

Guy Ludbrook's interview and talk will be available on TopMedTalk in the new year.

Our friend and collaborator Jeremy Sassoon is here: https://www.facebook.com/watch/jeremysassoon/

The highlighted piece from the American Association of Nurse Anesthetists is here: https://www.topmedtalk.com/aana-e-cigarettes-and-their-impact-on-patients-undergoing-anesthesia-2/

Presented by Monty Mythen and Desiree Chappell with producer Nick Margerrison.

Happy Holidays and - if you celebrate it - Merry Christmas from everyone here at TopMedTalk!