TopMedTalk

From a UK perspective this piece covers variation in access to critical care, behaviors and decisions regarding its use. With reference to how, over the last 20 years, efforts have been made in Torbay to improve access to critical care we look at what can be done and what works. Finally there's a summary of where we are on this issue today.

Getting it right first time (GIRFT) is here: https://www.gettingitrightfirsttime.co.uk/

Presented by Mike Swart, Consultant in Anaesthesia and Critical Care Medicine at Torbay Hospital and advisor to the UK Department of Health for the Enhanced Recovery Programme.

This piece provides an update on the Perioperative Exercise, Testing and Training Society (POETTS); "established back in 2017, in the context, in the United Kingdom, of cardiopulmonary exercise testing becoming much more common in the preoperative period". Now, more than half of acute hospital trusts in the United Kingdom have a cardiopulmonary exercise testing service to evaluate their patient's functional capacity prior to surgery. Furthermore exercise interventions to optimise a patient's fitness before surgery have seen a sudden and growing interest.

With just over 400 members POETTS exists to help standardize education and training in the field, develop consensus clinical guidelines, look after patients around the time of surgery and help club together acute hospital trusts across the UK, so that they can do collaborative research.

Their website is here: https://www.poetts.co.uk/

Presented by Denny Levett, Professor of Perioperative Medicine at the University of Southampton and President of the Perioperative Exercise, Testing and Training Society (POETTS).

"Obstetric anaesthesia" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM on www.topmedtalk.com

Hear this excellent talk, for free, on this podcast.

If you'd like to attend an event like this ensure your next click is here: https://www.ebpom.org/meetings

If you have any comments or questions you'd like to send to the team email: [email protected]

Presented by Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and Improvement lead for the National Emergency Laparotomy Network (www.NELA.org.uk).

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.

The electronic cigarette market is a $14 billion industry worldwide. As of August 2019, 215 cases of severe pulmonary illness related to e-cigarette use are being investigated in the United States. The known hazards of e-cigarette use are rapidly coming to light with the sudden onset of serious bronchiolitis-related pulmonary disease in otherwise healthy people who were known to use e-cigarettes. Learn also how COVID 19 has increased these dangers.

Presented by Desiree Chappell with Monty Mythen and Bernard Gilligan, III, DNP, CRNA, APRN, Program Assistant Director, Assistant Professor, Cedar Crest College Nurse Anesthesia Program, Allentown, PA.

"In the elective surgical domain 20% of people who are scheduled to have surgery are not ready for surgery"

The road towards economic reality is paved with data; this talk, confidently assertive in tone, provides you with a number of useful facts and reassurances which can be transformed into reasons why you and your patients can enjoy the benefits of prehabilitation; a better value of care and a higher standard of good quality outcomes.

This piece works well in tandem with this debate here: https://www.topmedtalk.com/ebpom-london-2020-the-business-case-for-prehabilitation/

Presented by Sol Aronson, tenured Professor, Duke University, Durham, North Carolina.

What is a "Respect Officer"? Why is respect so important in perioperative care? How does improving 'the culture of safety' also help to improve outcomes? Should we be overly concerned about high cancellation rates for surgery? And what are the advantages of a preoperative risk assessment clinic (PRAC)?

Presented by Desiree Chappell and Monty Mythen with their guest Amir Jaffer, Chief Medical Officer, New York Presbyterian / Queens.

What are the aims of The International Prehabilitation Society? Its vision is about "bringing together international multidisciplinary expertise, across healthcare and beyond, creating a platform of shared learning, research and education for the benefit of patients".

This piece updates you on the current board members, the roles of committee members, conferences that the society has previously supported alongside those being planned for the future. Also there's an update on some exciting new sponsorship news and a brief overview of future plans.

The society's website is here: https://prehabsociety.com/

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

This piece gives you the evidence base required to deliver an even higher standard of perioperative medicine where you work. Hear about the "Fit 4 surgery" studies; the "fit 4 surgery consortium", the ongoing e-studies, key findings, recent studies and the set up in Southampton.

Physical fitness is greatly affected by chemotherapy; poor outcomes are significantly linked to physical fitness; learn how preoperative cardio-pulmonary exercise testing and training can monitor and track this potentially dangerous spiral. Hear how multiple studies are now providing a clear evidence base for this exciting area of perioperative care.

Could more such targeted interventions, alongside shared decision making, provide a real difference to outcomes for your patients and a higher standard of value based care in your institution?

For more on this go here: http://wesfit.org.uk/

Read more about the great work being done by MacMillan Cancer Trust here: https://www.macmillan.org.uk/

The video version of this presentation, along with slides, was presented to the many thousands of people who attended the hugely successful Evidence Based Perioperative Medicine (EBPOM) virtual conference, "Live from London". For more details on this and future conferences please visit www.ebpom.org

Presented by Professor Sandy Jack, PhD, Consultant Clinician Scientist in The Anaesthesia and Critical Care Research Unit at University Hospital Southampton NHS Foundation Trust, Honorary Senior Lecturer at the University of Liverpool, University of Southampton and University College London.

"The people of Wales are particularly unfit", there is a high incidence of smoking, physical inactivity, and alcohol intake. Grim news from one angle but on the other hand it's a huge opportunity to make a massive difference in the prehabilitation stage of the perioperative process. Hear how cancer outcomes are being dramatically improved as a clear pathway of optimisation is rolled out.

Presented by Rachael Barlow, National Lead, Enhanced Recovery, Prehabilitation and Optimisation, at Cardiff and Vale health board, Wales.