TopMedTalk

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.

Pediatric patients can present quite a challenge when emerging from anesthesia. Here we discuss ways to "ACE" your transition to PACU! "A"void Emergence Agitation, and discover the latest evidence about "C"riteria for "E"xtubation in this challenging population. How do the protocols and standard of care compare between the UK and US. What does the evidence tell us? Also, how is Enhanced Recovery After Surgery progressing in pediatrics?

Presented by Desiree Chappell and Monty Mythen with their guest Kristin Henderson, DNAP, CRNA, CHSE, CPT, USAR Assistant Professor, Wake Forest School of Medicine, Nurse Anesthesia Program.

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.

What do we mean by "nutritionally fit" and why does it matter? How do we identify those most at risk in terms of screening and assessment and what's the difference between these two processes? How can we use screening and assessment to triage patients into care? Also, in the time of COVID19, are there ways we can perform some tasks related to these processes remotely?

Presented by Steve Wooton, Senior Lecturer in Human Nutrition within Medicine at the University of Southampton.

"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.

How important is it to screen patients and measure their fitness prior to surgery? What is exercise training in the preoperative period?

There is a very clear relationship between physical fitness and mortality. Importantly, when we think of prehabilitation, or exercise training, it's good to remember that you get the greatest benefit in the most unfit patients, in terms of mortality reductions. The "pandemic ... of physical inactivity worldwide" is believed to cause more than 5 million deaths annually. The advantage of fitness in terms of predicting perioperative outcomes is it is an important modifiable risk factor before major surgery; we can modify health behaviors and exercise and we can sometimes optimize comorbidities before surgery. Exercise is real medicine!

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 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.

This wide ranging talk asks where and how we should focus on the needs of postoperative care patients. "Brain care has an impact way beyond the acute surgical episode"; how do we minimise the risks of a poor outcome when it comes to postoperative care?

"Advanced recovery from anaesthesia and surgery" is a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: "Updates in Perioperative Medicine 360" which took place between November 7th-9th 2019.

Presented by Professor Jacqueline Close, Principal Research Fellow, NeuRA Conjoint Professor, UNSW Consultant Geriatrician, Prince of Wales Hospital.

This piece has been released to coincide with the first virtual International Fluid Academy Day (IFAD). TopMedTalk listeners have enjoyed following the meeting annually for some time now; we're equally as excited about their online proposition. Find out more here: https://www.fluidacademy.org/

This piece digs deep into the realities of coping with COVID 19 patients who have had their care escalated to the Intensive Care Unit (ICU); "we don't seem to be looking at our typical sepsis patients who get multiple organ failure in the classical way" and "you're surprised at how young some of the patients are...".

Our guest provides us further insight; a 'household name' in the haemodynamic monitoring space; he is treating patients in a medium sized hospital (500 beds) with mostly COVID patients in Spain. How are things going there, how does it compare to Italy? How are the patients being dealt with, what can we learn about the basics here, airway, breathing, ventilation (ABC)?

There is also a gripping discussion regarding dynamic arterial elastance. If you'd like to know more about that do check out our discussion here: https://www.topmedtalk.com/periop-coach-2-09-haemodynamic-monitoring/

The webinar mentioned in this piece can be found here: https://www.esicm.org/education/webinars/

Presented by Desiree Chappell and Monty Mythen with their guest Dr. Manuel Ignacio Monge García who works in an ICU in the South of Spain.

This piece has been released to coincide with the first virtual International Fluid Academy Day (IFAD). TopMedTalk listeners have enjoyed following the meeting annually for some time now; we're equally as excited about their online proposition. Find out more here: https://www.fluidacademy.org/

The Perioperative Quality Initiative (POQI) is a vital part of the process needed to more widely implement sensible practice which, using a clear evidence base, provides better value care with more positive outcomes for the patient. POQI continues to provide its work in an attempt to clarify fundamental concepts in perioperative care. The fact this one focuses upon fluid management makes it particularly appropriate.

Link to the paper: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00142-8

Presented by Desiree Chappell with Monty Mythen and their guests Tim Miller, Professor of Anesthesiology from Duke University Medical Centre and Greg Martin Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine

Like this, want more?

Try our popular in depth series "Fluid Matters" http://topmedtalk.libsyn.com/fluid-matters-1

TopMedTalk provides world leading information about perioperative medicine like this every day. Dr Greg Martin's deeper dive into these issues is here: http://topmedtalk.libsyn.com/fluid-matters-3

This piece has been released to coincide with the first virtual International Fluid Academy Day (IFAD). TopMedTalk listeners have enjoyed following the meeting annually for some time now; we're equally as excited about their online proposition.

This piece is a chance to hear a now famous discussion which TopMedTalk recorded at the Peroperative Quality Initiative (POQI) at Washington Duke University in Durham. The discussion is predominately about total body water, electrolytes and the movement of fluid around the body; the idea of circulation of interstitial fluid; the Starling Curve and lymphatics; sodium balance and, at the end, there's a moment when the speakers agree to disagree about whether saline is "abnormal" or not.

If you would like to find out more about IFAD go here: https://www.fluidacademy.org/

Presented by Monty Mythen and Henry Howe with their guests Tom Woodcock, an independent consultant in patient safety, medical law and ethics, and Manu Malbrain, Professor at Faculty of Medicine and Pharmacology Vrije University in Brussells.