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Brain Health: Frailty, Delirium and Post-operative cognitive dysfunction Part 1 | EBPOM USA - Chicago 2020 May 12, 2021

Show notes

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.

Frailty, Brain Health and Perioperative Cognitive Dysfunction | EBPOM USA - Chicago May 11, 2021

Show notes

"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/

Methadone use in Perioperative Medicine | EBPOM USA - Chicago May 10, 2021

Show notes

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 Future of Prehabilitation "Standardisation of definitions and outcomes" | EBPOM 2020 London May 09, 2021

Show notes

"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.

Getting "fit for surgery" | EBPOM 2020 London May 08, 2021

Show notes

"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.

Functional Assesment | EBPOM London 2020 May 07, 2021

Show notes

"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.

Nutrition and metabolism before surgery - PART 2 of 2 | EBPOM London 2020 May 06, 2021

Show notes

"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: paul.wischmeyer@duke.edu

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

Nutrition and metabolism before surgery - PART 1 of 2 | EBPOM London 2020 May 05, 2021

Show notes

"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.

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: paul.wischmeyer@duke.edu

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

Models of Prehabilitation in Greater Manchester | EBPOM 2020 London May 04, 2021

Show notes

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.

Perioperative team: a surgeon's view | EBPOM London 2020 May 03, 2021

Show notes

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.

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