EBPOM 2020 London | The Future of Prehabilitation “Standardisation of definitions and outcomes”
“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.
EBPOM London 2020 | The Business Case for Prehabilitation
“It was successful early on within the National Health Service.. [because] you could eliminate the cost of some unhelpful, unnecessary tests… referrals to other “-ologists”… in our system that works, because more work is just more work. It’s not more money.” Is the business case for prehabilitation a “slam dunk”, as some enthusiasts claim? If so how do you measure value versus volume, is value always a subjective term and can the balance between the two be addressed? How does the NHS’s “internal market” compare to the US’s fee for service environment? Furthermore, where are the sensible limits of prehabilitation, how far do we take it before we move forward to an operation? This piece has been available to EBPOM London attendees since it was first recorded in the earlier part of the year. For exclusive access to other similar pieces now and in the future please visit www.ebpom.org Presented by Monty Mythen and Kay Mitchell, Senior Research Manager for critical care research, NIHR Biomedical Research Centre, University Hospital Southampton, UK, with their guests, David Selwyn, Deputy Medical Director at Nottingham University Hospitals NHS Trust and Director of The Centre for Perioperative Care (CPOC), Sol Aronson, tenured Professor, Duke University and 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
EBPOM 2019 | Delivery of Prehabilitation, panel discussion
How do we convince patients that prehabilitation is safe? What forms of certification are available for the accreditation of a balanced multidisciplinary team? How do you monitor home based patients? How do we tap into the wider ‘exercise industry’ on behalf of perioperative prehabilitation? Panel discussion, featuring; Daniel Santa Mina, Assistant Professor at University of Toronto & Scientist in ELLICSR at the Princess Margaret Cancer Centre; Stefan van Rooijen, surgical resident in Maxima Medical Center, The Netherlands, lecturer at the first Health Innovation School (Ministry of Health, Welfare and Sport and Reshape innovation), Surgical resident, Department of Surgery at Maxima Medical Center (ANIOS); Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust; Ken Van Someren, Director KvS Performance Ltd. This piece follows on from the presentation to be found here: http://www.topmedtalk.com/ebpom-2019-the-science-of-high-performance-insights-from-elite-sport-2/
EBPOM 2019 | Community-based Prehabilitation
In the UK community based prehabilitation is being spearheaded by the Prepwell Initiative, supported by a grant from Sports England. Their pioneering work is a great example of the way in which prehabilitation is gathering pace at the moment. The “PREP: Preoperative Risk Education Package” website is here: https://www.prepwell.co.uk/ What are the economics of such a programme? Why did the project start to get referrals from initially sceptical surgeons? How did the programme impact the lives and treatment of patients? Presented by Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust.
EBPOM 2019 | Multi-modal Prehabilitation
This panel discussion includes questions such as: In a prehabilitation service what screening tools should we use to assess nutritional risk? What tools are there related to patient self management? What advice would you give a patient about cannabis smoking cessation? Should denial of surgical procedures be used as a motivator for lifestyle change? Can the questions used in interventions sometimes be open to misinterpretation by patients? How do we assess and treat sleep disorders? If not a psychologist, what team members might handle psychological behaviour change? Does immunonutrition work? Are there sensitive approaches to addressing weight loss, physical activity and diet that the panel reccomend? Panel discussion chaired by Sandy Jack and Daniel Santa Mina, featuring, David Yates, Consultant in Anaesthesia and Critical Care Medicine at York Teaching Hospital, Chloe Grimmett, National Institute of Health Research (NIHR) post-doctoral Research Fellow and Senior Research Fellow for the Macmillan Survivorship Research Group at the University of Southampton, Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University, Chelsia Gillis, Registered Dietitian, Canadian Vanier Scholar, and PhD Candidate in Epidemiology at the University of Calgary, Canada, she is leading the first prehabilitation program for colorectal surgery in Alberta.
ASA | Prehabilitation, the word of the year
This piece tackles “prehabilitation”, TopMedTalk’s word of the year. What is it, why is it so important, who is doing it and why are some people reticent about something that is so obviously good for their health? Furthermore, what are the transatlantic nuances to this debate? Presented by Desiree Chappell with Sol Aronson, tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and their guest Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton. Recorded at Anesthesiology 2019 at the Orange County Convention Center in Orlando, over 14,000 delegates, clinicians, thought leaders and professionals; the largest gathering of Anesthesiologists and Anesthesia providers in the world. The ASA has gone virtual, check them out here: www.asahq.org — Like this, want more? Sol Aronson’s excellent talk “EBPOM 2018| Perioperative medicine is Population Health Management” is here: https://www.topmedtalk.com/ebpom-2018-perioperative-medicine-is-population-health-management/ And Mike Grocott co-chair’s a gripping debate about prehabilitation, “EBPOM 2019 | System wide change for prehabilitation”, is here: https://www.topmedtalk.com/ebpom-2019-system-wide-change-for-prehabilitation/
TopMedTalk | Prehabilitation, the word of the year?
Is it fair to say that prehabilitation is the new direction for practitioners of Enhanced Recovery After Surgery (ERAS)? Discussion expands into patient awareness initatives, The Macmillan Cancer Support, Principles and guidance for prehabilitation guide mentioned is here: https://www.macmillan.org.uk/about-us/health-professionals/resources/practical-tools-for-professionals/prehabilitation.html Age care naturally follows as the roundtable discussion continues. This piece gives a truly pan-national perspective with informed comment from prominent perioperative opinion leaders from The UK, Australia and America. How do those different systems work and what can they each learn from the others? The journal article mentioned in this piece is here: https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511 Presented by Desiree Chappell with Monty Mythen and Lee A. Fleisher, Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania and Ross Kerridge, John Hunter Hospital, Newcastle, Australia, often cited as ‘the father of Modern Perioperative Medicine’.
EBPOM Highlight | The evolution of a community-based Prehabilitation service
“POETTS 2018 | The evolution of a community-based Prehabilitation service” – originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 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: www.ebpom.org/meetings If you have any comments or questions you’d like to send to the team email: contact@topmedtalk.com Presented by Gerard Danjoux, consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Trust.
EBPOM 2019 | Delivering Personalised Care: aligning prehabilitation with healthcare policy
How can we align personalised care with prehabilitation? “Personalised care is where people have more choice and control over how their health and care needs are met” where we recognise “people themselves can sometimes be the best integrators of health and care”. In this context our role is to support them to “live as independently as they wish”. With shared decision making and personal choice at the heart of this we allow patients to be “experts in their own lives, health and care”. The increase in life expectancy means more long term conditions and comorbidities in patients, what opportunities does this present? How do we hone in on what matters to patients and help them manage the cumulative burden of long term health difficulties? How comfortable are healthcare practitioners when talking about physical activity? Is it possible that personalised care could eventually be business as usual? The NHS Long Term Plan has a website which you can see here: https://www.longtermplan.nhs.uk/ The NHS website is here: www.england.nhs.uk Presented by Anna Lowe, Programme manager, National Centre for Sport and Exercise Medicine, Lead Allied Health Physical Activity Clinical Champion at Public Health, England.
EBPOM 2019 | Financial aspects of prehabilitation
This piece presents the prehabilitation ‘business case’; why it’s important to care about costs, how outcomes and value based care can help and why money has to be important in healthcare. How do we convert health benefits and risk management into something which explains the financial bottom line? Can we really argue that a process which appears, at the point of practice, to take more time, resources and involve a shorter length of stay for patients, is actually cheaper for institutions in the long run and better value for patients? Is there in fact more than one ‘business case’ for a proper perioperative prehabilitation clinic at your practice? The Fit 4 Surgery website (Netherlands) is here: http://fit4surgery.nl/ Presented by Stefan van Rooijen, surgical resident in Maxima Medical Center, The Netherlands, lecturer at the first Health Innovation School (Ministry of Health, Welfare and Sport and Reshape innovation), Surgical resident, Department of Surgery at Maxima Medical Center (ANIOS).