EBPOM 2019 | Prehab trials; international study
The International PREHAB trial. This short piece explains the trial’s protocol and the scope of the study. Presented by Charlotte Molenaar, PhD Candidate, multimodal prehabilitation in colorectal cancer care, BIJ Maxima Medisch Centrum, Coordinator of the international PREHAB trial.
EBPOM 2019 | The Science of High Performance: Insights From Elite Sport
Insights and perspectives on the science of prehabilitation from a very different angle. It’s often said on TopMedTalk that preparing for an operation is not unlike getting ready for a marathon; how do the insights of professionals who work with elite sports men and women to ensure they are fully prepared to do their physical best, on the world stage? Also, what about the teamwork inherent in such activities as the pitstop of a formula one car? Athletes, coaches and a wide number of different experts come into play ensuring a multidisciplinary team converge with essentially the same end in sight as a perioperative prehabilitation team; optimum performance at a crucial time. Challenges are similar between the two disciplines; how do we foster a culture of learning and teamwork in a high pressure environment where the bottom line carries enormous life changing consequences? Regular listeners to TopMedTalk may recall the unofficial preamble to this talk, “Prehab Periop World Congress: Gerard Danjoux, Ken Van Someren”: https://www.topmedtalk.com/prehab-periop-world-congress-gerard-danjoux-ken-van-someren/ Presented by Ken Van Someren, Director KvS Performance Ltd.
EBPOM 2019 | The Manchester devolution revolution
What are the opportunities presented to a perioperative practitioner when political devolution becomes a reality? What can we learn from the experiences of a team leading the introduction of ERAS+ and prehabilitation across Greater Manchester with a ‘Spread and Scale innovation grant’ from the Health Foundation? How do you demonstrate benefits which patients and fee payers can understand? How do you go about leading a prehab transformation program, which aims to provide prehab for more than 2000 patients affected by cancer, over 2 years? The GM teams are very happy to host teams in Manchester who may want to visit MFT and see Surgery School in action and show colleagues what they are aiming to achieve with GM Cancer Prehab. Email John on John.moore@mft.nhs.uk or john.moore@erasplus.co.uk ERAS+ website is here: https://www.erasplus.co.uk/ NHS Innovation Accelerator website: https://nhsaccelerator.com/ GM Active are here: https://www.gmactive.co.uk/ Presented by John Moore, consultant in anaesthetics and critical care medicine from Manchester, UK, Clinical Head of the Division of Anaesthetics, Peri-operative medicine and Critical Care at Manchester University Hospital NHS Foundation Trust.
POCAPALOOZA | EBPOM USA, PASS clinic and shared decision making
The focus for the first part of this POCAPALOOZA was Duke University’s PASS clinic. Find out more about the PASS clinic: https://www.dukehealth.org/locations/duke-pre-anesthesia-testing-center-clinic-2d “So it’s a new approach to really changing the paradigm from just evaluating a patient and sort of passing that information forward to the receiving team […] rather we take a much more proactive progressive approach to identify those chronic co-morbid conditions and try to bend that curve, we try to modify that which may be modifiable” If you’ve heard Sol’s passion and want to transform your practice get more detail from these two excellent pieces from Anesthesia and Analgesia here: Roadmap for Transforming Preoperative Assessment to Preoperative Optimization https://journals.lww.com/anesthesia-analgesia/Abstract/2020/04000/Roadmap_for_Transforming_Preoperative_Assessment.4.aspx?context=FeaturedArticles&collectionId=4 Preoperative Optimization: A Continued Call to Action https://journals.lww.com/anesthesia-analgesia/Citation/2020/04000/Preoperative_Optimization__A_Continued_Call_to.3.aspx There follows an engaging conversation about prehabilitation, “it’s like Rocky Balboa training to get in the ring”. For more resources here please check this website from the Choosing Widely campaign: https://www.choosingwisely.co.uk/about-choosing-wisely-uk/ Also – regular listeners will be excited to hear our lead presenter Desiree Chappell’s news towards the end of the podcast! Presented by Desiree Chappell with Monty Mythen and Sol Aronson, tenured Professor at Duke University and their guests Jeanna D. Blitz, Associate Professor of Anesthesiology, Medical Director, Duke PASS Clinic Director, Perioperative Medicine Fellowship, Denny Levett, Professor in Perioperative Medicine and Critical Care, Consultant in Perioperative Medicine, Southampton University Hospital NHS Foundation trust (UHS), President of the Perioperative Exercise Testing and Training Society (POETTS) and Mike Grocott Professor of Anaesthesia and critical care at the University of Southampton.
ASA 2019 | ‘We advocate good public health, within the crucible of surgery’
Originally broadcast live from Anesthesiology 2019, this piece focuses on the mission to advocate and apply prehabilitation, pre-optimisation and enhanced recovery. Defined here as “good public health […] with the crucible of surgery”. How do we do that in a way that both patients and front line providers understand the value of it? Can this message help to allow for delays in surgery? Also, how do we take our message to social media, specifically Twitter? Listen in for some excellent tips before you make a point of following our guest’s twitter account here: https://twitter.com/jeffsimmons Presented by Desiree Chappell and Mike Grocott with Jeff Simmons, Associate Professor, Medical Director for UAB’s Preoperative Assessment, Consultation, and Treatment Clinics and all Paranesthesia Care Units. Co-Chair of the Operating Room Executive and Perioperative Oversight Committees.
ASA 2019 | A data based conversation about payment methods
Away from the world of politics there is a sensible debate to be had about payment methods for healthcare. Here you will find evidence, shared goals and specific payment models from the US being looked at in detail. It’s a debate about total cost of care and a two sided risk model that could potentially be cheaper and better for both patients and providers. Bundle payments provoke debate, “the interesting question is; ‘post operatively, do you need that expensive care’?” Population health is an inevitable terrain for the discussion, could alternative payment models benefit wider society? “Healthy people don’t need anything other than wellness care, the poorly managed chronically co-morbid medical conditions are the population that is costing us and driving the cost of care up disproportionately greater than everyone else”; how do the needs of these two groups knit together in a way that is helpful and equitable financially? How is enhanced recovery and perioperative medicine helping to reduce the cost of healthcare? Can prehabilitation help reduce costs even further? The Centers for Medicare and Medicaid services (CMS) website is here: https://www.cms.gov/ Presented by Desiree Chappell with Monty Mythen, Sol Aronson and their guest Lee Fleisher, Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania. If you enjoyed this conversation you will certainly find value in this piece as well: https://www.topmedtalk.com/roundtable-highlight-the-maryland-funding-experiment/
EBPOM 2019 | Who delivers Prehab?
How can a multidisciplinary group collectively define and maintain what they do while maintaining a patient centred approach? How focused can prehabilitation become? Should personal trainers be more widely involved in perioperative medicine? What is the correct terminology when it comes to expertise in the various areas of your team? Should practitioners be expected to apply lifestyle behaviour changes which other members of our team advocate to patients? Why is a collaborative approach so important to perioperative medicine? The ELLICSR Kitchen is here: https://www.ellicsr.ca/en/clinics_programs/ellicsr_kitchen Presented by Daniel Santa Mina, Assistant Professor at University of Toronto & Scientist in ELLICSR at the Princess Margaret Cancer Centre.
EBPOM 2019 | POETT Controversies Panel discussion
Doesn’t the decision to delay surgery depend upon the type of cancer? Can you measure complications as an outcome? What’s the cause of non cardiac complications that are related to lack of exercise? Can we change the mindset of prehabilitation by explaining that prehabilitation is the start of treatment? How do we convince patients and decision makers that delaying surgery is a good idea? How involved are oncologists in perioperative decisions? Presented by Duminda Wijeysundera, Professor in the Department of Anaesthesia and the Institute of Health Policy Management and Evaluation at the University of Toronto, and a Staff Anesthesiologist at St Michael’s Hospital and Gerrit Slooter, MD, PhD, Surgical Oncologist, Maxima Medical Centre, The Netherlands.
TopMedTalk & MacMillan Cancer Support | Mental well being for the patient
TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis. “It’s very normal to sit with some difficult thoughts and feelings” after a cancer diagnosis. Broadly there are two types of mindsets; anxiety, which can be helpful, an element of wanting to ‘do something’ and, on the other hand, low mood, a feeling of not wanting to do anything, this can be unhelpful if not addressed at a certain level. We should expect both of these mindsets the question is ‘how does the latest scientific research show can we control them’? Your body and mind are not separate, one effects the other, this is why it is so important we look at mental health as part of an overall approach. “You can do quite a lot of things […] that put you into a better mood”; exercise, meditation, even simple breathing exercises. Spending time communicating with friends and family is another suggestion. Recorded at the height of the COVID 19 crisis this podcast also reflects upon how this is applied in the context of a global pandemic; how important is it that people engage with online facilities and opportunities to maintain relationships? “In an odd way the relationships seem to intensify”. It’s not about ignoring negative feelings though, anxiety and low mood are very common for people with a cancer diagnosis. Hear how it is important to allow yourself to reflect, part of understanding your mental health is about regaining control, we are allowed to let ourselves feel difficult thoughts as part of the process of monitoring and working with them. This podcast also contains a reminder about the importance of goal setting in allowing people to regain control over their lives. Small, realistic and specific, short term goals are useful at this particular stage of life; “start with the thing you are most confident you are able to change […] make a day and a time that you’ll stick to”. Presented by Nick Margerrison with his guests Judit Varkonyi-Sepp psychologist, psychology lead for the Wesfit prehabilitation programme and Chloe Grimmett, behavioural scientist and lead for Wesfit prehabilitation. For more information, in the UK, phone: 0808 808 00 00 Email: CancerPrehabilitation@macmillan.org.uk Twitter: @macmillancancersupport
TopMedTalk & MacMillan Cancer Support | Healthy eating and cancer
TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis. We know food gives us energy “but it also provides so much more”. This podcast looks at the raw materials you’ll need, when facing a cancer diagnosis, to get a better outcome; the vitamins, minerals and proteins, as well as the energy sources you’re best using. What is a balanced diet when you have cancer? “We’re talking about eating well to stay well […] we’re not really looking for people to lose weight”; it’s often important for people to try to maintain their weight during a cancer diagnosis, should you track your weight throughout your cancer journey? Recorded at the height of the COVID 19 crisis this podcast also reflects upon how this information is applied in the context of a global pandemic. What foods can we store which also contain the vital building blocks of our body’s natural defenses? Presented by Nick Margerrison with his guest Clare Shaw, consultant Dietician at The Royal Marsden NHS Foundation Trust. For more information, in the UK, phone: 0808 808 00 00 email: CancerPrehabilitation@macmillan.org.uk Twitter: @macmillancancersupport