The anaesthetist and peri‐operative medicine: migration and evolution

Carlisle, J. B.; White, Stuart; Tobin, Antony

doi:10.1111/anae.13339

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…Reduced quality of life and independence, increased rates of readmission, reduced longer term survival and an increased health economic burden may all follow. Healthcare professionals working across peri-operative medicine should develop strategies to address this problem [18][19][20].…”

Section: Background To Pre-operative Exercise Trainingmentioning

confidence: 99%

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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SummaryDespite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations. Summary of key recommendations1 Pre-operative exercise training should be offered to patients scheduled for major or complex elective surgery with a view to improving their physical fitness and health status and reducing the risk of peri-operative morbidity and mortality. If resources are limited, priority of referral to preoperative exercise training should go to patients who are at increased risk of peri-operative complications, such as those with low cardiorespiratory fitness.2 Pre-operative exercise training should be offered as part of a multi-modal prehabilitation programme that addresses a variety of peri-operative risk factors including cigarette smoking, excessive alcohol consumption, and anaemia. 3 Healthcare professionals making referrals to a preoperative exercise programme should have basic knowledge about what the programme entails and its potential effects. A pre-operative exercise programme should be presented to the patient by the referring clinician as a fundamental part of their 750

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Section: Background To Pre-operative Exercise Trainingmentioning

confidence: 99%

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

et al. 2018

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“…The specialty of anaesthesia has grown, and separate branches of critical care and pain management have flourished; and perioperative medicine has defined itself as a new focus for anaesthesia in many areas of the world. 3 Times have changed in medical education too. Curricula are focusing less on acquisition of knowledge and instead on achieving competencies to equip students for work in complex clinical settings.…”

mentioning

confidence: 99%

“…In the perioperative context, a 'reverse pain ladder' is useful, starting with local anaesthetics and strong opioids immediately after surgery, and 'stepping down' to less potent agents as the pain becomes less severe. 24 Perioperative medicine is a logical extension of anaesthesia and critical care, 3 dealing with the assessment and optimisation of the patient's condition before surgery, and providing enhanced rehabilitation after operation. Correcting chronic health conditions, such as anaemia, and optimising diseases such as chronic obstructive pulmonary disease, tends to improve postoperative outcomes.…”

mentioning

confidence: 99%

Anaesthesia and the undergraduate medical curriculum

Smith

Sadler

Carey

2018

British Journal of Anaesthesia

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pathways for neurobehavioural testing or management of patients with perioperative NCD. Ultimately, adoption of the recommendations by Evered and colleagues 7 will depend on the greater community of investigators that study cognitive disorders after anaesthesia and surgery, and the policy of journals that publish their work. Other groups have attempted to standardize the diagnosis of POCD to allow comparisons of results between studies. 13 Despite the latter efforts, the criteria for detecting and defining POCD have remained variable and inconsistent over the ensuing quarter of a century since their opinions were published. Evered and colleagues 7 provide a thorough and thoughtful approach to address how to define cognitive changes after anaesthesia and surgery. Nonetheless, with the exception of delirium, neurocognitive decline after anaesthesia and surgery currently remains a research observation.

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“…Alongside these changes, there has been a national and international focus on developing the specialty of peri‐operative medicine to address the needs of the high‐risk surgical population, spanning pre, intra‐ and post‐operative care . As most high‐risk patients are older, integrated peri‐operative care pathways with routine structured contributions from geriatricians have been recommended .…”

Section: Introductionmentioning

confidence: 99%

A Foundation Programme educational placement in peri‐operative medicine for older people: mixed methods evaluation

2018

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We established an innovative Foundation placement in peri-operative medicine for older patients in response to the need for training in 'whole patient' medicine and the challenge of fewer Foundation doctors in acute surgical roles. The placement and underpinning curriculum were co-designed with junior doctors and other clinical stakeholders. This resulted in a modular design offering acute and community experience and dedicated quality improvement project time. To evaluate the placement we used a mixed methods study based on Kirkpatrick's model of workplace learning. Level 1 (trainee reaction) was evaluated using Job Evaluation Study Tool questionnaires and nominal group technique. Levels 2 and 3 (trainee learning/behaviour) were assessed using a Likert-style survey mapped to curriculum objectives, e-portfolio completion, nominal group technique and documentation of completed quality improvement projects and oral/poster presentations. Sixty-eight foundation trainees underwent the new placement. A similar-sized 'control' sample (n = 57) of surgical Foundation trainees within the same Trust was recruited. The trainees in the peri-operative placement attained both generic Foundation and specific peri-operative curriculum competencies, and gave higher job satisfaction scores than trainees in standard surgical placements. The top three ranked advantages from the nominal group sessions were senior support, clinical variety and project opportunities. Universal project completion resulted in high rates of poster and platform presentations, and in sustained service changes at hospital level.

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The anaesthetist and peri‐operative medicine: migration and evolution

Cited by 8 publications

References 18 publications

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Clinical guideline and recommendations on pre‐operative exercise training in patients awaiting major non‐cardiac surgery

Anaesthesia and the undergraduate medical curriculum

A Foundation Programme educational placement in peri‐operative medicine for older people: mixed methods evaluation

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