Great presentation & discussion on Why we need to operate early @doc_hnaqvi @SujitAgarwal -thanks. Post CCT view is a more accurate one!
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subash s
195 posts
subash s
@subashken
Consultant Anaesthetist, Sandwell & West Birmingham Hospitals
Birmingham, England Entrou em Ocak 2014
74 Seguindo31 Seguidores
@KTheivendran @doc_hnaqvi The fact 1600 patients were randomised means they all received standardised care - and hence everyone is likely to have a good outcome - and soit is always going to contradict observational studies (which would include the sicker exclusion criteria patients in this trial)
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@KTheivendran @doc_hnaqvi Technically correct but a 15 min intervention is unlikely to produce any difference in 60 day outcome due to the huge temporal disconnect, multiple confounders and mortality as an outcome difference for anaesthetic techniques is a very low bar in my estimation.
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“Spinal anesthesia for hip-fracture surgery in older adults was not superior to general anesthesia with respect to survival and recovery of ambulation at 60 days. The incidence of postoperative delirium was similar with the two types of anesthesia” @doc_hnaqvi @subashken
Luke Farrow@docfarrow
Great new RCT in the hip fracture world - further evidence that Spinal & General Anaesthesia outcomes are likely equivalent. Do what you do and do it well! nejm.org/doi/full/10.10… @A_MacLullich @kirstymward @JonAntrobus @KarenAdam13 @andrewhallortho @IainMoppett @xlgriffin
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@IainMoppett @Sandwell and City Hospitals Birmingham (last 3 yrs), all elective patients are given a bottle of water - encouraged to take sips throughout... Similarly, hip fracture & Emergency patients have a jar of water bedside and allowed sips. THINK DRINK...
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💯% agree. Resonant echoes across all units I hope #electiverecovery #perioperative @subashken @AtulAtulmalik @sitenroy @DonnaJa98889626
Grumpy Geriatrician@GeriatricDr
All the more evidence that older patients will require significant peri operative support, with the impact of delays and risk changing. Geriatricians can assist with shared decision making, pre-optomisation and the patients peri operative journey. bbc.co.uk/news/health-56…
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@doc_hnaqvi @chrisvthompson @mrdgwatt @ChaseSurgical @sitenroy Periop care 2021 @SWBHnhs is
#Block it Fast
#Fix it Fast
#Get up Fast
Simples..
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@chrisvthompson @mrdgwatt @ChaseSurgical Timely Chris. Been having similar discussions with @subashken @sitenroy regarding pre optimisation of the returning elective patients in surgery
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Interesting and quite topical at present. Could there be reluctance....’we know how to look after our post op patients...!’, however would geriatric input (and I’m not talking about the senior surgeon in the department..😃) help in more holistic or maybe better care...?
TeachMeSurgery@teachmesurgery
Would outcomes improve if all elderly patients are reviewed by a geriatrician during admission? publishing.rcseng.ac.uk/doi/full/10.13… @NELANews @ASiTofficial @Dukes_Club @ChaseSurgical @roux_group
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@SpOrthopod @MrGella @KTheivendran @doc_hnaqvi @SaadElAshry @SWBHnhs @AtulAtulmalik I was hoping the provocative message will start a conversation, bottom line is More delays due to any reason = More delirium = Poor outcomes. PS. I've also urged my colleagues to BLOCK it FAST, so that FIX it Fast can happen.
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@subashken @MrGella @KTheivendran @doc_hnaqvi @SaadElAshry @SWBHnhs In our small study, factors which DID NOT show statistically significant association with the development of delirium included delay in surgery i.e. >36 h from admission, use of GA, prolonged operating time i.e. >2 h, & post-op hypotension
@AtulAtulmalik
ncbi.nlm.nih.gov/pmc/articles/P…
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@MrGella @KTheivendran @doc_hnaqvi @SaadElAshry Kind Reminder to T&O colleagues & Anaesthetists. FIX IT FAST @SWBHnhs
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@doc_hnaqvi @KTheivendran @MrGella
Early nutritional supplementation was associated with a significantly shorter hospital stay without an increase in costs.
bjanaesthesia.org/article/S0007-…
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@doc_hnaqvi @sitenroy @doc_AMajeed @natashajh86 @DonnaJa98889626 @Nataliecutmore1 @KTheivendran @drnickmakwana @AtulAtulmalik @SWBHnhs @SWBHnhs Desperately need an additional geriatrician to form part of the MDT team that enables this transformation
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Today was all about recovery/restoration/planning & innovation
Lots of food for thought & developing new ways of working towards #MMUH 💙
a year on from covid, enthusiasm & verve is resonant 👏👏
#hopeforthefuture @sitenroy @doc_AMajeed @natashajh86 @subashken @DonnaJa98889626
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"Despite experience in self-management, many people with diabetes, particularly those on insulin, are often DISEMPOWERED to self-manage in hospital." @CPOC_News @SWBHnhs
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Do you practice SDM? Often doctors think so…..but patients do not…@CPOC_News @doc_hnaqvi @chrisvthompson
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@SWBHnhs Need to raise awareness regarding the misconception amongst many-BPT for hip fracture is not merely a financial tool for income-its aim is to provide additional income which is reflective of the quality of practice. Evidence = Delay means higher mortality/morbidity
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@KTheivendran @manojsikand @natashajh86 @sitenroy @doc_hnaqvi "Central to this concept is the physical separation of resources or ‘ring-fencing' & Ring-fencing is of proven financial benefit in orthopaedic surgery and is
also associated with improved outcomes" -some work to do to convince Managment Team @swbh
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Providing a Continuous Safe Elective Orthopaedic Environment #BOA #GIRFT @manojsikand @natashajh86 @sitenroy @subashken @doc_hnaqvi
BOA@BritOrthopaedic
*New* @BritOrthopaedic Standard (BOASt) ‘Providing a Continuous Safe Elective Orthopaedic Environment’ published. Why and how we can maintain a sufficient/stable bed base (ring-fencing of beds) to provide year round care. Important issues – please share: boa.ac.uk/standards-guid…
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@doc_hnaqvi @chrisvthompson Yes - Needs CROSS SKILLING to facilitate TRANS - disciplinary working
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Just caught up on this excellent webinar, good to hear so many professionals on the same page. A new concept in redefining the MDT, think this is done better in some areas of geriatrics already #frontdoorfrailtycare comes to mind. Plenty of work to do @chrisvthompson @subashken😊
The Royal College of Surgeons of England@RCSnews
It’s your last chance to register for our #RCSWebinar tonight with @scarlettmcnally @totallytigers @JKDhesi @drlouisebates & Lawrence Mudford. Tune in to hear them discuss how good perioperative care can help surgical patients beyond the pandemic. ow.ly/N2Xi50DwyBf
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@KTheivendran @Ash75044681 @natashajh86 @doc_hnaqvi @sitenroy V True - that's what we are supposed to do:
Doctors must try to FIND OUT WHAT MATTERS TO PATIENTS so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.
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@Ash75044681 @natashajh86 @doc_hnaqvi @sitenroy @Drjay3 @subashken Interesting. T&O it’s all about #PROMs & therefore quality of life. Cancer is about survival & PROMs is less considered. If you ask patients you might be surprised
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I’ve seen the impact of surgery positively on those who needed it and the negative impacts of delayed surgery; deconditioned, worsening CFS and overall poorer outcomes for QOL. Recovery for #electivesurgery essential 🙌🏽 @sitenroy @Drjay3 @subashken @KTheivendran @natashajh86
Benjamin Bloch@Bloch_ortho
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subash s retweetou
Why has the so-called 'developing world' responded with more urgency & efficiency to coronavirus than Europe?
@MacaesBruno argues that cultures with a recent experience of poverty & disease are less likely to take human life & healthcare for granted
quillette.com/2020/03/14/con…
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@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca" target="_blank" rel="nofollow noopener">medium.com/@tomaspueyo/co…
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Anaesthesia Updates: @RCoANews: All anaesthetists should be trained and competent in the delivery of TIVA. Schools of Anaesthesia and training bodies should provide teaching, training and practical experience of TIVA to all anaesthetic and intensive care medicine trainees.
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