Katie Samuel
Katie is an Anaesthetic Consultant in the UK
Twitter: @katie_samuel_
Location UK
Activity
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Katie Samuel made a comment
I have been reading through your comments with great interest. Mary's case has generated a lot of discussion and debate on just the 3rd day of the course.
Many of you have raised the point that in Mary's case this was an elective operation in a co-morbid patient, and that she would have clearly benefited from not only thorough preoperative assessment and...
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Katie Samuel made a comment
Welcome all to the 10th run of the Perioperative Medicine in Action course. We are delighted that you are joining us to learn about perioperative medicine and the perioperative journey.
As we move through the 4 weeks we will cover a range of topics, including an update on COVID-19's impact on surgical services.
Throughout the course there is an...
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Yes - the importance of putting an individuals risk of surgery (and not having surgery) in a format that is easily understandable to them, and put into the context of their personal health, circumstances, priorities and beliefs, is the central aim of 'Shared decision making' - which we will cover next week.
Do you work in the UK or abroad currently?
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This is a very good point re dynamic health and 'fitness for surgery' being a somewhat moving goalpost.
As an example, I personally have seen patients 1 year after their initial preoperative assessment for elective surgeries that have been unavoidably postponed due to COVID-19. The change in both functional status and chronic disease management, although...
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Katie Samuel made a comment
It is really interesting to hear about how the traditional model of care fits in with your current practice in a number of countries, with many of you identifying the key benefits as well as potential disadvantages.
In the next step we will learn about the limitations of this model of care, and learn about alternative models later in the chapter.
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Katie Samuel replied to Anne O Neill
Delighted to hear a physio perspective on Mary's care. Re spinal anaesthetic - this procedure is routinely done under both regional anaesthesia (most commonly) and general anaesthesia in trusts in the UK, so yes it could theoretically have been done under spinal. However, the choice of anaesthetic technique is usually made as a shared decision between the...
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Katie Samuel replied to Jose Lopes Vieira
I think the discrimination between a proactive and reactive response is a really important one. Applying this to patients undergoing both elective and emergency care will be focussed on in weeks 3 when we look at emergency and elective care protocols.
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Katie Samuel made a comment
Welcome all to the 9th run of the Perioperative Medicine in Action course. We are delighted that you are joining us to learn about perioperative medicine and the perioperative journey.
As we move through the 4 weeks we will cover a range of topics, including an update on COVID-19's impact on surgical services.
Throughout the course there is an...
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Katie Samuel replied to Giovanni De Falco
@OdgerelTumur: Yes, you can upgrade at any point, and welcome to the course.
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@MichelleBrack POPS is Perioperative medicine for older people undergoing surgery. We will learn more about this specifically in week 4, step 4.11
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Katie Samuel replied to Katie Samuel
Of course - completing the course should give you a solid understanding of perioperative care including the current issues and practices.
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Katie Samuel replied to Giovanni De Falco
The formal certificate would meet your requirements, but Future Learn does require for you to pay to upgrade the course to receive this. However, the final step on week 4 does confirm completion of the course, which some learners have found useful to save as evidence of completion.
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Katie Samuel made a comment
Welcome all to the 8th run of the course. We are delighted that you are joining us to learn about perioperative medicine and the perioperative journey.
As we move through the 4 weeks we will cover a range of topics, including an update on COVID-19's impact on surgical services.
Throughout the course there is an opportunity to comment on the learning...
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Hola, Maria. Eesta revisión sistemática analiza la validación de la laparotomía de emergencia. No sé en qué país trabaja, pero P-POSSUM ha sido bien estudiado en varios países. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475666/
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Hi Maria. El sitio web http://www.riskprediction.org.uk tiene muchas herramientas de predicción de riesgos disponibles, y es de libre acceso. Otra de uso común es la herramienta de riesgo SORT disponible en http://www.sortsurgery.com
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Katie Samuel made a comment
From myself and Abigail, thank you all so much for your contributions and insightful discussion throughout the course.
We hope these four weeks of learning have invigorated your interest and drive to deliver high quality perioperative care in your own places of work.
Thank you for learning with us!
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That does sound like a particularly frustrating case, where I presume the surgery needed to be postponed?
I think some of the issue, at least in the UK, is that the importance of correction of even mild anaemia preoperatively isn't conveyed to all MDT members involved in the perioperative pathway appropriately. An asymptomatic chronic Hb of 11.5, for...
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Katie Samuel made a comment
I have been reading your comments from this step with interest - it is inspiring to hear how many of you take the time to explore the decision making around end of life care as fully as possible with your patients and their family. It seems that as a group, your recognition of the importance of carrying out these consultations openly and with compassion is...
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Katie Samuel made a comment
This case demonstrates an example of 'ideal' patient care, through integrating service provision infrastructure and MDT working to provide efficient and thorough perioperative care.
Whilst this model clearly has been highly effective for the POPS team, how would this structure of care translate to the hospitals that other learners are currently working in?...
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Katie Samuel made a comment
Its lovely to hear a number of people commenting that their own hospitals are starting to adhere to and provide the care bundles described in the article. I think the 'shift' towards recognising that these high risk patients do require bespoke intervention from specific members of the MDT is a great marker of progress.
A number of people have commented...
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Katie Samuel made a comment
Most people have rightly raised the pertinent points that make emergency surgical patients higher risk; less time available for optimisation, out of hours care, junior staff, and already deranged physiological parameters.
As one learner summarised, these patients are to some degree 'already broken'. We will learn more about the positive outcomes which...
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Hi Pamela, to answer your question re followup; those who are discharged before postoperative elements of the PQIP dataset are completed are phoned at home by the local study team.
Re day case surgery in the UK - this is a fairly broad question, but yes a lot of minor surgery is managed as day case. There is fairly strict criteria in most hospitals as to...
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Katie Samuel replied to Miles Curtis
Many thanks Miles for spotting this - it is now corrected in the text, but is also available in the 'see also' section
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Very pleased to hear you are finding it useful!
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Katie Samuel made a comment
It is lovely to hear the positive feedback for Dr Swart's consultation - many have pointed out that he was able to undertake a thorough, high quality and professional yet approachable consultation. There are certainly factors of this example consultation that can be adapted to different hospitals preoperative assessment clinics - specifically we will learn...
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Katie Samuel made a comment
The topic of communicating risk to patients is a very interesting one - there has been a lot of work done by several bodies looking at how we can better communicate risk to the public in ways that they can understand (for example the Winton risk centre for risk and evidence communication - https://wintoncentre.maths.cam.ac.uk) as probabilities etc are complex...
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Katie Samuel made a comment
There has been a number of really interesting and personal statements made in the comments - some themes seem to be people feeling out of control and vulnerable, not being listened to, communicated with poorly, their opinions not been sought out or met, but most importantly being 'told' things rather than having things discussed with them. Conversely, and...
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Katie Samuel replied to Pamela Cuddihy
There are a number of drinks available that come as clear liquids with approx 50g of protein, but a common brand used in my UK institution is Ensure drinks.
There is a cochrane review that highlights the impact they can have, although it is noted more trials would be beneficial - 'Patients given carbohydrates before planned surgical procedures went home...
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Katie Samuel replied to Paul Maguire
Delighted to hear that this has encouraged you to adopt the practice suggested in the video.
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Katie Samuel replied to Pamela Cuddihy
You raise a pertinent point Pamela, which is that variation in surgical (or any specialities) practice can be detrimental to patients' outcomes. In the UK, there is a programme called Getting it Right First Time (GIRFT), which aims to standardise practice nationally on key performance indicators to provide optimal patient care.
Whilst not strictly enhanced...
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Katie Samuel replied to Ian Smith
Thank you Ian - it is great to hear your positive experiences with enhanced recovery, and certainly your observations on when it works well seem to be when all stakeholders (including the patient) are involved and 'buy in' to the process.
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Katie Samuel replied to Albert Naah Damyeng
Indeed! I think we will see an increasing presence of specialised services focussing on the challenges of caring for elderly patients in the next few years.
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Katie Samuel replied to Alastair Duncan
It is certainly a key topic - Prof Mike Grocott's video in step 4.14 discusses POM as a value proposition.
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There has also been a recent collaborative document produced in the UK by RCoA, Macmillan and NIHR on prehabilitation in surgical patients with cancer. It focuses on the MDT and holistic nature of prehabilitation, and is well worth a read.
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Katie Samuel made a comment
Most comments seem to concur that the perioperative pathway of care should start right from the initial decision or even consideration for surgery, whether that be with the patients GP or whilst attending surgical outpatient clinic. Again, the majority of learners agree that care should be delivered comprehensively by an MDT team, each inputting their...
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You are absolutely right - and this raises the issue and importance of shared decision making when deciding on the best course of action for a specific patient. There is a section on this in week 2.
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Creo que el número limitado de camas de cuidados críticos es un problema importante en todo el mundo. Puede ser necesaria una predicción precisa de pacientes con mayor riesgo; Es probable que el uso de camas para quienes tienen más que ganar con la provisión de cuidados críticos sea el futuro de la práctica.
Disculpas si mi español es pobre!
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Can I ask which frailty assessment tool you are using for your screening? My experience is that a lot of institutions are using the clinical frailty scale - probably for ease of use/interpretation.
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I think you all raise the important point that the perioperative journey is as much about preoperative optimisation/preparation and postoperative community recovery to an acceptable quality of life, as it is the 'in-hospital' surgical journey.
I think we will see continuing emphasis on these elements in the coming years. The launch of the UK's CPOC (Centre...
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Katie Samuel made a comment
It is really interesting to hear about how the traditional model of care fits in with your current practice in a number of countries, with many of you identifying the key benefits as well as potential disadvantages.
In the next step we will learn about the limitations of this model of care, and learn about alternative models later in the chapter.
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Katie Samuel replied to Marijke Hoen
Welcome all - great to have you on the course
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Katie Samuel replied to Antash Daryanani
It will - just make sure you keep your evidence of completion. To quote the application criteria 'Online courses can be counted if candidate can present relevant certificate and course details and also give details of the time/commitment spent doing the course'.
Hope that helps and good luck with your application!
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Katie Samuel replied to Eka Yudha Lantang
Great to have you on the course - I hope you find it useful!
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Katie Samuel made a comment
Welcome everyone to the course! We are delighted that you have joined us for our 7th run of Perioperative medicine in action, and very much look forward to learning with you over the coming weeks.
Myself, Abigail, and other members of the faculty team will be online reading your posts and joining in on discussions. Please do feel free to comment or share...
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Katie Samuel replied to Sara Mistry
2 - I think it is difficult to mandate any non-evidential practice, but the scope of a result on the morning of survey is limited to informing perioperative blood management decisions, unless you are considering cancelling the patient if their Hb comes back as low (I suspect that not many people would do this on the morning of surgery if it is close to...
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Katie Samuel replied to Sara Mistry
Hi Chris - no need to apologise, although we stop actively reviewing course comments after the 1st 4 weeks of each run.
To answer your questions:
1 - With the caveat that the deficiency diagnosis is correct, and there are not ongoing losses, functioning bone marrow etc.
- An incremental increase of >10g/L in Hb after 2 weeks of oral iron therapy is...
