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...
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Katie Samuel made a comment
Thank you all for sharing your personal experiences and thoughts on end of life discussions - I would like to again thank Rob Stephens for his open and inspiring discussion of his personal events. I think this really drives home the importance of compassion and personalised decision making for our patients, despite the human barriers we often feel to broaching...
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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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Katie Samuel replied to Sara Mistry
There is a relatively recent international consensus statement published in 'Anaesthesia' on post operative management of anaemia - this is the first to focus specifically on post operative management. Although it isn't specific to obstetrics, it suggests the use of a single high dose intravenous iron preparation to rapidly replete iron stores :...
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Katie Samuel replied to Bernardo Matias
Thank you very much Bernado for bringing this to our attention - I have looked into the RCoA link, and it appears to be a problem with the RCoA website and file location, and isn't available anywhere else online that I can find. We will look into this and rectify, along with the repeated link, for the next run.
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Thank you for sharing this Jen - we will incorporate this update into the next run of the course.
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Yes - it refers to patient blood management (PBM). It is discussed in more detail in steps 3.7 and 3.8, but it refers to prevention and management of anaemia preop, intraop and post op.
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Brilliant that you have been able to use local PQIP data to bring about change. I hope that we will see it used more and more in the UK over the coming years.
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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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Thank you - I am delighted to hear that you are enjoying learning about POM. The next few weeks will take us through even more important topics, so do continue.
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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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Agree - an excellent point. As mortality thankfully becomes a reasonably rare outcome, it is perhaps not the most sensitive marker of a successful outcome. Disability free survival following a high risk surgical episode is what the majority of patients value, and we have already started to see a shift towards valuing patient centric measures as outcomes-...
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As all of you in this thread highlight, the process of shared decision making is of the utmost importance and has a vital role to play in perioperative medicine. There is a whole section in week 2 on 'Patients at the centre of their decisions', but you may want to take an advance peek at the choosing wisely UK website https://www.choosingwisely.co.uk - a great...
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Katie Samuel replied to Deborah Lewis
Hi Deborah - hopefully you will enjoy the sections on perioperative anaemia in week 3.
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Katie Samuel replied to kathleen Cowe
Great to have you back!
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Katie Samuel replied to Kamrun Nahar
We are delighted to hear that this course will be useful in helping you achieve your aims!
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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 made a comment
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 optimisation, but also a strong MDT input to her postoperative care. This is the crux of perioperative medicine - focussing not just on the operation but the...
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Katie Samuel made a comment
I have been reading all 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
Many of you have commented how 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...
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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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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...
-
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 - the common 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.
The bottom...
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Great - looking forward to seeing you in week 2!
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Great that you found the animation useful! I think it is a great resource to show to anyone who hasn't come across perioperative medicine or isn't clear as to what it actually means - patients, colleagues etc
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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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I think that is a reasonable point Irene - some would argue it goes even beyond the 30 days. There are a number of publications on the effect of surgery in the longer term (1 year and beyond), and the impact that it has on patients. Some never return to their baseline function, and so it has impacts on both social as well as health care. This is a particular...
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SORT is one of the really useful tools for risk assessing patients preoperatively. There is more on this, as well as looking at the other risk assessment tools, in week 2.
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Katie Samuel made a comment
Welcome all to the course - myself and Abigail Whiteman are very much looking forward to working with you over the next 4 weeks.
We hope you find the course interesting, stimulating and useful - any problems or questions at any time please just let us know (in the comments). There will also be a some of the expert contributors present during the weeks...
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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 made a comment
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 optimisation, but also a strong MDT input to her postoperative care. This is the crux of perioperative medicine - focussing not just on the operation but the...
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Katie Samuel replied to Jiten Patel
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@MarkS - The opinion and evidence base on male vs female blood loss and threshold for anaemia is taken from the International consensus statement on the perioperative management of anaemia and iron deficiency. The summary in the article is copied below - the link is (https://onlinelibrary.wiley.com/doi/full/10.1111/anae.13773) if you wish to review the...
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Katie Samuel made a comment
I have been reading all 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
Many of you have commented how 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...
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Katie Samuel replied to Ju Ju
From my reading there is no evidence that tranexamic acid is contraindicated in this group if they are actively bleeding - it is not routine to give TXA in our trust for caesarian sections. Likewise, major haemorrhage increases the risk of postoperative VTE in obstetric patients - another factor to consider.
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There was an international consensus statement on management and treatment of perioperative anaemia published in 2017 (https://onlinelibrary.wiley.com/doi/full/10.1111/anae.13773). The Authors of this decided to adhere to the following 'When treating anaemia pre‐operatively, the target haemoglobin concentration should be ≥ 130 g.l−1 in both sexes, to minimise...
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I think the answer to this obviously varies depending on the urgency of surgery, but at our centre the majority of elective patients have their blood tests taken in preoperative assessment clinic. If they are anaemic then treatment with IV iron is arranged through the trust, or oral iron via their GP, depending on patient specific factors and time until...
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Katie Samuel made a comment
Its lovely to hear a number of people commenting that their own hospitals are adhering to and providing 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.
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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.
We will learn more about the positive outcomes which protocol use can provide in some patient cohorts in the next few steps.
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Yes - there is the clinical data collection, but also a separate patient questionnaire.
The patient is therefore seen face to face to consent to the study and complete preoperative data on level of function, and are then seen at set intervals post op. During these visits they answer questions on satisfaction with anaesthetic care, post operative symptoms...
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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 - the common 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.
The bottom...
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Katie Samuel replied to Richard Bayliss
Including patients individual values in the decision making process is a really important point that you make. Shared decision making is a vital part of the perioperative process that is currently undertaken to a variable extent in different centres by different teams.
There are some key documents and guidelines discussing shared decision making that are...
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Really pleased that the course is sparking your interest!
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Katie Samuel made a comment
Realmente he disfrutado leyendo todos sus comentarios esta semana y escuchando lo positivo que es la mayoría de ustedes acerca de cómo la medicina perioperatoria mejorará los resultados para los pacientes quirúrgicos.
Observo que a muchos de ustedes les preocupa cómo se logrará la financiación de estas vías. En última instancia, esperamos que la medicina...
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Katie Samuel made a comment
Es fantástico ver a tantos miembros diferentes del equipo multidisciplinario en el curso: ¡bienvenidos! La medicina perioperatoria es una verdadera especialidad de MDT.
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Katie Samuel made a comment
Estoy encantado de ver tanto debate ya, en el segundo día del curso. Ya se han explorado muchas definiciones de medicina perioperatoria, pero todas apuntan a mejorar la atención de los pacientes quirúrgicos en todo el mundo. Espero mucho más debate y debate en las próximas cuatro semanas.
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Katie Samuel made a comment
Es realmente interesante escuchar cómo encaja el modelo tradicional de cuidado con su práctica actual en varios países, y muchos de ustedes identifican los beneficios clave y las posibles desventajas.
En el siguiente paso, aprenderemos sobre las limitaciones de este modelo de atención y aprenderemos sobre modelos alternativos más adelante en este capítulo.
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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 made a comment
Muchos de ustedes han señalado que, en el caso de Mary, esta era una operación electiva en un paciente comórbido, y que claramente se habría beneficiado no solo de una evaluación y optimización preoperatoria minuciosa, sino también de una fuerte aportación de MDT a su cuidado postoperatorio. Este es el quid de la medicina perioperatoria, que se centra no solo...
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Katie Samuel made a comment
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 optimisation, but also a strong MDT input to her postoperative care. This is the crux of perioperative medicine - focussing not just on the operation but the...
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Katie Samuel made a comment
Gracias a todos por sus amables comentarios: se los pasaré a toda la Facultad.
Estamos realmente encantados de que ha sido útil para usted y han estado tan satisfechos con el compromiso y la participación de tantos estudiantes. He disfrutado leyendo todas sus discusiones y he aprendido mucho.
Esperamos repetir el curso más adelante en el año así que por...
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Katie Samuel made a comment
I have been reading all 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...
