Teamwork is an essential part of perioperative care. Here the case is made that we should approach both pre and post habilitation as being akin to playing a team sport. Presented by Desiree Chappell with her guest Dr Steve Flanagan, Chair of Physical Medicine and Rehabilitation at NYU Langone. The fuller version of this piece is here: http://topmedtalk.libsyn.com/physical-medicine-in-rehabilitation-applying-a-team-approach-in-care-and-pre-and-post-habilitation...
Mar 22, 2019•7 min
Learn how to develop a national Quality Improvement (QI) network which will increase both communication and knowledge implementation. What are the essential elements of a useful network, how do you build a community within one and solidify it as an essential part of your practice? Presented by Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London.
Mar 21, 2019•19 min
"Postoperative changes in cognition: The role of biomarkers" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.com/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented by Miles Berger, Neuroanesthesiologist at Duke ...
Mar 20, 2019•24 min
How do you best work a pre-op clinic? Should they be places where you get your problems documented or where you get your problems 'fixed'? How do you convince your practice to optimise patients for life and not just 90 days? How do we encourage population health? How do we get round the fact that we're still in a 'fee for service world'? What is "PBPM"? Featuring Desiree Chappell, Monty Mythen, Dr Lee A. Fleisher, Chair of Anesthesiology and Critical Care (University of Pennsylvania) and Vicki M...
Mar 19, 2019•10 min•Season 2Ep. 11
This podcast covers the physiological principles of goal directed fluid therapy, fluid responsiveness, the stressed system and the glycocalyx. Originally streamed live on www.topmedtalk.com Presented by Dr Joff Lacey with his guest Dr Randall Dull of the University of Illinois, live from the ASA in 2017.
Mar 18, 2019•20 min•Season 2Ep. 5
TopMedTalk catches up with another online media source, The Critical Care Practitioner podcast, organised by our guest who - appropriately enough - is a critical care practitioner. What's it like being a critical care practitioner in the UK at the moment? Originally a lot of nurses moved into the sphere but now paramedics, physiotherapists and many others progress into it. Furthermore what's it like taking your professional passion into the world of podcasting? You can hear the Critical Care Pra...
Mar 17, 2019•13 min
Recorded on the first day of the Intensive Care Society's annual conference this conversation starts with some reflections about how conferences have moved into the modern age now with interactivity and new media revitalising the scene in unexpected ways. Conversation then moves out to some of the big questions: Is the pulmonary artery catheter back? What have been some of the big take aways in nutrition? Why should you feed a cold and starve a fever? More Protein or less? Finally, ‘humanizing i...
Mar 16, 2019•36 min•Season 2Ep. 5
Shared decision making is a meeting between experts, on the one hand we have a clinician who understands a diagnosis and a likely prognosis, on the other we have a patient who exclusively understands their values and personal tolerance for risk. Ideally these two perspectives are encouraged to combine into high quality decisions tailored to individual patients. What are the essential elements of this process? Presented by Angela Coulter, a UK based health policy analyst and researcher. Originall...
Mar 15, 2019•10 min
"Perioperative nutrition" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented by Paul Wischmeyer, Professor of the Department of Anesthesiology, Duke University...
Mar 14, 2019•26 min
"Does choice of opioid influence health outcomes?" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented by Padma Gulur, Professor of Anaesthesia and Executive Vi...
Mar 13, 2019•28 min
What is the Enhanced Recovery After Surgery (ERAS) Shared Interest Group (SIG)? How does it relate to the advancement of perioperative medicine? TopMedTalk was at the American Association of Nurse Anaesthetists (AANA) 2018 conference in Boston, check the podcast timeline for more, or click here: https://www.topmedtalk.com/?s=AANA Desiree Chappell speaks with her guests, Josh Newman Lead CRNA at Passavant Area Hospital, Springfield, Illinois Area and now Chair of the Enhanced Recovery After Surge...
Mar 12, 2019•19 min•Season 2Ep. 10
How do we address the issue of post operative delirium? Here you will find fascinating further discussion about cognitive function after surgery. What practical, simple steps can patients and providers take to bridge the gap between new discoveries in this area and risk minimisation? Featuring Desiree Chappell interviewing her guests, Carol Peden, Professor of Anesthesiology and Executive Director of the Center for Health System Innovation, University of Southern California, University of Bath a...
Mar 11, 2019•15 min•Season 2Ep. 4
What is POPS (Proactive care for Older People undergoing Surgery) and how have things gone since this service was introduced to Guy's and St Thomas's back in 2004? How does the team apply the techniques of this programme to the perioperative pathway of a patient? Would a service like this be useful at your practice? Can your institution accommodate a fully comprehensive geriatric assessment and optimisation process? Furthermore, should a programme like this be rolled out across the UK and could ...
Mar 10, 2019•58 min•Season 2Ep. 8
What can practitioners do to preoperatively screen for signs that their patients may have issues with post operative delirium? How do we get patients fit for surgery, particularly with regard to delirium? Can you build up mental resilience in the run up to an operation? Do puzzles and mental activity - such as sudoku or a good crossword - help and is there any evidence of that? Should preoperative sedation be, generally speaking, withheld from people over 60? How do we explain the risks of this ...
Mar 09, 2019•22 min
Is it unreasonable to give a patient six months to lose weight before, for example, knee surgery? Going even further should we be considering meditation, mindfullness and yoga as part of a pre-habilitation clinic? Hosted by Desiree Chappell and Monty Mythen, recorded at the Interdisciplinary Conference on Orthopedic Value-Based Care, with their guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in...
Mar 08, 2019•11 min
The full title of the paper being looked at here is: "Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial". The link to the paper is here: https://www.ncbi.nlm.nih.gov/pubmed/30721296 The editorial referenced in the piece is here: https://jamanetwork.com/journals/jama/article-abstract/2724007 Presented by Monty Mythen and Desiree Chappell. -- Do you have your ticket to the D...
Mar 07, 2019•28 min
"PQIP Pain: from individual case to systems management" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com If you're looking for the talk mentioned here featuring Paul Wishmeyer it is here: https://www.topmedtalk.com/topmedtalks-to-dr-paul-wischmeyer/ if you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team ...
Mar 06, 2019•21 min
How do we best negotiate working in a multidisciplinary team? Generalisations regarding surgeons and anaesthetists only ever work generally, the specifics of each practitioner and their priorities inevitably contrast. How do we keep sight of these broad differences without falling foul of stereotypes? The conversation evolves; how does the surgical journey fully utilise the team based perioperative approach? With specific focus on geriatric care there is further discussion regarding shared decis...
Mar 05, 2019•14 min•Season 2Ep. 9
What can practitioners do to preoperatively screen for signs that their patients may have issues with post operative delirium? How do we get patients fit for surgery, particularly as regards delirium? Can you build up mental resilience in the run up to an operation, do suggestions that puzzles and mental activity such as sudoku and a good crossword help have any evidence behind them? This piece features Monty Mythen and Desiree Chappell in conversation with Dan Cole, professor of clinical anesth...
Mar 04, 2019•6 min•Season 2Ep. 3
How is it the case that some people can lose significant muscle mass while they are being cared for on the Intensive Care Unit (ICU)? What can practitioners do to help avoid this? How do we integrate a dynamic stimulus and react to new research relating to nasogastric feeding? In this piece you will hear about a randomised controlled pilot study investigating the effect of intermittent versus continuous nasogastric feeding on muscle mass and function in intensive care unit survivors. Hugh Montgo...
Mar 03, 2019•12 min•Season 2Ep. 7
How do you become well known in the NHS for being innovative, particularly in the perioperative area regarding evaluation and communication of risk? How can cardiopulmonary exercise testing lead to shared decision making? Hear how aortic aneurysms are dealt with by a world class professional perioperative physician. Learn how that process and its success then spread out into other areas of healthcare within his institution. Do you need to develop a broad knowledge of all surgery and medicine so ...
Mar 02, 2019•18 min
The gap between ambition and action is familiar to us all but when it's potentially a matter of life and death how do we overcome it? This piece gives you a sense of both the research which illustrates the 'behaviour gap' in patients who are attempting to make good on their promise to regularly exercise. Presented by Chloe Grimmett, behavioural scientist from Southampton University. She works closely alongside the 'Fit for Surgery Team', providing the behavioural intervention which is part of th...
Mar 01, 2019•12 min
Interesting thoughts on the use of ACE inhibitors and ARBs, alongside considerations regarding asprin. We look at the following papers: Anesthesia and Analgesia : A Systematic Review of Outcomes Associated With Withholding or Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Before Noncardiac Surgery. https://www.ncbi.nlm.nih.gov/pubmed/29381513 Anesthesia and Analgesia : A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Sys...
Feb 28, 2019•11 min
"Perioperative nutrition should be a key part of Enhanced Recovery" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented by Paul Wischmeyer, Professor of the Dep...
Feb 27, 2019•27 min
How does the treatment of anemia fit into the perioperative process? How far should patient optimisation extend to treatment of this condition? Live from the hugely successful EBPOM USA conference, directly after their presentation Desiree Chappell talks with her guests; Dr Lori Heller, Cardiac Anesthesiologist, Swedish Medical Center, through US anaesthesia partners and acting instructor at the University of Washington, Seattle and Dr Bobbie Jean Sweitzer, Associate Professor and Director of pr...
Feb 26, 2019•25 min•Season 2Ep. 8
This piece starts with the question: Is there a hierarchy amongst the various elements of an enhanced recovery pathway? The conversation that follows tackles some of the essential elements of perioperative care. This conversation is taken from a longer piece to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-2/ For further expert discussion regarding the Drink, Eat, Mobilise, Sleep (DrEaMS) concept there is another short piece you can find here: https://www.topmedtalk.com/stand...
Feb 25, 2019•5 min•Season 2Ep. 2
Trainees with an interest in perioperative medicine (TRIPOM) is an ever growing organisation set to continue the global push for perioperative care. This high energy podcast gives you a taste of the enthusiasm people pick up as they learn more about the value of these ideas. Moving more obviously into the perioperative period this piece continues on from last week's talk regarding mitochondrial health where 'healthy ageing' was the focus. The panel now draw the conversation into areas such as nu...
Feb 24, 2019•34 min•Season 2Ep. 6
NAP (National Audit Project) 6 is the largest ever prospective study of anaphylaxis related to anaesthesia and surgery. Find out the details behind this intriguing study, how long did it take, how does the data impact upon our day to day practice? There follows a deep dive into the results and recomendations that NAP 6 has produced. Packed with useful information this podcast is one of the stand out pieces of our coverage of the Royal College of Anaesthetists' annual conference in London. Joff L...
Feb 23, 2019•28 min
Community based prehabilitation in the UK is being spearheaded by the Prepwell Initiative. Supported by a grant from Sports England this pioneering work is a great example of the way in which a perioperative enhancement team can be formed around your practice. The "PREP: Preoperative Risk Education Package" website mentioned in this piece is here: https://www.prepwell.co.uk/ Desiree Chappell and Joff Lacey are presenting with their guests Dr Mark Edwards, Consultant in Anaesthesia and Perioperat...
Feb 22, 2019•9 min
This piece ploughs into some of the academic papers that have provoked discussion recently in the perioperative community. We discuss the following papers: Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses. https://www.ncbi.nlm.nih.gov/pubmed/30552274 Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty. https://www.ncbi.nlm.nih.gov/pubmed/29975266 Effect of A1C and Gluc...
Feb 21, 2019•13 min
