This piece discusses how the contributors are driving better perioperative care in their clinics; the importance of getting patient records in advance; ERAS for obstetrics; challenging opioid use with the multimodal pain management; shared decision making in pain management; the importance of clear communication pathways and patient literacy. This podcast features Desiree Chappell interviewing; Dr Ellen Flanagan, anaesthesiologist and medical director at the Duke preoperative assessment testing ...
Sep 04, 2019•19 min
Frailty is a common condition which has been topical in geriatric medicine for some time but now it is appearing in the surgical and anaesthetic literature. This talk explores how our understanding and discussion has improved regarding a condition that is still yet to have a clear, universally accepted, definition. How do we build a patient's physical reserve? What is the best way to conceptualise frailty? Are there any universal treatments available? Presented by Dr Jugdeep Dhesi, Clinical Lead...
Sep 04, 2019•22 min
This piece focuses on the article "The malnourished surgery patient, a silent epidemic in perioperative outcomes?" which you can find here: https://journals.lww.com/co-anesthesiology/Abstract/2019/06000/The_malnourished_surgery_patient__a_silent.23.aspx The Perioperative Quality Initiative is here: www.poqi.org Presented by Desiree Chappell with Monty Mythen and their guests Jeroen Molinger, Clinical Medical Exercise Physiologist at Duke University Medical Center, Department of Anesthesiology &a...
Sep 03, 2019•16 min•Season 2Ep. 32
In short; Post-Op recovery in less than 3 days with over 90% mobilised on day 1. This in depth discussion relates to the consensus paper from the Perioperative Quality Initiative, see link below. It focuses on: outcomes, length of stay and DREAMS (Drinking, Eating and Mobilising) within hours after major surgery- all key measures of compliance and success in an Enhanced Recovery Program. Monty Mythen and Joff Lacey with Mike Grocott presenting with contributions from Dr Julie Thacker, Colorectal...
Sep 02, 2019•11 min•Season 4Ep. 9
"The father of prehabilitation" reflects on where the discipline is now and where it used to be, from new kid on the block to being touted now as the word of the moment. How has this change come about? Is it the focus value based care? Is it the fact we're becoming more patient focused? Is it fair to say this is an evidence led focus brought about by more information and understanding regarding long term patient outcomes? Further discussion includes frailty, engaging patients in their prehabilit...
Sep 01, 2019•23 min
Prehabilitation is about planned pathways, preparing our patients for a journey which we as practitioners have already travelled. 4.2 million deaths are attributable to surgery each year globally, this presents a huge opportunity to improve the world for those who focus on perioperative surgery and prehabilitation. On the financial side, complications from surgery are proven to put costs up. It's now widely accepted that perioperative medicine is the future of anaesthesia, how do we help the dis...
Aug 31, 2019•23 min
"Enhanced recovery after bariatric surgery" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 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 David Voellinger, Lead Physician, Novant Health Bariatric Solutions Ch...
Aug 29, 2019•13 min
This piece starts with some words from patients; prehabilitation is "a set of actions that can be taken in advance of treatment to ease your passage through cancer". This vital talk explains how prehabilitation can leave cancer patients feeling personally empowered and ready to live well. Living is one thing, how do we get people to enjoy 'living well'? Further to this how do we do that in such a way that respects patient decisions and life choices? How can we get to a position where exercise, n...
Aug 28, 2019•20 min
This piece gets into the detail regarding one of the big talking points in perioperative medicine over the last year or so; what is the impact of intraoperative hypotension on post operative outcomes? Further discussion encompases the modern uses of a pulmonary artery catheter. If you enjoyed hearing Andy Shaw's take on these topics further listening can be found here; https://www.topmedtalk.com/hemodynamic-monitoring-and-the-pulmonary-artery-catheter/ Presented by Desiree Chappell with Monty My...
Aug 27, 2019•13 min•Season 2Ep. 31
Should we still measure urine output? How useful is permissive oliguria? Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh.
Aug 26, 2019•5 min•Season 4Ep. 8
This panel discussion reacts to various questions from the online audience and those in attendance. Questions include; Is there any good evidence for the use of wearable tech in prehabilitation? How come, if the evidence is almost there, prehabilitation is not yet included in every pathway? In this respect, is change just around the corner? How do we have patients are partners rather than passive participants? What are the benefits of prehabilitation which can be seen in two weeks? How does one ...
Aug 25, 2019•27 min
This piece focuses on the "Wessex Fit-4-Cancer Surgery Trial"; a unique multi-centre, efficacy pragmatic, factorial design, randomised controlled trial, with patient informed development and process evaluation "You wouldn't run a marathon without preparing," why would you want an operation where you don't get ready for a physically stressful event such as surgery? Prehabilitation is an obvious advantage, gathering the data which proves that is essential to perioperative medicine because it means...
Aug 24, 2019•16 min
How important is it to screen patients for anaemia before surgery? Has anaemia fallen off the health care agenda? We begin with a conversation about patients who are anaemic and then turn to why this is sometimes not checked enough. Monty Mythen mentions UK University students appear to suffer from the condition more these days and Lori Heller points out that treating the condition, as part of patient optimisation, is something of a revelation for some, even occasionally removing the need for su...
Aug 23, 2019•22 min
Hear how you can transform your practice through team leadership, courage and a finely tuned awareness of the financial aspects of what you are trying to achieve. How can growth be tempered to suit the long term vision of a company? Why is teambuilding so crucial to large organisations? Can we determine the direction in which healthcare is evolving overall? Is 'population health in the perioperative space', a widely accepted future direction these days? Presented by Brian Woods, Anesthesiologist...
Aug 22, 2019•28 min
Why does the complex pain patient need ‘perioperative pain medicine’ to optimize outcomes of surgery? This piece faces the realities behind a perioperative approach which tries to prevent or manage cases of complex regional pain syndrome (CRPS) during surgery and the postoperative period. Should chronic pain be seen as a nervous system disorder? How do we deal with patients who catastrophise their pain? Should we pledge to use a regional analgesia technique wherever possible? Can atypical opioid...
Aug 21, 2019•27 min
The Hypotension Prediction Index (HPI) Monitor takes 2.6 million features from a single waveform which it then applies to 150 million different wave forms looking for factors which can predict hypotension. It's the first fully approved foray into predictive analyitics for the world of anaesthesia. This conversation looks at how it works and how it is being adopted in detail. Presented by Desiree Chappell with Monty Mythen and Feras Hatib Phd, Director, Research and Development, Algorithms and Si...
Aug 20, 2019•27 min•Season 2Ep. 30
This episode of The Perioperative Coach reflects on the pain management discussions being had by the American Society of Enhanced Recovery (ASER) and its members. For further reading see the articles in Perioperative Medicine Journal: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0064-5 This conversation taken from a longer piece to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ Presented by Monty Mythen with Dr Jof...
Aug 19, 2019•5 min•Season 4Ep. 7
How do we accurately calculate the risks to our patients? What are the best tools for the right circumstances? Where can we find data to improve these methods? Originally titled "50 shades of grey, how (in)accurate are risk prediction scores" the slides from this talk are here: http://www.anzca.edu.au/documents/02-doug-campbell_fifty-shades-of-grey.pdf The risk calculator is here: https://nzrisk.com/ Presented by Dr Doug Campbell, Anaesthesia Specialist at Auckland City Hospital. -- Brought to y...
Aug 18, 2019•28 min
The Perioperative Quality Initiative (POQI) have featured frequently on TopMedTalk, here we discuss their focus on hypotension and blood pressure. Perioperative Quality Initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine https://bjanaesthesia.org/article/S0007-0912(19)30047-9/fulltext Perioperative Quality Initiative consensus statement on preoperative blood pressure, risk and outcomes for elective surgery https://bjanaesthesia.org/articl...
Aug 17, 2019•13 min
This piece discusses the changes enhanched recovery brings, the conversation then moves to narcotics and the opioid epidemic. Presented by Desiree Chappell, Dr Vijaya Gottumukkala, cardiac anaesthesiologist from MD Anderson and member of the board of directors for the American Society of Enhanced Recovery (ASER) and Dr George Nassif, colorectal surgeon at the Center for Colon & Rectal Surgery in Florida.
Aug 16, 2019•14 min
This piece is about the application of data, how do we use it and when should we gather it? How important is it to "just get started and find out what the problem is"? Further reading is available here: https://bjanaesthesia.org/article/S0007-0912(17)33828-X/fulltext If you're interested in hearing more about the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial go here: https://www.topmedtalk.com/desirees-roundtable-carol-peden-epoch-qa/ Presented by Professor Carol Peden, Execu...
Aug 15, 2019•34 min
This piece features discussion regarding three randomised trials. How can the insights provided by these trials save us money and increase value of care while also improving outcomes? Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial DOI: https://doi.org/10.1136/bmj.j5916 REstrictive Versus LIbEral Fluid Therapy in Major Abdominal Surgery: RELIEF Study (RELIEF): https://clin...
Aug 14, 2019•28 min
"Thank you for taking this meeting beyond these walls" - this piece is the final part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. Check out the AANA here: https://www.aana.com/ Presented by Desiree Chappell and Monty Mythen with their guest Lynn Reede, Associate Clinical Professor, Northeastern University Nurse Anesthesia Program.
Aug 13, 2019•37 min
This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. Check out the AANA here: https://www.aana.com/ Middle Tennessee School of Anesthesia's website is here: https://mtsa.edu/ Our guest kindly shares their email with us: bill.johnson@mtsa.edu Presented by Desiree Chappell and Monty Mythen with their guest, Bill Johnson, DNAP, CRNA, Director, Acute Surgical Pain Management Fellowship at Middle Tennessee School of Ane...
Aug 13, 2019•17 min
This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. Check out the AANA here: https://www.aana.com/ The podcast "Beyond The Mask: Innovation & Opportunities For CRNAs" is here: https://beyondthemask.podbean.com/ Presented by Monty Mythen and Desiree Chappell with their guests, Sharon Pearce MSN, CRNA and Jeremy Stanley CFP, AIF; co-presenters of Beyond The Mask: Innovation & Opportunities For CRNAs....
Aug 13, 2019•18 min
This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. Check out the AANA here: https://www.aana.com/ The Pdf our guest mentions "The PAIN MANAGEMENT BEST PRACTICES INTER-AGENCY TASK FORCE REPORT" is here: https://www.hhs.gov/sites/default/files/pain-mgmt-best-practices-draft-final-report-05062019.pdf The Perioperative Quality Initiative (POQI) is here: http://poqi.org/ Presented by Monty Mythen and Desiree Chappell ...
Aug 13, 2019•31 min
This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. Check out the AANA here: https://www.aana.com/ The Open-Source Anesthesia Electronic Medical Record (OSAEMR) website is here: https://www.osaemr.com/ Presented by Monty Mythen and Desiree Chappell with John T. "Jack" Hitchens, CRNA, BA, ARNP, partner in a CRNA owned and operated Anesthesia Practice, Watchful Care and Dan Simonson, CRNA, MHPA retired as Chief CRNA...
Aug 13, 2019•26 min
Enhanced Recovery After Surgery, (ERAS) is a familiar concept to the typical TopMedTalk listener but what is ERAS+? How can you target high risk surgery patients with a comprehensive plan for them to help themselves get a better outcome? From managing expectations, to breathing exercises all the way up to significant lifestyle changes such as exercise and smoking cessation. The ERAS+ website is here: https://www.erasplus.co.uk/ Presented by Joff Lacey with Desiree Chappell with their guest Danie...
Aug 13, 2019•17 min•Season 2Ep. 29
This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. Check out the AANA here: https://www.aana.com/ Presented by Desiree Chappell and Monty Mythen with their guests Jaclyn Migliarese, BSN, RN, Second-year student, Duke University Nurse Anesthesia Program and Stephan Bodnar, BSN, RN is a second-year student in the Duke University Nurse Anesthesia Program.
Aug 12, 2019•23 min
This piece is part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. Check out the AANA here: https://www.aana.com/ The Diversity CRNA website is here: https://diversitycrna.org/ Presented by Desiree Chappell and Monty Mythen with their guests Debra Diaz, DNP, CRNA, APRN, CDR, AANA Board of Directors, Lena Gould, CRNA, Founder, Diversity in Nurse Anesthesia Mentorship Program, John Bing, Owner, JBing and Assoc Anesthesia Services,...
Aug 12, 2019•30 min
