What is a "Respect Officer"? Why is respect so important in perioperative care? How does improving 'the culture of safety' also help to improve outcomes? Should we be overly concerned about high cancelation rates for surgery? And what are the advantages of a preoperative risk assessment clinic (PRAC)? Presented by Desiree Chappell and Monty Mythen with their guest Amir Jaffer, Chief Medical Officer, New York Presbyterian / Queens.
Shared decision making is key to any perioperative enhancement team, this piece is a fascinating debate between various interesting positions. For more on the (Perioperative Optimization of Senior Health) POSH clinic mentioned in this piece look here: https://medicine.duke.edu/divisions/geriatrics/patient-care/duke-perioperative-optimization-senior-health Presented by Monty Mythen with his guest Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton and cont...
This exciting panel discussion covers a wide variety of questions, including; what is the definition of high risk patients in your clinic? What is your criteria for referal regarding pre-op patients? Who is in the multidisciplinary pre-op team? How long does each patient appointment last? How should we prioritise antihypertensives? Should anaesthetists be more involved in the postoperative care of patients? This piece is chaired by Dr Ar Kar Aun and features; Imogen Mitchell, Senior Staff Specia...
"POETTS 2018 | Psychological Behavioural Change Interventions in Cancer Patients" - 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 Chloe Grimmett, behavio...
"What drove enhanced recovery for us was not the short lengths of stay but the cancer outcomes" - this conversation explains how enhanced recovery gains traction in practice. Even after a relatively short period of application an evidence based approach is hard to refute. Desiree Chappell presents 'The Roundtable blog'; in this piece she’s in conversation with Dr Michael Scott, Professor of Anesthesiology at Virginia Commonwealth University and Professor at The University of Pennsylvania, Dr Nei...
As a general rule, should ward monitoring be increased? Should continuous blood pressure monitoring be more frequent? This short piece follows on from Tim Miller's talk "Perioperative Blood Pressure (PeriOperative Quality Initiative: POQI 3) how low can you safely go?". Presented by Desiree Chappell and Monty Mythen with Tim Miller, Associate Professor of Anesthesiology from Duke University Medical Centre.
Pets as Therapy are a fantastic charity who have provided a practical theraputic service to various people in assorted contexts, here you can hear them work their magic on the TopMedTalk team. What are the advantages of taking pets into the ward? Can patients benefit from some therapy from our 'hairy friends'? Meet the volunteers and practitioners who have a dogged determination to cheer up our patients. Presented by Desiree Chappell and Monty Mythen with their guests; Hillary Burbage, with Matl...
Most people are familiar with ultrasound these days, next to the stethoscope and thanks largely to baby photographs, it's one of the most frequent public facing technologies in medicine. New developments in transesophageal echocardiography have brought about huge advancements in its use as a technology; not to mention the incredible images now available from three dimensional echocardiography. As ultrasound becomes more available and more portable this conversation gives you an idea of where, wh...
The need for patient education is a constant theme on TopMedTalk, many are keen to soak up information and become and active team player in their operation, how can we make the most of their patricipation? For example, do you let your patients go to "surgery school"? Presented by John Moore, Adult Critical Care Clinical Director and Consultant Critical Care & Anaesthesia at Manchester. The fuller version of the original talk is here: http://topmedtalk.libsyn.com/poetts-2018-pre-operative-ins...
Australia has an interesting history both generally and with perioperative medicine specifically. Here the story is told and their current progress is revealed. How do comparisons between various countries help us to understand where improvements can be made? How do the differences between the way in which healthcare is funded impact patients and providers? Moderated by Dr Mark Edwards, University College London Hospital, with his guests Ross Kerridge, John Hunter Hospital, Newcastle, Australia,...
"POETTS 2018 | Pre-operative Inspiratory Muscle Training" - 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 Denny Levett, Professor in Perioperative Medici...
We learn more about what the Perioperative medicine summit is and have a quick fire review of the current literature related to Perioperative Medicine. Discussions in this piece include the use of ACE inhibitors and ARBs, Hypotension, the Measurement of Exercise Tolerance before Surgery (METS) Trial and the improving fortunes of asprin. The SPAQI website is here: https://www.spaqi.org Presented by Desiree Chappell with Monty Mythen and their guests Barbara Slawski, Professor of Medicine and Orth...
This piece outlines some of the topics related to the third Perioperative Quality Initiative (POQI). What is 'perioperative blood pressure'? What have been the major developments in this area? Also, should we be looking at increasing monitoring of patients, particularly regarding their blood pressure, in hospital? The Perioperative Quality Initiative (POQI) is discussed here: https://www.topmedtalk.com/anesthesia-and-analgesia-go-big-on-poqi/ The POQI website is here: http://poqi.org/ The INPRES...
This invaluable piece is a chance to attend a workshop which looks at the latest thinking on "perioperative cognition" and 'post-operative cognitive dysfuntion'. We advise you use this link here to find the PDF of the paper being discussed: https://bjanaesthesia.org/article/S0007-0912(17)54082-9/fulltext Presented by David Scott, Professor, University of Melbourne, Director, Anaesthesia and Acute Pain Medicine, St Vincent’s Hospital, Melbourne and Lis Evered, Scientific Head of Research, Departm...
Does perioperative medicine alow institutions to take a broader view? Population health has been a theme on TopMedTalk, is it a logical extension of the perioperative process? How do we manage specialist care for the elderly and ensure high quality shared decision making? What lies behind the mindset change needed for some to accept surgery is not always the answer? Should we expect medical students to be taught the principles of perioperative medicine? What are some of the unique tensions in th...
When it comes to breathlessness how do we better diagnose and apply treatment? How do we overcome the fact that referring to a specialist can sometimes take a patient 'down the wrong route' with a condition that might not be just heart or lung related? Should we take a more perioperative approach to treatment and diagnosis? "Nick, the patient" asks a few questions and demonstrates the misunderstanding that many sufferers might have; breathlessness is not always connected to your lungs. "Johnny, ...
"Increasing the richness and the reach of what we do" is the mantra of 'Anesthesiology'; hear from its Editor in Chief how it managed to self study and discover the essential idea behind the journal: "trusted evidence, from discovery to practice". Conversation then moves on to methadone, the overlooked opiate; where do you use it and what sort of dose is appropriate? What are the benefits of including this in your practice and should it really be considered in the same category as most other opi...
The results of the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial; where does it put perioperative practice in 2019? What have we learned? Originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 on www.topmedtalk.com 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 Carol Peden, Pr...
How does one go about becoming a Master of Perioperative Medicine? This piece takes a look at the growing movement which all TopMedTalk listeners are at the forefront of. Further debate covers, "NPO after midnight", getting buy in from the institution to practice perioperatively and keeping the momentum going after one leaves a conference. Presented by Desiree Chappell and Monty Mythen with their guests, Marc Koch President & CEO of Somnia Inc and Gregory Pato, internal medicine physician as...
When it comes to blood pressure, hypotension is associated with poor outcomes for patients, how do we react to this? How do we manage and avoid hypotension where possible? How has technology caught up with this challenge? Could automated closed loop systems be helpful here? The bottom line is simple; "If we measure blood pressure properly, we can predict it". Presented by Dr Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust.
This invaluable piece is a chance to attend a workshop which looks at the latest thinking on "perioperative cognition" and 'post-operative cognitive dysfuntion'. We advise you use this link here to find the PDF of the paper being discussed: https://bjanaesthesia.org/article/S0007-0912(17)54082-9/fulltext Presented by David Scott, Professor, University of Melbourne, Director, Anaesthesia and Acute Pain Medicine, St Vincent’s Hospital, Melbourne and Lis Evered, Scientific Head of Research, Departm...
More of our coverage of the American Society of Enhanced Recovery (ASER) annual general meeting. Reflections regarding the rise of Cardiopulmonary Exercise Testing (CPET); a growing field, particularly in the US. The "Prehabilitation World Congress in association with POETTS & EBPOM" meeting discussed in this podcast is here: https://ebpomusa.org/Prehab-2019 If you are interested in hearing more about the Measurement of Exercise Tolerance before Surgery (METS) trial: https://www.topmedtalk.c...
Perioperative medicine is defined here as: "the practice of patient centred multidisciplinary and integrated medical care of patients from the moment of contemplation of surgery until full recovery". Population health is defined as: "the health outcomes of a group of individuals including the distribution of such outcomes within the group". Do the two compliment each other? Use this concise 15 minute presentation to help build the case for a perioperative care programme at your institution. Pres...
If we look at the evidence, is there a case for "vascular geriatrics"? Co-managed care in vascular surgery could be a way forward, this talk builds the case for change. Readmission rates in this group are dissapointing, how do we reasonably tackle this issue? How do we balance questions regarding appropriateness and need for surgery in this area? What about the priorities of the patient, do they align with our aims? Is it possible there are geriatiricans who are already doing co-management with ...
This piece is taken from the free papers presentations given at EBPOM 2019. Can two weeks of prehabilitation really make a difference for patients facing primary surgical resection of colorectal cancer? How feasable is it to recruit patients into such a programme? Can we make a real change in their objectively measured fitness? Is there patient buy in? What is the strain on an institution's resources? Presented by Andrew Bates, Senior Research Nurse at Royal Bournemouth Hospital NIHR Intern....
Obstructive sleep apnea is important to identify in patients, this piece explains how; use the official STOP BANG website here: http://www.stopbang.ca/osa/screening.php Opioids and pain management strategy is discussed, alongside reflections on the differences between the healthcare systems of Canada, the UK and America. Finally, what is "the beard test" and "the upper lip bite test"? Presented by Desiree Chappell and Monty Mythen with their guests, Frances Chung, Professor, Department of Anesth...
Some practitioners habitually prescribe opioids, the consequences in America are now described as a national crisis. Essentially the focus here is "better opioid stewardship" and a "move away from the traditional fundamental principle of opioids first". Presented by Michael Manning, MD, PhD, Assistant Professor at Duke University Medical Center, Director of Research for the Perioperative Medicine Fellowship at Duke.
This invaluable piece is a chance to attend a workshop which looks at the latest thinking on "perioperative cognition" and 'post-operative cognitive dysfuntion'. We advise you use this link here to find the PDF of the paper being discussed: https://bjanaesthesia.org/article/S0007-0912(17)54082-9/fulltext This is Part 2, to find Part 1 follow this link here: https://www.topmedtalk.com/sunday-special-the-perioperative-cognition-workshop-part-1/ Part 3 is here: https://www.topmedtalk.com/sunday-spe...
Perioperative nutrition is a topic which has fascinates us here on TopMedTalk. Ever evolving and moving forward the questions continue as we explore an area which will only keep growing. Should evidence based arguments be the way we make the case for true investment in this area? Presented by Korey Springman with her guest William Wooden, Director of Operative Services at Indiana University of Health.
This piece dives into the latest thinking behind opioid-free anaesthesia; how can we improve? Is the challenge of the opioid crisis being met head on by perioperative medicine? Is it realistic to expect to reach a point where opioids are removed from the equation entirely? Presented by Michael Manning, MD, PhD, Assistant Professor at Duke University Medical Center, Director of research for the Perioperative Medicine Fellowship at Duke.
