"We've been doing cryoneurolysis for total knees now for three years... people gravitate to practices that that practice this technology" This piece focuses upon two 'early adopter' orthopedic surgeons changing up the way we treat joint pain for surgical patients. We mention Iovera, a provider at the forefront of this technology: https://www.iovera.com/ The Doc Social website is here: www.doc.social/ The Evidence Based Perioperative Medicine (EBPOM) website is here: www.ebpom.org This piece also...
Jun 28, 2021•47 min
This piece is a worthwhile deep dive into this perioperative medicine and how we go forward with it. Hear the panel speak about what it is they want for the future and what it is they are doing now. With questions submitted from the online audience the panel get into the detail. Essential listening for any student of perioperative medicine. It includes a mention for the Welsh Perioperative Medicine Society, their website is here: https://www.welshpoms.com/ This is part two of a two part piece of...
Jun 27, 2021•38 min
This is a story that starts with some of the challenges faced in our world outside the operating theatre and it's about how we might address some of these problems systematically. Healthcare organizations have to deliver high quality, competitive and sustainable results and costs. Good quality perioperative surgery is absolutely critical to maintain the health and well being of our population going forwards; this talk is a step in that direction. Presented by Guy Ludbrook Professor of Anaesthesi...
Jun 26, 2021•37 min
This piece is a worthwhile deep dive into this perioperative medicine and how we go forward with it. Hear the panel speak about what it is they want for the future and what it is they are doing now. With questions submitted from the online audience the panel get into the detail. Essential listening for any student of perioperative medicine. When should we pre-assess patients? Should all anaesthetists be doing pre-operative sessions? What is it about the role of the anaesthestist that makes it un...
Jun 25, 2021•33 min
"More than 300 million patients have surgery annually worldwide and an increasing proportion of them are elderly and at risk of perioperative adverse events. There's very few proven primary or secondary prevention measures, and the resources for monitoring and trading complications are inadequate. So - more action is required". This piece looks at the evidence as regards perioperative outcomes for the elderly, depth of anesthesia and mortality. Also, what's the latest on depth of anesthesia and ...
Jun 24, 2021•41 min
"The song remains the same" The story picks up toward the end of the 1970's; "interesting stuff was going on ... Professor William Shoemaker, a surgeon and intensive care doctor one of the founding members of the American critical care society ... fiddling around with pulmonary artery catheters in his high risk surgical patients in South Los Angeles, and identified that those patients that were surviving tended to have higher cardiac indexes higher option deliveries than the non survivors". This...
Jun 23, 2021•36 min
"Accelerated surgery for hip fracture is safe and feasable, with troponin elevation before randomization, there was a mortality advantage with accelerated surgery. The logistics and resources required for accelerated surgery need to be balanced with the demonstrated benefits and patient's desires for accelerated surgery" This exciting piece from EBPOM 2020 provides a data download that further illucidates the perennial debate surrounding hip fractures and their management and treatment. What is ...
Jun 22, 2021•16 min
This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being questions from the online audience: What is your opinion about spinals and hip fractures for patients on clopidogrel? Do you use any near patient tests to confirm residual anticoagulation? Where are the best guidelines to be found? We suggest you listen to this piece alongside part 1. Presented by Sol Aronson, tenured Professor at Duke University, with his guests; Angela Bader, Ha...
Jun 21, 2021•25 min
The conversation begins with "a day in the life" with respect to managing the anti coagulation questions that come up commonly. The contributors swap stories from their time in practice. The conversation moves to protocols, guidelines and also, when where and how to begin bridging. This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being questions from the online audience. Presented by Sol Aronson, tenured Professor at Duke University, ...
Jun 20, 2021•34 min
How can enhanced recovery after surgery (ERAS) be applied to cardiac and what exciting opportunities are there for those who have made this their mission? This detail driven address contains more information on The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac), more information can be found on their website: https://www.erascardiac.org/ Since this address was given at Evidence Based Perioperative Medicine (EBPOM) Chicago's 2020 meeting TopMedTalk has been proud to bring you...
Jun 19, 2021•19 min
"Look at it from where is the patient, and what's best for the patient; I think that the other answers follow and yes, it is higher quality, yes, there can be some opportunities for cost savings; even if it 'breaks even' if the patients are happier, isn't that worth moving into the concept and proving that it does make a difference?" The value proposition is an essential element of advocating perioperative care; we know it provides safer, better quality outcomes but how do we translate that into...
Jun 18, 2021•24 min
"When I heard Sol Aronson, speak about perioperative medicine as 'population health', for me, it was like a eureka moment because our platform within Michigan is really an unmatched place to kind of realize that vision." This piece asks the question; "why do we need perioperative medicine"? The answer is illustrated with a real success story where practitioners realise the value proposition it unlocks for their patients every day. Hear how it is achieved and why it is so important. Presented by ...
Jun 17, 2021•20 min
This piece is part one of a two part piece. It's a short didactic presentation on the tough realities the U.S. healthcare system faces as the fee for payment system creaks against concerns about rising costs and the need for population health management. Can we move forward with "the science of value" which true perioperative medicine offers us? It's a talk which is designed to spark debate and that follows in part two of this piece. Presented by Sol Aronson, tenured Professor, Duke University, ...
Jun 16, 2021•16 min
"So in all these ERAS programs, you need a physician champion, a nurse champion, a coordinator; then we brought our pharmacist in - I will not start rounds without a pharmacist. I refuse. I won't start because the pharmacist is integral ... it's just you need that multidisciplinary team" This piece is a question and answer session prompted by the address our guest gave during EBPOM Chicago. Both the online audience and the team challenge our speaker to explain more. If you missed the address Top...
Jun 15, 2021•25 min
This piece is a question and answer session with questions from the online audience. What do we think is the clinical care difference that having an elevated level of monitoring and more people around of all all sorts? Why is it good for our patients? As regards admissions to your campus care area; what criteria do you use? Do we need rapid critical care expansion in countries with very few beds? Could the enhanced care wards, in their approach, be compared with the post anaesthetic care unit? W...
Jun 14, 2021•48 min
This roundtable discussion tackles questions from the online audience and is the third part of a longer discussion. It follows on from "The value proposition in perioperative medicine | EBPOM 2021 Las Vegas", if you'd like to hear that go here: https://topmedtalk.libsyn.com/the-value-proposition-in-perioperative-medicine-ebpom-2021-las-vegas How do we as practitioners deliver value? How does 'population health' fit into the picture? How long before and after surgery are we invested in managing? ...
Jun 13, 2021•22 min
This piece is the second part of a conversation about leadership in medicine, during times of change. It follows on from the first part where our speaker outlines his thoughts in a short talk. Now questions from the audience are considered and the conversation develops. What have we learned after the recent huge changes we've seen in our profession? Presented by Desiree Chappell and Monty Mythen with Jeff Vender, Emeritus, Harris Family Foundation Chairman of the Department of Anesthesiology at ...
Jun 12, 2021•18 min
"I believe most people can be leaders or better leaders. You can create or participate in change and a better future. You can make a difference in your own lives, the lives of others and the life of your organization. If you believe you can." This piece contains a powerful, inspirational and prescient talk about leadership. Part 1 contains some conversation and the talk, to be followed by questions from the audience in Part 2. Where do leaders come from, what makes them stand out and how do they...
Jun 11, 2021•19 min
This question and answer session was a highlight of EBPOM London 2020, it works as a standalone piece or as a companion piece to this talk here: https://topmedtalk.libsyn.com/ebpom-2020-london-am-i-safe The discussion follows themes outlined in the presentation as our online audience asked a series of questions. Some of the questions included in the discussion are "How should leaders deal with anxiety both in themselves and their team? What is the evidence on perceived command gradient in reside...
Jun 10, 2021•28 min
This piece focuses on iDelirium; The International Federation of Delirium Societies on world delirium day. As well as considering this difficult condition the conversation asks what the latest research shows us and how things could improve both for patients and practitioners. For more detail check out their website here: http://www.idelirium.org/ Presented by Desiree Chappell and Monty Mythen with their guests Heidi L. Lindroth, Senior Associate Consultant Nurse Scientist, Nursing Research Divis...
Jun 09, 2021•22 min
"The goal of ERAS® Cardiac is when you leave one of our meetings, you're going to be chock full of tips and tricks that you can take back and implement, if not the next day, then in the next week or next month." TopMedTalk's coverage of The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac) conference continues with a conversation that covers the nuggets and insights that a conference such as this delivers. This exclusive chat is only possible thanks to the support of the societ...
Jun 08, 2021•17 min
"You didn't have to think about it, the compliance continued, because it was so standardized. We had a well oiled machine that just kept on working through COVID". The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac)'s conference has gotten off to a great start; this exclusive chat gets into some of the stand out moments so far; nutrition, data collection, the essentials of ERAS and the importance of standardization. For more information on the conference check out https://www...
Jun 07, 2021•31 min
"You have to take the viewpoint that if the Nurses and the Physical Therapists and the Pharmacists are resisting the idea that you're putting forward, then there's probably something wrong with it, it doesn't work for them, for some reason, and you got to find out what that is..." This long form conversation is a highlight for TopMedTalk's coverage of The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac) conference. The conversation covers a wide range of interesting areas, inc...
Jun 06, 2021•51 min
"Our real 'next barrier' in the continuum of care is, it's okay to have pain, right? It's expected to have pain. [...] but it is better for you recovery wise, complication wise; to be able to get up, move around, know what's going on, not be confused, right? A little bit of that education goes a really long way." The opioid crisis, spine surgery, working as a team, pioneering efforts being done at the world leading Norton Leatherman Spine Center, enhanced recovery after surgery (ERAS) and some o...
Jun 05, 2021•28 min
This piece is a continued deep dive into the subject, of 'fitness, function, or frailty' and, perhaps, "fixing". It's essential listening for anyone interested in the latest thinking on this crucial topic and was a highlight of the London conference. How can we integrate frailty and cognitive scores in risk assessment tools to facilitate inclusion in shared decision making? How can we improve a surgical colleague's ability to identify frailty? Most patients will have an operation sometime in the...
Jun 04, 2021•29 min
Fitness, function and, or, frailty are important determinants of the quality of the life that we live. In the context of major surgery it's very important we recognize and work with individual patients improving and optimizing them and their ability to handle an operation. This piece is an essential deep dive into the subject, essential listening for anyone interested in the latest thinking on this crucial topic. What are the limitations on your resources when considering a plan of preoperative ...
Jun 03, 2021•25 min
With questions from the online audience, this piece looks at the "not too much and not too litte" sweet spot regarding fuel, fluid and oxygen; where is it and how do we get there, according to our distinguished panel? This podcast works well as a companion piece to the following talks which have already been released here on TopMedTalk: Helen McKenna, "Fuel, can you have too much?" https://www.topmedtalk.com/ebpom-2020-london-fuel-can-you-have-too-much/ Tim Miller "Optimising fluid and hemodynam...
Jun 02, 2021•49 min
"I just feel there is some intrinsic value to, you know, a human presence" This piece tells the story of an anesthesiologist who, once vaccinated, decided to go the extra mile and work out a way to spend some quality time with his COVID-19 patients. Hear how he went through the appropriate procedures to arrange for them to be able to have as much human interaction as was safely possible. "With vaccination with full PPE, N-95, you know, face shield, gloves, gown, all the rest of it, you are very ...
Jun 01, 2021•34 min
Part 2 of this conversation continues the momentum of Part 1 with a conversation about electronic medical records (EMR), how important data is to the process, the need for those who collect it to understand it and then, more broadly, the importance of putting the patient at the heart of what you do. Presented by Desiree Chappell with Vicki Morton, Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates, P.A, Cheryl Crisafi, Cardiac Surgery Care Coordinator Nurse at Bays...
May 31, 2021•35 min
This piece is a two part conversation about the essence of what many of TopMedTalk's listeners do; Enhanced Recovery. A fascinating conversation between a number of experts in the field the conversation presented here was part of the hugely popular EBPOM Chicago 2020 meeting. For more on Evidence Based Perioperative Medicine (EBPOM) go to www.ebpom.org This first part of the conversation covers what the main elements of an Enhanced Recovery After Surgery program entail, what literature our contr...
May 30, 2021•35 min
