The Measurement of Exercise Tolerance before Surgery (METS) trial has both raised, and answered, complicated questions. In the immediate wake of EBPOM 2018, this conversation explores some of the deeper issues and big take home moments from the trial. How will it change practice? Will it alter the use of the Duke Activity Status Index (DASI) for example? Cardiopulmonary Exercise Testing (CPET) clearly predicts major complications and is more predictive than the comparators. Why is this not clear...
Jul 19, 2018•15 min
What are the benefits of Cardio Pulmonary Exercise Testing (CPET) in cancer patients? What is the evidence that suggests prehabilitation changes outcomes? Furthermore, what is the National Emergency Laparotomy Audit (NELA) and what are its benefits? Presented by Joff Lacey and Desiree Chappell with their guests; Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and Improvement lead for the National Emergency Laparotomy Network ( NELA.org.uk ) and Malcolm West, National I...
Jul 16, 2018•20 min
Key messages and big takeaways from a hugely successful meeting, The Second Annual Prehabilitation World Congress, held in Eindhoven, The Netherlands. What was the 'dare to dream' section? How is the business case for prehabilitation being made? Also - listen out for details of the third World Congress and discover how you can get involved. Mike Grocott presents with his guests; Sandy Jack, MD, PhD, Senior Researcher, Southampton University Hospital, United Kingdom, Gerrit Slooter, MD, PhD, Surg...
Jul 13, 2018•6 min
What's the relationship between Enhanced Recovery after Surgery (ERAS) and Prehabilitation? How are randomised trials showing outcome data in a positive way? Furthermore, according to some of the keynote speakers, what were the highlights and big headlines at this important gathering? Mike Grocott presents with his guests Olle Ljungqvist, Prof. of Surgery, MD, PhD, Surgeon, Örebro University Hospital & Karolinska Institutet, Sweden and Franco Carli, Prof. MD, PhD, Anesthesiologist, McGill Un...
Jul 12, 2018•7 min
What is pre-habilitation and how important is early mobilisation to perioperative post-operative rehabilitation? Desiree Chappell presents with her guests Dr Steve Flanagan, Chair of Physical Medicine and Rehabilitation at NYU Langone and Colleen Walsh, Assistant Professor, Nursing University of Southern Indiana, President, National Association of Orthopaedic Nurses. This piece taken from a longer conversation to be heard here: https://www.topmedtalk.com/rehabilitation-exercise-is-real-medicine/...
Jul 11, 2018•3 min
What are the goals of healthcare providers, how do we measure success and why does value based care matter? Insight from The American Association of Retired People puts the focus in this conversation upon the patient. How do they measure value? What do they want and why? This piece features Desiree Chappell with two of the guest speakers from the American College of Perioperative Medicine's 2018 conference; Eric J Schneidewind president of the AARP and Kevin Bozic, Chair of Surgery & Periope...
Jul 10, 2018•6 min
Cold water adaptation for theraputic purposes. How can you gain the benefits of this unusual but increasingly popular activity? Open water swimming is discussed, how long you need to do it and what the benefits are. It's suggested that it might work because it is an anti-inflammatory. There's even the suggestion it can help with issues such as chrohn's disease. This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-1/ This edition of T...
Jul 08, 2018•5 min
TopMedTalk live is a gathering of Trainees with an interest in Perioperative Medicine (TRIPOM) alongside TopMedTalk listeners and EBPOM 2018 attendees in the IET London, England. This conversation is driven by questions from listeners online and attendees in the audience. What do you do when it comes to 'screening for frailty? Should it be physical frailty or mental frailty? What do we then do with that information? How do we acknowledge the fact that, over the perioperative period, a 'frailty s...
Jul 07, 2018•28 min
TopMedTalk live is a gathering of Trainees with an interest in Perioperative Medicine (TRIPOM) alongside TopMedTalk listeners and EBPOM 2018 attendees in the IET London, England. This conversation is driven by questions from listeners online and attendees in the audience. Two pain management experts alongside the TRIPOM representatives and Desiree and Monty respond in detail to some of the key controversies in Perioperative medicine. Is there an opioid crisis and is it unique to the USA? Is ther...
Jul 06, 2018•34 min
Back in London for EBPOM 2018! This piece features a quick rundown of some of the things you can expect to hear from www.TopMedTalk.com on our live streaming page. As always highlights of that will feature in the main podcast but, while the conference is on, we're streaming it live. TO LISTEN CLICK ON THIS LINK HERE: https://playall.sharp-stream.com/topmedtalk.mp3?autoplay=true This edition of TopMedTalk is presented by Desiree Chappell, Joff Lacey and Vicki Morton. Join in the debate: contact@t...
Jul 04, 2018•5 min
This is the third presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from Dr Lee A. Fleisher Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania. If you like the sound of this and think you and your practice would benefit from attending such a course don't worry, just go to The EBPOM website: https://www.ebpom.org/EBPOM-USA-2018...
Jul 02, 2018•32 min
This is the second presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from our Editor In Chief, Professor Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care at University College London. If you like the sound of this and think you and your practice would benefit from attending such a course don't worry, just go to The EBPOM website: https://ww...
Jul 01, 2018•28 min
This is the opening address and first presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology. If you like the sound of this and think you and your practice would benefit from attending such a course don't worry, just go to The EBPOM websit...
Jun 30, 2018•29 min
How and where do you measure a patient's temperature? This is a detailed answer to a frequently asked question, various methods are discussed. This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-1/ This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum. The conversation features Professor Monty Mythen and his two guests; Dr Sim...
Jun 29, 2018•4 min
This is another excerpt from "Controversies in perioperative medicine"; "The Great Fluid Debate". A fascinating piece containing Dr Tim Miller's enthusiastic advocation of goal directed fluid therapy and then the subsequent debate that follows. It ends up moving into the subject of 'enhanced recovery after cardiothoracic surgery' and what lessons we can learn from excessive hemofiltration during on bypass surgery. Chaired by Professor Monty Mythen and featuring a presentation by Dr Tim Miller, a...
Jun 28, 2018•37 min
Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis B. Cohen, Y.N. Schacham, K. Ruetzler, S. Ahuja, D. Yang, E.J. Mascha, A.B. Barclay, M.H. Hung, D.I. BACKGROUND Whether supplemental intraoperative oxygen reduces surgical site infections remains unclear. Recent recommendations from the World Health Organization and Center for Disease Control to routinely use high inspired oxygen concentrations to reduce infection risk have been widely criticized. We ...
Jun 27, 2018•3 min
Fluid Matters - the ‘nil by mouth’ or ‘NPO’ debate This piece is taken from "The Great Fluid Debate", it's about changes in practice that have been implimented both in the UK and at various medical centres in the US. Hear how and why the old 'nil by mouth' or ‘NPO’ policy has changed in many instances. From water to carbohydrate drinks, to black coffee, the thinking has changed in many institutions but part of the battle is in educating patients and their well meaning friends and relatives. Chai...
Jun 26, 2018•11 min
How do we develop a way to teach perioperative medicine and once that's in place, how should it be overseen? What sort of official endorsement might it need? Developing a broad knowledge of the process is distinct from being a specialist, how do we develop that further - without developing a schism? This complicated topic is discussed alongside more detail regarding the future for this area. Presented by Monty Mythen and Mike Grocott with their guests; Joel Symmons, Staff Consultant Anaesthetist...
Jun 25, 2018•12 min
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...
Jun 24, 2018•5 min
This is an excerpt from 'The Great American Fluid Debate' which was hosted at Duke University Medical Centre's "Controversies in Perioperative Medicine" conference of this year. The debate is framed as "restrictive versus liberal" but, as you'll hear, those terms are questioned by panel members. How do the results of 'The Relief Trial' figure in this debate? Is the pendulum of progress swinging too far - from overly liberal to too restrictive? What can the research and detailed data around these...
Jun 23, 2018•29 min
What is 'the morpheus consortium'? What's the current thinking on pain management and the 'opioid crisis'? On reflection were people wrong to emphasise the message that 'pain is the fifth vital sign'? How did 'pain management' instead become 'opioid management'? The UK has had a slightly different ride to the US in this respect, although not without its problems, could that be due to this 'fifth vital sign' message being less popular on the other side of the atlantic? Is it important to manage e...
Jun 22, 2018•31 min
Monty sits down with one of the co-organisers of this year's meeting in Orlando and discusses this year's annual conference, "Controversies in perioperative medicine". The discussion encompasses pain relief, opioids, the increased use of ultrasound and the use of particular blocks during abdominal surgery. As ultrasound improves how is perioperative medicine changing? What are the challenges presented by larger patients? What are the potential problems with an ultrasound guided tap block? Presen...
Jun 21, 2018•21 min
This conversation reflects a discussion had at the Perioperative Quality Inititative (POQI). It originally ran under the title, "Intervascular volume and fluid responsiveness" but, as this conversation explains, it was renamed "Fluid Responsiveness and venous capacitance". With a genuinely multidisciplinary approach on display here this piece gives you a glimpse at the inner workings of the POQI process. How does macro circulation interlock with micro circulation and cellular function? How do pe...
Jun 20, 2018•27 min
This discussion focuses on the perioperative quality initiative's intense focus this year on total body water and electrolights. How often should we weigh patients to monitor water balance? What can we learn from a real understanding of the circulation of interstitial fluid and lymphatics? What is the role of diuretics for the perioperative practitioner? Also, haemodilution, what should you do if you have a patient with a positive post operative fluid balance and a low haemoglobin? Finally, how ...
Jun 19, 2018•38 min
How does perioperative care relate to obstetrics? Who does it benefit, the patient, the hospital or both? How does it help to engage pregnant patients through the perioperative process? Furthermore, does the issue of addiction arise in this area? Coming from this summer's Peroperative Quality Initiative (POQI), hosted at Washington Duke University in Durham, this podcast features Monty Mythen and Desiree Chappell interviewing their guests Dr Attila Kett, anaesthesiologist and Chairman at St Pete...
Jun 18, 2018•17 min
Names, titles and definitions were sliced, diced and discussed at the Perioperative Quality Initiative (POQI). This conversation, recorded on the morning of the second day of the meeting and featuring some of the participants, reflects that. "Stress volumes" and "Pre-load" are a couple of examples given in this piece. Everyone involved knew what these words described but once discussions got into detail it became clear multiple definitions were at play. Part of the point of an initiative like PO...
Jun 17, 2018•34 min
We begin with a question from the audience; 'how do we drive change in our institutions towards enhanced recovery after surgery?' The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned. This conversation is taken from a longer piece to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-2/ This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) lea...
Jun 16, 2018•7 min
Association of Multimodal Pain Management Strategies with Perioperative Outcomes and Resource Utilization: A Population-based Study. Memtsoudis SG1, Poeran J, Zubizarreta N, Cozowicz C, Mörwald EE, Mariano ER, Mazumdar M. BACKGROUND: Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive large-scale data are scarce. The authors aimed to determine how the number and type of analgesic modes is associated with reduced opioid prescription, complicati...
Jun 15, 2018•3 min
The debate ' Direct laryngoscopes should be consigned to history ' was hosted by The Royal College Of Anaesthetists and carried out by the two guests on this piece. The conversation explores the fact that this skill is a key part of the job of practitioners, are we "de-skilling" the profession in an overly enthusiastic race toward new technology, or are some resisting it simply because it's not what they are used to? This piece is taken from a longer conversation, to be found here: https://www.t...
Jun 14, 2018•12 min
The patient experience can be quite passive and, as a result, people can lose temperature quickly. The consequences can be very negative, this conversation revolves around how you can keep your patients warm. This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-1/ This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum. The conve...
Jun 13, 2018•6 min
