What is after ERAS, do we have an 'ERAS of ERAS' - so to speak? This conversation focuses upon bringing about change, managing and sustaining it over time and helping relate it to patient outcomes. Desiree Chappell interviews her guest Arman Dagal, Medical Director - Spine COAP at Foundation for Health Care Quality.
Implementing better practice and "ERAS 2.0". The ground up approach of a 'council of nurses' sparks some fascinating debate and discussion. Can a roundtable approach sometimes work better than the traditional hierarchical power structure? Presented by Desiree Chappell with her guests Dr Ruchir Gupta, medical lead for enhanced recovery at Stony Brook University and Joni Brady, Perianesthesia, Pain Management Nursing Consultant Alexandria, Virginia.
This piece is a chance to reflect upon the importance of new media within the sphere of medical education. As the run away success of TopMedTalk and other podcasts in this area shows people are hungry to use the unique potential of this medium. Also - how has social media, video casting and live streaming altered the way conferences are both organised, executed and received? Finally, our team of experts tackle the eternal question; where to next? Presented by Joff Lacey with his guests; David Ly...
The Hypotension Prediction Index (HPI), which uses a machine learning algorithm to help predict intraoperative hypotension. Regular listeners to www.topmedtalk.com will be familiar with concerns about perioperative hypotension. For those who have just joined us, or anyone who fancies a quick refresher on this issue, it is covered in detail here: https://www.topmedtalk.com/live-from-boston-asa-2017-the-elephant-in-the-room-intraoperative-hypotension/ Many practitioners believe they can predict hy...
What is a 'micromort'? Even more of a worry, what does ten of them mean? How do we measure and communicate risk to patients? Everyday activities all carry inherent risks, how do we put surgery into a context 'everyday people' can more easily understand? Professor Monty Mythen presents with guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and Dr Mike Irwin, Professor and Head, Department of Anaesthesiology, Univ...
The piece discussed in this week's Journal Club is called "Acute kidney injury in postoperative shock: is hyperoncotic albumin administration an unrecognized resuscitation risk factor?". The link is here: https://perioperativemedicinejournal.biomedcentral.com/track/pdf/10.1186/s13741-018-0110-y Additional links here: "Association between albumin administration and survival in cardiac surgery: a retrospective cohort study": https://www.ncbi.nlm.nih.gov/pubmed/30006911 "Association between Initial...
A three part series covering the year in TopMedTalk. Here are some links to the pieces discussed: The Randy Moore piece: https://www.topmedtalk.com/aana-2018-is-there-a-global-shortfall-of-anesthesia-providers/ Here's the piece Monty mentions which celebrated the 60th anniversary of Edwards Life Sciences: https://www.topmedtalk.com/the-hypotension-prediction-index-hpi/ Here's are the pieces with Matthew McEvoy, the second is the Q&A section: https://www.topmedtalk.com/ebpom-usa-chicago-2018-...
A three part series covering the year in TopMedTalk. Here are some links to the pieces discussed: Paul Myles and the RELIEF trial results: https://www.topmedtalk.com/the-relief-trial-results/ And here is the "deep dive" we mention: https://www.topmedtalk.com/the-topmedtalk-top-ten-rcoa-11-the-relief-trial-your-essential-deep-dive-into-the-results-2/ And here are all the RELIEF trial pieces we've done: https://www.topmedtalk.com/?s=RELIEF Also, make sure you listen to this piece, "RCoA 12 Should ...
A three part series covering the year in TopMedTalk. Here are some links to the pieces discussed: The conversation with Zeev Kain is here: https://www.topmedtalk.com/zeev-kain-organiser-of-the-american-college-of-perioperative-medicine-interdisciplinary-conference-on-orthopaedic-value-based-care/ The Eric J Schneidewind piece is here: http://topmedtalk.libsyn.com/the-topmedtalk-top-ten-i-want-to-dance-at-my-daughters-wedding The first ever Roundtable discussion is here: https://www.topmedtalk.co...
Fresh from an expedition to Antarctica, on the National Geographic Explorer, Mike Grocott gives us an update on the "Anaesthesia at the Extreme" conference. Regular listeners will remember his excellent talk about Xtreme Everest, which you can find here: https://www.topmedtalk.com/10-xtreme-everest-physiology-on-top-of-the-world/ Presented by Desiree Chappell and Monty Mythen with their guest Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton and Dr Jim ...
Lessons learned from the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial. This conversation focuses upon the challenges of quality improvement programmes; how do we keep track of patients and improve follow up questions after surgery? How do we clearly show Quality Improvement Programmes work for the patient? Further discussion encompasses innovation and utilization in practice. Presented by Monty Mythen and Desiree Chappell with their guest Carol Peden, Professor of Anesthesio...
Fitness for surgery and an understanding of the realities of risk. How important is it for surgery to take place when balanced against the specific health needs of the patient? How do we encourage patients to alter pathological aspects of their lives in order to minimise the chances of a negative outcome? Professor Monty Mythen presents with Dr Joff Lacey and guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and...
Here we have a very special edition of Journal Club, in two distinct parts; the The Measurement of Exercise Tolerance before Surgery (METS) trial is discussed here both before and after the results were released into the public domain. The Measurement of Exercise Tolerance before Surgery (METS) trial has both raised, and answered, complicated questions. How will it change practice? Will it alter the use of the Duke Activity Status Index (DASI) for example? Cardiopulmonary Exercise Testing (CPET)...
"Sprint National Anaesthesia Project, SNAP" was 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 Ramani Moonesinghe, Director of the UK National Institute o...
Desiree Chappell of The Roundtable blog, with Monty Mythen of TopMedTalk discuss outcomes and patient care, what matters the most? They are joined by 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 & Perioperative Care at the Dell Medical School.
A conversation about ASER fluid management; NPO; preop drinks and keeping the i.v down. Monty Mythen is presenting with his guest Dr Scott Brudney, Professor, Departments of Anaesthesiology and Internal Medicine, University of Manitoba, Winnipeg, Canada. Click here for the American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management withinan enhanced recovery pathway for colorectal surgery: https://periopera...
A transatlantic perspective. This conversation explores the extended role of the anaesthetist, brought about partly by perioperative care but more widely because of societal changes. Practitioners face a dilemma; how do you best impact value based care, as a specialist, when multidisciplinary approaches are becoming essential? In the UK, The Royal College of Anaesthetists, are working on this very issue; find out how they are becoming part of conversations regarding public health and modifiable ...
The Elephant In The Room - intraoperative hypotension. A discussion regarding the exciting results from the first multicentre, randomised controlled trial into targeted intraoperative blood pressure management. This conversation reflects the start of many debates and concern regarding hypotension, a frequent topic here on TopMedTalk. Monty Mythen and Mike Grocott are with Tim Miller, Duke University Medical Centre, speaking with their guest Dr Dan Sessler, Cleveland Clinic.
POET - The Perioperative Enhancement Team 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 that you understand what is going on within the different surgical specialities Presented by Monty Mythen, ...
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...
The RELIEF (Restrictive versus liberal fluid therapy in major abdominal surgery) trial has been a huge story for us here at TopMedTalk, recorded on the second day of The Royal Collage of Anaesthetists' annual conference at the British Museum this is the moment the team get to pick over the results in detail. One of the biggest trials ever, it has both raised questions and provided answers. Inevitably there has been a huge debate, this piece puts all the major questions and concerns to the organi...
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...
How essential is training in focused transthoracic echo for adult intensive care? Ultrasound technology has evolved in recent years, some people say handheld devices look set to become as ubiquitous as a doctor's stethoscope. Could the nurse at the bedside get more involved in the process or is it 'protected turf'? Also, can this technology help patients to become more involved in their treatment and its monitoring? Presented by Monty Mythen and Desiree Chappell with their guest Marcus Peck, NHS...
This piece starts with a discussion about indirect calorimetry and the challenges associated with it as well as recent improvements in the field. The penn state equation is discussed. Muscle wastage and the need for resistence training, as well as protein feeding is covered. More widely; what does good ICU feeding look like? How can friends and relatives of patients be sure that a loved one is getting good nutritional care? Desiree Chappell and Monty Mythen presenting with their guest Danielle B...
Fresh from an expedition to Antarctica, on the National Geographic Explorer, Mike Grocott gives us an update on the "Anaesthesia at the Extreme" conference. Regular listeners will remember his excellent talk about Xtreme Everest, which you can find here: https://www.topmedtalk.com/10-xtreme-everest-physiology-on-top-of-the-world/ Presented by Desiree Chappell and Monty Mythen with their guest Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton and Dr Jim ...
The Pets as Therapy team have been a huge hit at the Intensive Care Society annual conference. How would you incorporate something like this into your practice? There are currently over 6,000 dogs and cats working in healthcare in the UK. Presented by Desiree Chappell with Monty Mythen and their guests Alfie the therapy dog, Suzy Emsden, volunteer for Pets as Therapy and a pediatric intensivist from the North West, and Matthew Robinson, national project co-ordinator for Pets as Therapy....
How do we maintain hydration in a way which is both safe and comfortable for the patients we treat? What about the post-surgical patient who is full of salt and water but tells us they are thirsty? How can we allow patients to hydrate themselves? Presented by Desiree Chappell with Monty Mythen and their guests Professor Hugh Montgomery, Intensive Care Society Board Member and Professor of Cardiovascular Genetics and Critical Care University College London and Fintan Hughes, Academic Intern at St...
Recorded live at the Intensive Care Society This piece is a fascinating discussion regarding the use of antibiotics and fluid balance. The conversation then moves into haemodynamic monitoring and the differences between protocols guidelines and algorythms. Presented by Monty Mythen and Desiree Chappell with their guests Professor Mervyn Singer, Intensive Care Medicine at University College London and Fintan Hughes, Academic Intern at St. James's Hospital Dublin.
"Post-operative critical care: what should we do?" was 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 Presented by Denny Levett, Professor in Perioperative Medicine and Critical Care at the University of Southampton....
A discussion about consent, staying on the right side of the law, shared decision making and 'The Montgomery case' which has defined a Doctor's duty in these sorts of areas. Presented by Monty Mythen with Desiree Chappell and their guests Hugh Montgomery, and Paul Sankey, Enable Law partner and Clinical Negligence solicitor acting for patients, an accredited expert in his field.
