"Moving as medicine; is it the most underused but proven health promotion and healthcare practice?" Prehabilitation and population health naturally walk alongside each other. Learn here how Sport England's ambitious strategy to reduce inactivity and improve the nation’s physical and mental health is connected to prehabilitation and Enhanced Recovery After Surgery. Should patients be seeking expert condition specific advice before becoming active? How do we improve the quality of conversations be...
Oct 04, 2019•18 min
Thrombosis is the commonest cause of death and disability worldwide, antithrombotic therapy is incredibly beneficial but it promotes bleeding; how then do we manage anticoagulation in the peri-operative period? How do you assess a patient's risk of bleeding? When should you consider bridging? What are we to think as regards the current status of asprin? How do we approach dual anti platelet therapy (DAPT) and does it promote more bleeding? Lecture slides: http://www.anzca.edu.au/documents/03-har...
Oct 03, 2019•31 min
This panel discussion includes questions on; the multidisciplinary aspect of perioperative medicine, the drop off in Enhanced Recovery that some institutions experience, how to lead and coach an institution into an enhanced recovery programme, outcome data, informed decision making, the importance of strategic flexibility and the importance of good shared decision making when resources are stretched. Chaired by Ramani Moonsinghe this piece features; Monty Mythen, Smiths Medical Professor of Anae...
Oct 02, 2019•29 min
How do you best work a pre-op clinic? Should they be places where you get your problems documented or where you get your problems 'fixed'? How do you convince your practice to optimise patients for life and not just 90 days? How do we encourage population health? How do we get round the fact that we're still in a 'fee for service world'? What is "PBPM"? Featuring Desiree Chappell, Monty Mythen, Dr Lee A. Fleisher, Chair of Anesthesiology and Critical Care (University of Pennsylvania) and Vicki M...
Oct 01, 2019•10 min•Season 2Ep. 34
What can the experiences of a team who helped to introduce pre-operative assesment and prehabilitation to Barcelona teach us about how to most effectively implement and sustain similar programmes where we are? How and why is prehabilitation helpful in terms out outcomes and value based care? How long can the benefits of prehabilitation be maintained? What is the value of nutritional consultation, how important is it to asses your patients pre-operative protien intake? Would it help to offer all ...
Sep 30, 2019•23 min
Is it still ethically viable to have a standard arm in a prehabilitation trial? Which allied health professionals supervises the exercise part of these trials? What are the biggest reasons for non-adherence to home based exercise programmes? How do you address a possible selection bias with candidates? What is the best time to follow up a study with these patients? Featuring; Krishna Moorthy Senior Lecturer, Consultant Surgeon, Imperial College London, Academic surgeon, with research interests i...
Sep 29, 2019•17 min
Insights and perspectives on the science of prehabilitation from a very different angle. It's often said on TopMedTalk that preparing for an operation is not unlike getting ready for a marathon; how do the insights of professionals who work with elite sports men and women to ensure they are fully prepared to do their physical best, on the world stage? Also, what about the teamwork inherent in such activities as the pitstop of a formula one car? Athletes, coaches and a wide number of different ex...
Sep 28, 2019•31 min
This piece presents the prehabilitation 'business case'; why it's important to care about costs, how outcomes and value based care can help and why money has to be important in healthcare. How do we convert health benefits and risk management into something which explains the financial bottom line? Can we really argue that a process which appears, at the point of practice, to take more time, resources and involve a shorter length of stay for patients, is actually cheaper for institutions in the ...
Sep 27, 2019•21 min
This piece gives an insight into how the insights of an ex-colorectal surgeon can be blended with the understandings of a medical administrator; how can those two roles work together and understand each other more? There's a useful Perioperative Coach segment which outlines "Stop Bang" here: https://www.topmedtalk.com/periop-coach-3-02-stop-bang-identifying-obstructive-sleep-apnea/ There's a link to the slides here: http://www.anzca.edu.au/documents/03-bruce-waxman_two-sides-to-the-coin.pdf Pres...
Sep 26, 2019•22 min
What is 'knowledge mobilisation'? What's the difference between data used for quality assurance and data used for quality improvement? What's important to patients? Does compettition and publicly reporting data actually help anyone other than those who are already leading in their field? Can league tables lead to a 'culture of blame'? 'We need to spend less time measuring and more time improving'; how do we effectively support practitioners who want to get better? Presented by Dr Ramani Moonesin...
Sep 25, 2019•29 min
What is the Enhanced Recovery After Surgery (ERAS) Shared Interest Group (SIG)? How does it relate to the advancement of perioperative medicine? TopMedTalk was at the American Association of Nurse Anaesthetists (AANA) 2018 conference in Boston, check the podcast timeline for more, or click here: https://www.topmedtalk.com/?s=AANA Desiree Chappell speaks with her guests, Josh Newman Lead CRNA at Passavant Area Hospital, Springfield, Illinois Area and now Chair of the Enhanced Recovery After Surge...
Sep 24, 2019•19 min•Season 2Ep. 33
This piece is taken from the free papers presentations given at EBPOM 2019. Malnutrition and functional capacity; what is the effect of multimodal prehabilitation? What can the six minute walk test really show us? Does nutritional status predict preoperative change in a six minute walk test in colorectal cancer patients following a prehabilitation programme? Presented by Lauren Richer, Director, Nutritional Services, Keyto, Registered Dietician, Greene Family Medicine Clinic and Montreal General...
Sep 23, 2019•10 min
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...
Sep 22, 2019•12 min
The Silver Tsunami is coming, are you prepared to assess the elderly patient? Mature patients present unique and interesting opportunities to perioperative practitioners. New ways of thinking and different approaches are always necessary. The British Geriatric Society's "Fit For Frailty" is here: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty Presented by Desiree Chappell and Monty Mythen with their guest Houman Javedan, MD. Geriatrician at Brigham and Women’s Hospital, assista...
Sep 21, 2019•13 min
NAP (National Audit Project) 6 is the largest ever prospective study of anaphylaxis related to anaesthesia and surgery. Find out the details behind this intriguing study, how long did it take, how does the data impact upon our day to day practice? There follows a deep dive into the results and recomendations that NAP 6 has produced. Packed with useful information this podcast is one of the stand out pieces of our coverage of the Royal College of Anaesthetists' annual conference in London. Joff L...
Sep 21, 2019•28 min
Can delirium, the most frequent complication in an elderly patient, be tackled with multimodal prehabilitation? This piece explains how that challenge is being investigated at the moment. It was originally one of the EBPOM 2019 Free Papers. A link to the paper is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564537/ Presented by Ties Lukas Janssen, General Surgery Resident at Amphia Ziekenhuis.
Sep 20, 2019•12 min
This piece gives you information that will empower you when using Warfarin in the perioperative period. How should you sensibly balance bleeding and thrombotic risk? Anti-coagulants are increasing in number, what are the principles behind them which we should learn? An understanding of patient, procedure and type of drug being used is essential, are there other factors that can come into play? Here is a link to the slides used in this talk: http://www.anzca.edu.au/documents/02-kate-burbury_fast-...
Sep 19, 2019•26 min
The effectiveness and cost-effectiveness of INSPIRatory musclE training (IMT) for reducing postoperative pulmonary complications (PPC): a sham-controlled randomised controlled trial (RCT) (INSPIRE). This piece is a concise guide to the method and thinking behind the trial. Presented by Denny Levett, Professor in Perioperative Medicine and Critical Care at the University of Southampton, Consultant in Perioperative Medicine, Southampton University Hospital NHS Foundation trust (UHS), President, Pe...
Sep 18, 2019•16 min
A quick surprising poll of perioperative practitioners sets the tone for a robust advocation of the responsibility of surgeons and practitioners to do surgery right; as opposed to being inclined to feeling it must be done "right now!". A data driven approach combined with a patient focused attitude are at the centre of the argument. How do these factors combine to produce a business case which all institutions, practitioners and patients can understand? In terms of time spent, what do we mean wh...
Sep 17, 2019•20 min
The healthcare profession has a mixed history when it comes to messaging around alcohol. Nowadays, from a public health perspective, it is clear that overall it is not helpful for our physiology and well being. How often do you have alcohol? How many units do you drink? How often do you have a binge? What are the age groups where drinking problems are most apparent? Where is the latest research regarding a perioperative approach to alcohol consumption? How effective is intervention for risky dri...
Sep 16, 2019•19 min
Formed five years ago, the Academic Health Science Networks (AHSNs) in England are driving innovation and speeding up the process of implimenting and discovering improvement in institutions. This piece explains how that occured and what we can all learn from it. Presented by Natasha Curran, pain medicine University College London Hospital (UCLH) and Medical Director at the Health Innovation Network.
Sep 15, 2019•24 min
How is the AANA facilitating the care of patients? How can you make a patient a 'partner in safety'? How do we coordinate so many disaparate systems of information and care? Patient records and data ownership is discussed, as is Paul Upton's excellent interview on TopMedTalk regarding "My Preop". The original piece is here: https://www.topmedtalk.com/my-pre-op-empowering-patients-before-surgery/ How do we reach out to patients and inform them about the risks and choices which will be presented t...
Sep 14, 2019•19 min
Learn how to inspire a team to act, create change and get things done. How important are financial incentives, emotional connection and the relative ease of change? Originally streamed live from the hugely successful EBPOM USA Dallas Master's course. Presented by Michael Englesbe, Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.
Sep 12, 2019•24 min
This panel discussion tackles, amongst others, the following questions: How can knowledge and health innovation be moved from the theoretical world and turned into practice? How do we overcome ego in the profession? How do efficient systems improve the experience of staff as well as patients? How can perioperative practitioners truly embed ideas into devolved healthcare systems? Featuring; Anna Batchellor, Anaesthesia and Intensive Care Medicine (ICM), Newcastle upon Tyne; past President of the ...
Sep 11, 2019•17 min
Should prehabilitation be thought of also as "primary prevention" and used to avoid health problems occuring in the first place? If "exercise is real medicine" how do we change the culture so GPs are comfortable prescribing physical activity to patients? How can we get people to exercise more when the political mood is turning against Government interference and the so-called "nanny state"? What is 'the business case' for prehabilitation? Co-chaired by Mike Grocott and Stefan van Rooijen and fea...
Sep 10, 2019•18 min
What are the results if you apply Enhanced Recovery to obstetrics? This podcast features Desiree Chappell interviewing Dr Attila Kett, anaesthesiologist and Chairman at St Peter’s University Hospital at New Jersey. Join in the debate: contact@topmedtalk.com
Sep 09, 2019•5 min•Season 4Ep. 10
This piece explains how the "Getting It Right First Time" (GIRFT) project got off the ground. How does it help improve quality of care within the NHS reduce unwarranted variations, bring efficiencies and improve patient outcomes? This piece gives you the detail. Led by frontline clinicians, who are experts in the areas they review, hear how the project helps to manage services on a daily basis; sharing best practice between trusts, GIRFT identifies changes that help improve and change an institu...
Sep 08, 2019•26 min
"The predominant emotion was fear..."; this piece is essential listening for every TopMedTalk listener who really cares about the experience of their patients. Hear what it was like to participate in the pioneering, tailored exercise training programme, The Encourage Trial. Also, find out about "the Buddy Scheme" and how becoming a member of a local support group: SPICOS (Support for People Impacted by Cancer of the Oesophagus and Stomach) led to it. Could a 'Buddy', volunteers who have been in ...
Sep 07, 2019•18 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...
Sep 06, 2019•7 min
This piece is a fascinating overview of Australia and New Zealand's Emergency Laparotomy Audit - Quality Improvement (ANZELA-QI). It works as an update on the initiative, provides all the background you need including explanations regarding, structure, organisation and additional support as well as answering key questions such as: Do we need it? How do you join and what happens when you do? A link to the slides for this talk is here: http://www.anzca.edu.au/documents/03-ben-griffiths_anzela-qi-a...
Sep 05, 2019•26 min
