This piece focuses in upon the important work being done by The Enhanced Recovery After Cardiac Surgery Society, specifically the new guidelines which were published in May 2019. Furthermore, how is the society going to move forward, will it continue to push for a sensible combination of both care providers and academics and what areas of focus are most impactful when it comes to improving care and helping implementation? The article discussed in this piece "Guidelines for Perioperative Care in ...
Oct 31, 2020•12 min
In the UK community based prehabilitation is being spearheaded by the Prepwell Initiative, supported by a grant from Sports England. Their pioneering work is a great example of the way in which prehabilitation is gathering pace at the moment. The “PREP: Preoperative Risk Education Package” website is here: https://www.prepwell.co.uk/ What are the economics of such a programme? Why did the project start to get referrals from initially sceptical surgeons? How did the programme impact the lives and...
Oct 30, 2020•22 min
"The more I learn about this, the more my eyes are opened to how much opportunity we have to improve in this area" This piece covers the "perennial topic" of whether paralysis is bad for breathing, here with a focus upon outcome criteria associated with residual neuromuscular blockade. It's a piece based in part upon a recent talk at the American Association of Nurse Anesthetists annual conference which was this year held virtually. Presented by Desiree Chappell with her guest Brent Dunsworth, C...
Oct 29, 2020•30 min
Burn out and stress management have been an important theme on TopMedTalk recently, here we have a top medical professional sharing their story in relation to the topic. How do we describe "burn out", are certain words a barrier to discussion? How do we cut through to people who are most likely to suffer from this incredibly dangerous condition? Is the medical profession finally making progress here? Our interview with Sasha Shillcut is here "Sunday Special | Burn out": https://www.topmedtalk.co...
Oct 28, 2020•19 min
This panel discussion covers essential ground for any institution that is trying to make real and lasting change. What do we need to know? What do our patients need to know? Who is responsible for questions of safety? How important are checklists? What about "patient advocates"? This piece was generously supported by Massimo.com it follows on from this piece here: https://www.topmedtalk.com/ebpom-chicago-patient-safety-how-do-you-make-the-changes-that-change-culture/ Presented by Sol Aronson wit...
Oct 27, 2020•29 min
In this piece you can hear the co-editors of the Journal of Perioperative Medicine describing this year's "Editor's Picks"; the best manuscripts, literature and lessons learned in the last year in the space of perioperative medicine. "Functional performance and 30-day postoperative mortality after emergency laparotomy—a retrospective, multi-center, observational cohort study of 1084 patients" is here: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00143-7 Ther...
Oct 26, 2020•31 min
Why does the US have the highest maternal mortality rate of any developed country? This piece tackles a very controversial issue in healthcare head on, could the problem be due to racism? The chances of a serious issue is "substantially higher if you come from a minority group, in particular if you are African-American". We also cover the issue of postpartum hemorrhage, what are the key signs that a patient is at risk? Furthermore, how are quality care initiatives and standardization of care hel...
Oct 25, 2020•19 min
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...
Oct 24, 2020•9 min
This piece deals with the prediction of opioid induced respiratory depression for our inpatients on hospital wards, could a change in monitoring practices help? The postoperative period seems to be critical, the thirty day period immediately after anesthesia being a key area. 7.7% of postoperative deaths are in this period, according to The Lancet here; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33139-8/fulltext What is happening in the post operative period? How do we fi...
Oct 23, 2020•37 min
"Data is destiny"; this piece looks at way we can unlock it for Anesthetists. The Open-Source Anesthesia Electronic Medical Record (OSAEMR) was developed specifically for Nurse Anesthetists. Its focus is on solo or small-practice nurse anesthetists operating in environments with limited or no network and computing resources other than an iPad. One patient, one nurse anesthetist, and one iPad. It can now be scaled to larger multi-provider practices outside of CRNAs. Hear how this innovation came ...
Oct 22, 2020•25 min
Patient safety, as a priority, is assumed to be at the heart of medical practice. Yet still, preventable harm and death occurs in our profession, how do we change this and how do we make the changes we implement last? Can safety and avoidable harm be somehow hardwired into the culture of what we do in a way similar to that of the airline industry? This popular and refreshing talk is presented here after it was a big hit at the Chicago 2020 conference organised by Evidence Based Perioperative Med...
Oct 21, 2020•23 min
Patients with physiological and psychological resilliance have a clear advantage in surgery. The Wessex Fit-4-Cancer Surgery Trial (WesFit) is attempting to determine the effects of multi-modal physical and psychological prehabilitation. This piece gives you the detail and ends with a short informative question and answer session. Presented by Samantha Leggett, Study Director, University Hospitals Southampton NHS Foundation Trust.
Oct 20, 2020•10 min
"At the moment perioperative care in the UK doesn't really have the profile that I think it needs; now I suspect that COVID-19 has raised it up the agenda" If you enjoyed Monty's explanation regarding the UK's perioperative journey you may find this link interesting: Evidence submitted by the Improving Surgical Outcomes Group (ISOG) (NICE 75): https://publications.parliament.uk/pa/cm200607/cmselect/cmhealth/503/503we35.htm "Now we're here at this Pocapalooza" - POC, standing for Perioperative Ca...
Oct 19, 2020•16 min
"It also must start and end in primary care" This piece is a fascinating in-depth conversation moving through various medical perspectives on perioperative medicine from Australia and New Zealand. A real highlight of the festival. How has perioperative medicine evolved over the years around the world? What's the status of Perioperative Care as a specialty? How does one specialise in this area, in terms of education? Discussing the development of the International Board:- "We decided perioperativ...
Oct 18, 2020•39 min
This piece focuses on The Balanced Anesthesia Study, 'A Prospective Randomized Clinical Trial of Two Levels of Anesthetic Depth on Patient Outcome After Major Surgery'. How can delerium be measured and standardised in a multi-centre trial? More on the study here: https://journals.lww.com/anesthesia-analgesia/FullText/2015/08000/Rationale_and_Design_of_the_Balanced_Anesthesia.14.aspx More on the Confusion Assesment Method here: https://www.guysandstthomas.nhs.uk/resources/our-services/acute-medic...
Oct 17, 2020•16 min
After a short overview of the history of the Society of Cardiovascular Anesthesiologists (SCA) this conversation zones in on some of the hot topics that are being discussed in the field; devices and extracorporeal membrane oxygenation (ECMO) machines, as well as trans-esophageal echocardiography and how the practice has evolved. The conversation ends with a discussion about pre-habilitation in a resource stretched environment. Presented by Desiree Chappell with Sol Aronson and Jamie Ramsey, Medi...
Oct 16, 2020•19 min
This piece focuses on the Preoperative Intravenous Iron To Treat Anaemia in major surgery (PREVENTT) trial; a randomized double-blind controlled phase III study to compare the efficacy and safety of intravenous ferric carboxymaltose with placebo in patients with anaemia undergoing major open abdominal surgery. The main question is if we properly mobilize our patients, feed them and correct their anemia, do they do better? How can we get a patient fitter for surgery? Can we correct anemia before ...
Oct 15, 2020•26 min
This panel discussion includes questions such as: In a prehabilitation service what screening tools should we use to assess nutritional risk? What tools are there related to patient self management? What advice would you give a patient about cannabis smoking cessation? Should denial of surgical procedures be used as a motivator for lifestyle change? Can the questions used in interventions sometimes be open to misinterpretation by patients? How do we assess and treat sleep disorders? If not a psy...
Oct 14, 2020•30 min
"ERAS in Colorectal Surgery" - was 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 Anthony Senagore, Professor and Vice Chair Western Michigan University-Homer Stryker MD School of Medicine Borgess Medical Center Kalamazo...
Oct 13, 2020•10 min
This piece focuses upon the African Surgical Outcomes Study (ASOS-2). More than a thousand people across Africa have combined forces to make this research into perioperative medicine in a resource limited environment happen. We know patients in Africa are twice as likely to die following surgery when compared to the global average, why is this? How does "failure to rescue" play into this? The website mentioned in this piece for more details: https://www.asos.org.za Presented by Desiree Chappell ...
Oct 12, 2020•23 min
"There seems to be a little extra buzz in the cardiac community". This conversation focuses upon the psychology of change, specifically regarding the leadership role presented within perioperative medicine to anaesthesiologists. How can perfectionism, as a barrier to change, be overcome? How do practitioners build the confidence to make a difference? Furthermore, how do we engage in 'internal marketing' where we promote success within our own institutions? More information on The Morpheus Consor...
Oct 11, 2020•17 min
This hugely important talk was the centerpiece of EBPOM 2019 and, appropriately enough, it focuses on a big topic for us here at TopMedTalk; the future of fluid therapy. Originally given as the EBPOM 2019 Ernest Henry Starling plenary lecture the talk is complimented by this piece which was recorded on the same day: https://www.topmedtalk.com/desirees-roundtable-fluids-in-the-2020s/ Where is the latest thinking on fluid therapy, what new evidence and understandings do we now have? Presented by D...
Oct 10, 2020•54 min
Dingle 2020 is now on! Make sure you check out www.ebpom.org for more details. Today's TopMedTalk is another sampler from the conference, made available because this vital piece deals with a variety of issues related to COVID-19; what we know and what we know we do not know: - Similarities and differences between COIVD-19 and Aqute Respiratory Distress Syndrome (ARDS) - The most useful information observed by practitioners at the bedside, conscious of the lack of Randomised Controlled Trials (RC...
Oct 09, 2020•37 min
What are some of the major issues regarding billing? What are the most common mistakes when it comes to documentation? How do we keep the focus on great healthcare, as well as good book keeping? How does "the false claims act" impact on billing? If you find a mistake or an issue in your note keeping the advice here is clear; deal with it the moment it is discovered. Also, under recording is an obvious issue, can the same be said of 'excessive documentation'? The bottom line is that practitioners...
Oct 08, 2020•27 min
This piece is a chance to hear more about the work of our guest, who made a big impact as a guest on a recent edition of TopMedTalk: https://www.topmedtalk.com/topmedtalk-computer-gamer-to-life-saver/ The Perioperative Quality Initiative (POQI) is here: www.poqi.org This piece covers cerebral oximetry with near-infrared spectroscopy (NIRS), often used during the perioperative period of cardiovascular operations. Article here: "American Society for Enhanced Recovery and Perioperative Quality Init...
Oct 07, 2020•36 min
The American Associaton of Retired People (AARP), an organisation with a membership almost equal to the entire voting population of the United Kingdom, are focusing on brain health, in response to the demands of their members. Further conversation includes how practitioners both explain the risks of surgery and also calm possible misunderstandings or fears regarding them, as well as wider reflections on 'The Brain Health Initiative'. Presented by Desiree Chappell with Mike Grocott and their gues...
Oct 06, 2020•15 min
Joff and his guests visit the hallowed turf that is the Boston Ether Dome, in the Bulfinch Building, Massachusetts General Hospital. How have times moved on since those early pioneering days when the relatively young profession of Anaesthesia was born? Back then the word wasn't as widely used and the gentlemen in question described their activities as "rendering people insensible using sulphuric ether for the conduct of surgery". Remember - if you've not yet subscribed to our mailing list you're...
Oct 06, 2020•8 min
On the morning of the first day of the 2018, annual conference, of the American Society of Anesthesiologists (ASA) Monty Mythen and Desiree Chappell were lucky enough to get an exclusive interview with Professor Henrik Kehlet. Henrik Kehlet is a gastrointestinal surgeon and former professor of surgery, Copenhagen University, and now professor of perioperative therapy and Head of Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University. He has published more than 650 articles wi...
Oct 05, 2020•18 min
This piece is a reflection upon and celebration of conversations that were made possible by both The American Society of Anesthesiologists and Edwards Life Sciences, a key sponsor for TopMedTalk. If you would like to hear these conversations in full please follow the links below: Greg Fischer, Chairman, Department of Anesthesiology & Critical Care Medicine at Memorial Sloan Kettering Cancer Center: https://www.topmedtalk.com/anes19-greg-fischer/ Tim Miller, Associate Professor of Anesthesiol...
Oct 05, 2020•34 min
Recorded at the American Society of Anesthesiologists' Annual General Meeting in 2019; "The Power of The Interdisciplinary Team"; introducing the Enhanced Recovery team from Keck Medical Center at The University of Southern California (USC). Our guests kindly share an email address you can contact them on: Enhanced.Recovery@med.usc.edu Presented by Desiree Chappell and Monty Mythen with their guests Professor Carol Peden, Robin Cresner, CCRN, Dr Shane Dickinson, anesthesiologist and Snow Shoo So...
Oct 04, 2020•24 min
