"Accelerated surgery is not a panacea" This piece, presented in two parts, is a discussion about enabling enhanced recovery. Originally part of EBPOM London this is an 'as live' discussion with four of the main presenters from the conference. Get more detail on nutrition, hip fractures, psychological optimisation and discover both where the difficulties are and what opportunities they provide. For more of this sort of content go now to www.ebpom.org to find out more about how you can be part of ...
Feb 28, 2021•33 min
"Accelerated surgery is not a panacea" This piece, presented in two parts, is a discussion about enabling enhanced recovery. Originally part of EBPOM London this is an 'as live' discussion with four of the main presenters from the conference. Get more detail on nutrition, hip fractures, psychological optimisation and discover both where the difficulties are and what opportunities they provide. For more of this sort of content go now to www.ebpom.org to find out more about how you can be part of ...
Feb 27, 2021•20 min
This piece is an informative conversation about the models of prehabilitation from a number of different angles. Questions come in from an online audience as our panelists tackle the topic from their respective areas. What are the risks and how are they mitigated? Where does your funding come from and why? How safe is iron for cancer patients? The link to Safe Fit self referal is here: https://www.macmillan.org.uk/cancer-information-and-support/get-help/physical-help/safefit%20#refer_yourself_to...
Feb 26, 2021•41 min
"I hope to impress upon you that this is a topic that we can and must do better at ... no malnourished patient should ever have elective surgery without having a nutrition assessment done" This piece is presented in two parts; this is part 2. Using perioperative nutrition to optimize our patients outcomes; data shows us that nutrition therapy or nutrition optimization is literally life saving. Anyone who uses evidence as their guide know it has to be part of their practice. Enhanced Recovery Aft...
Feb 25, 2021•17 min
"I hope to impress upon you that this is a topic that we can and must do better at ... no malnourished patient should ever have elective surgery without having a nutrition assessment done" This piece is presented in two parts; this is part 1. Using perioperative nutrition to optimize our patients outcomes; data shows us that nutrition therapy or nutrition optimization is literally life saving. Anyone who uses evidence as their guide know it has to be part of their practice. Enhanced Recovery Aft...
Feb 24, 2021•24 min
"In the United States approximately 112,000 patients annually are at risk for adverse events associated with discharge from the operating room with residual neuromuscular blockade" This talk highlights the latest thinking on both monitoring and management of neuromuscular blockade. Where does the data lead us to? How big a problem do they suggest poor efficiency in this area is? What are the realities behind postoperative pulmonary complications? How can we reduce the risk of residual block? Pre...
Feb 23, 2021•27 min
"If you want to take population based data, and define hypotension, you'll be right for the majority of our average patients, but not for all patients and it appears that the amount of time we spend below the lower limit of autoregulation has meaning for patient outcomes" Starting from the origins of blood pressure monitoring, via the father of neurosurgery endocrinology, Harvey Cushing, through to the current debate as to what exactly constitutes hypotension this piece is an important part of a...
Feb 22, 2021•31 min
"Perhaps assessing functional performance is something that we've overlooked in medicine" This piece is about the role of functional assessment and status in perioperative medicine. The Duke Activity Status Index (DASI) can be found here: https://www.mdcalc.com/duke-activity-status-index-dasi The Mini Cog assessment is here: http://mini-cog.com/wp-content/uploads/2015/12/Mini-Cog-Form-010816.pdf The video resources mentioned in the piece are here: https://www.youtube.com/channel/UCvOamR8Sb4RXENr...
Feb 21, 2021•20 min
This piece digs deep into the realities of coping with COVID 19 patients who have had their care escalated to the Intensive Care Unit (ICU); "we don't seem to be looking at our typical sepsis patients who get multiple organ failure in the classical way" and "you're surprised at how young some of the patients are...". Our guest provides us further insight; a 'household name' in the haemodynamic monitoring space; he is treating patients in a medium sized hospital (500 beds) with mostly COVID patie...
Feb 20, 2021•18 min•Season 2Ep. 5
This piece gives us a look at some of the latest thinking on Post Operative Nausea and Vomiting (PONV). It includes a discussion about Amisulpride and discusses new, yet to be published, consensus guidelines for PONV. The original guidelines are here: https://www.ncbi.nlm.nih.gov/pubmed/24356162 Also, you may like to check out the details of this paper here: Amisulpride: A New Dopamine Antagonist for Treatment of Postoperative Nausea and Vomiting https://www.ncbi.nlm.nih.gov/pubmed/31094771 Pres...
Feb 19, 2021•7 min
"Some practical tips you can take away and implement in your hospital..." In the UK there is a legal imperative to minimalise and individualise risk now but it's widely understood to be helpful if you want to provide better value and patient outcomes. How can risks be identified and minimised? How can these risks then help to provide better quality shared decision making? How can plan a perioperative pathway tailored to these needs? Presented by Ramani Moonsinghe, Professor of Perioperative Medi...
Feb 18, 2021•15 min
"I did a study back in 2002 where I was able to count a grand total of forty patients above the age of eighty in our (Intensive Care Unit) ICU and our (High Dependency Unit) HDU, nowadays I'd count close enough to a hundred and sixty" How do we refine our diagnostic tools? How can teaching in this area help to save lives? Should you consider a 'geriatric intensive care unit'? Is this an area where true perioperative practice and surgery is a guarantee we can immediately see improvement in an ins...
Feb 17, 2021•27 min
This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers now. This piece is part two of two. This piece gets a mention "End of life decision planning in the perioperative set...
Feb 16, 2021•22 min
This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers. This piece gets a mention "End of life decision planning in the perioperative setting: the elephant in the room?" ht...
Feb 15, 2021•33 min
"It might just be 'boring old blood pressure ... (but) ... every fourth operation there is evidence of a modifiable risk factor". The Perioperative Quality Initiative (POQI) is our starting point for this conversation, seven concensus conferences focusing on various topics of interest to the perioperative practitioner. Check out their extensive open source resources here: www.poqi.org Hypotension and Mean Arterial Pressure (MAP) are discussed in detail; how are patients now being managed? How ca...
Feb 14, 2021•34 min
"We're so invested in outcomes and data that it really gives us an objective view on how to approach things" This wide ranging conversation looks at how a data driven approach to change can produce better results in terms of patient outcomes. How do you highlight those opportunities with tact and clarity? How do we start to reward and recognise the best care that the evidence supports? We also hear more about Evidence Based Perioperative Medicine (EBPOM) in 2021; for more on the opportunities me...
Feb 13, 2021•41 min
Warning; this piece may make for uncomfortable listening. It is a fascinating look at the recent history of medicine and how our profession may in fact be sick. Contained within the story is a message of hope; evidence may contain the cure. In our recent history we seem to have enjoyed something of a "Golden Age" of medicine which, by raising quality of life so dramatically, has transformed our understanding of concepts such as "public health" and even "standard of living". However, running alon...
Feb 12, 2021•37 min
"We wanted to know if goal directed therpy using a (Hypotension Prediction Index) HPI monitor can prevent hypotension". This piece looks in detail at the HPI monitor in practice- what is the benefit of this piece of technology in relation to hypotensive episodes? Furthermore how else is it to be tested and when will these tests be carried out? Presented by Desiree Chappell and Monty Mythen with their guest Marit Habicher, Specialist, Department of Anesthesia and Critical Care at UKGM Giessen....
Feb 11, 2021•12 min
"We have to remember that patients have a team" How do we involve patients in the increasingly complex conversations we have in the perioperative space? This piece is a detailed case study which shows how shared decision making works in the perioperative setting. We know this improves patient experience yet in the last 10 or so years, consistently only 50 to 60% of patients say they were involved in decision making. How can shifting towards a value based care model help? What is "moral injury" a...
Feb 10, 2021•28 min
"In this session, we're going to talk about the importance of fitness, frailty, function and perioperative medicine." Fitness, frailty and function are overlapping concepts. In the UK, about quarter of patients will be over the age of 65 by 2034. As patients age they may develop comorbidities. These factors combine to present a unique opportunity for the perioperative physician; fitness increases the chances of a positive outcome, time to ensure every patient is "fit for surgery". The Making Eve...
Feb 09, 2021•23 min
"If I were to develop a simple uncomplicated urinary tract infection, I may well be able to continue to go to work as I was being treated for that illness but if an older frail patient develops a similar uncomplicated urinary tract infection, that can be a very significant illness, that patient may well be unable to walk or transfer as they could" Frailty in the perioperative period - what is it, what is it not and how do we work with and manage it before, during and after an operation so as to ...
Feb 08, 2021•24 min
TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis. We know food gives us energy "but it also provides so much more". This podcast looks at the raw materials you'll need, when facing a cancer diagnosis, to get a better outcome; the vitamins, minerals and proteins, as well as the energy sources you're best using. What is a balanced diet when you have cancer? "We're talking abo...
Feb 07, 2021•14 min
TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis. It's vital you remain active after a cancer diagnosis, why is this? Hear the fascinating story behind the discovery that activity not only reduces your overall levels of fatigue but also improves your chances of recuperation. "You have to pace yourself [...] listen to your body"; but any physical activity will help fight fee...
Feb 06, 2021•27 min
TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis. "It's very normal to sit with some difficult thoughts and feelings" after a cancer diagnosis. Broadly there are two types of mindsets; anxiety, which can be helpful, an element of wanting to 'do something' and, on the other hand, low mood, a feeling of not wanting to do anything, this can be unhelpful if not addressed at a c...
Feb 05, 2021•25 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 ...
Feb 04, 2021•16 min
This is an Edwards Lifesciences Sponsored Lecture which was originally streamed live on TopMedTalk from the hugely successful EBPOM USA 2019 in Dallas. In this piece we hear about the ongoing need for institutions and healthcare professionals to recognise the damaging consequences of intraoperative hypotension. Evidence has been mounting here on TopMedTalk over the last couple of years; there's no doubt hypotension is an area of concern for many of our experts and contributors. Listen to more on...
Feb 03, 2021•22 min
"Babies are still being born" Still! Revisiting this conversation from early in the pandemic, we discuss obstetrics during COVID. This piece looks at the area of obstetrics in the midst of an unprecedented global crisis regarding the COVID 19 outbreak. How can the delicate balance between reducing infections and social distancing be interwoven with the needs of modern childbirth. Should we be concerned that some patients may shun hospital assisted births for fear of contagion? How has the data f...
Feb 02, 2021•31 min•Season 2Ep. 4
What are the latest developments in quality improvement programs that help operative teams around the world take what they do to the next level? When does the surgical journey begin? How has a focus upon patients prior to surgery improved outcomes? What are "the five phases of care"? How has data collection and management helped us to continually improve a patient's surgical journey? This piece is a talk which was given during the 8th Australian and New Zealand Symposium of Perioperative Medicin...
Feb 01, 2021•34 min
This piece, originally streamed live on www.topmedtalk.com features a conversation about the implementation of enhanced recovery protocols and the results practitioners report. The discussion starts with the observation that just implementing the ERAS intraoperative protocols drove outstanding outcomes in practice. The wider discussion focuses on the importance of putting into practice a bigger plan. Presented by Desiree Chappell with her guests Raul Castillo, Anesthesia Medical Director at the ...
Jan 31, 2021•10 min•Season 4Ep. 1
"I'm also a United States Air Force Officer and reservist and on April 4th was activated and given approximately 48hrs to deploy on a C-5 Galaxy Military Aircraft to the epicenter, New York City and I've been here for approximately, it's been almost a month now" This piece follows on from a previous exclusive conversation regarding the US military deployment to New York; here we get more detail and spend time thinking about how Enhanced Recovery must be an essential part of any "new normal". The...
Jan 30, 2021•20 min•Season 2Ep. 3
