This piece covers the PREP-WELL project which is a community based prehabilitation program in South Tees, in the North of England: "We established the following guiding principles; we wanted to provide patient centered care under one roof with facilitated self management; we wanted to work as a cross sector collaborative, by that I mean primary care, secondary care and public health; all working together to try and improve on the fragmented service provision and sign work that we often see in ou...
Mar 30, 2021•35 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...
Mar 29, 2021•28 min
This talk aims to answer four major questions: How much fluid should you give perioperatively? Does hypotension matter? Should you use advanced hemodynamic monitoring, and do colloids have any advances over crystalloids? Using high quality studies and a data based approach in all four categories, a lot of which has come from conversations that have had happened at Evidence Based Perioperative Medicine (EBPOM) meetings, this talk draws some interesting conclusions. The American Society of Enhance...
Mar 28, 2021•24 min
"As Anaesthetists the ultimate goal of almost all of our interventions and monitoring is to support cell energy production to provide mitochondria with the oxygen and the fuel they need to produce enough adenosine triphosphate (ATP) to power cell function and integrity". How human cells produce energy, how this changes in response to stress and how this may influence survival; this piece focuses what we know about how our bodies get the fuel they need to survive surgery and thrive as a result, p...
Mar 27, 2021•20 min
This is a story that starts with some of the challenges faced in our world outside the operating theatre and it's about how we might address some of these problems systematically. Healthcare organizations have to deliver high quality, competitive and sustainable results and costs. Good quality perioperative surgery is absolutely critical to maintain the health and well being of our population going forwards; this talk is a step in that direction. Presented by Guy Ludbrook Professor of Anaesthesi...
Mar 26, 2021•37 min
"I cannot sleep. It's like, I wake up at 1am and my mind's going crazy ... if you had someone come to you and say; 'I'm really struggling right now, I'm having a lot of anxiety, with work with family, with kids with whatever'; what are some of the top things that you want to share with them?" How can a regular yoga practice bring you into a deeper union with what you do and help improve your performance? Why is it that people in the caring profession sometimes leave self care at the bottom of th...
Mar 25, 2021•24 min
"I think you're now famous in the CRNA community for being one of the first people in Fargo to receive the the COVID vaccine" This piece sees us catching up with Certified Registered Nurse Anesthetists (CRNA's) who have just been vaccinated for COVID-19. Their story reminds us that even now some practitioners are facing their first real wave of the pandemic in their area: "We had a kind of trickle in, so to say, of COVID patients, and then this in this fall, the middle of November was really whe...
Mar 24, 2021•24 min
"Perioperative medicine ... I always think of a Venn diagram where there's truly an intersection between surgery anesthesia and medicine, and perhaps even a subset of medicine called geriatrics, that really create this convergence of what we're now creating as a novel science ... Perioperative medicine, I would say is a new clinical science that really incorporates all that" This piece is a fascinating debate, it follows on from Part 1 of the same name; the panel discuss ways forward for periope...
Mar 23, 2021•41 min
This piece is essential listening for any medical practitioner. The pathophysiology of COVID 19 is now being understood, although there are still a number of outstanding questions. This piece attempts to answer those questions; where does it come from, what do we know about it now, what would we like to know about it in the future? Why is the disease more pronounced in men, how come obesity seems to be a factor, what's the mechanism which leaves children less at risk than adults and senior citiz...
Mar 22, 2021•24 min
This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being questions from the online audience: What is your opinion about spinals and hip fractures for patients on clopidogrel? Do you use any near patient tests to confirm residual anticoagulation? Where are the best guidelines to be found? We suggest you listen to this piece alongside part 1. Presented by Sol Aronson, tenured Professor at Duke University, with his guests; Angela Bader, Ha...
Mar 21, 2021•25 min
The conversation begins with "a day in the life" with respect to managing the anti coagulation questions that come up commonly. The contributors swap stories from their time in practice. The conversation moves to protocols, guidelines and also, when where and how to begin bridging. This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being questions from the online audience. Presented by Sol Aronson, tenured Professor at Duke University, ...
Mar 20, 2021•34 min
How can enhanced recovery after surgery (ERAS) be applied to cardiac and what exciting opportunities are there for those who have made this their mission? This detail driven address contains more information on The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac), more information can be found on their website: https://www.erascardiac.org/ Since this address was given at Evidence Based Perioperative Medicine (EBPOM) Chicago's 2020 meeting TopMedTalk has been proud to bring you...
Mar 19, 2021•19 min
This piece looks at some of the latest research from a perioperative perspective regarding an essential question, when and how is surgery possible after a COVID-19 infection? How do we balance that ideal with the other pressures coming to bare on patients, practitioners and public health as a whole? The paper "Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study" is here: https://doi.org/10.1111/anae.15458 Presented by Desiree Chappell with Monty Mythen, Sm...
Mar 18, 2021•22 min
This piece focuses on iDelirium; The International Federation of Delirium Societies on world delirium day. As well as considering this difficult condition the conversation asks what the latest research shows us and how things could improve both for patients and practitioners. For more detail check out their website here: http://www.idelirium.org/ Presented by Desiree Chappell and Monty Mythen with their guests Heidi L. Lindroth, Senior Associate Consultant Nurse Scientist, Nursing Research Divis...
Mar 17, 2021•22 min
"You have to take the viewpoint that if the Nurses and the Physical Therapists and the Pharmacists are resisting the idea that you're putting forward, then there's probably something wrong with it, it doesn't work for them, for some reason, and you got to find out what that is..." This long form conversation is a highlight for TopMedTalk's coverage of The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac) conference. The conversation covers a wide range of interesting areas, inc...
Mar 16, 2021•51 min
"Critical Care has a moment in time, a moment where we can make some big changes, a moment of opportunity" This uncompromising and informative talk from the technical lead for critical care in the Getting It Right First Time (GIRFT) project takes us through how services can improve and work alongside perioperative care to improve standards and outcomes for patients. Sharing best practice between trusts GIRFT identifies changes that help improve and change an institution’s procedures and cost sav...
Mar 15, 2021•20 min
From a UK perspective this piece covers variation in access to critical care, behaviors and decisions regarding its use. With reference to how, over the last 20 years, efforts have been made in Torbay to improve access to critical care we look at what can be done and what works. Finally there's a summary of where we are on this issue today. Getting it right first time (GIRFT) is here: https://www.gettingitrightfirsttime.co.uk/ Presented by Mike Swart, Consultant in Anaesthesia and Critical Care ...
Mar 14, 2021•20 min
This piece provides an update on the Perioperative Exercise, Testing and Training Society (POETTS); "established back in 2017, in the context, in the United Kingdom, of cardiopulmonary exercise testing becoming much more common in the preoperative period". Now, more than half of acute hospital trusts in the United Kingdom have a cardiopulmonary exercise testing service to evaluate their patient's functional capacity prior to surgery. Furthermore exercise interventions to optimise a patient's fit...
Mar 13, 2021•13 min
This piece gives you the evidence base required to deliver an even higher standard of perioperative medicine where you work. Hear about the "Fit 4 surgery" studies; the "fit 4 surgery consortium", the ongoing e-studies, key findings, recent studies and the set up in Southampton. Physical fitness is greatly affected by chemotherapy; poor outcomes are significantly linked to physical fitness; learn how preoperative cardio-pulmonary exercise testing and training can monitor and track this potential...
Mar 12, 2021•32 min
"The goal of ERAS® Cardiac is when you leave one of our meetings, you're going to be chock full of tips and tricks that you can take back and implement, if not the next day, then in the next week or next month." TopMedTalk's coverage of The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac) conference continues with a conversation that covers the nuggets and insights that a conference such as this delivers. This exclusive chat is only possible thanks to the support of the societ...
Mar 11, 2021•17 min
"You didn't have to think about it, the compliance continued, because it was so standardized. We had a well oiled machine that just kept on working through COVID". The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac)'s conference has gotten off to a great start; this exclusive chat gets into some of the stand out moments so far; nutrition, data collection, the essentials of ERAS and the importance of standardization. For more information on the conference check out https://www...
Mar 10, 2021•32 min
"In the elective surgical domain 20% of people who are scheduled to have surgery are not ready for surgery" The road towards economic reality is paved with data; this talk, confidently assertive in tone, provides you with a number of useful facts and reassurances which can be transformed into reasons why you and your patients can enjoy the benefits of prehabilitation; a better value of care and a higher standard of good quality outcomes. This piece works well in tandem with this debate here: htt...
Mar 09, 2021•34 min
"There is some great literature out there that has been shared ... great data, especially in cardiac surgery, which is where we are using it and I would like to expand it out to other service lines as well..." Methadone has had something of a resurgence recently, thanks in part to the work of some of our contributors in this piece. Could it be that this "opioid sparing opioid" could be a way to actually help fight the crisis we can see in US hospitals and beyond? This piece gets into the detail,...
Mar 08, 2021•38 min
This piece, part 2 of 2, is a series of questions related to part 1; "Monitoring and management of neuromuscular blockade | EBPOM Chicago". This piece gets into the detail regarding one of the stand out moments of EBPOM Chicago 2020; questions from the online audience facilitate the discussion. Given the fact that our methods of monitoring residual neuromuscular blockade are often inadequate do you transport and do you recommend routine transport to patients from the operating room to the post-a...
Mar 07, 2021•29 min
This piece is an informative conversation about "the Perioperative Care Team"; who is essential to the team and how do we make sure everyone feels included? What elements do you need to make up such a team, how do you keep people energized and excited about it over the long term? How do we ensure, in this context, that a fee for service system interlocks with the needs of both the institution and its patients? Furthermore, how does such a team increase our commitment to value based care and good...
Mar 06, 2021•31 min
Part 2 of this conversation continues the momentum of Part 1 with a conversation about electronic medical records (EMR), how important data is to the process, the need for those who collect it to understand it and then, more broadly, the importance of putting the patient at the heart of what you do. Presented by Desiree Chappell with Vicki Morton, Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates, P.A, Cheryl Crisafi, Cardiac Surgery Care Coordinator Nurse at Bays...
Mar 05, 2021•35 min
This piece is a two part conversation about the essence of what many of TopMedTalk's listeners do; Enhanced Recovery. A fascinating conversation between a number of experts in the field the conversation presented here was part of the hugely popular EBPOM Chicago 2020 meeting. For more on Evidence Based Perioperative Medicine (EBPOM) go to www.ebpom.org This first part of the conversation covers what the main elements of an Enhanced Recovery After Surgery program entail, what literature our contr...
Mar 04, 2021•35 min
What are the aims of The International Prehabilitation Society? Its vision is about "bringing together international multidisciplinary expertise, across healthcare and beyond, creating a platform of shared learning, research and education for the benefit of patients". This piece updates you on the current board members, the roles of committee members, conferences that the society has previously supported alongside those being planned for the future. Also there's an update on some exciting new sp...
Mar 03, 2021•10 min
"The people of Wales are particularly unfit", there is a high incidence of smoking, physical inactivity, and alcohol intake. Grim news from one angle but on the other hand it's a huge opportunity to make a massive difference in the prehabilitation stage of the perioperative process. Hear how cancer outcomes are being dramatically improved as a clear pathway of optimisation is rolled out. Presented by Rachael Barlow, National Lead, Enhanced Recovery, Prehabilitation and Optimisation, at Cardiff a...
Mar 02, 2021•13 min
This piece focuses on the great work done by The Anesthesia Patient Safety Foundation. We turn to their specific focus on COVID 19 and then look at the wider benefits of a network dedicated to patient safety in our field. Their section on COVID 19 is here: https://www.apsf.org/news-updates/perioperative-considerations-for-the-2019-novel-coronavirus-covid-19/ Furthermore there is a remarkably prescient article by Mike Grocott and Monty Mythen on there in which we discuss, Perioperative Fluid Mana...
Mar 01, 2021•24 min•Season 2Ep. 6
