TopMedTalk

Adverse outcomes, we all know they happen but how do we handle them, record them and avoid them in the first place? The discussion then moves to (Patient Recorded Outcome Measures) PROMS. Patient optimisation is then discussed. Exercise, could it be so effective because it works as an anti inflammatory? A deep dive into the research on that is contained in this conversation. The RELIEF trial is di...

The International PREHAB trial. This short piece explains the trial's protocol and the scope of the study. Presented by Charlotte Molenaar , PhD Candidate, multimodal prehabilitation in colorectal cancer care, BIJ Maxima Medisch Centrum, Coordinator of the international PREHAB trial.

Is methadone "the opioid sparing opioid"? This talk looks at where we are at as regards opioids, in the shadow of a national crisis for the USA; is it possible that methapone might offer us answers? This piece looks at the idea that methadone might be a way to deliver a better more effective, multimodal, opioid sparing, analgesia with a reduced chance of a post operative repiratory events and decr...

What can practitioners do to preoperatively screen for signs that their patients may have issues with post operative delirium? How do we get patients fit for surgery, particularly with regard to delirium? Can you build up mental resilience in the run up to an operation? Do puzzles and mental activity - such as sudoku or a good crossword - help and is there any evidence of that? Should preoperative...

"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...

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 therap...

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 stretch...

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 ,...

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,...

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 Senio...

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...

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, resou...

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...

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';...

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 Pa...

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,...

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 cont...

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 Mon...

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 o...

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 Ziekenhu...

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? Her...

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...

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...

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 re...

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 Netwo...