TopMedTalk

What is POPS (Proactive care for Older People undergoing Surgery) and how have things gone since this service was introduced to Guy's and St Thomas's back in 2004? How do the team apply the techniques of this programme to the perioperative pathway of a patient? Would a service like this be useful at your practice? Can your institution accommodate a fully comprehensive geriatric assessment and opti...

Here we feature a central figure in the ongoing Great World Fluid debate. He was sadly unable to attend EBPOM 2018 but we still wanted to get a very important contribution from him. What are the big takeaways from some of the larger trials such as Saline versus Albumin Fluid Evaluation ( SAFE )? What about the long term implications of Crystalloid versus Hydroxyethyl Starch Trial (CHEST)? What new...

The Measurement of Exercise Tolerance before Surgery (METS) trial has both raised, and answered, complicated questions. In the immediate wake of EBPOM 2018, this conversation explores some of the deeper issues and big take home moments from the trial. How will it change practice? Will it alter the use of the Duke Activity Status Index (DASI) for example? Cardiopulmonary Exercise Testing (CPET) cle...

What are the benefits of Cardio Pulmonary Exercise Testing (CPET) in cancer patients? What is the evidence that suggests prehabilitation changes outcomes? Furthermore, what is the National Emergency Laparotomy Audit (NELA) and what are its benefits? Presented by Joff Lacey and Desiree Chappell with their guests; Carolyn Johnston , consultant Anaesthetist in St Georges hospital in London and Improv...

Key messages and big takeaways from a hugely successful meeting, The Second Annual Prehabilitation World Congress, held in Eindhoven, The Netherlands. What was the 'dare to dream' section? How is the business case for prehabilitation being made? Also - listen out for details of the third World Congress and discover how you can get involved. Mike Grocott presents with his guests; Sandy Jack , MD, P...

What's the relationship between Enhanced Recovery after Surgery (ERAS) and Prehabilitation? How are randomised trials showing outcome data in a positive way? Furthermore, according to some of the keynote speakers, what were the highlights and big headlines at this important gathering? Mike Grocott presents with his guests Olle Ljungqvist, Prof. of Surgery, MD, PhD, Surgeon, Örebro University Hospi...

What is pre-habilitation and how important is early mobilisation to perioperative post-operative rehabilitation? Desiree Chappell presents with her guests Dr Steve Flanagan, Chair of Physical Medicine and Rehabilitation at NYU Langone and Colleen Walsh, Assistant Professor, Nursing University of Southern Indiana, President, National Association of Orthopaedic Nurses. This piece taken from a longer...

What are the goals of healthcare providers, how do we measure success and why does value based care matter? Insight from The American Association of Retired People puts the focus in this conversation upon the patient. How do they measure value? What do they want and why? This piece features Desiree Chappell with two of the guest speakers from the American College of Perioperative Medicine's 2018 c...

Cold water adaptation for theraputic purposes. How can you gain the benefits of this unusual but increasingly popular activity? Open water swimming is discussed, how long you need to do it and what the benefits are. It's suggested that it might work because it is an anti-inflammatory. There's even the suggestion it can help with issues such as chrohn's disease. This piece is taken from a longer co...

TopMedTalk live is a gathering of Trainees with an interest in Perioperative Medicine (TRIPOM) alongside TopMedTalk listeners and EBPOM 2018 attendees in the IET London, England. This conversation is driven by questions from listeners online and attendees in the audience. What do you do when it comes to 'screening for frailty? Should it be physical frailty or mental frailty? What do we then do wit...

TopMedTalk live is a gathering of Trainees with an interest in Perioperative Medicine (TRIPOM) alongside TopMedTalk listeners and EBPOM 2018 attendees in the IET London, England. This conversation is driven by questions from listeners online and attendees in the audience. Two pain management experts alongside the TRIPOM representatives and Desiree and Monty respond in detail to some of the key con...

Back in London for EBPOM 2018! This piece features a quick rundown of some of the things you can expect to hear from www. TopMedTalk.com on our live streaming page. As always highlights of that will feature in the main podcast but, while the conference is on, we're streaming it live. TO LISTEN CLICK ON THIS LINK HERE: https://playall.sharp-stream.com/topmedtalk.mp3?autoplay=true This edition of To...

This is the third presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from Dr Lee A. Fleisher Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania. If you like the sound of this and think you and your practice would benefit from attendi...

This is the second presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from our Editor In Chief, Professor Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care at University College London. If you like the sound of this and think you and your pract...

This is the opening address and first presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology. If you like the sound of this and think you a...

How and where do you measure a patient's temperature? This is a detailed answer to a frequently asked question, various methods are discussed. 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...

This is another excerpt from "Controversies in perioperative medicine"; "The Great Fluid Debate". A fascinating piece containing Dr Tim Miller's enthusiastic advocation of goal directed fluid therapy and then the subsequent debate that follows. It ends up moving into the subject of 'enhanced recovery after cardiothoracic surgery' and what lessons we can learn from excessive hemofiltration during o...

Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis B. Cohen, Y.N. Schacham, K. Ruetzler, S. Ahuja, D. Yang, E.J. Mascha, A.B. Barclay, M.H. Hung, D.I. BACKGROUND Whether supplemental intraoperative oxygen reduces surgical site infections remains unclear. Recent recommendations from the World Health Organization and Center for Disease Control to routine...

Fluid Matters - the 'nil by mouth' or 'NPO' debate This piece is taken from "The Great Fluid Debate", it's about changes in practice that have been implimented both in the UK and at various medical centres in the US. Hear how and why the old 'nil by mouth' or 'NPO' policy has changed in many instances. From water to carbohydrate drinks, to black coffee, the thinking has changed in many institution...

How do we develop a way to teach perioperative medicine and once that's in place, how should it be overseen? What sort of official endorsement might it need? Developing a broad knowledge of the process is distinct from being a specialist, how do we develop that further - without developing a schism? This complicated topic is discussed alongside more detail regarding the future for this area. Prese...

This piece starts with the question: Is there a hierarchy amongst the various elements of an enhanced recovery pathway? The conversation that follows tackles some of the essential elements of perioperative care. This conversation is taken from a longer piece to be found here:  https://www.topmedtalk.com/live-from-the-iseh-part-2/ For further expert discussion regarding the Drink, Eat, Mobilise, Sl...

This is an excerpt from 'The Great American Fluid Debate' which was hosted at Duke University Medical Centre's "Controversies in Perioperative Medicine" conference of this year. The debate is framed as "restrictive versus liberal" but, as you'll hear, those terms are questioned by panel members. How do the results of 'The Relief Trial' figure in this debate? Is the pendulum of progress swinging to...

  What is 'the morpheus consortium'? What's the current thinking on pain management and the 'opioid crisis'? On reflection were people wrong to emphasise the message that 'pain is the fifth vital sign'? How did 'pain management' instead become 'opioid management'? The UK has had a slightly different ride to the US in this respect, although not without its problems, could that be due to this 'fifth...

Monty sits down with one of the co-organisers of this year's meeting in Orlando and discusses this year's annual conference, "Controversies in perioperative medicine". The discussion encompasses pain relief, opioids, the increased use of ultrasound and the use of particular blocks during abdominal surgery. As ultrasound improves how is perioperative medicine changing? What are the challenges prese...

This conversation reflects a discussion had at the Perioperative Quality Inititative (POQI). It originally ran under the title, "Intervascular volume and fluid responsiveness" but, as this conversation explains, it was renamed "Fluid Responsiveness and venous capacitance". With a genuinely multidisciplinary approach on display here this piece gives you a glimpse at the inner workings of the POQI p...