TopMedTalk

This talk examines the rationale for using methadone in our surgical patient population, reviews clinical trials that assess the effect of intraoperative methadone on post operative outcomes and discusses some unanswered questions related to the administration of this long acting opioid in the perioperative period. Presented by Glenn Murphy , Jeffery S. Vender Chair of Anesthesiology Research and...

"The main challenge around the variability in the perioperative period is nomenclature, definitions and standardized endpoints. Well designed and well conducted randomized control trials determine effectiveness to an unbiased comparison of outcomes, events, or endpoints between intervention groups". If data is destiny it is to this that we must look if we want to understand what the future may hol...

"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...

"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 T...

"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. Any...

"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. Any...

It's widely understood that high value care during, before and immediately after surgery is optimal whereas poor quality care in the perioperative period produces long term difficulties which are compounded by the acute stresses produced during and immediately after a procedure. This talk covers three main areas; surgical care for patients in Greater Manchester, "ERAS+"; prehabilitation for cancer...

This piece looks at some of the advantages to having a perioperative interdisciplinary team reducing complications, understanding and discussing risk, facilitating better shared decision making and increased patient satisfaction, even among those who - as part of this process - decide not to go ahead with an operation. It also incorporates evidence regarding what we know about COVID-19; "The risks...

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...

"More than 300 million patients have surgery annually worldwide and an increasing proportion of them are elderly and at risk of perioperative adverse events. There's very few proven primary or secondary prevention measures, and the resources for monitoring and trading complications are inadequate. So - more action is required". This piece looks at the evidence as regards perioperative outcomes for...

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"? Presented by Sol Aronson with Mike Ramsey , Chair of the department of Anesthesia and pain management at the Baylor Univ...

  How have we adapted in our views on the use of video laryngoscopy during the Covid-19 pandemic? Who is best suited to intubate? Are we seeing "a poorly managed first wave"? How are practitioners changing their approach in light of the possibility of infections? What lessons are being learned by practitioners in the midst of the COVID crisis? This piece was generously supported by Medtronic.com P...

This piece is a worthwhile deep dive into this perioperative medicine and how we go forward with it. Hear the panel speak about what it is they want for the future and what it is they are doing now. With questions submitted from the online audience the panel get into the detail. Essential listening for any student of perioperative medicine. It includes a mention for the Welsh Perioperative Medicin...

"We've been doing cryoneurolysis for total knees now for three years... people gravitate to practices that that practice this technology" This piece focuses upon two 'early adopter' orthopedic surgeons changing up the way we treat joint pain for surgical patients. We mention Iovera, a provider at the forefront of this technology: https://www.iovera.com/ The Doc Social website is here: www.doc.soci...

This piece is a worthwhile deep dive into this perioperative medicine and how we go forward with it. Hear the panel speak about what it is they want for the future and what it is they are doing now. With questions submitted from the online audience the panel get into the detail. Essential listening for any student of perioperative medicine. When should we pre-assess patients? Should all anaestheti...

  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...

This piece is part one of a two part piece. It's a short didactic presentation on the tough realities the U.S. healthcare system faces as the fee for payment system creaks against concerns about rising costs and the need for population health management. Can we move forward with "the science of value" which true perioperative medicine offers us? It's a talk which is designed to spark debate and th...

"Data is key and having champions is key" This piece provides a truly transatlantic in-depth perspective on an area of opportunity highlighted by our needs in the wake of COVID 19; now more than ever true enhanced recovery after surgery (ERAS) is essential. Optimising value, reducing the need for return visits, decreased length of stay, there is almost no aspect of perioperative medicine and enhan...

"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,...

"It's useful to reflect on what SNAP-2 EPICCS might offer us in the brave new world that we find ourselves in with Coronavirus" The 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care after Surgery (SNAP-2 - EPICCS) study launched in March 2017 around the UK. More than 2,200 investigators at more than 250 sites across the UK were signed up to take part. The observational study c...

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...

This roundtable discussion tackles questions from the online audience and is the third part of a longer discussion. It follows on from "The value proposition in perioperative medicine | EBPOM 2021 Las Vegas", if you'd like to hear that go here: https://topmedtalk.libsyn.com/the-value-proposition-in-perioperative-medicine-ebpom-2021-las-vegas How do we as practitioners deliver value? How does 'popu...

"Look at it from where is the patient, and what's best for the patient; I think that the other answers follow and yes, it is higher quality, yes, there can be some opportunities for cost savings; even if it 'breaks even' if the patients are happier, isn't that worth moving into the concept and proving that it does make a difference?" The value proposition is an essential element of advocating peri...

"When I heard Sol Aronson, speak about perioperative medicine as 'population health', for me, it was like a eureka moment because our platform within Michigan is really an unmatched place to kind of realize that vision." This piece asks the question; "why do we need perioperative medicine"? The answer is illustrated with a real success story where practitioners realise the value proposition it unl...

This question and answer session was a highlight of EBPOM London 2020, it works as a standalone piece or as a companion piece to this talk here: https://topmedtalk.libsyn.com/ebpom-2020-london-am-i-safe The discussion follows themes outlined in the presentation as our online audience asked a series of questions. Some of the questions included in the discussion are "How should leaders deal with anx...