TopMedTalk

When it comes to blood pressure, hypotension is associated with poor outcomes for patients, how do we react to this? How do we manage and avoid hypotension where possible? How has technology caught up with this challenge? Could automated closed loop systems be helpful here? The bottom line is simple; "If we measure blood pressure properly, we can predict it". Presented by Dr Simon Davies , Consult...

This invaluable piece is a chance to attend a workshop which looks at the latest thinking on "perioperative cognition" and 'post-operative cognitive dysfuntion'. We advise you use this link here to find the PDF of the paper being discussed: https://bjanaesthesia.org/article/S0007-0912(17)54082-9/fulltext Presented by David Scott , Professor, University of Melbourne, Director, Anaesthesia and Acute...

More of our coverage of the American Society of Enhanced Recovery (ASER) annual general meeting. Reflections regarding the rise of Cardiopulmonary Exercise Testing (CPET); a growing field, particularly in the US. The "Prehabilitation World Congress in association with POETTS & EBPOM" meeting discussed in this podcast is here: https://ebpomusa.org/Prehab-2019 If you are interested in hearing more a...

Perioperative medicine is defined here as: "the practice of patient centred multidisciplinary and integrated medical care of patients from the moment of contemplation of surgery until full recovery". Population health is defined as: "the health outcomes of a group of individuals including the distribution of such outcomes within the group". Do the two compliment each other? Use this concise 15 min...

If we look at the evidence, is there a case for "vascular geriatrics"? Co-managed care in vascular surgery could be a way forward, this talk builds the case for change. Readmission rates in this group are dissapointing, how do we reasonably tackle this issue? How do we balance questions regarding appropriateness and need for surgery in this area? What about the priorities of the patient, do they a...

This piece is taken from the free papers presentations given at EBPOM 2019. Can two weeks of prehabilitation really make a difference for patients facing primary surgical resection of colorectal cancer? How feasable is it to recruit patients into such a programme? Can we make a real change in their objectively measured fitness? Is there patient buy in? What is the strain on an institution's resour...

Obstructive sleep apnea is important to identify in patients, this piece explains how; use the official STOP BANG website here: http://www.stopbang.ca/osa/screening.php Opioids and pain management strategy is discussed, alongside reflections on the differences between the healthcare systems of Canada, the UK and America. Finally, what is "the beard test" and "the upper lip bite test"? Presented by...

Some practitioners habitually prescribe opioids, the consequences in America are now described as a national crisis. Essentially the focus here is "better opioid stewardship" and a "move away from the traditional fundamental principle of opioids first". Presented by Michael Manning , MD, PhD, Assistant Professor at Duke University Medical Center, Director of Research for the Perioperative Medicine...

This invaluable piece is a chance to attend a workshop which looks at the latest thinking on "perioperative cognition" and 'post-operative cognitive dysfuntion'. We advise you use this link here to find the PDF of the paper being discussed: https://bjanaesthesia.org/article/S0007-0912(17)54082-9/fulltext This is Part 2, to find Part 1 follow this link here: https://www.topmedtalk.com/sunday-specia...

Perioperative nutrition is a topic which has fascinates us here on TopMedTalk. Ever evolving and moving forward the questions continue as we explore an area which will only keep growing. Should evidence based arguments be the way we make the case for true investment in this area?   Presented by Korey Springman with her guest William Wooden , Director of Operative Services at Indiana University of...

This piece dives into the latest thinking behind opioid-free anaesthesia; how can we improve? Is the challenge of the opioid crisis being met head on by perioperative medicine? Is it realistic to expect to reach a point where opioids are removed from the equation entirely? Presented by Michael Manning , MD, PhD, Assistant Professor at Duke University Medical Center, Director of research for the Pe...

The team aspect of perioperative care is an essential element, this piece gets into the details as thought leaders and key opinion makers engage with the debate regarding how that actually works in practice. Moderated by Ross Kerridge , John Hunter Hospital, Newcastle, Australia, often cited as 'the father of Modern Perioperative Medicine'; the panel consists of, Charlie Corke , Associate Professo...

Quality initiatives are all about connecting people, this piece gives you real life experiences which show you how and why that can work alongside some of the challenges that come with it. Can an organisation reach a point where it does not need to improve? How can an "external stakeholder" pick things up? What is "psychological safety"? Can a pure focus on rules and tools become misleading? How c...

"About a year ago our chief CRNA sent me a podcast from TopMedTalk about fluid management" - this podcast is a fascinating insight into how Enhanced Recovery continues to reach out across the world to the bedside of patients. How do you take your institution from where you're at now to where you need to be tomorrow? What are the essential ingredients? How do you work, through education, towards re...

The Cleveland Clinic London Hospital opens to inpatients in early 2021. Here you can hear what it is about, how it is going to work and how it intends to improve healthcare in the UK. In addition to his clinical commitments he was President of the Association for Cardiothoracic Anaesthesia and Critical Care, and is an editor of British Journal of Anaesthesia Education. Dr Fletcher has published mo...

This piece focuses upon a new report from the World Health Organisation (WHO) looking at Arts and Health. The first of its kind, the report demonstrates the relationship between the arts, health and wellbeing. Are there ways you could incorporate the arts into your practice? Can it help with issues such as brain health, addiction and pain relief? A link to the report, "What is the evidence on the...

Speaking with a legend in the world of anaesthesia; this piece allows us to explore some of the bigger issues and milestones in the profession. How has it evolved, particularly in relation to the simultanious evolution of perioperative practice? Where are we now and where do things look set to go in the future?   This piece was originally streamed live on www. TopMedTalk.com under the title: "Educ...

This piece is a question and answer session regarding the care of elderly patients undergoing surgery. Discussion topics include; The RELIEF trial, e health tools, gathering and accessing data, whether it is better to over estimate risks and which risk calculator is most appropriate to use where you are? It features; Professor Jacqueline Close , Geriatrician, Prince Of Wales Hospital, Clinical Dir...

This piece features a short informative presentation from our Editor in Chief Monty Mythen regarding Artificial Intelligence and the HPI Monitor developed by Edwards Life Sciences. It is followed by question and answer session faciliated by both our online presence, studio audience and invited guests. The "Perioperative Quality Initiative consensus statement on the physiology of arterial blood pre...

This piece gives you a wider perspective on perioperative medicine over the years. How have institutions risen to this challenge and what can we learn from them? How do systems and cultures change over time? When implimenting change have you asked the following questions; Is it scientifically rational? Is it clinically reasonable? What are the risks? What are the resource implications? Are there a...

The results of the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial are a huge talking point in the perioperative sphere; this stand alone piece follows on from "EBPOM Conference Highlight | Lessons on EPOCH in the UK". To hear that click here: https://www.topmedtalk.com/ebpom-conference-highlight-1-21-lessons-on-epoch-in-the-uk/ Originally streamed live from the Charles Sammons C...

Preoperative risk stratification; what is are the risks and controversies behind preoperative exercise testing and the six minute walk test? This piece looks at the evidence behind both and some practical guidance for informing clinical care. Does the six minute walk test predict complications? What is the true value for cardiopulminary exercise testing (CPET)? For more on the METS study go here:...

Preoperative optimisation and prehabilitation are key areas where your institution can increase value for patients. How do you negotiate the different pitfalls presented by the various core stakeholders? Smoking cessation, nutrition, exercise; all are proven to help produce better outcomes for a patient. How do we express this in such a way that we get buy-in from everyone concerned? When it comes...

Can artificial intelligence drive new changes in care and the value of big data? We're already comfortable with using tools that help us to do our job better, what are the opportunities and pitfalls related to this new technology? Are we ready yet for big data? The changes it may cause are staggering but equally; nuance is the friend of truth, do we have enough 'data literacy' to handle it all? Al...

How do we convince patients that prehabilitation is safe? What forms of certification are available for the accreditation of a balanced multidisciplinary team? How do you monitor home based patients? How do we tap into the wider 'exercise industry' on behalf of perioperative prehabilitation? Panel discussion, featuring; Daniel Santa Mina , Assistant Professor at University of Toronto & Scientist i...