TopMedTalk

Discussion begins with an explanation of 'Trainees with an Interest in Perioperative Medicine' (TRIPOM), a big hit at the conference this year, then a wider discussion follows which includes thoughts regarding further research and application of the perioperative method as well as where it impacts medicine and care. The importance of a multidisciplinary team based approach is strongly emphasised....

How can you make a difference in the preoperative assessment clinic? How do we remain working as a team while respecting everyone's skillset in a multidisciplinary environment? The value of a good comprehensive preoperative evaluation is clear; how do we ensure that, when this can happen, it does? How do we best use the 'teachable moment' that prehabilitation for surgery is? Looking at the data is...

How can goal directed therapy be used to prevent acute kidney injury (AKI)? What do we know about AKI? Which members of the surgical team should be involved in AKI detection? Where do we stand on ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin-receptor blockers)? Where should a perioperative practitioner stand on the choice between restrictive versus liberal fluid t...

Is it fair to say that prehabilitation is the new direction for practitioners of Enhanced Recovery After Surgery (ERAS)? Discussion expands into patient awareness initatives, The Macmillan Cancer Support, Principles and guidance for prehabilitation guide mentioned is here: https://www.macmillan.org.uk/about-us/health-professionals/resources/practical-tools-for-professionals/prehabilitation.html Ag...

A discussion about fluid management in an enhanced surgical recovery pathway in relation to the guidelines from ASER and the work of The Perioperative Quality Initiative (POQI http://www.poqi.org ). Presented by Monty Mythen with his guest Dr Tim Miller , anaesthesiologist at Duke Medical Centre and Vice President of ASER. For more come to our meetings: http://www.ebpom.org/EBPOM-USA This highligh...

This is the panel discussion which tackles emergency surgery. Discussion begins with more detail regarding the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial. Featuring, Professor Carol Peden , Executive Director of the Center for Heath System Innovation and Professor of Anesthesiology at the Keck School of Medicine of the University of Southern California, Fellow of the Institu...

Treating patients as people rather than 'jobs to be done' and 'boxes to be ticked' is the focus of this piece. What can Doctors do better when it comes to treating patients? Find out what happened when a perioperative care doctor became a patient. A fascinating conversation streamed live from Atlanta Georgia during the second day of TopMedTalk's coverage of "EBPOM-USA Masters Course, A Perioperati...

What should we think about issues regarding the Perioperative Ischemic Evaluation Study (POISE)? Is it time to treat men and women equally when it comes to haemoglobin levels? What advice should we give to clinicians who are managing change at a hospital? What should our approach to iron be and can interventions make a real difference? Featuring; Bruce Waxman , Adjunct Associate Professor (Honorar...

Should we refuse surgery to those who won't change? What about pathological issues, such as smoking, should practitioners become more didactic in their approach? How do we effectively communicate risk, both to the patient and the institution you work for? Professor Monty Mythen presents with Dr Joff Lacey and guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice...

This panel discussion provides a vital and thought provoking insight into frailty in a perioperative patient. Further, as perioperative medicine evolves, how do we know enhanced recovery after surgery (ERAS) works? Are there any large randomised controlled trials that prove it? This piece is moderated by Dr Ming Loh , Staff Specialist Geriatrician and Clinical Lecturer at Westmead Hospital and the...

How important is it to triage the patient? Which triage tool should we use? How do we determine which of our surgical patients is most at risk? Which procedures carry the highest risks? What should our approach be towards managing patient deterioration? What about when it comes to acute clinical deterioration? What, in terms of research and technology, can we expect in the future to help us? The s...

An entertaining and informative discussion about the implementation process; how do you bring everyone to the table? Desiree Chappell speaks with Robin Anderson , Enhanced Recovery (ERAS) program coordinator at Duke University, Bethany Sarosiek , Enhanced Recovery After Surgery (ERAS) Development Coordinator at UVA Health System, and Vicki Morton , Director of Clinical and Quality Outcomes at Prov...

Implementing better practice and "ERAS 2.0". The ground up approach of a 'council of nurses' sparks some fascinating debate and discussion. Can a roundtable approach sometimes work better than the traditional hierarchical power structure? Presented by Desiree Chappell with her guests Dr Ruchir Gupta , medical lead for enhanced recovery at Stony Brook University and Joni Brady , Perianesthesia, Pai...

This piece is a chance to reflect upon the importance of new media within the sphere of medical education. As the run away success of TopMedTalk and other podcasts in this area shows people are hungry to use the unique potential of this medium. Also - how has social media, video casting and live streaming altered the way conferences are both organised, executed and received? Finally, our team of e...

The Hypotension Prediction Index (HPI), which uses a machine learning algorithm to help predict intraoperative hypotension. Regular listeners to www.topmedtalk.com will be familiar with concerns about perioperative hypotension. For those who have just joined us, or anyone who fancies a quick refresher on this issue, it is covered in detail here: https://www.topmedtalk.com/live-from-boston-asa-2017...

What is a 'micromort'? Even more of a worry, what does ten of them mean? How do we measure and communicate risk to patients? Everyday activities all carry inherent risks, how do we put surgery into a context 'everyday people' can more easily understand? Professor Monty Mythen presents with guests, Professor Sol Aronson , a tenured professor at Duke University and Executive Vice Chairman in the Dep...

This piece explores some of the talking points and controversies related to dealing with frail patients who are in need of prehabilitation. How do we meet the needs and concerns of elderly patients while delivering a comprehensive standard of perioperative care? Presented by David Storey , Head of Anaesthesia, Perioperative and Pain Medicine Unit (APPMU), Melbourne Medical School, University of Me...

"Post-operative critical care: what should we do?" was originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings Presented by Denny Levett , Professor in Perioperative Medicine...

What is after ERAS, do we have an 'ERAS of ERAS' - so to speak? This conversation focuses upon bringing about change, managing and sustaining it over time and helping relate it to patient outcomes. Presented by Desiree Chappell with her guest Arman Dagal , Medical Director - Spine COAP at Foundation for Health Care Quality.

A conversation about ASER fluid management; NPO; preop drinks and keeping the i.v down. Monty Mythen is presenting with his guest Dr Scott Brudney, Professor, Departments of Anaesthesiology and Internal Medicine, University of Manitoba, Winnipeg, Canada. Click here for the American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on periope...

Fresh from an expedition to Antarctica, on the National Geographic Explorer, Mike Grocott gives us an update on the "Anaesthesia at the Extreme" conference. Regular listeners will remember his excellent talk about Xtreme Everest, which you can find here: https://www.topmedtalk.com/10-xtreme-everest-physiology-on-top-of-the-world/ Presented by Desiree Chappell and Monty Mythen with their guest Mike...

Lessons learned from the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial. This conversation focuses upon the challenges of quality improvement programmes; how do we keep track of patients and improve follow up questions after surgery? How do we clearly show Quality Improvement Programmes work for the patient? Further discussion encompasses innovation and utilization in practice....

Fitness for surgery and an understanding of the realities of risk. How important is it for surgery to take place when balanced against the specific health needs of the patient? How do we encourage patients to alter pathological aspects of their lives in order to minimise the chances of a negative outcome? Professor Monty Mythen presents with Dr Joff Lacey and guests, Professor Sol Aronson , a tenu...

University College London (UCL) offer a fantastic Masters Course in Perioperative Medicine, hear how it works in this podcast. Also, if you're intrigued, here's the link to the free 4 week course discussed in this podcast: https://www.ucl.ac.uk/lifelearning/courses/perioperative-medicine Presented by Desiree Chappell with Sam Bampoe , consultant in Anaesthesia and Perioperative Medicine at Univers...

This week's conference highlight "Exercise and cancer" was originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings Presented by Mike Grocott , Professor of Anaesthesia and Critical Care Medicine, University of Southampton.