TopMedTalk

"Does choice of opioid influence health outcomes?" - 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 If you have any comments or questions you'd like to send to the...

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...

How do we address the issue of post operative delirium? Here you will find fascinating further discussion about cognitive function after surgery. What practical, simple steps can patients and providers take to bridge the gap between new discoveries in this area and risk minimisation? Featuring Desiree Chappell interviewing her guests, Carol Peden , Professor of Anesthesiology and Executive Directo...

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 does 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 op...

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...

Is it unreasonable to give a patient six months to lose weight before, for example, knee surgery? Going even further should we be considering meditation, mindfullness and yoga as part of a pre-habilitation clinic?   Hosted by Desiree Chappell and Monty Mythen , recorded at the Interdisciplinary Conference on Orthopedic Value-Based Care, with their guests; Shawna Butler (RN, NBA who works with Sing...

The full title of the paper being looked at here is: "Effect of Electroencephalography-Guided Anesthetic Administration on Postoperative Delirium Among Older Adults Undergoing Major Surgery: The ENGAGES Randomized Clinical Trial".   The link to the paper is here:   https://www.ncbi.nlm.nih.gov/pubmed/30721296   The editorial referenced in the piece is here:   https://jamanetwork.com/journals/jama/...

"PQIP Pain: from individual case to systems management" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on  www.topmedtalk.com If you're looking for the talk mentioned here featuring Paul Wishmeyer it is here: https://www.topmedtalk.com/ topmedtalks-to-dr-paul- wischmeyer/   if you'd like to attend an event like this ensure your next cl...

How do we best negotiate working in a multidisciplinary team? Generalisations regarding surgeons and anaesthetists only ever work generally, the specifics of each practitioner and their priorities inevitably contrast. How do we keep sight of these broad differences without falling foul of stereotypes? The conversation evolves; how does the surgical journey fully utilise the team based perioperativ...

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 as regards delirium? Can you build up mental resilience in the run up to an operation, do suggestions that puzzles and mental activity such as sudoku and a good crossword help have any evidence behind them?   This piec...

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...

How do you become well known in the NHS for being innovative, particularly in the perioperative area regarding evaluation and communication of risk? How can cardiopulmonary exercise testing lead to shared decision making? Hear how aortic aneurysms are dealt with by a world class professional perioperative physician. Learn how that process and its success then spread out into other areas of healthc...

The gap between ambition and action is familiar to us all but when it's potentially a matter of life and death how do we overcome it? This piece gives you a sense of both the research which illustrates the 'behaviour gap' in patients who are attempting to make good on their promise to regularly exercise. Presented by Chloe Grimmett , behavioural scientist from Southampton University. She works clo...

Interesting thoughts on the use of ACE inhibitors and ARBs, alongside considerations regarding asprin.   We look at the following papers:   Anesthesia and Analgesia : A Systematic Review of Outcomes Associated With Withholding or Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Before Noncardiac Surgery.   https://www.ncbi.nlm.nih.gov/pubmed/29381513   Anesthes...

"Perioperative nutrition should be a key part of Enhanced Recovery" - 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 If you have any comments or questions you'd like...

How does the treatment of anemia fit into the perioperative process? How far should patient optimisation extend to treatment of this condition? Live from the hugely successful EBPOM USA conference, directly after their presentation Desiree Chappell talks with her guests; Dr Lori Heller , Cardiac Anesthesiologist, Swedish Medical Center, through US anaesthesia partners and acting instructor at the...

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...

Trainees with an interest in perioperative medicine ( TRIPOM ) is an ever growing organisation set to continue the global push for perioperative care. This high energy podcast gives you a taste of the enthusiasm people pick up as they learn more about the value of these ideas.   Moving more obviously into the perioperative period this piece continues on from last week's talk regarding mitochondria...

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...

Community based prehabilitation in the UK is being spearheaded by the Prepwell Initiative. Supported by a grant from Sports England this pioneering work is a great example of the way in which a perioperative enhancement team can be formed around your practice. The "PREP: Preoperative Risk Education Package" website mentioned in this piece is here: https://www.prepwell.co.uk/ Desiree Chappell and J...

This piece ploughs into some of the academic papers that have provoked discussion recently in the perioperative community. We discuss the following papers: Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses. https://www.ncbi.nlm.nih.gov/pubmed/30552274 Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Fol...

"Hypotension probability in practice" - 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 If you have any comments or questions you'd like to send to the team email: con...

How has the Royal College of Anaethestists (RCoA) evolved over the years and why is perioperative medicine so crucial to its agenda? How has this leadership in perioperative medicine become a force for change and improvement worldwide and what are the common themes that emerge as we take a global perspective on the discipline? The RCoA's global partnership programme is explained, how can periopera...

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...

We begin with a question from the audience; 'how do we drive change in our institutions towards enhanced recovery after surgery?'   The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned. This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum. Th...