TopMedTalk

Professor John Kellum gives a thumbnail sketch summary of the fluid debate. Presented by Professor Monty Mythen and Dr Joff Lacey with guest John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh.   Join in the debate:  contact@topmedtalk.com   This conversation taken from a longer piece here:  http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/

Reactions to one of the big take away points of EBPOM 2017, intraoperative hypotension lower than 65 mmHg appears to show a close correlation to terrible, sometimes fatal, outcomes. Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh....

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? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with guests, Professor Sol Aronson, a tenured professor at Duke University and...

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? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with Dr Joff Lacey and guests, Professor Sol Aronson, a tenured professor at...

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 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? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with Dr Joff Lacey and guests, P...

ASER 2017 and the POET acronym - a truly multidisciplinary Perioperative Enhancement Team; responsible for project managing optimisation programmes. Monty Mythen speaks with Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology. This piece is taken from a longer conversation to be found here:  http://www.topmedtalk.com/aser-eb...

Pain Relief in Enhanced Surgical Recovery. Monty Mythen asks Dr Joff Lacey and Professor Mike Grocott to reflect on the pain management discussions from day 1 of the American Society of Enhanced Recovery 2017. For further reading see the articles in Perioperative Medicine Journal: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0064-5 This conversation taken from...

Dr Ramani Moonesinghe on Standardised Outcomes from Major Surgery. Dr Joff Lacey and Professor Monty Mythen talk to Dr Ramani Moonesinghe, Director of the Heath Services Research Centre at the Royal College of Anaesthetists and a lead author of the Perioperative Quality Initiative (POQI  http://www.poqi.org ) guidelines on outcomes from surgery. Simple objective measures such as Drinking, Eating a...

Discussion focused on: outcomes, length of stay and DREAMS (Drinking, Eating and Mobilising) within hours after major surgery, all key process and outcome measures. This in depth discussion relates to the recently published consensus paper from the Perioperative Quality Initiative. Monty Mythen and Joff Lacey with Mike Grocott presenting with contributions from Dr Julie Thacker , Colorectal Surgeo...

What is the SNAP-2 project? This piece explains in detail, the 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care provision after Surgery (SNAP-2: EpiCCS) SNAP-2: EpiCCS will describe the epidemiology of perioperative risk, outcome, critical care referral and admission after inpatient surgery in the UK. It also aims to examine whether planned postoperative critical care admissi...

Bowel Prep and Enhanced Recovery After Surgery. Monty Mythen interviewing Dr Julie Thacker, President of the American Society of Enhanced Recovery and a Colorectal Surgeon at Duke, USA. Dr Thacker explains the consensus statement from ASER and the Perioperative Quality Initiative ( http://www.poqi.org ).  Taken from a longer conversation here:  http://www.topmedtalk.com/ebpom-2017-pod-one-live-fro...

"More than half our patients who come to us for surgery with enhanced recovery are malnourished"; nutrition for patients scheduled for major surgery. Monty Mythen and Joff Lacey speak with Dr Paul E Wischmeyer, Professor of Anesthesiology and Surgery at Duke University School of Medicine. Hear more from Dr Wischemeyer on YouTube: https://www.youtube.com/watch?v=XAYrjf1dhJU This piece is taken from...

Fit 4 Surgery School and can exercise help fight cancer. Monty Mythen and Joff Lacey talk to Professor Mike Grocott about the 'pre-habillitation re-habilitation' on day one of the ASER 2017 meeting in Washington DC. Prof Grocott also gives more detail on on-going research that is exploring the impact of exercise on cancer therapy. For more CME read "Re-designing the pathway to surgery: better care...

Colorectal surgery and Enhanced Surgical Recovery. Dr. Julie Thacker is an Associate Professor of Surgery at Duke University and Dr Julie Thacker and president elect at ASER. This conversation is taken from a longer piece found here:  http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/ Join the debate: contact@topmedtalk.com

( http://www.ebpom.org/EBPOM-USA ) about getting back to normal after major colorectal surgery. Attend our next meeting: http://www.ebpom.org/EBPOM-USA Monty Mythen speaks with his guest Dr. Julie Thacker is an Associate Professor of Surgery at Duke University and president elect at ASER. This taken from a longer conversation here:  http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/  ...

Measuring Outcomes Monty Mythen and Joff Lacey talk to Prof Mike Grocott (UK), Tim Miller (USA) and special guest Dr Ramani Moonesinghe about outcomes from major surgery for patients on enhanced recovery pathways. Dr Moonesinghe also talks in some detal about the UK perioperative quality improvement program ( https://pqip.org.uk/content/home ). "A multidisciplinary initiative supporting local qual...

Discussion of the ASER and POQI papers of 2017. Joff Lacey and Monty Mythen talk to Dr Tim Miller, Anaesthesiologist at Duke and vice-president of the American Society of Enhanced Recovery. Recorded on day one of ASER 2017 meeting in Washington DC this interview is taken from a longer conversation which you can find here:  http://www.topmedtalk.com/aser-ebpom-2017-pod-two-live-from-washington-dc/...

Dr Tim Miller anaesthesiologist at Duke Medical Centre and Vice President of ASER on Fluid Management in ESR and the recent guidelines from ASER and The Perioperative Quality Initiative (POQI http://www.poqi.org ). For more come to our meetings: http://www.ebpom.org/EBPOM-USA This highlight clip is taken from a longer conversation to be found here:  http://www.topmedtalk.com/aser-ebpom-2017-pod-tw...

Reflections on 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. "AmericanSociety for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management w...

The horrors of 'the opioid crisis'. The fuller version of this piece is to be found here:  http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ Featuring Joff Lacey and Monty Mythen with their guest Desiree Chappell, CRNA from Louisville Kentucky and Board Member of ASER on Narcotics in Enhanced Surgical Recovery. Check out EBPOM's meetings here: http://www.ebpom.org/EBPOM-U...

Dr Julie Thacker, President of ASER talking to TopMedTalk Radio live at ASER 2017, Washington DC, USA. Multidisciplinary teams and managing change - 'it's all about the patient'.

The team begin with a fascinating discussion regarding statistics and the assessment of risk. The generalised risks of surgery and the way in which NELA (National Emergency Laparotomy Audit) data may soon make it possible to work out specific odds for a specific patient. Handling modifiable risk factors; how do we get patients ready for surgery, particularly if they are suffering from comorbiditie...

This discussion, recorded on day one of EBPOM 2017, a truly international gathering with many countries represented. The  Intraoperative hypotension is discussed. New information regarding cognitive function for patients raises big questions. Should shared decision making be re-evaluated? The team then discuss the Perioperative Quality Initiative (POQI) and new information regarding intraoperative...

Discussion includes a recap of the last few podcasts. Desiree Chappell joins us to update the team on 'the opioid crisis'; 50 overdoses in a twenty hour period reported in Kentucky? Can a perioperative multimodal approach to pain management help tackle it? How important is managing patient expectations as regards pain? Dr Ramani Moonesinghe, Director of the Health Services Research Centre at the R...

In this piece you will hear more discussion regarding the POQI papers, a growing concensus on goal directed fluid therapy and the move away from opioids. One of the big stories, The American College of Surgeons's announcement that ERAS is to be rolled out to more than 750 hospitals, is also discussed. The POQI (Perioperative Quality Initiative) papers on outcomes and fluid management are discussed...