TopMedTalk

What are the benefits of Cardio Pulmonary Exercise Testing (CPET) in cancer patients? What is the evidence that suggests prehabilitation changes outcomes? Furthermore, what is the National Emergency Laparotomy Audit (NELA) and what are its benefits?

Presented by Joff Lacey and Desiree Chappell with their guests; Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and Improvement lead for the National Emergency Laparotomy Network (NELA.org.uk) and Malcolm West, National Institute for Health Research (NIHR) funded clinical lecturer in surgery and honorary colorectal surgical specialist registrar at the University of Southampton, United Kingdom.

Join in the debate: [email protected]

The British Journal of Anaesthesia article, which inspired this series, is here: https://bjanaesthesia.org/article/S0007-0912(20)30003-9/fulltext

"Enhanced Recovery After Cardiac Surgery" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 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: [email protected]

Daniel Engelman is the Medical Director of the Heart, Vascular and Critical Care Units at Baystate Medical Center. He is an Associate Professor of Surgery at The University of Massachusetts-Baystate. He started the ERAS® Cardiac Collaborative to internationally standardize best practices.

This piece is a detailed and reassuring look at how preparations are being made in North Carolina by our occasional host and regular contributor Vicki Morton. "I was told a few weeks ago [that] my focus was shifting to Covid preparedness"; hear how a taskforce was put together to prepare for the global pandemic. "Various different countries have been in denial" but now the fight back has begun in ernest. Will testing kits be made more widely available soon?

Questions for our listeners: Could a 'remote buddy system' - facilitated by online facetime or video communication - help practitioners to put on personal protection equipment in your practice? Do you have creative ways of dealing with children off school and the current pressures other providers like you might face? Are you prepared for more patients were you work? Do you consider cohorting to be the way forward? What are your thoughts on the plans where you work? Please email us: [email protected] and we will share them with the audience.

Presented by Monty Mythen and Desiree Chappell with Vicki Morton, Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates, P.A.

Our conversation with Dan Martin is here: https://www.topmedtalk.com/covid-19-oxygen-economy-cpap-and-ventilators/

Our guest kindly shared her email with us: [email protected]

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

Our guest is an intensivist and specialist in dangerous transmissible diseases as well as being one of the scientists who took part in the Xtreme Everest expedition which investigated the effects of human tolerance of hypoxia.

What about continuous positive airway pressure (CPAP)? Information suggests this may be more useful as we head into the pandemic stage "based on the experience the Italians are describing to us".

This piece looks at how the UK is preparing to tackle the global pandemic before asking some important questions about oxygen supplies. There's a tendency for people to use more rather than less, should we look to reverse this? "We give people a range to put their oxygen saturation between and people naturally want to go for the higher end of that target," in this time of crisis and potential shortages is it important to change that habit?

"The whole National Health Service has changed its thinking..." the piece wraps with some thoughts about how enticing it is to see the UK's Government and health service move to stop medics being bound by red tape and overly strict guidelines.

Presented by Monty Mythen with his guest Dan Martin, OBE, Anaesthetist and Intensivist at the Royal Free Hospital and Reader at University College London (UCL).

Link to the story about the Critical Care Nurse who attracted the nation's sympathy in the press recently: https://www.standard.co.uk/news/uk/nurse-urges-public-stop-panic-buying-dawn-bilbrough-a4392596.html

For more of our COVID 19 coverage go here: https://www.topmedtalk.com/covid-19/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

Can delirium, the most frequent complication in an elderly patient, be tackled with multimodal prehabilitation? This piece explains how that challenge is being investigated at the moment. A link to the paper is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564537/

Presented by Ties Lukas Janssen, General Surgery Resident at Amphia Ziekenhuis.

Desiree and Monty update each other on how it's going as both the US and UK healthcare services prepare for, and begin battle with, COVID 19. School closures in both the UK and the US; how do the practicalities of cancelling school attendance impact upon frontline providers? What do comparisons with other countries tell us about the oncoming tsunami?

Presented by Monty Mythen and Desiree Chappell.

Link to Hugh Montgomery's piece: https://www.topmedtalk.com/covid-19-hugh-montgomery-north-london-uk/

Link to NEJM: https://www.nejm.org/coronavirus

How to use PPE by The Center for Disease Control: https://www.youtube.com/watch?v=Ca66dpjPWZc

Desiree's tweet: https://twitter.com/ChappellDesiree/status/1240480154117451776

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

A large part of the journey towards enhanced recovery, better outcomes and fewer complications, is to do with educating patients. How do we explain to patients that an operation is something which is ideally a collaboration between both practitioner and patient?

The "Fitter, Better, Sooner" toolkit, which this piece focuses on, can be found here: https://www.rcoa.ac.uk/fitterbettersooner

The excellent video we mention is here: https://www.youtube.com/watch?v=0NMHMX-nFgY

Presented by Nick Margerrison with his guest Dr Hilary Swales, lead for Patient Information at The Royal College of Anaesthetists.

Go here for some of TopMedTalk's COVID-19 coverage: https://www.topmedtalk.com/covid-19-you-must-learn-the-epidemiology/

"Thank you for taking this meeting beyond these walls" - this piece was the final part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. We begin with the global audience in mind and break down what it is to be a Nurse Anesthetist. It's a role which is expanding in scope, our guest walks us through how and why that's the case.

This wide ranging conversation then moves to the future of enhanced recovery and the AANA's future development.

For more on the Drink Eat Mobilise topic go here: https://www.topmedtalk.com/periop-coach-2-02-eras-whats-the-secret-sauce/

Check out the AANA here: https://www.aana.com/

Presented by Desiree Chappell and Monty Mythen with their guest Lynn Reede, Associate Clinical Professor, Northeastern University Nurse Anesthesia Program.

"The parade here in Dingle is usually the first in Ireland..." but this year it is postponed. We speak to a Councillor in Dingle, a place much loved by many TopMedTalk listeners who attend the annual Evidence Based Perioperative Medicine (EBPOM) conference there.

Monty Mythen is joined by Cllr. Breandán Fitzgerald, County Councillor on Kerry County Council.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"Maintaining your staffing is key"; this piece is a conversation recorded immediately after a deeply concerning report regarding the situation in Bergamo, Italy. The risk of overwhelm at our institutions is present as the understanding sinks in regarding the fact this is a massive population health issue.

Presented by Desiree Chappell and Monty Mythen with their guests Dr Michael Scott, Professor of Anesthesiology at Virginia Commonwealth University, Maurizio Cereda, Associate Professor at Hospital of the University of Pennsylvania.

The conversation which preceded this is here: https://www.topmedtalk.com/covid-19-you-must-learn-the-epidemiology/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation