TopMedTalk

On the last occasion we spoke with our guest she was a Perioperative Medicine Fellow at Duke University; learn now how her experiences have helped change her practice and the edge she has dealing with healthcare. The conference is producing a number of talking points, the Measurement of Exercise Tolerance before Surgery (METS) Trial seems to have shifted opinions, does a genuine 'perioptimist' have a deeper insight into the issues there? Also - does North America really lack the resources, expertise and money to adpot Cardiopulmonary Exercise Testing (CPET)? Presented by Desiree Chappell and Monty Mythen with their guest Dr Elena Koepke, Assistant Professor at Moffitt Cancer Center/USF, Physician Anesthesiologist, Perioperative Medicine Specialist. You can find POETTS here: https://www.poetts.co.uk

How do new technologies impact the postoperative elements of Enhanced Recovery? Here we discuss "ward monitoring 3.0" and new technologies which are now available, or in the pipeline, to improve outcomes. How do we best use this information and these innovations?

The website mentioned in the podcast is here: https://www.michardconsulting.com/

Presented by Desiree Chappell with Monty Mythen and their guest Frederic Michard of MiCo Consulting.

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 University of Sydney, Clinical Lead for the Orthogeriatric Service, Subacute Rehabilitation Ward and Falls Clinic, and features; Ruth E. Hubbard, Professor in Geriatric Medicine at the University of Queensland, Consultant Geriatrician at the Princess Alexandra Hospital and Head of School for PA-Southside Clinical Unit, with Bobbie Jean Sweitzer, Professor of Anesthesiology and Director of Perioperative Medicine at Northwestern University in Chicago, Illinois, and David Storey, Head of Anaesthesia, Perioperative and Pain Medicine Unit (APPMU), Melbourne Medical School, University of Melbourne; Director, Melbourne Clinical and Translational Sciences (MCATS) research platform.

Doesn't the decision to delay surgery depend upon the type of cancer? Can you measure complications as an outcome? What's the cause of non cardiac complications that are related to lack of exercise? Can we change the mindset of prehabilitation by explaining that prehabilitation is the start of treatment? How do we convince patients and decision makers that delaying surgery is a good idea? How involved are oncologists in perioperative decisions?

Presented by Duminda Wijeysundera, Professor in the Department of Anaesthesia and the Institute of Health Policy Management and Evaluation at the University of Toronto, and a Staff Anesthesiologist at St Michael's Hospital and Gerrit Slooter, MD, PhD, Surgical Oncologist, Maxima Medical Centre, The Netherlands.

This question and answer session is a valuable insight into where the latest thinking is as regards tackling the opioid crisis. How do we get to an understanding where the entire continuum of care is on the same page as regards pain relief? What's the level of adoption for opioid free anaesthesia? Can re-languaging pain or "re-writing the narrative" help, for example is it better to speak of 'comfort levels' as opposed to pain? What's the latest thinking as regards caffeine as an aid to comfort? Should we be worried about post operative delerium as regards ketamine use? What about gabapentinoids in the elderly? What about Midazolam? What should we send patients home with afterwards?

Presented by Michael Manning, MD, PhD, Assistant Professor at Duke University Medical Center, Director of research for the Perioperative Medicine Fellowship at Duke.

This piece argues that troponin screening is useful, if used appropriately. Is it the case that this test has been 'over sold' and as a result has provoked unhelpful pushback from practitioners?

It's part 1 of 3 from The EBPOM 2019 TopMedTalk session which debated the issue.

Presented by Duminda Wijeysundera, Professor in the Department of Anaesthesia and the Institute of Health Policy Management and Evaluation at the University of Toronto, and a Staff Anesthesiologist at St Michael's Hospital.

A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

How can cold water adaption help people deal with medical issues? There's evidence to suggest that cold water adaption reduces inflamation, can open water swimming help with issues such as chrohn's disease? On the other hand how important is it to ensure patients do not become cold while in our care? Hypothermia is never good, how important is it to keep patients warm? Keeping patients and their environments warm is discussed, as is pre-warming, going beyond the standard blankets and patient insulation to include active warming and even patients exercising as a method of warming up. Further to this conversation, how do you measure a patient's temperature?

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. The piece also includes patient communication and the question of 'how much is too much?', when administering a dose of morphine. Also, is there a hierarchy on the pathway of enhanced recovery after surgery?

The conversation features Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for theraputic purposes. There are also attributed questions from the audience.

Post op respiratory complications are the focus of this piece. How can they be anticipated, detected early and dealt with appropriately? What about objective neuromuscular monitoring? Should you revese every single patient? If so, how do you do it? What about the risk of pulmonary complications? Presented by Desiree Chappell with her guest Frances Chung, Professor, Department of Anesthesiology and Pain Medicine, University of Toronto.

Learn about the Perioperative Anesthesia and Surgical Screening Clinic (PASS Clinic), do you need one at your practice? What is pain control for a perioperative patient? Hear also about the 'subacute period' and how you can incorporate it into your practice. Also, how do we keep patients 'opioid free' once they leave our care? Finally, how does individualised pain management and pain education fit into this picture?

Presented by Desiree Chappell and Vicki Morton, with their guests; Professor Padma Gulur, Anaesthesia and Executive Vice-Chair at Duke University and Dr Natasha Curran, pain medicine University College London Hospital (UCLH) and Medical Director at the Health Innovation Network.

The fuller version of this conversation is available here: https://www.topmedtalk.com/ebpom-2018-14-the-realities-of-pain-management/

Our Holiday Special, part 3 of 3, is a sampling of our favorite conversations and lectures from 2019. It is a chance for new listeners to the hear the outstanding content that has made TopMedTalk the success it is after 2 amazing years. And for our regular listeners, a check in to make sure they've not missed some of the crucial pieces of the last year.

🙏🙏 All of us at TopMedTalk want to send a BIG thank you to ALL of our amazing fans and listeners. The support these past 2 years is inspiring and much appreciated. We want to thank our guests and lecturers from this past year as well. Your contribution to the show is what makes TopMedTalk so special. And a final THANK YOU to our Sponsors. Your generous support keeps TopMedTalk free open access to the world! Happy Holidays and Cheers to the New Year!! 🥂🥂🎉

More about caring for the transgender patient is here: https://www.topmedtalk.com/aana-2019-caring-for-the-transgender-patient/

Emotional intelligence is explored further here: https://www.topmedtalk.com/aana-2019-emotional-intelligence-and-occupational-stress/

Paul Myles is here: https://www.topmedtalk.com/live-from-asa-2017-paul-myles-3000-patients-in-study-of-fluid-restriction/

Joan Mythen may feature in the future on TopMedTalk.

The Grenfell fire episode is here: https://www.topmedtalk.com/topmedtalk-the-grenfell-inquiry-2/

The Dingle conference for 2020 is here: https://www.ebpom.org/Dingle2020

Carol Peden is here: https://www.topmedtalk.com/anes19-carol-peden-robin-cresner-shane-dickinson-snow-shoo-son/

Mike Scott is here: https://www.topmedtalk.com/anes19-michael-scott/

The interview with Andrew Shaw is here: https://www.topmedtalk.com/anes19-andrew-shaw/

Presented by Desiree Chappell with Monty Mythen alongside a selection of clips from the last year.