TopMedTalk

Here we feature a central figure in the ongoing Great World Fluid debate. He was sadly unable to attend EBPOM 2018 so we wanted to get a very important contribution from him: What are the big takeaways from some of the larger trials such as Saline versus Albumin Fluid Evaluation (SAFE)? What about the long term implications of Crystalloid versus Hydroxyethyl Starch Trial (CHEST)? What new trials should be on the horizon - given the information we now have?

Monty Mythen speaks with his guest Professor John A Myburgh, Intensive Care Medicine, University of New South Wales; Director of the Division of Critical Care and Trauma at the George Institute for Global Health and Senior Intensive Care Physician at the St George Hospital, Sydney. He holds honorary Professorial appointments at the University of Sydney and Monash University School of Public Health and Preventive Medicine.

What are the opportunities presented to a perioperative practitioner when political devolution becomes a reality? What can we learn from the experiences of a team leading the introduction of ERAS+ and prehabilitation across Greater Manchester with a 'Spread and Scale innovation grant' from the Health Foundation? How do you demonstrate benefits which patients and fee payers can understand? How do you go about leading a prehab transformation program, which aims to provide prehab for more than 2000 patients affected by cancer, over 2 years?

The GM teams are very happy to host teams in Manchester who may want to visit MFT and see Surgery School in action and show colleagues what they are aiming to achieve with GM Cancer Prehab. Email John on [email protected] or [email protected]

ERAS+ website is here: https://www.erasplus.co.uk/

NHS Innovation Accelerator website: https://nhsaccelerator.com/

GM Active are here: https://www.gmactive.co.uk/

Presented by John Moore, consultant in anaesthetics and critical care medicine from Manchester, UK, Clinical Head of the Division of Anaesthetics, Peri-operative medicine and Critical Care at Manchester University Hospital NHS Foundation Trust.

Here we explore the detail behind Brian Woods' talk "Leading a large, multi-state group to achieve excellence", which was streamed live on TopMedTalk (link at the foot of these notes) from the EBPOM USA Dallas Master's Course 2019.

Enhanced Recovery is about pathways and then compliance with those pathways; there is usually an approximate compliance rate of 60%, how can that be increased? What are the most efficient dataset and reporting protocols that an instituition can use? Can personal primary accountability be used to leverage performance within a team structure? Can incentive metrics and incentive pay really make the difference or is human behaviour motivated by other forces?

Presented by Monty Mythen with Desiree Chappell and their guest Brian Woods, MD President, Chief Medical Officer of Northstar Anesthesia. Additional contributions from Professor Sol Aronson, tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology as well as TopMedTalk listeners and conference delegates.

Surgery may represent a "teachable moment" should we try to exploit that for only short term, prehabilitation purposes? What is the difference between being motivated and being confident when it comes to success in these areas? How do patients feel about changing multiple behaviours at the same time?

Presented by Suzanne Mcdonald, Research Associate at The University of Queensland (Australia), Visiting Researcher at Newcastle University (UK) and registered Chartered Health Psychologist.

The TopMedTalk team are live from Anesthesiology 2019 at the Orange County Convention Center in Orlando. With over 14,000 delegates, clinicians, thought leaders and professionals, it's the largest gathering of Anesthesiologists and Anesthesia providers in the world.

Check out the www.topmedtalk.com website now to hear live audio, while you are there remember to subscribe for updates so you can always be one step ahead of the crowd. Also, if you fancy watching the show as it happens go to our Twitter feed www.twitter.com/topmedtalk to see the team in action.

This piece focuses upon patient safety and the work of our guest. How does perioperative medicine fit into the picture, are anesthetists right to take the lead in this field?

You can find the Anesthesia Patient Safety Foundation here: https://www.apsf.org/

Presented by Desiree Chappell with Monty Mythen and Henry Howe alongside their guest Mark Warner, Annenberg Professor of Anesthesiology at the Mayo Clinic in Rochester, 2019 American Society of Anesthesiologists (ASA) recipient of 'The Distinguished Service Award' and President of the Anesthesia Patient Safety Foundation (APSF).

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Like this, want more?

Our guest mentions this excellent piece here: https://www.topmedtalk.com/anes19-alexander-hannenberg-kris-torgeson/

Further listening, regarding patient safety, globally, can be found here: https://www.topmedtalk.com/ebpom-highlight-1-19-the-patient-safety-movement-foundation/

The TopMedTalk team are live from Anesthesiology 2019 at the Orange County Convention Center in Orlando. With over 14,000 delegates, clinicians, thought leaders and professionals, it's the largest gathering of Anesthesiologists and Anesthesia providers in the world.

Check out the www.topmedtalk.com website now to hear live audio, while you are there remember to subscribe for updates so you can always be one step ahead of the crowd. Also, if you fancy watching the show as it happens go to our Twitter feed www.twitter.com/topmedtalk to see the team in action.

This piece focuses upon cerebral oximetry. Can it help practitioners monitor cerebral oxygenation in situations in which pulse oximetry alone may not be fully indicative of the oxygen in the brain? How does it relate to hypoxia?

This piece is a deep dive into the technology and its front line applications.

Presented by Desiree Chappell and Monty Mythen with Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton and their guest, Greg Fischer, Chairman, Department of Anesthesiology & Critical Care Medicine at Memorial Sloan Kettering Cancer Center.

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Mike mentions the exciting research done during Xtreme Everest, hear his engaging lecture on that project here: https://www.topmedtalk.com/10-xtreme-everest-physiology-on-top-of-the-world/

The TopMedTalk team are live from Anesthesiology 2019 at the Orange County Convention Center in Orlando. With over 14,000 delegates, clinicians, thought leaders and professionals, it's the largest gathering of Anesthesiologists and Anesthesia providers in the world.

Check out the www.topmedtalk.com website now to hear live audio, while you are there remember to subscribe for updates so you can always be one step ahead of the crowd. Also, if you fancy watching the show as it happens go to our Twitter feed www.twitter.com/topmedtalk to see the team in action.

This piece focuses on a new article recently published in The Lancet: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32315-3/fulltext

Find out more about the ANZCA Clinical Trials Network here: http://www.anzca.edu.au/research/anzca-clinical-trials-network/anzca-clinical-trials-network-executive

Presented by Desiree Chappell and Monty Mythen with their guests Kate Leslie, Honourary Professor, Monash University, Melbourne, VIC, Australia, Specialist Anaesthetist, The Royal Melbourne Hospital & North Western Mental Health and Non-Executive Director, Australian Medical Council and Timothy Short, Clinical Anaesthetist and Honoury Professor at Auckland University Hospital, New Zealand.

The TopMedTalk team are live from Anesthesiology 2019 at the Orange County Convention Center in Orlando. With over 14,000 delegates, clinicians, thought leaders and professionals, it's the largest gathering of Anesthesiologists and Anesthesia providers in the world.

Check out the www.topmedtalk.com website now to hear live audio, while you are there remember to subscribe for updates so you can always be one step ahead of the crowd. Also, if you fancy watching the show as it happens go to our Twitter feed www.twitter.com/topmedtalk to see the team in action.

This piece focuses on alternative payment models for healthcare. "We keep saying we're going to go to value based care rather than volume based care" and this movement now appears to be picking up pace. How is enhanced recovery and perioperative medicine helping to reduce the cost of healthcare? Can prehabilitation help reduce costs?

Presented by Desiree Chappell with Monty Mythen, Sol Aronson and their guest Lee Fleisher, Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania.

The TopMedTalk team are live from Anesthesiology 2019 at the Orange County Convention Center in Orlando. With over 14,000 delegates, clinicians, thought leaders and professionals, it's the largest gathering of Anesthesiologists and Anesthesia providers in the world.

Check out the www.topmedtalk.com website now to hear live audio, while you are there remember to subscribe for updates so you can always be one step ahead of the crowd. Also, if you fancy watching the show as it happens go to our Twitter feed www.twitter.com/topmedtalk to see the team in action.

This detailed discussion sheds more light on The Perioperative Quality Initiative (POQI), the resources available to you and the impact it is having on a global understanding of Enhanced Recovery and Perioperative Medicine.

Check out their website here: www.poqi.org

Further discussion delves into the evergreen fluid debate and walks us through the timeline of how attitudes toward them have changed in the perioperative sphere over the last ten years or so. "We should be fair to the originators of Enhanced Recovery who did not talk about fluid restriction but instead about avoidance of fluid excess"

Presented by Desiree Chappell and Monty Mythen with Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and their guests Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton and Tim Miller, Associate Professor of Anesthesiology from Duke University Medical Centre.

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Check out this fascinating series, "Fluid Matters". It's an opportunity to listen to a POQI meeting as if you were there in person. Part one, of six, is here: https://www.topmedtalk.com/fluid-matters-series-1-6-definite-definitions-fluid-physiology/

Originally streamed live from the EBPOM USA 2019 conference in Dallas this piece looks into the realities of enhanced recovery. Patient satisfaction and outcomes rise to the top of the priority list as an institution invests in the idea, how long does it take for a clear financial return on the investments required to get it off the ground? How do we get a team motivated to work towards these ideas? Are there any disadvantages to enhanced recovery? How do patients react to it? Also, how does blockchain technology (the innovation behind cryptocurrencies such as Bitcoin) interlock into more practical transfers of patient data? What other innovations are on the horizon? Presented by Desiree Chappell with Monty Mythen and their guest Sabry Ayad, Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University.