TopMedTalk

"Accelerated surgery for hip fracture is safe and feasable, with troponin elevation before randomization, there was a mortality advantage with accelerated surgery. The logistics and resources required for accelerated surgery need to be balanced with the demonstrated benefits and patient's desires for accelerated surgery"

This exciting piece from EBPOM 2020 provides a data download that further illucidates the perennial debate surrounding hip fractures and their management and treatment. What is the correct perioperative approach to this nasty injury?

For more on the Hip Attack Trial go here: https://clinicaltrials.gov/ct2/show/NCT02027896

Presented by P.J. Devereaux, cardiologist, clinical epidemiologist, and perioperative care physician, Professor in the Departments of Health Research Methods, Evidence, and Impact (HEI) and Medicine, Director of the Division of Perioperative Care, McMaster University, Associate Deputy Director of the Population Health Research Institute, President of the Society of Perioperative Research and Care.

This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being questions from the online audience: What is your opinion about spinals and hip fractures for patients on clopidogrel? Do you use any near patient tests to confirm residual anticoagulation? Where are the best guidelines to be found?

We suggest you listen to this piece alongside part 1.

Presented by Sol Aronson, tenured Professor at Duke University, with his guests; Angela Bader, Harvard Medical School and Vice Chair of Perioperative Medicine at Mass General Brigham, BobbieJean Sweitzer, Professor of Anesthesiology and Director of Perioperative Medicine at Northwestern University in Chicago, Illinois and Jeanna Blitz, Associate Professor of Anesthesiology, Director of the Preoperative Anesthesia and Surgery Screening Clinic, Director of Perioperative Medicine Fellowship at Duke University School of Medicine, Durham, North Carolina.

The conversation begins with "a day in the life" with respect to managing the anti coagulation questions that come up commonly. The contributors swap stories from their time in practice. The conversation moves to protocols, guidelines and also, when where and how to begin bridging.

This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being questions from the online audience.

Presented by Sol Aronson, tenured Professor at Duke University, with his guests; Angela Bader, Harvard Medical School and Vice Chair of Perioperative Medicine at Mass General Brigham, BobbieJean Sweitzer, Professor of Anesthesiology and Director of Perioperative Medicine at Northwestern University in Chicago, Illinois and Jeanna Blitz, Associate Professor of Anesthesiology, Director of the Preoperative Anesthesia and Surgery Screening Clinic, Director of Perioperative Medicine Fellowship at Duke University School of Medicine, Durham, North Carolina.

How can enhanced recovery after surgery (ERAS) be applied to cardiac and what exciting opportunities are there for those who have made this their mission? This detail driven address contains more information on The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac), more information can be found on their website: https://www.erascardiac.org/

Since this address was given at Evidence Based Perioperative Medicine (EBPOM) Chicago's 2020 meeting TopMedTalk has been proud to bring you coverage of ERAS® Cardiac's online meeting. For more on that start here: https://www.topmedtalk.com/the-eras-cardiac-society-conference-topmedtalk/

Presented by Daniel Engleman, 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.

"Look at it from where is the patient, and what's best for the patient; I think that the other answers follow and yes, it is higher quality, yes, there can be some opportunities for cost savings; even if it 'breaks even' if the patients are happier, isn't that worth moving into the concept and proving that it does make a difference?"

The value proposition is an essential element of advocating perioperative care; we know it provides safer, better quality outcomes but how do we translate that into a language that both patients, fee payers and providers can all understand?

This piece follows on from "The size and scope of the problem with Jim Grant & Mike Englesbe | EBPOM 2021" Las Vegas, if you'd like to hear that go here: https://topmedtalk.libsyn.com/the-size-and-scope-of-the-problem-with-jim-grant-mike-englesbe-ebpom-2021-las-vegas

Presented by Desiree Chappell, introducing her panellists Linda Groah, CEO, Executive Director of the Association of periOperative Registered Nurses (AORN) and Amy Stout, Operating Partner at Cranemere and Interim President Clinical Services at NorthStar; alongside contributions from additional contributors from the previous session, Jim Grant, Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield of Michigan and Mike Englesbe Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.

"When I heard Sol Aronson, speak about perioperative medicine as 'population health', for me, it was like a eureka moment because our platform within Michigan is really an unmatched place to kind of realize that vision."

This piece asks the question; "why do we need perioperative medicine"? The answer is illustrated with a real success story where practitioners realise the value proposition it unlocks for their patients every day. Hear how it is achieved and why it is so important.

Presented by Desiree Chappell with her guests Jim Grant, Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield of Michigan and Mike Englesbe, Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.

If you enjoyed this piece you'll love TopMedTalk's exclusive and ground breaking series POET: Perioperative Enhancement Team "Perioperative medicine is population health": https://topmedtalk.libsyn.com/poet-601-perioperative-medicine-is-population-health

This piece is part one of a two part piece. It's a short didactic presentation on the tough realities the U.S. healthcare system faces as the fee for payment system creaks against concerns about rising costs and the need for population health management.

Can we move forward with "the science of value" which true perioperative medicine offers us?

It's a talk which is designed to spark debate and that follows in part two of this piece.

Presented by Sol Aronson, tenured Professor, Duke University, Durham, North Carolina.

"So in all these ERAS programs, you need a physician champion, a nurse champion, a coordinator; then we brought our pharmacist in - I will not start rounds without a pharmacist. I refuse. I won't start because the pharmacist is integral ... it's just you need that multidisciplinary team"

This piece is a question and answer session prompted by the address our guest gave during EBPOM Chicago. Both the online audience and the team challenge our speaker to explain more. If you missed the address TopMedTalk has it for you here: https://topmedtalk.libsyn.com/daniel-engelman-updates-in-cardiac-ebpom-chicago

Presented by Desiree Chappell and Monty Mythen with Daniel Engelman, Cardiac Surgeon, Medical Director of the Heart, Vascular and Critical Care Units at Baystate Medical Center, Associate Professor of Surgery at The University of Massachusetts - Baystate, Associate Professor-Adjunct at Tufts University School of Medicine. He president and co-founder of the ERAS® Cardiac Society.

This piece is a question and answer session with questions from the online audience.

What do we think is the clinical care difference that having an elevated level of monitoring and more people around of all all sorts? Why is it good for our patients? As regards admissions to your campus care area; what criteria do you use? Do we need rapid critical care expansion in countries with very few beds? Could the enhanced care wards, in their approach, be compared with the post anaesthetic care unit? Would you cancel or postpone a cancer patient's operation, if not enhanced care or post operative critical care bed available? If you feel it is essential, if you feel the operation essential?

Presented by Mike Grocott, Professor of Anaesthesia and Critical Care at the University of Southampton and Lee Fleisher, Emeritus Professor of Anesthesiology and Critical Care, University of Pennsylvania with Ramani Moonsinghe, Professor of Perioperative Medicine at University College London (UCL), Hon Consultant in Anaesthesia, UCLH, Mike Swart, Consultant in Anaesthesia and Critical Care Medicine at Torbay Hospital and advisor to the UK Department of Health for the Enhanced Recovery Programme and Anna Batchellor, trained in anaesthesia and Intensive Care Medicine (ICM) she works in Newcastle upon Tyne; past President of the Intensive Care Society, past Dean of the Faculty of ICM, past member of Council of the Royal College of Anaesthetists. She tried to retire in June 2016 and managed to spend a year working part time before being hijacked by the Getting It Right First Time (GIRFT) programme.

This roundtable discussion tackles questions from the online audience and is the third part of a longer discussion. It follows on from "The value proposition in perioperative medicine | EBPOM 2021 Las Vegas", if you'd like to hear that go here: https://topmedtalk.libsyn.com/the-value-proposition-in-perioperative-medicine-ebpom-2021-las-vegas

How do we as practitioners deliver value? How does 'population health' fit into the picture? How long before and after surgery are we invested in managing? What's the key point to start a perioperative medicine program in a low income country with no incentives at all; how do you approach the hospital financial department?

Presented by Desiree Chappell, introducing her panelists Linda Groah, CEO, Executive Director of the Association of periOperative Registered Nurses (AORN) and Amy Stout, Operating Partner at Cranemere and Interim President of Clinical Services at NorthStar; alongside contributions from additional contributors from the previous session, Jim Grant, Senior Vice President and Chief Medical Officer at Blue Cross Blue Shield of Michigan and Mike Englesbe, Darling Sr. & Cyrenus G. Darling Jr. Professor of Surgery, Michigan.