TopMedTalk

This piece looks at some of the advantages to having a perioperative interdisciplinary team reducing complications, understanding and discussing risk, facilitating better shared decision making and increased patient satisfaction, even among those who - as part of this process - decide not to go ahead with an operation.

It also incorporates evidence regarding what we know about COVID-19; "The risks ... of the COVID-19 virus is that if people contract it during or after their surgery, they have a much worse result with perhaps 51% pulmonary complications or 24% mortality".

The World Health Organisation report mentioned in this piece, "Smoking greatly increases risk of complications after surgery", is here: https://www.who.int/news/item/20-01-2020-smoking-greatly-increases-risk-of-complications-after-surgery

The Montgomery ruling is covered on a previous TopMedTalk in more detail in "Sunday Special | Being on the right side of the law" here: https://www.topmedtalk.com/sunday-special-being-on-the-right-side-of-the-law-2/

The Centre for Perioperative Care website is an excellent resource, here is the section specifically for your patients: https://www.cpoc.org.uk/patients

The Royal College of Surgeons is here: https://www.rcseng.ac.uk/

Our presenter has a website dedicated to her work here: http://www.scarlettmcnally.co.uk/

And she maintains a twitter feed - focused on medical issues - here: https://twitter.com/scarlettmcnally

Presented by Scarlett McNally, Deputy Director of The Centre for Perioperative Care (CPOC) consultant Orthopaedic Surgeon, Eastbourne DGH, UK.

This piece is essential listening for any medical practitioner. The pathophysiology of COVID 19 is now being understood, although there are still a number of outstanding questions. This piece attempts to answer those questions; where does it come from, what do we know about it now, what would we like to know about it in the future?

Why is the disease more pronounced in men, how come obesity seems to be a factor, what's the mechanism which leaves children less at risk than adults and senior citizens?

This piece is a standout part of Evidence Based Perioperative Medicine's (EBPOM) Dingle 2020 conference. For more of the latest up to date information go now to www.ebpom.org

Presented by Hugh Montgomery, Professor of Cardiovascular Genetics and Critical Care University College London.

"More than 300 million patients have surgery annually worldwide and an increasing proportion of them are elderly and at risk of perioperative adverse events. There's very few proven primary or secondary prevention measures, and the resources for monitoring and trading complications are inadequate. So - more action is required".

This piece looks at the evidence as regards perioperative outcomes for the elderly, depth of anesthesia and mortality. Also, what's the latest on depth of anesthesia and delirium?

Presented by Kate Leslie, Honorary Professor, Monash University, Melbourne, VIC, Australia, Specialist Anaesthetist, The Royal Melbourne Hospital & North Western Mental Health and Non-Executive Director, Australian Medical Council.

This panel discussion covers essential ground for any institution that is trying to make real and lasting change. What do we need to know? What do our patients need to know? Who is responsible for questions of safety? How important are checklists? What about "patient advocates"?

Presented by Sol Aronson with Mike Ramsey, Chair of the department of Anesthesia and pain management at the Baylor University Medical Center in Dallas and Board Chair of the Patient Safety Movement Foundation, Lee Fleisher, CMO and director for the Center for Clinical Standards and Quality for the centers of Medicare and Medicaid, Sarah Lenz Lock, Senior Vice President for Policy Research and International Affairs for the AARP, Lili Brillstein, Director of Specialty Care Value Based Models for Horizon Blue Cross Blue Shield of New Jersey and Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care at University College London.

How have we adapted in our views on the use of video laryngoscopy during the Covid-19 pandemic? Who is best suited to intubate? Are we seeing "a poorly managed first wave"? How are practitioners changing their approach in light of the possibility of infections? What lessons are being learned by practitioners in the midst of the COVID crisis?

This piece was generously supported by Medtronic.com

Presented by Desiree Chappell with Monty Mythen and her guests, Patrick Schoettker, Professor of Anesthesia and Emergency Medicine at Lausanne University Hospital, Sol Aronson, tenured Professor, Duke University, Henry Howe, Junior Doctor, NHS England and TopMedTalk team member.

This piece is a worthwhile deep dive into this perioperative medicine and how we go forward with it. Hear the panel speak about what it is they want for the future and what it is they are doing now. With questions submitted from the online audience the panel get into the detail. Essential listening for any student of perioperative medicine.

It includes a mention for the Welsh Perioperative Medicine Society, their website is here: https://www.welshpoms.com/

This is part two of a two part piece of the same name.

Presented by David Walker, Professor in Anaesthesia and Critical Care Medicine, University College London Hospitals, Honorary Senior Lecturer UCL, Kim Caulfield, Perioperative Medicine Fellow, University College London Hospitals NHS Foundation Trust, Mike Grocott Professor of Anaesthesia and critical care at the University of Southampton, Aislinn Sherwin, a Fellow in Perioperative Medicine and Onco-Anaesthesia at the Peter MacCallum Cancer Centre, Melbourne, Roisin Coary, final year SpR in Geriatric and General Internal Medicine, with a specialist interest in Peri-operative Medicine, Dublin Ireland and Isra Hassan, a post-CCT Perioperative Medicine Fellow at the University College of London Hospital she co-founded the Welsh Perioperative Medicine Society in 2018 which now has over 100 members, and to date has delivered two national conferences, Andrea Haren, perioperative medicine fellow at UCLH she worked with Guys and St Thomas' working with the POPS Clinic she is currently a locum consultant anaesthetist at St. Vincent's Hospital in Dublin and Pádraig Ó Scanaill, Locum Consultant Anaesthetist at the Mater Misericordiae University Hospital, Dublin.

"We've been doing cryoneurolysis for total knees now for three years... people gravitate to practices that that practice this technology"

This piece focuses upon two 'early adopter' orthopedic surgeons changing up the way we treat joint pain for surgical patients.

We mention Iovera, a provider at the forefront of this technology: https://www.iovera.com/

The Doc Social website is here: www.doc.social/

The Evidence Based Perioperative Medicine (EBPOM) website is here: www.ebpom.org

This piece also features important news for TopMedTalk fans as, towards the end, we explain how your favorite perioperative podcast is asking listeners for feedback and thoughts. Email [email protected]

Presented by Desiree Chappell and Monty Mythen with their guests Vinod Dasa, Vice Chairman of Academic Affairs, Irv Cahen Chair of Orthopaedic Surgery and Research, Co-Director LSU Musculoskeletal Research Consortium and Josh Urban, board-certified orthopedic surgeon, OrthoNebraska, Omaha, Nebraska.

This piece is a worthwhile deep dive into this perioperative medicine and how we go forward with it. Hear the panel speak about what it is they want for the future and what it is they are doing now. With questions submitted from the online audience the panel get into the detail. Essential listening for any student of perioperative medicine.

When should we pre-assess patients? Should all anaesthetists be doing pre-operative sessions? What is it about the role of the anaesthestist that makes it uniquely suited to the discipline of perioperative medicine?

This is part one of a two part piece of the same name.

Presented by David Walker, Professor in Anaesthesia and Critical Care Medicine, University College London Hospitals, Honorary Senior Lecturer UCL, Kim Caulfield, Perioperative Medicine Fellow, University College London Hospitals NHS Foundation Trust, Mike Grocott Professor of Anaesthesia and critical care at the University of Southampton, Aislinn Sherwin, a Fellow in Perioperative Medicine and Onco-Anaesthesia at the Peter MacCallum Cancer Centre, Melbourne, Roisin Coary, final year SpR in Geriatric and General Internal Medicine, with a specialist interest in Peri-operative Medicine, Dublin Ireland and Isra Hassan, a post-CCT Perioperative Medicine Fellow at the University College of London Hospital she co-founded the Welsh Perioperative Medicine Society in 2018 which now has over 100 members, and to date has delivered two national conferences, Andrea Haren, perioperative medicine fellow at UCLH she worked with Guys and St Thomas' working with the POPS Clinic she is currently a locum consultant anaesthetist at St. Vincent's Hospital in Dublin and Pádraig Ó Scanaill, Locum Consultant Anaesthetist at the Mater Misericordiae University Hospital, Dublin.

In this piece you can hear the co-editors of the Journal of Perioperative Medicine describing this year's "Editor's Picks"; the best manuscripts, literature and lessons learned in the last year in the space of perioperative medicine.

"Functional performance and 30-day postoperative mortality after emergency laparotomy—a retrospective, multi-center, observational cohort study of 1084 patients" is here: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00143-7

There is more information about the Eastern Cooperative Oncology Group (ECOG) here: https://ecog-acrin.org/resources/ecog-performance-status

"A randomised trial of non-invasive cardiac output monitoring to guide haemodynamic optimisation in high risk patients undergoing urgent surgical repair of proximal femoral fractures (ClearNOF trial NCT02382185)" is here: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-019-0119-x

"The effect of virtual reality technology on preoperative anxiety in children: a Solomon four-group randomized clinical trial" is here: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-019-0116-0

Presented by Mike Grocott, Professor of Anaesthesia and Critical Care at the University of Southampton and a Consultant in Critical Care Medicine at University Hospital Southampton NHS Foundation Trust with his guests Clifford Ko, Professor of Surgery at UCLA, Director of the Division of Research and Optimal Patient Care at the American College of Surgeons and Lee Fleisher, Professor of Anesthesiology and Critical Care, University of Pennsylvania.

Originally part of the hugely successful EBPOM 2020 Chicago this piece is introduced by Sol Aronson, tenured Professor at Duke University.

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.