TopMedTalk

From a UK perspective this piece covers variation in access to critical care, behaviors and decisions regarding its use. With reference to how, over the last 20 years, efforts have been made in Torbay to improve access to critical care we look at what can be done and what works. Finally there's a summary of where we are on this issue today.

Getting it right first time (GIRFT) is here: https://www.gettingitrightfirsttime.co.uk/

Presented by 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.

This piece provides an update on the Perioperative Exercise, Testing and Training Society (POETTS); "established back in 2017, in the context, in the United Kingdom, of cardiopulmonary exercise testing becoming much more common in the preoperative period". Now, more than half of acute hospital trusts in the United Kingdom have a cardiopulmonary exercise testing service to evaluate their patient's functional capacity prior to surgery. Furthermore exercise interventions to optimise a patient's fitness before surgery have seen a sudden and growing interest.

With just over 400 members POETTS exists to help standardize education and training in the field, develop consensus clinical guidelines, look after patients around the time of surgery and help club together acute hospital trusts across the UK, so that they can do collaborative research.

Their website is here: https://www.poetts.co.uk/

Presented by Denny Levett, Professor of Perioperative Medicine at the University of Southampton and President of the Perioperative Exercise, Testing and Training Society (POETTS).

This piece gives you the evidence base required to deliver an even higher standard of perioperative medicine where you work. Hear about the "Fit 4 surgery" studies; the "fit 4 surgery consortium", the ongoing e-studies, key findings, recent studies and the set up in Southampton.

Physical fitness is greatly affected by chemotherapy; poor outcomes are significantly linked to physical fitness; learn how preoperative cardio-pulmonary exercise testing and training can monitor and track this potentially dangerous spiral. Hear how multiple studies are now providing a clear evidence base for this exciting area of perioperative care.

Could more such targeted interventions, alongside shared decision making, provide a real difference to outcomes for your patients and a higher standard of value based care in your institution?

For more on this go here: http://wesfit.org.uk/

Read more about the great work being done by MacMillan Cancer Trust here: https://www.macmillan.org.uk/

The video version of this presentation, along with slides, was presented to the many thousands of people who attended the hugely successful Evidence Based Perioperative Medicine (EBPOM) virtual conference, "Live from London". For more details on this and future conferences please visit www.ebpom.org

Presented by Professor Sandy Jack, PhD, Consultant Clinician Scientist in The Anaesthesia and Critical Care Research Unit at University Hospital Southampton NHS Foundation Trust, Honorary Senior Lecturer at the University of Liverpool, University of Southampton and University College London.

"The goal of ERAS® Cardiac is when you leave one of our meetings, you're going to be chock full of tips and tricks that you can take back and implement, if not the next day, then in the next week or next month."

TopMedTalk's coverage of The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac) conference continues with a conversation that covers the nuggets and insights that a conference such as this delivers. This exclusive chat is only possible thanks to the support of the society who's excellent website is here: https://erasvirtual2021.com/

"I think that also your [TopMedTalk] platform is going to be key. We need to have more of these podcasts. We need short little vignettes, eight to 15 minutes that people can listen to in the car on the way home where they learn and thought leaders having interactive discussions and get ideas. And that's the future really of education"

Presented by Desiree Chappell with her guests, Seenu Reddy, Cardiothoracic Surgeon at HCA's TriStar Cardiovascular Surgery in Nashville, National Physician Director for HCA Healthcare's CV Service line and 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 and President of the ERAS Cardiac international Society.

"You didn't have to think about it, the compliance continued, because it was so standardized. We had a well oiled machine that just kept on working through COVID".

The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac)'s conference has gotten off to a great start; this exclusive chat gets into some of the stand out moments so far; nutrition, data collection, the essentials of ERAS and the importance of standardization.

For more information on the conference check out https://www.erascardiac.org/

We mention Dan Engelman in this piece, he features in this popular conversation from the TopMedTalk archives here: https://www.topmedtalk.com/sunday-special-preoperative-optimization-framing-up-the-value-proposition/

Paul Wischmeyer gets mentioned on this piece as a "fan favourite", he features frequently. If you've not yet heard him start with this podcast - one of our most popular so far - here: https://www.topmedtalk.com/topmedtalks-to-dr-paul-wischmeyer/

Presented by Desiree Chappell with her guests Gina McConnell, ERAS Coordinator for all WakeMed health systems and Cheryl Crisafi, Cardiac Surgery Care Coordinator Nurse at Baystate Medical Center in Springfield, MA.

"In the elective surgical domain 20% of people who are scheduled to have surgery are not ready for surgery"

The road towards economic reality is paved with data; this talk, confidently assertive in tone, provides you with a number of useful facts and reassurances which can be transformed into reasons why you and your patients can enjoy the benefits of prehabilitation; a better value of care and a higher standard of good quality outcomes.

This piece works well in tandem with this debate here: https://www.topmedtalk.com/ebpom-london-2020-the-business-case-for-prehabilitation/

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

"There is some great literature out there that has been shared ... great data, especially in cardiac surgery, which is where we are using it and I would like to expand it out to other service lines as well..."

Methadone has had something of a resurgence recently, thanks in part to the work of some of our contributors in this piece. Could it be that this "opioid sparing opioid" could be a way to actually help fight the crisis we can see in US hospitals and beyond?

This piece gets into the detail, how and where and why is it used?

Presented by Sol Aronson with questions from the online audience for his panelists; Glenn Murphy, Jeffery S. Vender Chair of Anesthesiology Research and Education and Director of Cardiac Anesthesia and Clinical Research at NorthShore University HealthSystem, a hospital affiliated with the University of Chicago Pritzker School of Medicine, Evan Kharasch, Professor and Vice Chair for Innovation in the Department of Anesthesiology at Duke University, and Director of Academic Entrepreneurship in Duke University School of Medicine and Vicki Morton Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates, P.A.

We suggest listening to this piece alongside this excellent talk: https://www.topmedtalk.com/ebpom-chicago-methadone-use-in-perioperative-medicine/

For more details on Evidence Based Perioperative Medicine go now to www.ebpom.org

This piece, part 2 of 2, is a series of questions related to part 1; "Monitoring and management of neuromuscular blockade | EBPOM Chicago".

This piece gets into the detail regarding one of the stand out moments of EBPOM Chicago 2020; questions from the online audience facilitate the discussion.

Given the fact that our methods of monitoring residual neuromuscular blockade are often inadequate do you transport and do you recommend routine transport to patients from the operating room to the post-anesthesia care unit?

Sugammadex is a unique drug that does exactly what we want it to do; why are alternatives still used and available?

Some wearables have accelerometer hardware, are you aware of, or do you know if anyone is studying, firm software solutions, marshaling this ubiquitous hardware?

Don't forget, for more details on Evidence Based Perioperative Medicine EBPOM conferences go now to www.ebpom.org

Presented by Sol Aronson, tenured Professor at Duke University, Glenn Murphy, Jeffery S. Vender Chair of Anesthesiology Research and Education and Director of Cardiac Anesthesia and Clinical Research at NorthShore University HealthSystem, a hospital affiliated with the University of Chicago Pritzker School of Medicine.

This piece is an informative conversation about "the Perioperative Care Team"; who is essential to the team and how do we make sure everyone feels included? What elements do you need to make up such a team, how do you keep people energized and excited about it over the long term? How do we ensure, in this context, that a fee for service system interlocks with the needs of both the institution and its patients? Furthermore, how does such a team increase our commitment to value based care and good quality long term outcomes?

Also, an exciting commitment is made toward a journal club, stick with TopMedTalk for more details.

Presented by Vicki Morton with panelists Dennie Levett, Professor in Perioperative Medicine and Critical Care at Southampton University Hospital NHS Foundation trust and Honorary Associate Professor at the University of Southampton, Kay Mitchell, Senior Research Manager for Critical Care Research, NIHR Biomedical Research Center, University Hospital, Southampton, UK and Gina McConnell, ERAS Coordinator for all WakeMed health systems.

Part 2 of this conversation continues the momentum of Part 1 with a conversation about electronic medical records (EMR), how important data is to the process, the need for those who collect it to understand it and then, more broadly, the importance of putting the patient at the heart of what you do.

Presented by Desiree Chappell with Vicki Morton, Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates, P.A, Cheryl Crisafi, Cardiac Surgery Care Coordinator Nurse at Baystate Medical Center in Springfield, MA and Gina McConnell, ERAS Coordinator for all WakeMed health systems.