TopMedTalk

"The peak keeps getting pushed..."

What's the difference between a strategy of rationing as compared with one where the aim is concordence?

As the crisis rumbles on, how do we decide who should have surgery, as well as the pressing question of how and where? The principles of perioperative medicine kick in here, pre-optimisation and enhanced recovery are uniquely suited within the profession to assist in the worldwide battle against this pandemic.

What about the need for end of life conversations? How does the process of informed decision making apply here, how also does it apply to providers? How can we protect our essential human resources?

Finally, the conversation wraps with an important nod from the healthcare profession to the overwhelming goodwill being expressed around the world to people in medicine who are risking their lives to defeat this virus.

Presented by Desiree Chappell and Monty Mythen with their guest Professor of Anesthesia, Angela Bader, Harvard Medical School and Vice Chair of Perioperative Medicine at Mass General Brigham.

If you loved Angela Bader's incisive take why not listen to this popular interview we previously featured here on TopMedTalk: https://www.topmedtalk.com/topmedtalks-to-angela-bader/

We also mention TopMedTalk favorite Carol Peden, why not check out her appearance here: https://www.topmedtalk.com/covid-19-disruptive-innovation/

And Bobbie Jean Sweitzer is here: https://www.topmedtalk.com/covid-19-promote-your-anemia-clinics-in-the-pandemic-era/

Thank you to our sponsor's Edward's Life Sciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

This piece gives you clear practical suggestions which you might want to include in your practice and institution. How do we improve the physiological reserve of patients? Is there a way to do enhanced recovery with an extra edge? Specifically, how do we reduce pulmonary complications? What is 'surgery school'? How does 'icough' fit into this? How can practitioners and admin staff help to reduce anxiety as surgery comes closer?

Visit the I COUGH UK website here: https://mft.nhs.uk/mri/services/i-cough-uk/

Make sure you check out the surgery school on the ERAS+ website here: https://www.erasplus.co.uk/How/SurgerySchool

Presented by Dr Daniel Conway, consultant in anaesthesia and critial care at University Hospitals Manchester.

The opioid crisis "a unique American problem". This piece uncovers the origin of some of the misinformation about opioids, the consequences of calling pain a "fifth vital sign" and the absurd practice of waking patients up in the middle of the night to ask them if they are in any pain.

As these factors combined fatalities started to spiral into the crisis we see today. Recent statistics make for grim reading, in 2017 it was estimated over 47,000 Americans died from an opioid overdose. However action is now being taken; learn how The American Association of Nurse Anesthetists (AANA) has pushed forward with a sensible, responsible, pain management strategy which tackles the crisis head on.

Opioids are a last resort, many cases do not need them at all and a 30 day prescription to a highly addictive substance is something practitioners should never take lightly. Furthermore ensure patients are well informed, not 'opioid naive' and ideally do not have a family history of opioid dependence.

If you enjoyed this piece we have more on the topic here: https://www.topmedtalk.com/periop-coach-3-06-is-pain-the-fifth-vital-sign/

Also, if you've not yet heard Paul Wishmeyer's powerful take on this topic we highly reccomend you go here: https://www.topmedtalk.com/treating-patients-properly-ebpom-usa/

The Center For Disease Control's guidelines, mentioned in this piece, are here: https://www.cdc.gov/drugoverdose/prescribing/guideline.html

The PDF our guest mentions "The PAIN MANAGEMENT BEST PRACTICES INTER-AGENCY TASK FORCE REPORT" is here: https://www.hhs.gov/sites/default/files/pain-mgmt-best-practices-draft-final-report-05062019.pdf

This piece was part of our coverage of The AANA 2019 Annual Congress in Chicago, Illinois.

Check out the AANA here: https://www.aana.com/

Presented by Monty Mythen and Desiree Chappell with their guest, Bruce Schoneboom, PhD, CRNA, FAAN, Associate Dean for Practice, Innovation and Leadership at Johns Hopkins School of Nursing.

"Patients undergo surgery for important reasons, we need to improve surgical outcomes to the point where anyone can have surgery - and I believe that is do-able; we need to implement what we know, we need to avoid missed opportunities and we need to conduct more research. We should learn from the history of anesthesiology and how intraoperative care so dramatically improved outcomes"

This powerful data based talk sets a bold standard for the year, a highlight from the momentous (Evidence Based Perioperative Medicine) EBPOM 2020 - Live From London, it featured as this year's Ernest Henry Starling Plenary Lecture, entitled: "Perioperative Care: A new paradigm for the next decade".

Introduced by Mike Grocott and presented by P.J. Devereaux, MD, PhD, FRCP(C), McMaster University, cardiologist, clinical epidemiologist, and perioperative care physician. Director of the Division of Perioperative Care at McMaster University he is the Associate Deputy Director of the Population Health Research Institute. He is also the Scientific Leader of the Anesthesiology, Perioperative Medicine, and Surgical Research Group at the Population Health Research Institute. A full Professor in the Departments of Health Research Methods, Evidence, and Impact (HEI) and Medicine at McMaster University. He has published over 330 peer reviewed papers and over 80 book chapters, editorials, and commentaries. He has given over 900 lectures and research presentations in 40 countries. He is supported by the McMaster University/ Hamilton Health Sciences Chair in Perioperative Care and a Tier 1 Canadian Research Chair in Perioperative Medicine. He's also the President of the Society of Perioperative Research and Care.

This piece is a chance to hear more about the work of our guest, who made a big impact as a guest on a recent edition of TopMedTalk: https://www.topmedtalk.com/topmedtalk-computer-gamer-to-life-saver/

The Perioperative Quality Initiative (POQI) is here: www.poqi.org

This piece covers cerebral oximetry with near-infrared spectroscopy (NIRS), often used during the perioperative period of cardiovascular operations.

Article here:

"American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on the Role of Neuromonitoring in Perioperative Outcomes"

https://journals.lww.com/anesthesia-analgesia/Abstract/9000/American_Society_for_Enhanced_Recovery_and.95500.aspx

We're celebrating Evidence Based Perioperative Medicine's (EBPOM) Dingle conference which holds a special place in the hearts of TopMedTalk listeners. We've covered it for the last few years in detail, making many hours of valuable educational information accessible to a global audience of thousands of medical professionals each week. If you'd like to find out more about EBPOM's groundbreaking online proposition please checkout www.ebpom.org

Presented by Desiree Chappell and Monty Mythen with their guest Robert Thiele, Associate Professor, Departments of Anesthesiology and Biomedical Engineering, Division Chief, Critical Care Anesthesiology, Board of Directors, University Physicians Group, University of Virginia School of Medicine. He has a background in engineering and has been using technology to improve education since his residency in 2008. He is co-founder of www.OpenAnesthesia.org which lead to the development of Self-Study, and also authored one of the first iBooks focused on cardiac and critical care ultrasound.

This piece explores the current thinking on hemodynamics, get ready for a deep dive into the conversation and controversies. Originally streamed live from www.topmedtalk.com as part of our coverage of The EBPOM USA Dallas Master's Course 2019. This panel discussion is chaired by Desiree Chappell, CRNA from Louisville Kentucky and Board Member of ASER. It features Monty Mythen, TopMedTalk Editor In Chief, Smiths Medical Professor of Anaesthesia and Critical Care at University College London, Tim Miller, from Duke University Medical Centre and Dr Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust.

This piece ploughs into some of the academic papers that have provoked discussion in the perioperative community.

We discuss the following papers:

Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses.

https://www.ncbi.nlm.nih.gov/pubmed/30552274

Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty.

https://www.ncbi.nlm.nih.gov/pubmed/29975266

Effect of A1C and Glucose on Postoperative Mortality in Noncardiac and Cardiac Surgeries.

https://www.ncbi.nlm.nih.gov/pubmed/29440113

Frailty as a Predictor of Death or New Disability After Surgery: A Prospective Cohort Study.

https://www.ncbi.nlm.nih.gov/pubmed/30048320

Presented by Desiree Chappell and Monty Mythen with their guest Paul Grant, Hospitalist and Director of Perioperative and Consultant Medicine at the University of Michigan.

This piece took a look at the San Diego front line of the global fight against COVID 19 on March the 30th at the start of the crisis.

What unique pressures were there; the large homeless population is a particular challenge, how do psychiatric patients further the conundrum. Also, what about the assumption that patients are likely to be carrying the virus so should all be treated as if that is the case, does that apply here?

Presented by Desiree Chappell with Roneet Lev, MD FACEP, Chief Medical Officer, White House Office of National Drug Control Policy Director of Operations, Scripps Mercy Hospital Emergency Department San Diego.

This piece is a conversation with friends of ours at Medtronic. Now is an interesting and resource-scarce time for everyone in medicine; Medtronic made huge waves here with their support of the Ventilator Training App, today we ask them about where it's at and how things are changing in the world of medical technology.

How does product development actually work these days? How important have standards of proof become? Should we celebrate the fact hardware appears to be being pushed toward a similar evidence standard needed to take a new drug to market? How are research and development administered? How can we make a clinical and economic argument that makes sense to everyone?

Also, how has the Covid Crisis galvanized the medical industry and shown them that things can be achieved at speed in our profession?

The Ventilator Training App episode we reference is here: https://www.topmedtalk.com/covid-19-the-ventilator-training-alliance-app/

Presented by Desiree Chappell and Monty Mythen with their guests, Vafa Jamali, Senior Vice President and President of Respiratory, Gastrointestinal & Informatics (RGI) within Medtronic's Minimally Invasive Therapies Group (MITG) and Jennifer Doyle, Global Vice President, Medical Affairs - Respiratory, Gastrointestinal & Informatics and MITG at Medtronic.

"The more I learn about this, the more my eyes are opened to how much opportunity we have to improve in this area"

This piece covers the "perennial topic" of whether paralysis is bad for breathing, here with a focus upon outcome criteria associated with residual neuromuscular blockade. It's a piece based in part upon a recent talk at the American Association of Nurse Anesthetists annual conference which was this year held virtually.

Presented by Desiree Chappell with her guest Brent Dunsworth, CRNA, DNP, Director of Advanced Practice for the Department of Anesthesiology at Vanderbilt University Medical Center.