TopMedTalk

"Just having more staff doesn't always equate to better care, especially when the staff do not have the skills required."

Perioperative medicine has the opportunity to lead the way in advanced practice; the extended role of the practitioner within the perioperative pathway can be done with nurses, allied health professionals or physician associates. As we evolve these roles, we must be mindful and recognise not all services will be the same.

How can you tailor your service to your specific needs? How do you construct a business case which provides a better quality of value based care within your institution? Could this help by giving the practitioner role focus and allowing you to measure their effectiveness?

For more information about Guy's and St Thomas's practice we suggest you look at their website, an excellent information resource, here: https://www.guysandstthomas.nhs.uk/our-services/ageing-and-health/specialties/pops/overview.aspx

Presented by Jason Cross, Advanced Nurse Practitioner, Department of Aging and Health, Guy's and St Thomas's, London.

This vital piece deals with a variety of issues related to COVID-19; what we know and what we know we do not know:

- Similarities and differences between COIVD-19 and Aqute Respiratory Distress Syndrome (ARDS) - The most useful information observed by practitioners at the bedside, conscious of the lack of Randomised Controlled Trials (RCTs) in this area - The controversy regrading early invasive ventilation versus non-invasive ventilation - What are the aerosolization risks? - Pragmatic patient prioritization - The role of anti-coagulation - The role of continuous positive airwave pressure (CPAP) - who benefits and why?

Presented by Professor Mervyn Singer, Intensive Care Medicine at University College London.

"It's all about safety and recovery, it's not about speed"; this conversation focuses on enhanced recovery, are we getting it right and where are people getting it wrong? How reliable and well understood is the data behind it? Also, what are the current thoughts on perioperative steroids? How do we refocus and move back to enhanced recovery after surgery rather than "enhanced discharge" after surgery.

Presented by Monty Mythen and Desiree Chappell with Sol Aronson, tenured Professor at Duke University, and their guests Henrik Kehlet, a gastrointestinal surgeon and former professor of surgery, Copenhagen University, and now professor of perioperative therapy and Head of Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University and Nick Scott, an early proponent of Enhanced Recovery in the UK who has spent the last six years as the Vice Chairman of Anesthesia and Perioperative Medicine at Hamad Medical Corporation in Qatar.

TopMedTalk has recently engaged with a large number of new listeners, we are delighted to have you join our family of perioptimists! This piece works as a primer, it explains what lies at the core of the world's favorite perioperative medicine podcast; enhanced recovery. What is it? How do you implement it? What are its core principles?

If you've never heard TopMedTalk before but you are a medical practitioner this piece is a great place to start; if you're already onboard it will be a welcome refresher regarding the ideas we all gather around daily.

How widespread is enhanced recovery after surgery and, perhaps more importantly, how widespread are its principles? Are patients living the drinking, eating and mobilising early on and so "living the (drink, eat, mobilise) dream?".

The "POWER" study "Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study" is here: https://pubmed.ncbi.nlm.nih.gov/31066889/

The App Store has our app here: https://apps.apple.com/gb/app/topmedtalk/id1438159784

Google Play has it here: https://play.google.com/store/apps/details?id=com.topmedtalk.android.medtalk&hl=en_GB

There is a recent conversation with Henrik Kehlet here: https://www.topmedtalk.com/topmedtalk-henrik-kehlet-and-nick-scott/

There's also a recent one with Angela Bader here: https://www.topmedtalk.com/covid-19-angela-bader-the-need-for-end-of-life-conversations/

Our famous Bill Clinton piece is here: https://www.topmedtalk.com/sunday-special-bill-clinton-at-the-world-patient-safety-science-technology-summit-2/

The excellent Chris Snowden piece we mention is here: https://www.topmedtalk.com/dingle-2019-the-opportunity-in-variability/

(Enhanced Recovery After Surgery) ERAS Guidelines are here "Guidelines for Perioperative Care in Cardiac SurgeryEnhanced Recovery After Surgery Society Recommendations" : https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511?guestAccessKey=04f7090d-122c-4e94-a46f-22e49dab7c51

The Perioperative Quality Initiative is here: https://thepoqi.org/

Presented by Desiree Chappell and Monty Mythen.

This piece explores perioperative shared decision making from a variety of angles. Where is the latest research? Is it something we can reasonably out source? Does it always play in the favour of the patient or do we as practitioner benefit from this process also? How do we implement it without 'bulldozing' through years of experience?

Link to video featuring patient "Doug": http://www.petermac.org/sdm

Presented by Desiree Chappell and Ross Kerridge, "The Father of Perioperative Medicine", Debra Leung, Anaesthesiologist , Peter MacCallum Cancer Centre, Melbourne, Aisling Fleury, Geriatrician at Logan Hospital, Brisbane, Jon Gani, Conjoint Professor of Surgery at the University of Newcastle and an Honorary Medical Officer at John Hunter and Belmont District Hospitals, Pragya Ajitsaria is a staff Specialist Anaesthetist at John Hunter Hospital, Conjoint Lecturer at the University of Newcastle.

2020 was a big year for prehabilitation, the advent of a global pandemic has only increased the importance of this exciting field of medicine.

Various questions from EBPOM 2020 attendees were tackled by the panel: Can you use "Timed Up and Go" (TUG) and The Duke Activity Status Index (DASI) to screen out unnecessary cardio-pulminary exercise testing (CPET)? What exactly is prehabilitation and what's its natural scope? How important is nutrition? Is it possible to standardise these areas more? What areas are being significantly worked on in prehabilitation medicine in the UK this year? What about - in these COVID 19 times - remote screening and assessment? Also, what about the possibilities regarding aerosolisation, particularly of COVID-19, during CPET? Can prehabilitation work to minimise time spent in hospital?

Presented by Mike Grocott, Professor of Anaesthesia and Critical Care Medicine at the University of Southampton with Karen Kerr, Consultant Anaesthetist, Departmental Lead for CPET, Sheffield Teaching Hospitals (STH) and featuring panelists; Denny Levett, Professor in Perioperative Medicine and Critical Care at the University of Southampton and a Consultant in Perioperative Medicine at Southampton University Hospital NHS Foundation trust (UHS), June Davis, Director of Allied Health Solutions, Allied Health Professions Advisor (part time) for Macmillan Cancer Support and a professional advisor to the Care Quality Commission and Steve Wootton, OBE, Associate Professor in Nutrition at the University of Southampton with an honorary appointment with University Hospital Southampton in Clinical Nutrition.

"My first thought was - why can't we do this here?"

What is ketamine, what sort of drug is it and how is it used? How was it first synthesized? Was it intentionally found or another of science's happy accidents?

This piece is a fascinating look into the history and future of ketamine with a focus on outpatient infusion centers. Could this unusual and "dirty" drug - meaning it acts on many parts of the body and is not fully understood - have incredibly useful consequences for people who face the grueling task of handling depression or a post traumatic stress disorder?

We look at the research and evidence base regarding ketamine, how it is effective for different disease processes and how the drug might be more widely used in the future. It appears to have come into something of a renaissance, "thank you for getting the word out about ketamine".

Check out the clinic here: https://www.neuromendcenter.com/

Presented by Desiree Chappell and Monty Mythen with Tracy Young, MSNA, MBA, CRNA, CEO of YPS Anesthesia, he also a two time past State President for the Louisiana State Association of Nurse Anesthetists as well as currently sitting on several other boards.

How do we manage our operating room capacity and restore elective surgery in a post-COVID19 world? A world where conditions change week by week, sometimes day by day.

Managing capacity was always a challenge but now we need to think differently in order to stay resilient and agile. How has COVID19 changed the landscape now?

What are the tools that exist to handle it? What are the systems and best practice guidelines that are helping institutions cope? How do we look at supply and demand within the constraints of what's available to us?

Finally the possibility of a "second wave" is investigated, how should it be tackled should it arise?

Presented by Sanjeev Agrawal, President, LeanTaas.

"Oxygen is the commonest drug that we give to our patients today during surgery and the general anaesthetic" but what do we really know and understand about it from a perioperative perspective?

This talk illustrates why, even with some of the evidence and background physiology that we have at our fingertips today, the following questions are still perplexing: How much is too little oxygen? How much is too much oxygen? And how much is just the right amount of oxygen?

Presented by Daniel Martin, OBE, Professor of Perioperative and Intensive Care Medicine, University of Plymouth and the Royal Free Hospital, London.

This talk aims to answer four major questions: How much fluid should you give perioperatively? Does hypotension matter? Should you use advanced hemodynamic monitoring, and do colloids have any advances over crystalloids?

Using high quality studies and a data based approach in all four categories, a lot of which has come from conversations that have had happened at Evidence Based Perioperative Medicine (EBPOM) meetings, this talk draws some interesting conclusions.

The American Society of Enhanced Recovery (ASER) is here: https://www.aserhq.org/web/

The Perioperative Quality Initiative (POQI) is here: https://thepoqi.org/

Presented by Tim Miller, Associate Professor of Anesthesiology from Duke University Medical Centre.