TopMedTalk

The Perioperative Quality Initiative (POQI) is a vital part of the process needed to more widely implement sensible practice which, using a clear evidence base, provides better value care with more positive outcomes for the patient. POQI continues to provide its work in an attempt to clarify fundamental concepts in perioperative care. The fact this one focuses upon fluid management makes it particularly appropriate in these times.

Link to the paper: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-020-00142-8

Presented by Desiree Chappell with Monty Mythen and their guests Tim Miller, Professor of Anesthesiology from Duke University Medical Centre and Greg Martin Professor of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine

Like this, want more?

Try our popular in depth series "Fluid Matters" http://topmedtalk.libsyn.com/fluid-matters-1

TopMedTalk provides world leading information about perioperative medicine like this every day. Dr Greg Martin's deeper dive into these issues is here: http://topmedtalk.libsyn.com/fluid-matters-3

We begin with a conversation about The UK Perioperative Medicine Clinical Trials Network, their website is here: https://www.pomctn.org.uk/

This piece focuses on the Optimising Shared decision-makIng for high-RIsk major Surgery (OSIRIS) programme. Shared decision making can be very challenging when we're not sure what the risks are and older patients with chronic diseases often make very different decisions when informed. How do we make this process more evidence based? How do we better understand this group and communicate with them? Are there technological answers to these questions?

If you'd like to see the OSIRIS section there here's the link: https://www.pomctn.org.uk/OSIRIS

You can find the OSIRIS website here: https://osiris-programme.org/

Recorded at Anaesthesia 2019; where world-renowned experts presented the latest advances in perioperative medicine, critical care and pain medicine.

Presented by Monty Mythen with Mike Grocott, Professor of Anaesthesia and Critical Care Medicine, University of Southampton and Rupert Pearse, Professor of Intensive Care Medicine at Queen Mary, University of 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.

Why has 'prehabilitation' suddenly picked up pace in terms of both practice and interest? This piece takes a serious look at the widening interest in an idea familiar to many sportsmen.

Learn how the marginal gains we get through the application of science to optimise the moment of surgery as a real opportunity to apply everything we know.

Also; what are ketones and how can they be used to promote health?

Presented By Desire Chappell and Monty Mythen with their guests Gerard Danjoux, consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Trust and Ken Van Someren, Director KvS Performance Ltd.

This piece focuses in upon the important work being done by The Enhanced Recovery After Cardiac Surgery Society, specifically the new guidelines which were published in May 2019. Furthermore, how is the society going to move forward, will it continue to push for a sensible combination of both care providers and academics and what areas of focus are most impactful when it comes to improving care and helping implementation?

The article discussed in this piece "Guidelines for Perioperative Care in Cardiac Surgery, Enhanced Recovery After Surgery Society Recommendations" is here: https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511?guestAccessKey=04f7090d-122c-4e94-a46f-22e49dab7c51

The Enhanced Recovery After Cardiac Surgery website is here: https://www.erascardiac.org/

Presented by Desiree Chappell with her guest Kevin Lobdell, Director of Regional CVT Quality, Education, and Research.

In the UK community based prehabilitation is being spearheaded by the Prepwell Initiative, supported by a grant from Sports England. Their pioneering work is a great example of the way in which prehabilitation is gathering pace at the moment.

The "PREP: Preoperative Risk Education Package" website is here: https://www.prepwell.co.uk/

What are the economics of such a programme? Why did the project start to get referrals from initially sceptical surgeons? How did the programme impact the lives and treatment of patients?

Presented by Gerard Danjoux, Consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Foundation Trust.

"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.

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You heard Desiree correctly! We have passed the million downloads mark! An incredible achievement and a reflection of the global reach and power of our message.

Thank you for your support, thanks to those listeners who have gone above and beyond the cause to promote TopMedTalk for us on their social media and in their talks and presentations, thanks also to our sponsors who have allowed us to keep this vital information free to all; wherever in the world you are Perioperative Medicine is the safest way to cut reduce unnecessary surgery, improve outcomes and reduce the time spent in hospital by our patients.

Burn out and stress management have been an important theme on TopMedTalk recently, here we have a top medical professional sharing their story in relation to the topic. How do we describe "burn out", are certain words a barrier to discussion? How do we cut through to people who are most likely to suffer from this incredibly dangerous condition? Is the medical profession finally making progress here?

Our interview with Sasha Shillcut is here "Sunday Special | Burn out": https://www.topmedtalk.com/sunday-special-burn-out/

This piece was originally streamed live from 'The Society of Cardiovascular Anesthesiologists' (SCA) annual conference, 2019.

Presented by Desiree Chappell and Monty Mythen with Sol Aronson, Tenured Professor, Duke University and Executive Vice Chairman in the Department of Anesthesiology, and their guest Tjorvi Perry, Assistant Professor, Department of Anesthesiology, University Minnesota

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"?

This piece was generously supported by Massimo.com it follows on from this piece here: https://www.topmedtalk.com/ebpom-chicago-patient-safety-how-do-you-make-the-changes-that-change-culture/

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.

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.