TopMedTalk

Why does the US have the highest maternal mortality rate of any developed country? This piece tackles a very controversial issue in healthcare head on, could the problem be due to racism? The chances of a serious issue is "substantially higher if you come from a minority group, in particular if you are African-American".

We also cover the issue of postpartum hemorrhage, what are the key signs that a patient is at risk? Furthermore, how are quality care initiatives and standardization of care helping improve the field of obstetrics? Also, what is the latest thinking on home births, are they a financial decision for some?

The California Maternal Quality Care Collaborative is here: https://www.cmqcc.org/

For more info on the Society for Obstetric Anesthesia and Perinatology (SOAP) go to www.soap.org

Presented by Desiree Chappell and Monty Mythen with their guest Alexander J Butwick, Obstetric Anesthesiologist and Researcher in maternal hemorrhage, pain relief in labor, and obstetric epidemiology at Stanford University.

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On the subject of obstetrics find out more here:

EBPOM Highlight 1.27 | Obstetric anaesthesia - https://www.topmedtalk.com/ebpom-highlight-1-27-obstetric-anaesthesia/

ASA 2018 San Francisco | Smith's Medical Symposium on Enhanced Recovery – Part 5 - https://www.topmedtalk.com/asa-2018-san-francisco-smiths-medical-symposium-on-enhanced-recovery-part-5/

Periop Coach 4.10 | Enhanced Recovery for obstetrics https://www.topmedtalk.com/periop-coach-4-10-enhanced-recovery-for-obstetrics/

This piece is taken from the free papers presentations given at EBPOM 2019. Malnutrition and functional capacity; what is the effect of multimodal prehabilitation? What can the six minute walk test really show us? Does nutritional status predict preoperative change in a six minute walk test in colorectal cancer patients following a prehabilitation programme?

Presented by Lauren Richer, Director, Nutritional Services, Keyto, Registered Dietician, Greene Family Medicine Clinic and Montreal General Hospital, Montreal, Quebec.

This piece deals with the prediction of opioid induced respiratory depression for our inpatients on hospital wards, could a change in monitoring practices help? The postoperative period seems to be critical, the thirty day period immediately after anesthesia being a key area. 7.7% of postoperative deaths are in this period, according to The Lancet here; https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33139-8/fulltext

What is happening in the post operative period? How do we find out more? Are hospital general care wards the safe haven we expect them to be? What should we monitor and how do we avoid "alarm fatigue"?

More on the "PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY)" trial here:

https://clinicaltrials.gov/ct2/show/NCT02811302

The official STOP BANG score website is here: http://www.stopbang.ca/osa/screening.php

This piece was sponsored by Medtronic.

This is part 1 of a two part piece.

Presented by Monty Mythen with Desiree Chappell and Ashish Khanna, Associate Professor, Section Head for Research, Department of Anesthesiology, Section on Critical Care Medicine,Wake Forest School of Medicine.

If you loved this piece you'll also enjoy this piece here:

Desiree's Roundtable | Can you bite your upper lip? Assessing patients to reduce post-op respiratory complications

http://www.topmedtalk.com/desirees-roundtable-can-you-bite-your-upper-lip-assessing-patients-to-reduce-post-op-respiratory-complications-2/

"Data is destiny"; this piece looks at way we can unlock it for Anesthetists. The Open-Source Anesthesia Electronic Medical Record (OSAEMR) was developed specifically for Nurse Anesthetists. Its focus is on solo or small-practice nurse anesthetists operating in environments with limited or no network and computing resources other than an iPad. One patient, one nurse anesthetist, and one iPad. It can now be scaled to larger multi-provider practices outside of CRNAs. Hear how this innovation came about.

This piece was part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois.

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

The Open-Source Anesthesia Electronic Medical Record (OSAEMR) website is here: https://www.osaemr.com/

Presented by Monty Mythen and Desiree Chappell with John T. "Jack" Hitchens, CRNA, BA, ARNP, partner in a CRNA owned and operated Anesthesia Practice, Watchful Care and Dan Simonson, CRNA, MHPA retired as Chief CRNA and managing partner of the Spokane Eye Surgery Center, adjunct faculty at the Washington State University College of Nursing's Department of Health Policy and Administration.

Patient safety, as a priority, is assumed to be at the heart of medical practice. Yet still, preventable harm and death occurs in our profession, how do we change this and how do we make the changes we implement last? Can safety and avoidable harm be somehow hardwired into the culture of what we do in a way similar to that of the airline industry?

This popular and refreshing talk is presented here after it was a big hit at the Chicago 2020 conference organised by Evidence Based Perioperative Medicine (EBPOM). For more check out www.ebpom.org

Presented by Mike Ramsey, Chair of the Board of Directors of the Patient Safety Movement Foundation (PSMF), Chair of the Department of Anesthesiology at Baylor University Medical Center in Dallas, Texas.

Patients with physiological and psychological resilliance have a clear advantage in surgery. The Wessex Fit-4-Cancer Surgery Trial (WesFit) is attempting to determine the effects of multi-modal physical and psychological prehabilitation. This piece gives you the detail and ends with a short informative question and answer session.

Presented by Samantha Leggett, Study Director, University Hospitals Southampton NHS Foundation Trust.

"At the moment perioperative care in the UK doesn't really have the profile that I think it needs; now I suspect that COVID-19 has raised it up the agenda"

If you enjoyed Monty's explanation regarding the UK's perioperative journey you may find this link interesting:

Evidence submitted by the Improving Surgical Outcomes Group (ISOG) (NICE 75): https://publications.parliament.uk/pa/cm200607/cmselect/cmhealth/503/503we35.htm

"Now we're here at this Pocapalooza" - POC, standing for Perioperative Care and "apalooza" being an extravagant event. However, as one of our guests suggests, perhaps we should call this one a "CPOC-apalooza!" as a lot of our focus is on The CPOC (Centre for Perioperative Care).

The International Board of Perioperative Medicine is essential for anyone listening to this podcast: https://www.internationalboardpom.org/

Presented by Desiree Chappell with Monty Mythen, and their guests Mike Grocott - a frequent TopMedTalk anchor - and Professor of Anaesthesia and critical care at the University of Southampton and David Selwin, Medical Director at Sherwood Forest Hospitals NHS Foundation Trust.

For more information on these topics look for the next POCAPALOOZA and get the US perspective!

"It also must start and end in primary care"

This piece is a fascinating in-depth conversation moving through various medical perspectives on perioperative medicine from Australia and New Zealand. A real highlight of the festival. How has perioperative medicine evolved over the years around the world? What's the status of Perioperative Care as a specialty? How does one specialise in this area, in terms of education?

Discussing the development of the International Board:- "We decided perioperative education should not only be available for developed countries". We hear that TopMedTalk engaging with the African Perioperative Research Group (APORG) has helped move the cause of perioperative care forward, both in Africa and elsewhere.

The conversation further evolves: Once educated how do we demonstrate the value of perioperative practice? How do we launch projects that will really make a difference? Where, from a research perspective, do the more fruitful areas of investigation present themselves? Would a minimum data set help? Moving to clinical trials we hear how research is being conducted, both the challenges and the sources of success.

"Perioperative medicine is a team sport" - how do we use the interdisciplinary aspect of what we do to enhance our educational options?

Regular listeners to TopMedTalk may recall the series we did about the Perioperative Special Interest Group (SIG) - if you want more details of http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

The ANZCA Clinical Trials Network can be found at http://www.anzca.edu.au/ctn

Also, The International Board of Perioperative Medicine is here: https://www.internationalboardpom.org/

Further, make sure you check out https://www.periopmedicine.org.uk/ for more information on the perioperative medicine short course we discuss.

And Perioperative Medicine for The Junior Clinician is available here: https://www.amazon.co.uk/Perioperative-Medicine-Junior-Clinician-Symons/dp/1118779169

Presented by Desiree Chappell alongside co-host Ross Kerridge, Anaesthetist from Newcastle in Australia - sometimes called the 'Father of Perioperative Medicine'. Guests are Jill Van Acker, Staff Specialist Anaesthetist and Clinical Lead Perioperative Services, Canberra Hospital, and Chair of the ANZ Perioperative Special Interest Group; Vanessa Beavis, President, Australian & New Zealand College of Anaesthetists, & until recently Director of Perioperative Services, Auckland District Health Board; Prof. Jackie Close Orthogeriatrician at the Prince of Wales Hospital in Sydney and Clinical Director of the Falls, Balance and Injury Research Centre at Neuroscience Research Australia; Prof. Dave Story, Head of the ANZCA Clinical Trials Network, and Chair of the Anaesthesia, Perioperative and Pain Medicine Unit within the University of Melbourne Medical School. Joel Symons, Anaesthetist at the Alfred Hospital in Melbourne and Senior Lecturer at Monash University, Leader in the development of Educational Programs based at Monash University and member of International Board of Perioperative Medicine.

This piece focuses on The Balanced Anesthesia Study, 'A Prospective Randomized Clinical Trial of Two Levels of Anesthetic Depth on Patient Outcome After Major Surgery'. How can delerium be measured and standardised in a multi-centre trial?

More on the study here: https://journals.lww.com/anesthesia-analgesia/FullText/2015/08000/Rationale_and_Design_of_the_Balanced_Anesthesia.14.aspx

More on the Confusion Assesment Method here: https://www.guysandstthomas.nhs.uk/resources/our-services/acute-medicine-gi-surgery/elderly-care/cam-diagnostic-algorithm.pdf

The Hospital Elder Life Program (HELP) for Prevention of Delirium is here: https://www.hospitalelderlifeprogram.org/

We discuss the ENGAGES trial here: https://www.topmedtalk.com/journal-club-1-14-jama-the-engages-randomized-clinical-trial/

More on the Women in Anaesthesia Research, a BJA Symposium, here: https://www.periopmedicine.org.au/2019prato

Presented by Desiree Chappell and Monty Mythen with Lis Evered, neuroscientist and Head of Research in the Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne. She has led an international group to standardise nomenclature for cognitive change associated with anaesthesia and surgery. She is an Editorial Board member of British Journal of Anaesthesia.

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Lis Evered also features on TopMedTalk here: https://www.topmedtalk.com/sunday-special-the-perioperative-cognition-workshop-part-1/

After a short overview of the history of the Society of Cardiovascular Anesthesiologists (SCA) this conversation zones in on some of the hot topics that are being discussed in the field; devices and extracorporeal membrane oxygenation (ECMO) machines, as well as trans-esophageal echocardiography and how the practice has evolved. The conversation ends with a discussion about pre-habilitation in a resource stretched environment.

Presented by Desiree Chappell with Sol Aronson and Jamie Ramsey, Medical Director Cardiac ICU at UCF and Gerald Levy, MD at Duke University.