TopMedTalk

This piece tackles "prehabilitation", TopMedTalk's word of the year. What is it, why is it so important, who is doing it and why are some people reticent about something that is so obviously good for their health? Furthermore, what are the transatlantic nuances to this debate?

Presented by Desiree Chappell with Sol Aronson, tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and their guest Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton.

Recorded at Anesthesiology 2019 at the Orange County Convention Center in Orlando, over 14,000 delegates, clinicians, thought leaders and professionals; the largest gathering of Anesthesiologists and Anesthesia providers in the world.

The ASA has gone virtual, check them out here: www.asahq.org

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Sol Aronson's excellent talk "EBPOM 2018| Perioperative medicine is Population Health Management" is here: https://www.topmedtalk.com/ebpom-2018-perioperative-medicine-is-population-health-management/

And Mike Grocott co-chair's a gripping debate about prehabilitation, "EBPOM 2019 | System wide change for prehabilitation", is here: https://www.topmedtalk.com/ebpom-2019-system-wide-change-for-prehabilitation/

Emotional intelligence is the ability to perceive, integrate, understand and utilize emotions in an effective and meaningful way in order to cope and adapt to the situation. It's a hot topic at the moment, here we speak with the first CRNA to be certified in emotional intelligence. Stress and burn out is a common problem in the CRNA community, handling that could have a real impact on performance and outcomes.

Our guest mentions the Mayer-Salovey-Caruso Emotional Intelligence Test™ which can be found here: https://www.mhs.com/

She also advocates "The Student EQ Edge: Emotional Intelligence and Your Academic and Personal Success: Student Workbook" which can be found on Amazon here: https://www.amazon.co.uk/Student-EQ-Edge-Emotional-Intelligence/dp/1118094603

Our guest kindly allowed us to share her email with you: [email protected]

Presented by Desiree Chappell and Monty Mythen with their guest, Andrea Bittinger, CRNA at William Beaumont Hospital.

This panel discussion is an honest and challenging look at blood pressure management. Questions include but are not limited to: How should practitioners maintain blood pressure in patients and where is the threshold? How much precaution is inspired by eminence rather than actual evidence? What is the best and safest way to attenuate sympathetic responses intraoperatively? If harmful hypotension occurs between induction and incision should we refuse to induce anaesthesia until the surgeon is scrubbed and ready? If we had better, more specific or sensitive ways to monitor tissue perfusion rather than blood pressure and now - almost discounted - urine output, would this lead to better care? Is it the case that minimally invasive cardiac output technology may be of much greater value in the ward than in theatre?

Presented by Desiree Chappell with Monty Mythen and Dr Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust with Timothy Miller, Associate Professor of Anaesthesiology from Duke University Medical Centre.

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.

This year was always expected to be a big one 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.

Trainees with an interest in perioperative medicine (TRIPOM) is an ever growing organisation set to continue the global push for perioperative care. This high energy podcast gives you a taste of the enthusiasm people pick up as they learn more about the value of these ideas. Moving more obviously into the perioperative period this piece continues on from last week's talk regarding mitochondrial health where 'healthy ageing' was the focus. The panel now draw the conversation into areas such as nutrition, the impact of frailty on outcomes regarding surgery and patient assessment. How does this gripping research impact upon our work during the perioperative period? Presented by John Whittle, assistant Professor at Duke University Medical Centre and one of the founders of TRIPOM, with a panel including, Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton, Dr Brant Inman, Urologist at Duke University Medical Center, Dr Amy Pastva, immunologist, physiologist and researcher at Duke University School of Medicine, Dr Paul Wishmeyer, Professor of the Department of Anesthesiology, Duke University.

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.

What are the hot topics in the cardiac world at the moment? This piece tackles; the need for gender balance when composing panels and building a successful event; the need to do what we know and do it well; how quality improvement benefits from simplicity; the need to keep younger practitioners involved and finally the need for a fuller engagement with the multidisciplinary aspect of cardiac care.

Presented by Desiree Chappell and Monty Mythen with Sol Aronson, tenured Professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and Michael Eaton, Professor and Chair of Anesthesiology and Perioperative Medicine at the University of Rochester, New York.

This piece tells the story of two different innovators in the field of an anesthesia. The first is, The Pediatric Device for Induction of Anesthesia (PeDIA), a mask-free anesthesia delivery system designed for kids. The second is the Error Recovery and Mitigation Aide (ERMA), a reworking of the traditional needle box whereby a clear reservoir is inserted between the re-entry proof top and opaque terminal disposal portion, allowing practitioners to have visualization of all the syringes and vials used during the course of a procedure. At the end of a single procedure, a trap door in the bottom of the reservoir is released to allow those sequestered vials and syringes to drop into the bottom of the needle box for terminal disposal. This allows providers to recognise, check and confirm possible errors in a timely fashion.

Also during this piece there is a wide ranging and fascinating discussion about patents and patenting. How does the process work, how can you patent your ideas and how does the advent of block chain technology potentially change this forever?

Google Patents is here: https://patents.google.com/

Check out the PeDIA website here: https://www.pediallc.com/

For more information about ERMA go here: https://ii4change.com/how-we-innovate/products/error-recovery-and-mitigation-aide/

The Facebook Group "CRNA Inventors and Innovators" mentioned in this piece is here: https://www.facebook.com/groups/2150893568464906/

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

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

Presented by Desiree Chappell and Monty Mythen with their guests Diane Miller, Pediatric Devices for Induction of Anesthesia | Product Development | PeDIA, LLC and Jean Snyder, CRNA Inc. Co-owner Goodwin and Snyder Anesthesia Associates, PLLC.

This piece features a short informative presentation from our Editor in Chief Monty Mythen regarding Artificial Intelligence and the HPI Monitor developed by Edwards Life Sciences.

It is followed by question and answer session faciliated by both our online presence, studio audience and invited guests.

The "Perioperative Quality Initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine" piece mentioned is here: https://bjanaesthesia.org/article/S0007-0912(19)30047-9/fulltext

Presented by Desiree Chappell and Monty Mythen with, Feras Hatib, Phd, Director, Research and Development, Algorithms and Signal Processing at Edwards Lifesciences.