TopMedTalk

The focus for the first part of this POCAPALOOZA was Duke University's PASS clinic.

Find out more about the PASS clinic: https://www.dukehealth.org/locations/duke-pre-anesthesia-testing-center-clinic-2d

"So it's a new approach to really changing the paradigm from just evaluating a patient and sort of passing that information forward to the receiving team [...] rather we take a much more proactive progressive approach to identify those chronic co-morbid conditions and try to bend that curve, we try to modify that which may be modifiable"

If you've heard Sol's passion and want to transform your practice get more detail from these two excellent pieces from Anesthesia and Analgesia here:

Roadmap for Transforming Preoperative Assessment to Preoperative Optimization https://journals.lww.com/anesthesia-analgesia/Abstract/2020/04000/Roadmap_for_Transforming_Preoperative_Assessment.4.aspx?context=FeaturedArticles&collectionId=4

Preoperative Optimization: A Continued Call to Action https://journals.lww.com/anesthesia-analgesia/Citation/2020/04000/Preoperative_Optimization__A_Continued_Call_to.3.aspx

There follows an engaging conversation about prehabilitation, "it's like Rocky Balboa training to get in the ring". For more resources here please check this website from the Choosing Widely campaign: https://www.choosingwisely.co.uk/about-choosing-wisely-uk/

Also - regular listeners will be excited to hear our lead presenter Desiree Chappell's news towards the end of the podcast!

Presented by Desiree Chappell with Monty Mythen and Sol Aronson, tenured Professor at Duke University and their guests Jeanna D. Blitz, Associate Professor of Anesthesiology, Medical Director, Duke PASS Clinic Director, Perioperative Medicine Fellowship, Denny Levett, Professor in Perioperative Medicine and Critical Care, Consultant in Perioperative Medicine, Southampton University Hospital NHS Foundation trust (UHS), President of the Perioperative Exercise Testing and Training Society (POETTS) and Mike Grocott Professor of Anaesthesia and critical care at the University of Southampton.

Some of the big questions: Is the pulmonary artery catheter back? What have been some of the big take aways in nutrition? Why should you feed a cold and starve a fever? More Protein or less?

Finally, 'humanizing intensive care' is discussed, do we need more ITU pets?

Presented by Desiree Chappell and Monty Mythen confer on the events of the day with their guest Hugh Montgomery, Intensive Care Society Board Member and, Professor of Cardiovascular Genetics and Critical Care University College London.

Learn how and why the benefits of real-life health care simulation situations are used by institutions such as Northern Kentucky University. Interviewing a patient, reading an X-ray, or administering an injection, in a convincing virutal environment. The St. Elizabeth Healthcare Simulation Center features seven simulation rooms including an operating room and intensive care unit.

What are the future applications we can look forward to? Furthermore how is the AANA developing the way in which simulation is used to train anesthesia providers?

Checkout the Simulation Centre here: https://nku.edu/ihi/health-innovation-center-2/simulation-center.html

Our guest kindly shares their email: [email protected]

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/

Presented by Desiree Chappell with Monty Mythen and their guest Brett Kendon, DNP, CRNA, CHSE, Assistant Clinical Professor, Assistant Program Director, Nurse Anesthesia Program, Northern Kentucky University.

Care of older people in surgery (COPS). Are you properly assesing your patients for cognition? Surgery can be appropriate for some to reduce pain in palliative care, how do we make decisions regarding a possible intervention? How important is frailty in this process?

The slides from this talk are here: http://www.anzca.edu.au/documents/03-jacqueline-close_care-of-older-people-in-surger.pdf

Presented by Professor Jacqueline Close, Geriatrician, Prince Of Wales Hospital, Clinical Director, Falls, Balance and Injury Research Centre

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Brought to you by the Perioperative Medicine Special Interest Group (SIG) in association with the Australian and New Zealand Society for Geriatric Medicine and the Internal Medicine Society of Australia and New Zealand at the 7th annual Australasian Symposium of Perioperative Medicine.

The Perioperative Medicine Special Interest Group (SIG) has three aims; improve patient safety and outcomes, share knowledge and collaborate with specialty groups, develop the specialty of perioperative medicine with various craft groups.

For more information follow this link here: http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

This discussion begins with a focus upon some of the networking and information sharing events that go on in our field;

The Society for Perioperative Assessment and Quality Improvement (SPAQI, website here: https://www.spaqi.org/2020/ )

The 17th World Congress of Anaesthesiologists, September 5-9, 2020, Prague, Czech Republic (website: https://www.wcaprague2020.com/ ).

Discussion then moves to specific "The SQUEEZE Study"; A prospective multi-centre international observational study of postoperative vasopressor use (website: https://www.esahq.org/research/clinical-trial-network/planned-trials/squeeze/ )

Presented by Desiree Chappell and Monty Mythen with their guest Konstantin Balonov, Anesthesiologist; Vice Chair for Perioperative Medicine; Chair, Competency Committee; Assistant Professor, Tufts University School of Medicine.

Like this, want more?

"The Perioperative Medicine Summit", organised by The Society for Perioperative Assessment and Quality Improvement (SPAQI), is covered in detail here: https://www.topmedtalk.com/desirees-roundtable-what-is-the-perioperative-medicine-summit/

"It's like running an election campaign..."

Perioperative hemodynamic management; how do you make it really work within an institution? With extensive reference to real life experience hear first hand stories from our guest and Editor in Chief's experience of doing just that. How do you get people both in and outside of the team to understand the importance of it? Hear about new developments in Enhanced Recovery After Surgery (ERAS) and perioperative haemodynamic management. Find out how new technologies, techniques and information are being applied in this piece.

Also, when dealing with an institution, how important is the value proposition? "Are they up on the deal?"

We discuss The RELIEF trial in more detail here: https://www.topmedtalk.com/ebpom-highlight-1-30-visiting-professor-plenary-lecturer-results-of-the-relief-trial/

We discuss the INPRESS trial in more detail here: https://www.topmedtalk.com/ebpom-london-2018-any-answers-part-3-the-big-trials/

Presented by Desiree Chappell and Monty Mythen with Michael Scott, M.B., Ch.B. Professor of Anesthesiology at the University of Pennsylvania.

The POCAPALOOZA story begins with our fascination with The African Surgical Outcomes Study. Over the last year regular listeners have heard key parts of the narrative fall into place during TopMedTalk interviews and discussions. Learn how the European Surgical Outcomes Study (EUSOS), presented at a previous Evidence Based Perioperative Medicine (EBPOM) conference, helped to inspire the African Surgical Outcomes Study ASOS which then went on to inspire us all; after an international gathering in Prato. A truly global community - the perioperative medical community - has now been galvanised into action. Determined to further the research and increase the data at the last count we have all helped to raise over £7,000! Thank you for your help.

This piece was the first of our Pocapalooza specials; "Poc" standing for "perioperative care" and "palooza" meaning festival. This piece is an update on The African Surgical Outcomes Study (ASOS) and the African Perioperative Research Group (APORG): "Everybody in the audience was overwhelmed by the quality and importance of the work being done ... in the African study"; "Finding African solutions to the problems that we're having"

You will also find a discussion regarding the Prato conference we covered extensively here on TopMedTalk, a fascinating gathering of people interested in international collaborative trails, and we cover The UK Perioperative Medicine Clinical Trials Network, see link below, before moving on to ASOS in detail.

The Perioperative Medicine UK Clinical Trials Network is here: https://pomctn.org.uk/home

Presented by Desiree Chappell with Monty Mythen and their guests Paul Myles, Director, Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Bruce Biccard consultant anaesthetist at the University of Kwazulu-Natal, Director, Perioperative Research Unit, Department of Anaesthetics, Nelson R Mandela School of Medicine and Salome Maswime Obstetrician and Gynaecologist and Professor of Global Surgery at the University of Cape Town.

If you enjoyed this piece please find more Bruce Biccard here: https://www.topmedtalk.com/topmedtalk-african-surgical-outcomes-study-asos-2/

We discuss Rupert Pearse in this podcast, it's worth listening to this piece with him discussing the Clinical Trials Network here: https://www.topmedtalk.com/anaesthesia-2019-the-clinical-trials-network-and-optimising-shared-decision-making/

Paul Myles is a firm favourite on TopMedTalk, enjoy more of his incisive observations here: https://www.topmedtalk.com/prato-2019-paul-myles/

Pediatric patients can present quite a challenge when emerging from anesthesia. Here we discuss ways to "ACE" your transition to PACU! "A"void Emergence Agitation, and discover the latest evidence about "C"riteria for "E"xtubation in this challenging population. How do the protocols and standard of care compare between the UK and US. What does the evidence tell us? Also, how is Enhanced Recovery After Surgery progressing in pediatrics?

Presented by Desiree Chappell and Monty Mythen with their guest Kristin Henderson, DNAP, CRNA, CHSE, CPT, USAR Assistant Professor, Wake Forest School of Medicine, Nurse Anesthesia Program

After working at a Veterans Affair Medical Center, hear how our guests moved into the field of emergence delirium: "upon emergence our patients were swinging and very aggressive ... there must be some way to prevent this".

This fascinating piece enjoys an engaging discussion about an important topic for both patients and practitioners; how important is it for you to know a patient may suffer from post traumatic stress disorder? Do different anesthetics promote or avoid emergence delirium? Can emergence delirium cause further long term trauma? How do we deal with US military veterans specifically?

Patient Health Questionnaire 9 (PHQ-9) is here: https://patient.info/doctor/patient-health-questionnaire-phq-9

The State Trait Anxiety Inventory is here: https://www.advancedassessments.co.uk/resources/Mental-Health-Test.pdf

Presented by Desiree Chappell and Monty Mythen with Kristen Roman, MSN, MFA, SRNA, Ignacio Diaz, BSN, SRNA and Jena Borgonia, BSN, SRNA, student registered nurse anesthetists (SRNAs) at The University of Southern California.

The electronic cigarette market is a $14 billion industry worldwide. As of August 2019, 215 cases of severe pulmonary illness related to e-cigarette use are being investigated in the United States. The known hazards of e-cigarette use are rapidly coming to light with the sudden onset of serious bronchiolitis-related pulmonary disease in otherwise healthy people who were known to use e-cigarettes. Learn also how COVID 19 has increased these dangers.

Presented by Desiree Chappell with Monty Mythen and Bernard Gilligan, III, DNP, CRNA, APRN, Program Assistant Director, Assistant Professor, Cedar Crest College Nurse Anesthesia Program, Allentown, PA.