TopMedTalk

Pain is a subjective experience that affects all segments of the population. However, there are inter-individual differences in pain. The biopsychosocial model proposes that the intersection of biological, psychological, and social factors create a pain experience and pain outcomes that differ by sex, race, and socioeconomic status.

"The minority stress theory ... the idea that for racial minorities, especially blacks, they are exposed to chronic stress; the stress of daily racism"

Could epigenetics hold the key to understanding how social factors compound differences between patients? How does this impact on you and your practice?

Further reading is to be found here:

https://pubmed.ncbi.nlm.nih.gov/19411059/

https://pubmed.ncbi.nlm.nih.gov/32487870/

https://pubmed.ncbi.nlm.nih.gov/30863142/

Presented by Desiree Chappell and Monty Mythen with Edwin N. Aroke, Ph.D., CRNA, Assistant Professor, Associate Scientist, Minority Health and Health Disparities Research Center, Associate Scientist, Comprehensive Arthritis, Musculoskeletal, Bone, & Autoimmunity Center, The University of Alabama, Birmingham, US.

This invaluable piece is a chance to attend a workshop which looks at the latest thinking on "perioperative cognition" and 'post-operative cognitive dysfuntion'.

We advise you use this link here to find the PDF of the paper being discussed: https://bjanaesthesia.org/article/S0007-0912(17)54082-9/fulltext

Presented by David Scott, Professor, University of Melbourne, Director, Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne and Lis Evered, Scientific Head of Research, Department of Anaesthesia, St. Vincent's Hospital, Melbourne.

This is Part 1, to find Part 2 go here:

https://www.topmedtalk.com/sunday-special-the-perioperative-cognition-workshop-part-2/

Part 3 is here:

https://www.topmedtalk.com/sunday-special-the-perioperative-cognition-workshop-part-3/

Part 4 is here:

https://www.topmedtalk.com/sunday-special-the-perioperative-cognition-workshop-part-4/

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

"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.

"4-10% of opioid naïve patients will continue to use opioids more than 90 days after surgery"

Opioids are good for pain control but there's another issue, they also numb emotional pain. How do we responsibly deal with this? It's important to remember: "When you give patients high doses, you're putting them at risk".

Long term listeners will recall TopMedTalk spent the best part of our launch year on this topic. If you're one of our many new listeners please use this huge resource of podcasts to help update your practice and cut down unnecessary risk: https://www.topmedtalk.com/?s=opioid

"We should be minimizing opioids every chance we can", if you want to cut straight to our groundbreaking talk on opioid free anesthesia please go here: https://www.topmedtalk.com/ebpom-2019-opioid-free-anaesthesia-2/

Presented by Desiree Chappell and Monty Mythen with their guest Jennifer Lanzillotta-Rangeley, CRNA, PhD, Assistant Professor, College of Nursing, University of Cincinnati, Cincinnati, Ohio.

"Our job is to tell them; there is another solution ... there's another way to solve this problem and I can help you"

This piece takes a bold and honest look at suicide in anesthesia, although it has a US set of contributors the issues here are to do with everyone in healthcare. TopMedTalk is keen to promote the fact help is available, please seek it out if you are concerned you might be affected by these issues.

AANA Peer Assistance Helpline: 1 800 654 5167 National Suicide Hotline: 1-800-273-talk (8255)

How does the tactic of Question Persuade Refer (QPR) work? Should we directly discuss suicide with colleagues? What are the basic causes of this complicated problem? Can we simplify our approach by being more direct and honest? What does the evidence tell us is the best way to deal with the situation?

Presented by Desiree Chappell with her guests Catherine Horvath DNP, CRNA, Assistant Professor and Program Director of the Doctor of Nursing Practice Nurse Anesthesiology Track at Johns Hopkins School Of Nursing, Baltimore MD, Chuck Griffiths, PhD, CRNA, USC, Assistant Clinical Professor at the UCLA School of Nursing, Faculty, USC Doctor of Nurse Anesthesia Practice Program and Fara Lekhnych, MSN, CRNA, The Johns Hopkins Hospital, Baltimore.

How do you become well known in the NHS for being innovative, particularly in the perioperative area regarding evaluation and communication of risk? How can cardiopulmonary exercise testing lead to shared decision making? Hear how aortic aneurysms are dealt with by a world class professional perioperative physician. Learn how that process and its success then spread out into other areas of healthcare within his institution. Do you need to develop a broad knowledge of all surgery and medicine so that you understand what is going on within the different surgical specialities? Following this discussion is had about the GIRFT (Getting It Right First Time) project. The stated aim is 'to help improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes'. This piece gives you the detail from one of the joint clinical leads. Presented by Monty Mythen, Joff Lacey and Desiree Chappell with their guest Dr Michael Swart, Consultant in Anaesthesia and Critical Care Medicine at Torbay Hospital and advisor to the UK Department of Health for the Enhanced Recovery Programme.

This piece looks at innovations in our field, through the lens of the Hypotension Prediction Index (HPI). Innovations in medicine are always exciting, "neuro-monitoring" is discussed "if you told me two years ago that I was going to be able to understand an EG waveform I would have laughed at you".

"Data is what drives any change", how can new insights regarding hypotension potentially revolutionize your practice? Adoption of any new technology is complicated, how do you handle resistance to such innovations? When it comes to change management, if the new change takes more than "300 seconds" then, "unless there is an emotional tug ... it is hard". The value proposition has to be strong, what's the verdict on the H.P.I. monitor?

This piece is part of our coverage of Anesthesiology 2019 at the Orange County Convention Center in Orlando. With over 14,000 delegates, clinicians, thought leaders and professionals, it's the largest gathering of Anesthesiologists and Anesthesia providers in the world.

Presented by Desiree Chappell and Sol Aronson with their guest Neal Fleming, Professor, Anesthesiology and Pain Medicine, UC Davis.

"Perioperative nutrition should be a key part of Enhanced Recovery" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com

Hear this excellent talk, for free, on this podcast.

If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings

If you have any comments or questions you'd like to send to the team email: [email protected]

Presented by Paul Wischmeyer, Professor of the Department of Anesthesiology, Duke University.

"Thank you for taking this meeting beyond these walls" - this piece was the final part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. We begin with the global audience in mind and break down what it is to be a Nurse Anesthetist. It's a role which is expanding in scope, our guest walks us through how and why that's the case.

This wide ranging conversation then moves to the future of enhanced recovery and the AANA's future development.

For more on the Drink Eat Mobilise topic go here: https://www.topmedtalk.com/periop-coach-2-02-eras-whats-the-secret-sauce/

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

Presented by Desiree Chappell and Monty Mythen with their guest Lynn Reede, Associate Clinical Professor, Northeastern University Nurse Anesthesia Program.

How can we align personalised care with prehabilitation? "Personalised care is where people have more choice and control over how their health and care needs are met" where we recognise "people themselves can sometimes be the best integrators of health and care". In this context our role is to support them to "live as independently as they wish". With shared decision making and personal choice at the heart of this we allow patients to be "experts in their own lives, health and care".

The increase in life expectancy means more long term conditions and comorbidities in patients, what opportunities does this present? How do we hone in on what matters to patients and help them manage the cumulative burden of long term health difficulties? How comfortable are healthcare practitioners when talking about physical activity?

Is it possible that personalised care could eventually be business as usual?

The NHS Long Term Plan has a website which you can see here: https://www.longtermplan.nhs.uk/

The NHS website is here: www.england.nhs.uk

Presented by Anna Lowe, Programme manager, National Centre for Sport and Exercise Medicine, Lead Allied Health Physical Activity Clinical Champion at Public Health, England.