TopMedTalk

This piece focuses on the question of looking after yourself as a practitioner and interlinking into your team. How important is it to listen to your team? What is "burn out"? How does it express itself in people? What signs should we look for in our friends and colleagues?

Presented by Desiree Chappell, Sol Aronson and Monty Mythen with their guest Sasha Shillcutt, Vice Chair of Strategy and Innovation, Department of Anesthesiology, UNMC Founder, Brave Enough LLC.

Find Sasha's excellent website (and podcast) here: https://www.becomebraveenough.com/

This piece is about the application of data, how do we use it and when should we gather it? How important is it to "just get started and find out what the problem is"?

Further reading is available here: https://bjanaesthesia.org/article/S0007-0912(17)33828-X/fulltext

If you're interested in hearing more about the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial go here: https://www.topmedtalk.com/desirees-roundtable-carol-peden-epoch-qa/

Presented by Professor Carol Peden, Executive Director of the Center for Heath System Innovation and Professor of Anesthesiology at the Keck School of Medicine of the University of Southern California, Fellow of the Institute for Healthcare Improvement (IHI).

As a general rule, should ward monitoring be increased? Should continuous blood pressure monitoring be more frequent?

This short piece follows on from Tim Miller's talk "Perioperative Blood Pressure (PeriOperative Quality Initiative: POQI 3) how low can you safely go?".

Presented by Desiree Chappell and Monty Mythen with Tim Miller, Associate Professor of Anesthesiology from Duke University Medical Centre.

This panel discussion and extended question and answer session focuses upon troponin screening. Where is the latest evidence as regards this debate? Is MINS ( Myocardial injury after noncardiac surgery) the most common postoperative complication associated with death and if so why is there a transatlantic divide as regards the evidence? Is there a place for troponin screening preoperatively for risk stratification? What should one do with an asymptomatic post operative patient with raised troponin? Does MINS cause hypotension?

This is part 3 of 3 from The EBPOM 2019 TopMedTalk session which debated the issue.

Chaired by Monty Mythen, TopMedTalk's Editor in Chief, with, Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton and frequent TopMedTalk contributor, 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 Duminda Wijeysundera, Professor in the Department of Anaesthesia and the Institute of Health Policy Management and Evaluation at the University of Toronto and a Staff Anesthesiologist at St Michael's Hospital.

"Pain strategies" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 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

Presented by Dr. Ryan Hanson, Anesthesiologist in Boston, Massachusetts, affiliated with Brigham and Women's Hospital, received his medical degree from Penn State College of Medicine.

What are some of the major issues regarding billing? What are the most common mistakes when it comes to documentation? How do we keep the focus on great healthcare, as well as good book keeping? How does "the false claims act" impact on billing?

If you find a mistake or an issue in your note keeping the advice here is clear; deal with it the moment it is discovered. Also, under recording is an obvious issue, can the same be said of 'excessive documentation'?

The bottom line is that practitioners must remain educated, stay aware of what is going on and rely on the fact that patient care is crucial and has to remain at the heart of any healthcare practice.

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/

If you would like to contact our guest he has allowed us to post his email here: [email protected]

Presented by Desiree Chappell and Monty Mythen with Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology and their guest, Mark Silberman, Partner, Benesch Law Chair, White Collar, Government Investigations, & Regulatory Compliance Vice-Chair, Health Care.

"Some practical tips you can take away and implement in your hospital..."

In the UK there is a legal imperative to minimalise and individualise risk now but it's widely understood to be helpful if you want to provide better value and patient outcomes. How can risks be identified and minimised? How can these risks then help to provide better quality shared decision making? How can plan a perioperative pathway tailored to these needs?

Presented by Ramani Moonsinghe, Professor of Perioperative Medicine at University College London (UCL).

IMPORTANT NOTE: We discuss "The Montgomery Case" in more detail here; this piece is very relevant to you and your patients, legally speaking, if you work in the UK: https://www.topmedtalk.com/sunday-special-being-on-the-right-side-of-the-law-2/

Discussion begins with thoughts about University College London (UCL)'s Masters Course in Perioperative Medicine, moving further to the various ways in which people can learn more about the specialty

The wider conversation reaches out into the field of anaesthesia and the constant shortage of practitioners that there is in the UK and more widely around the world.

Also, if you're intrigued, here's the link to the FREE 4 week course discussed in this podcast:

https://www.ucl.ac.uk/lifelearning/courses/perioperative-medicine

Presented by Desiree Chappell and Monty Mythen with their guests David Walker, Professor in Anaesthesia and Critical Care Medicine, University College London Hospitals, Honorary Senior Lecturer UCL and Dr Rob Stephens, Consultant in Anaesthesia, UCLH, Hon Senior Lecturer in Anaesthesia, UCL.

"Delirium: The brain and the older surgical patient Part 2" was a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: "Updates in Perioperative Medicine 360" which took place between November 7th-9th 2019.

This piece is a look at some of the new technology which is becoming more widely used. A leadless pacemaker is a small implantable "bullet like" device that sends electrical pulses to the heart whenever it senses that the heartbeat is too slow. Also new implantable cardioversion defibrillators are discussed as are implantable cardiac monitors. There is also discussion regarding cardiac resynchronization therapy.

"Aqute brain failure is really the concept we're talking about"

Find out more about ANZCA here: http://www.anzca.edu.au/

Presented by Professor Alison Mudge, Conjoint Professor of Medicine, Royal Brisbane Clinical Unit, Faculty of Medicine and Gideon Caplan Associate Professor of Geriatrics, Prince Of Wales Hospital, Sydney.

The Silver Tsunami is coming, are you prepared to assess the elderly patient? Mature patients present unique and interesting opportunities to perioperative practitioners. New ways of thinking and different approaches are always necessary.

The British Geriatric Society's "Fit For Frailty" is here: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty

Presented by Desiree Chappell and Monty Mythen with their guest Houman Javedan, MD. Geriatrician at Brigham and Women's Hospital, assistant program director of the HMS Multi-Campus Fellowship in Geriatric Medicine, and Clinical Director for the Division of Aging in the Department of Medicine.