TopMedTalk

Originally broadcast live from Anesthesiology 2019, this piece focuses on the mission to advocate and apply prehabilitation, pre-optimisation and enhanced recovery. Defined here as "good public health [...] with the crucible of surgery".

How do we do that in a way that both patients and front line providers understand the value of it? Can this message help to allow for delays in surgery?

Also, how do we take our message to social media, specifically Twitter? Listen in for some excellent tips before you make a point of following our guest's twitter account here: https://twitter.com/jeffsimmons

Presented by Desiree Chappell and Mike Grocott with Jeff Simmons, Associate Professor, Medical Director for UAB's Preoperative Assessment, Consultation, and Treatment Clinics and all Paranesthesia Care Units. Co-Chair of the Operating Room Executive and Perioperative Oversight Committees.

"Exercise capacity and sarcopenia" - 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

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

Presented by John Whittle, assistant Professor at Duke University Medical Centre.

"I know how to manage pain medication [...] addiction was the absolute last thing that would happen to me".

This podcast helps tackle the difficult subject of Substance Use Disorder in healthcare practitioners. How do we, from a caring and helpful perspective, address this issue either within ourselves or others?

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 Peer Assistance section of the AANA's website is here: www.AANAPeerAssistance.com. Also see www.AANA.com/AboutPeerAssistance for additional facts and information.

The phone number we share in the podcast is: (800) 654-5167

Furthermore there is an interesting article about Parkdale here: https://www.aana.com/docs/default-source/wellness-aana.com-web-documents-(all)/aana-parkdale-partnership-jan-2019.pdf?sfvrsn=bd8f51b1_2

Presented by Desiree Chappell and Monty Mythen with their guests, Linda Stone, DNP, CRNA Assistant Program Director at Raleigh School of Nurse Anesthesia and Rodrigo Garcia, CEO Parkdale; APN, MSN, CRNA, MBA.

TopMedTalk has recently engaged with a large number of new listeners, we are delighted to have you join our family of perioptimists! This piece works as a primer, it explains what lies at the core of the world's favorite perioperative medicine podcast; enhanced recovery. What is it? How do you implement it? And, what are its core principles?

If you've never heard TopMedTalk before but you are a medical practitioner this piece is a great place to start; if you're already onboard it will be a welcome refresher regarding the ideas we all gather around daily.

How widespread is enhanced recovery after surgery and, perhaps more importantly, how widespread are its principles? Are patients living the drinking, eating and mobilising early on and so "living the (drink, eat, mobilise) dream?".

The "POWER" study "Association Between Use of Enhanced Recovery After Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study" is here: https://pubmed.ncbi.nlm.nih.gov/31066889/

The App Store has our app here: https://apps.apple.com/gb/app/topmedtalk/id1438159784

Google Play has it here: https://play.google.com/store/apps/details?id=com.topmedtalk.android.medtalk&hl=en_GB

There is a recent conversation with Henrik Kehlet here: https://www.topmedtalk.com/topmedtalk-henrik-kehlet-and-nick-scott/

There's also a recent one with Angela Bader here: https://www.topmedtalk.com/covid-19-angela-bader-the-need-for-end-of-life-conversations/

Our famous Bill Clinton piece is here: https://www.topmedtalk.com/sunday-special-bill-clinton-at-the-world-patient-safety-science-technology-summit-2/

The excellent Chris Snowden piece we mention is here: https://www.topmedtalk.com/dingle-2019-the-opportunity-in-variability/

(Enhanced Recovery After Surgery) ERAS Guidelines are here "Guidelines for Perioperative Care in Cardiac SurgeryEnhanced Recovery After Surgery Society Recommendations" : https://jamanetwork.com/journals/jamasurgery/fullarticle/2732511?guestAccessKey=04f7090d-122c-4e94-a46f-22e49dab7c51

The Perioperative Quality Initiative is here: https://thepoqi.org/

Presented by Desiree Chappell and Monty Mythen.

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Have you heard the incredible news about EBPOM Chicago yet? Go now to ebpom.org and find out more!

"Excellent teamwork"; the key to good outcomes.

This piece features an in depth discussion of post operative acute kidney injury (AKI), are there fresh approaches we can take? Could more data help us? The conversation then moves to myocardial injury after noncardiac surgery (MINS). What should our thoughts be as regards postoperative troponin levels?

Presented by Desiree Chappell and Monty Mythen with their guest Michelle Chew, Professor, Senior Consultant, Faculty of Medicine, Linköping University; Associate Professor, Faculty of Health and Medical Sciences, UCPH; Associate Professor, Consultant, Department of Anaestheisa and Intensive Care Medicine, Hallands Sjukhus Halmstad.

"Delirium: The brain and the older surgical patient Part 1" was a presentation 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.

"Acute brain failure is really the concept we're talking about", this piece covers delirium and dives into why this common and long discussed condition is not yet something we can always predict and prevent.

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.

This piece focuses upon goal directed fluid therapy, with an automated system, for decision support; "a step between a simple monitor and a fully automated system".

The "proof of concept" paper we highlight towards the end of the podcast, "Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate - and high-risk surgery" has now been published and can be found here: https://bjanaesthesia.org/article/S0007-0912(19)30443-X/abstract

This paper here "Perioperative goal directed therapy using automated closed-loop fluid management: the future?" is also referenced: https://www.ncbi.nlm.nih.gov/pubmed/26578397

You may also find this piece, which our guest is also part of, here interesting: https://www.ncbi.nlm.nih.gov/pubmed/29068831

Presented by Desiree Chappell and Monty Mythen with their guest Alexandre Joosten, Anesthetist at Hospital Erasme.

Away from the world of politics there is a sensible debate to be had about payment methods for healthcare. Here you will find evidence, shared goals and specific payment models from the US being looked at in detail. It's a debate about total cost of care and a two sided risk model that could potentially be cheaper and better for both patients and providers.

Bundle payments provoke debate, "the interesting question is; 'post operatively, do you need that expensive care'?" Population health is an inevitable terrain for the discussion, could alternative payment models benefit wider society?

"Healthy people don't need anything other than wellness care, the poorly managed chronically co-morbid medical conditions are the population that is costing us and driving the cost of care up disproportionately greater than everyone else"; how do the needs of these two groups knit together in a way that is helpful and equitable financially?

How is enhanced recovery and perioperative medicine helping to reduce the cost of healthcare? Can prehabilitation help reduce costs even further?

The Centers for Medicare and Medicaid services (CMS) website is here: https://www.cms.gov/

Presented by Desiree Chappell with Monty Mythen, Sol Aronson and their guest Lee Fleisher, Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania.

If you enjoyed this conversation you will certainly find value in this piece as well: https://www.topmedtalk.com/roundtable-highlight-the-maryland-funding-experiment/

"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

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

Presented by Glenn Murphy, Jeffery S. Vender Chair of Anesthesiology Research and Education and Director of Cardiac Anesthesia and Clinical Research at NorthShore University HealthSystem, a hospital affiliated with the University of Chicago Pritzker School of Medicine.

In the military Forward Surgical Teams (FSTs) are deployed into challenging environments to deliver "damage control surgery". They help people who have been injured, relieve the pain, stop the bleeding, 'patch the holes' and move them to a safer environment. It's from this background that our two contributors come, learn how they have been forced to innovate and what insights they can give to practitioners working in more familliar and well resourced contexts.

Hear how a 25 year-old male presented with penetrating chest trauma and an Erector Spinae Block was utilized in an incredibly dramatic context.

This inteview works well in tandem with this link to the paper discussed in the piece: https://www.ncbi.nlm.nih.gov/pubmed/31247096

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 and Monty Mythen with their guests Robert Fabich, Doctor of Nursing Practice, CRNA, Veteran and Sharrod R. Greene, CRNA, Sentara Anesthesiology Specialists.