TopMedTalk

This piece is a much needed contribution to a conversation about how we should be caring for the transgender patient within the scope of perioperative care.

Our guest's excellent article, "Anesthesia Inclusive Practices Amidst Adversity: Caring for the Transgender Patient", is here: https://cms.aana.com/docs/default-source/pr-aana-com-web-documents-(all)/anesthesia-inclusive-practices-amidst-adversity-caring-for-the-transgender-patient-may-2019.pdf?sfvrsn=d810a34d_4

The NHS's guidelines are here: https://www.nhs.uk/conditions/gender-dysphoria/guidelines/

Presented by Desiree Chappell and Monty Mythen with Jose Castillo, PhD, CRNA Faculty, Texas Wesleyan University, AANA Diversity and Inclusion Committee.

When it comes to blood pressure, hypotension is associated with poor outcomes for patients, how do we react to this? How do we manage and avoid hypotension where possible? How has technology caught up with this challenge? Could automated closed loop systems be helpful here? The bottom line is simple; "If we measure blood pressure properly, we can predict it".

Presented by Dr Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust.

This piece outlines some of the topics related to the third Perioperative Quality Initiative (POQI). What is 'perioperative blood pressure'? What have been the major developments in this area? Also, should we be looking at increasing monitoring of patients, particularly regarding their blood pressure, in hospital?

The Perioperative Quality Initiative (POQI) is discussed here: https://www.topmedtalk.com/anesthesia-and-analgesia-go-big-on-poqi/

The POQI website is here: http://poqi.org/

The INPRESS Trial is discussed here: https://www.topmedtalk.com/ebpom-london-2018-any-answers-part-3-the-big-trials/

We speak with Dan Sessler here: https://www.topmedtalk.com/topmedtalks-to-dan-sessler-2/

Presented by Tim Miller, Associate Professor of Anesthesiology from Duke University Medical Centre.

Check out www.ebpom.org for more details on EBPOM Chiago!

This piece argues that troponin screening might be overused, "it's not all about the heart". Myocardial injury after noncardiac surgery (MINS) is seen as a relatively common issue driving post-operative harm. This piece gets into the detail and asks some important questions as to how focused practitioners should be upon troponin screening.

It's part 2 of 3 from The EBPOM 2019 TopMedTalk session which debated the issue.

Presented by Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton and frequent TopMedTalk contributor.

"I did a study back in 2002 where I was able to count a grand total of forty patients above the age of eighty in our (Intensive Care Unit) ICU and our (High Dependency Unit) HDU, nowadays I'd count close enough to a hundred and sixty"

How do we refine our diagnostic tools? How can teaching in this area help to save lives? Should you consider a 'geriatric intensive care unit'? Is this an area where true perioperative practice and surgery is a guarantee we can immediately see improvement in an institution?

Presented by Brian Marsh, Anaesthesia, Critical Care Medicine, Extracorporeal Life Support, The Mater Hospital, Dublin.

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Go now to www.ebpom.org for details regarding EBPOM Chicago - exclusive offer now available!

"Perioperative medicine is an opportunity; it's multidisciplinary and its developing around a culture of trust between anaesthetists, surgeons and perioperative physicians"

The future of perioperative medicine embraces the full scope of medical advancement and is therefore difficult to predict, as a result truly informed shared decision making is both crucial and more complex. Variability of practice is a key factor; usually caused by the overuse or underuse of a facility and its resources. The former being a particular problem in America with the financial incentives associated with some forms of treatment and care.

Learn how a pilot study regarding orthopedics lead ultimately to variability becoming a widely recognised crucial area of improvement in medicine. More on this can be found on The British Orthopaedic Association's website here: https://www.boa.ac.uk/standards-guidance/getting-it-right-first-time.html

This talk empowers you with the detail regarding an area that now looks set to become a huge opportunity for perioperative practitioners world wide. Sharing processes, standardising care and allowing our focus to go where the evidence leads. How can we help as implementation teams are assembled both in the UK and elsewhere?

When it comes to patients; "we play a very small part in their life ... but that part can be massive if we get it wrong - so we have to get it right!"

The Getting It Right First Time website (GIRFT) is here: https://gettingitrightfirsttime.co.uk/

Presented by Chris Snowden, Consultant Anaesthetist, Freeman Hospital, Newcastle upon Tyne and Senior lecturer at the Institute of Cellular Medicine at Newcastle University.

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If you love this, you'll also enjoy this fantastic piece "EBPOM Highlight | Getting it right first time": https://www.topmedtalk.com/ebpom-highlight-getting-it-right-first-time/

Exclusive limited time only "EBPOM Chicago" ticket offer on now, go to: www.ebpom.org

This piece argues that troponin screening is useful, if used appropriately. Is it the case that this test has been 'over sold' and as a result has provoked unhelpful pushback from practitioners?

It's part 1 of 3 from The EBPOM 2019 TopMedTalk session which debated the issue.

Presented by 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.

This is an Edwards Lifesciences Sponsored Lecture which was originally streamed live on TopMedTalk from the hugely successful EBPOM USA 2019 in Dallas.

In this piece we hear about the ongoing need for institutions and healthcare professionals to recognise the damaging consequences of intraoperative hypotension.

Evidence has been mounting here on TopMedTalk over the last couple of years; there's no doubt hypotension is an area of concern for many of our experts and contributors. Listen to more on this here via our large selection of podcasts on the topic: https://www.topmedtalk.com/?s=hypotension

For those who are already across the data the next question is, how do we detect it and prevent it, ideally before it even occurs? Here the HPI monitor comes into play, a cutting edge piece of technology which uses artificial intelligence to analyse the data and make predictions which could save your patient from a problematic outcome.

Presented by Dr Simon Davies, Consultant Anaesthetist, York Teaching Hospitals, NHS Foundation Trust.

"Monty - we've done it!"

This piece wraps up one of our more ambitious experiments, the POCAPALOOZA. 24 hours around the world, combining powerful practice changing information and inspiration alongside entertainment from artists and supporters.

We hope you have enjoyed this year's conference, look forward to hearing some of the talks in full and entirely for free over the next few months here on TopMedTalk.

If you are one of the thousands of our listeners who signed up early for EBPOM Live From London please accept our thanks for helping to show the world how passionate we in the medical community are about safe perioperative care for all, stay tuned for more on our next event: EBPOM Chicago!

Check out the ebpom.org website now for more details.

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

If you'd like to hear more of Paul Myles please go here: https://www.topmedtalk.com/prato-2019-paul-myles/

If you'd like to hear more of Bruce Biccard he appears here: https://www.topmedtalk.com/prato-2019-bruce-biccard/

This piece is a fascinating in-depth conversation moving through various medical perspectives on perioperative medicine from Australia and New Zealand. A real highlight of the festival. How has perioperative medicine evolved over the years around the world? What's the status of Perioperative Care as a specialty? How does one specialise in this area, in terms of education?

Discussing the development of the International Board:- "We decided perioperative education should not only be available for developed countries". We hear that TopMedTalk engaging with the African Perioperative Research Group (APORG) has helped move the cause of perioperative care forward, both in Africa and elsewhere.

The conversation further evolves:- Once educated how do we demonstrate the value of perioperative practice? How do we launch projects that will really make a difference? Where, from a research perspective, do the more fruitful areas of investigation present themselves? Would a minimum data set help? Moving to clinical trials we hear how research is being conducted, both the challenges and the sources of success.

"Perioperative medicine is a team sport" - how do we use the interdisciplinary aspect of what we do to enhance our educational options?

Regular listeners to TopMedTalk may recall the series we did about the Perioperative Special Interest Group (SIG) - if you want more details of http://www.anzca.edu.au/fellows/special-interest-groups/perioperative-medicine

The ANZCA Clinical Trials Network can be found at http://www.anzca.edu.au/ctn

Also, The International Board of Perioperative Medicine is here: https://www.internationalboardpom.org/

Further, make sure you check out https://www.periopmedicine.org.uk/ for more information on the perioperative medicine short course we discuss.

Presented by Desiree Chappell alongside co-host Ross Kerridge, Anaesthetist from Newcastle in Australia - sometimes called the 'Father of Perioperative Medicine'. Guests are Jill Van Acker, Staff Specialist Anaesthetist and Clinical Lead Perioperative Services, Canberra Hospital, and Chair of the ANZ Perioperative Special Interest Group; Vanessa Beavis, President, Australian & New Zealand College of Anaesthetists, & until recently Director of Perioperative Services, Auckland District Health Board; Prof. Jackie Close Orthogeriatrician at the Prince of Wales Hospital in Sydney and Clinical Director of the Falls, Balance and Injury Research Centre at Neuroscience Research Australia; Prof. Dave Story, Head of the ANZCA Clinical Trials Network, and Chair of the Anaesthesia, Perioperative and Pain Medicine Unit within the University of Melbourne Medical School. Joel Symons, Anaesthetist at the Alfred Hospital in Melbourne and Senior Lecturer at Monash University, Leader in the development of Educational Programs based at Monash University and member of International Board of Perioperative Medicine.