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"Every fourth operation there is evidence of a modifiable risk factor".

The Perioperative Quality Initiative (POQI) is our starting point for this conversation, seven concensus conferences focusing on various topics of interest to the perioperative practitioner. Check out their extensive open source resources here: www.poqi.org

Hypotension and Mean Arterial Pressure (MAP) are discussed in detail; how are patients now being managed? How can a 'hazard index' help?

"25% of our patients experience hypotension!"; regular TopMedTalk listeners know this has been frequently highlighted as an issue for patient mortality.

Also, 26 minutes in, hear about the recent POQI and Acute Dialysis Quality Initiative (ADQI) meeting of 2019. "There is no such thing as a bit of a creatinine bump that is 'normal'".

Presented by Desiree Chappell, Monty Mythen and a surprise appearance from Sol Aronson, with their guest Andrew Shaw, Chairman, Department of Anesthesiology and Pain Medicine at The University of Alberta, Edmonton, Alberta and Zone Clinical Department Head for Anesthesia, Alberta Health Services Edmonton Zone. He is also a Fellow of the Royal College of Anaesthetists (UK), the American College of Critical Care Medicine and the Faculty of Intensive Care Medicine (UK).

Like this, want more?

Find out more about POQI here: "Desiree's Roundtable | What is the Perioperative Medicine Summit?" https://www.topmedtalk.com/desirees-roundtable-what-is-the-perioperative-medicine-summit/

For more regarding the papers published by POQI, referenced in this piece, go here: "Sunday Special | Blood Pressure" https://www.topmedtalk.com/sunday-special-blood-pressure/

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

Also, if you enjoyed Andrew Shaw's take on these issues go listen to this fascinating conversation: "Desiree's Roundtable | Fluids in the 2020's" https://www.topmedtalk.com/desirees-roundtable-fluids-in-the-2020s/

Finally, Professor Sol Aronson, tenured, Duke University, who features on this podcast, delivered a talk you're bound to love here: "Perioperative Medicine is population health" https://www.topmedtalk.com/poet-6-01-perioperative-medicine-is-population-health/

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EBPOM "Live from London" - the hottest tickets in anaesthesia and perioperative medicine - go now to the website: https://www.ebpom.org/EBPOM2020

This piece discusses The Brain Health Initiative and the sixth Peri-Operative Quality Initiative which focused upon delirium. How can progress in these areas be built upon and encouraged? Where is the data in regards to detecting and dealing with delirium?

Beers Criteria Medication List; Potentially Inappropriate Medications for the Elderly According to the Revised Beers Criteria is here: https://dcri.org/beers-criteria-medication-list/

The website for the AARP is here: https://www.aarp.org/

Presented by Lee A. Fleisher Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania. There is a short question and answer session at the end hosted by Desiree Chappell and Monty Mythen.

This piece focuses on the great work done by The Anesthesia Patient Safety Foundation. We turn to their specific focus on COVID 19 and then look at the wider benefits of a network dedicated to patient safety in our field.

Their section on COVID 19 is here: https://www.apsf.org/news-updates/perioperative-considerations-for-the-2019-novel-coronavirus-covid-19/

Furthermore there is a remarkably prescient article by Mike Grocott and Monty Mythen on there in which we discuss, Perioperative Fluid Management: Cheers to the Dream of Moderation: https://www.apsf.org/article/perioperative-fluid-management-cheers-to-the-dream-of-moderation/

Presented by Desiree Chappell and Monty Mythen with their guest Steven Greenberg, MD, FCCP, FCCM, Editor-in-Chief, Anesthesia Patient Safety Foundation (APSF) Newsletter, Vice Chairperson, Education, Department of Anesthesiology, Director of Critical Care Services, Evanston Hospital NorthShore University HealthSystem, Clinical Professor, Department of Anesthesiology Critical Care, University of Chicago, Pritzker School of Medicine

EBPOM 2020 is Live from London, go now to find out more: www.ebpom.org

"We are getting super excited about EBPOM Live from London at the end of June..." - thousands of you already have your tickets, this podcast is your essential primer; a fascinating rundown of what attendees to the virtual conference "EBPOM Live From London!" can expect.

As a listener to TopMedTalk you are part of a movement which aims to help save lives every year around the world. The practice of evidence based perioperative medicine guarantees healthcare as a whole, and surgery in particular, is done to the best of our medical understanding and ability. By doing our best at every point of contact between healthcare patient and provider we know we get better value and more positive outcomes. Thanks to your help this message is about to go truly global!

TopMedTalk is the broadcasting arm of Evidence Based Perioperative Medicine, EBPOM, who for many years have organised world class international conferences aimed at sharing the strategies and results perioperative practitioners have used to both save money and improve lives in healthcare globally.

The crisis of COVID 19 has been difficult for many and one of the casualties, for the forseeable future, has to be large social gatherings. However, curiously we had already been working on an alternative; EBPOM Live from London, the virtual conference. This event in fact represents a culmination of years of planning; initially inspired by the environmental concerns of many of its founders and described back then as 'carbon friendly conferencing'. The same idea was in part the inspiration behind TopMedTalk and now studios - purpose built to help ease our environmental impact - are being deployed to maintain our global community in a world where international travel makes less practical sense.

We're two weeks away from a truly historic moment in the development of a global vision; a perioperative medicine conference which you can attend without having to leave your home! The technology is here, the interest in the subject is out there and you are reading this now. Help us to bring more people to the cause, like, subscribe to and share TopMedTalk; free medical information for all, while looking forward to hearing some of the pieces which the conference attendees will be enjoying, later in the year. Or, join the conference and prepare yourself for a learning experience that could immediately change the way you save people's lives forever.

Check out ebpom.org for low ticket prices.

"It's been fantastic seeing the network of people involved in perioperative medicine growing around the world", says our guest Ross Kerridge, often cited as 'the Father of perioperative medicine', a Senior Staff Specialist Anaesthetist Clinician at the John Hunter Hospital, Newcastle, Australia and Associate Professor at the University of Newcastle. Join in the conversation as he, Desiree Chappell, Monty Mythen and Mike Grocott consider the future of one of the world's most important medical conferences.

Finally, make sure you listen in for exclusive details on the Chicago meeting!

"Data is destiny"; this piece looks at way we can unlock it for Anesthetists. The Open-Source Anesthesia Electronic Medical Record (OSAEMR) was developed specifically for Nurse Anesthetists. Its focus is on solo or small-practice nurse anesthetists operating in environments with limited or no network and computing resources other than an iPad. One patient, one nurse anesthetist, and one iPad. It can now be scaled to larger multi-provider practices outside of CRNAs. Hear how this innovation came about.

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 Open-Source Anesthesia Electronic Medical Record (OSAEMR) website is here: https://www.osaemr.com/

Presented by Monty Mythen and Desiree Chappell with John T. "Jack" Hitchens, CRNA, BA, ARNP, partner in a CRNA owned and operated Anesthesia Practice, Watchful Care and Dan Simonson, CRNA, MHPA retired as Chief CRNA and managing partner of the Spokane Eye Surgery Center, adjunct faculty at the Washington State University College of Nursing's Department of Health Policy and Administration.

"We believe these results are applicable to a very broad population"

Focusing on a study of over 6,000 patients, this hugely important piece attempts to finally move forward discussion regarding the long term consequences of deep anaesthesia?

There is no difference in the survival rate of patients who have had a "deep level" of anaesthesia, which is still strictly within the bounds of normal clinical practice. Could this research lead to us using less anaesthesia overall and improving our environmental impact?

The paper being discussed, "Anaesthetic depth and complications after major surgery: an international, randomised controlled trial" is here:

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(19)32315-3.pdf

We discuss the RELIEF trial briefly, if you want more on that go here: https://www.topmedtalk.com/ebpom-highlight-1-30-visiting-professor-plenary-lecturer-results-of-the-relief-trial/

We also discuss the work of Dan Sessler, who we interviewed here: https://www.topmedtalk.com/topmedtalks-to-dan-sessler-2/

A fuller look into The Clinical Trials Network is here: https://www.topmedtalk.com/anaesthesia-2019-the-clinical-trials-network-and-optimising-shared-decision-making/

Presented by Desiree Chappell and Monty Mythen with their guests Kate Leslie, Honorary Professor, Monash University, Melbourne, VIC, Australia, Specialist Anaesthetist, The Royal Melbourne Hospital & North Western Mental Health and Non-Executive Director, Australian Medical Council and Timothy Short, Clinical Anaesthetist and Honorary Professor at Auckland University Hospital, New Zealand.

"The NHS is composed by about 20% of non-white individuals"

This piece takes a data driven look at a controversial area, how well informed are we about the risks associated with the coronavirus behind this unprecedented global pandemic?

"The background issues of gender and ethnicity may out weigh the issues related to comorbidities" but, in terms of data, "it's a moving target".

There have been theories regarding vitamin D absorption, genetics and other hypotheses but in this piece we also ask if this data is driven by social factors and other issues which most prefer to ignore.

The bottom line, in terms of safety; "age trumps everything" but, for reasons we are not clear on, "being non white is an important risk factor".

Also in this piece, "if you had an antibody test and it came back positive, would your attitude to returning to work change?"

We frequently mention this paper here: https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1

The COVID 19 information hub mentioned is here: https://icmanaesthesiacovid-19.org/

The Health Service Journal is here: https://www.hsj.co.uk/

Our guest is also a prolific Twitter user here, https://twitter.com/doctimcook

He contributed to this excellent article here "Exclusive: deaths of NHS staff from covid-19 analysed" : https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

Presented by Desiree Chappell with Monty Mythen and their guests, Mike Grocott Professor of Anaesthesia and critical care at the University of Southampton and Tim Cook, Consultant in Anaesthesia and ICM, Royal United Hospitals, Bath.

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EBPOM "Live from London" - the hottest tickets in anaesthesia and perioperative medicine - go now to the website: https://www.ebpom.org/EBPOM2020

How can we learn more by seeing more? This fascinating piece looks at how learning and the zone of proximal development (ZPD) of a student can be used to help the process. We are learning about learning, thanks partly to the use of algorithms that monitor our progress and performance. This talk asks challenging questions; "In terms of performance, just think technical procedures at the moment, is there such a thing as an 'expert performance' of any of the techniques we do daily"? How do we get training to produce clinically meaningful performances?

The articles mentioned in this piece are here:

"Looking and seeing" by Roger Kneebone: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(19)30507-0.pdf

"Machine Learning Identification of Surgical and Operative Factors Associated With Surgical Expertise in Virtual Reality Simulation", published by The Journal of the American Medical Association (JAMA) is here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2740782

And, "Proficiency-based progression training: an 'end to end' model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study" is here: https://bmjopen.bmj.com/content/8/10/e020099

This talk, originally titled "Recent research articles in medical education", presented by George Shorten, Professor, Anaesthesiology and Intensive Care Medicine and Consultant Anaesthesiologist at Cork University Hospital, at last year's "21st Current Controversies in Anaesthesia & Peri-Operative Medicine and SIAA Autumn Congress" at the Dingle Skellig Hotel, Ireland.

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EBPOM "Live from London" - the hottest tickets in anaesthesia and perioperative medicine - go now to the website: https://www.ebpom.org/EBPOM2020

Evidence Based Perioperative Medicine (EBPOM) is the reason TopMedTalk exists; the vast majority of the content we love everyday comes from conferences organised by this important global initiative designed to promote high value perioperative practice around the world. Here on TopMedTalk, as you have heard, we immediately reacted as firmly as we could to the news of the novel coronavirus COVID 19. However we realised our dreams of a conference that truely moves the debate forward on perioperative medicine had to change shape slightly, after much consideration we think we might have constructed an ideal alternative.

EBPOM Live From London is here!

To help us promote this exiting new virtual conference we are joined by Lee Fleisher - who will be part of this year's incredible event - Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania. Hear how EBPOM has revolutionised the way thought leaders integrate and approach the principles of perioperative medicine into the wider world of medicine, psychology and politics.

Discover the piece our guest mentions, "The Contagion We Can Control" here: https://hbr.org/2020/03/the-contagion-we-can-control

We mention this piece "Normalizing High-Value Care: Findings of the National Quality Task Force", here: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0063

EBPOM 2020 – Live from London – is on!

For those who have listened to Desiree's special announcement go now to: https://ebpom.org/EBPOM2020

How does an experienced physician, health service changer, improver and researcher see the process of re-engineering perioperative care pathways? What are the challenges we face when we try to rework or improve the culture of an institution? How do we tackle common issues, which nowadays seem less acceptable, such as delirium?

This piece is part of a series of talks regarding "re-engineering perioperative care pathways" which were given during 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

Presented by Professor Alison Mudge, Conjoint Professor of Medicine, Royal Brisbane Clinical Unit, Faculty of Medicine.