TopMedTalk

Everything you ever wanted to know about CPET (Cardio Pulmonary Exercise Testing) but were too afraid to ask; this conversation is a fascinating deep dive into the topic with two experts in the field. Discover how widely practiced this technique is across the UK, hear about the advantages people who use it have in terms of outcomes and patient safety. Also, what do institutions then do with the data and how does that increase our understanding of the human body?

Some of the UCL podcasts mentioned in the piece are available here:

Introduction to Cardio Pulmonary Exercise Testing - https://www.youtube.com/watch?v=U_0Gi0gozgU

Cardio Pulmonary Exercise Testing: Setup - https://www.youtube.com/watch?v=qW9KFo0kiMk

Check out their YouTube channel for more: https://www.youtube.com/channel/UC_NlyaSqWQngSCFF1LLHW8w

The POETTS website is here: https://poetts.co.uk/

Finally, our excellent Xtreme Everest podcast archive is here: https://www.topmedtalk.com/category/conferences/xtreme-everest/

Presented by Desiree Chappell with Monty Mythen and their guests Jeroen Molinger, Clinical Medical Exercise Physiologist at Duke University Medical Center, Department of Anesthesiology & ICU and John Whittle, assistant Professor at Duke University Medical Centre.

How does the treatment of anemia fit into the perioperative process? How far should patient optimisation extend to treatment of this condition?

Live from the hugely successful EBPOM USA conference, directly after their presentation Desiree Chappell talks with her guests; Dr Lori Heller, Cardiac Anesthesiologist, Swedish Medical Center, through US anaesthesia partners and acting instructor at the University of Washington, Seattle and Dr Bobbie Jean Sweitzer, Associate Professor and Director of pre-operative medicine at the University of Chicago.

Desiree and Monty catch up with Dan Martin, OBE, and speak with him about treating infectious diseases and in particular patients with ebola. Presented by Desiree Chappell and Monty Mythen with their guest Dan Martin, OBE anaesthetist and intensivist at the Royal Free Hospital and Reader at University College London (UCL).

This piece presents the prehabilitation 'business case'; why it's important to care about costs, how outcomes and value based care can help and why money has to be important in healthcare.

How do we convert health benefits and risk management into something which explains the financial bottom line?

Can we really argue that a process which appears, at the point of practice, to take more time, resources and involve a shorter length of stay for patients, is actually cheaper for institutions in the long run and better value for patients?

Is there in fact more than one 'business case' for a proper perioperative prehabilitation clinic at your practice?

The Fit 4 Surgery website (Netherlands) is here: http://fit4surgery.nl/

Presented by Stefan van Rooijen, surgical resident in Maxima Medical Center, The Netherlands, lecturer at the first Health Innovation School (Ministry of Health, Welfare and Sport and Reshape innovation), Surgical resident, Department of Surgery at Maxima Medical Center (ANIOS).

Discussion begins with a hugely successful Enhanced Recovery program at a large community hospital, continued improvements and service line expansion. Learn about both the advantages and the challenges of a perioperative practice here. Presented by Desiree Chappell and Monty Mythen with their guests Kim Duggan, Perioperative Surgical Home (PSH) - Enhanced Recovery After Surgery (ERAS) Manager, New Hanover Medical Centre and Robin Davis, Clinical Education Specialist II at New Hanover Regional Medical Center.

"Updates in cardiac devices, 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 focused upon transcatheter aortic valve implantation (TAVI) devices. "A balloon valvular plasti in comparison to a TAVI is 90% of the risk, 10% of the gain" you're trading one problem with another, argues our speaker.

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

Presented by Dr Karl Poon, TAVI specialist at St Andrews War Memorial Hospital, Physician Proctor, Edwards LifeSciences, Senior Lecturer, University of Queensland Interventional cardiologist, The Prince Charles Hospital, Brisbane.

"Updates in cardiac devices, Part 1" 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 looks set to become 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 cardioverter defibrillators are discussed as are implantable cardiac monitors. There is also discussion regarding cardiac resynchronization therapy.

The TYRX™ Absorbable Antibacterial Envelope is here: https://www.medtronic.com/us-en/healthcare-professionals/products/cardiac-rhythm/infection-control.html

The CardioMEMS™ Heart Failure System: https://www.cardiovascular.abbott/us/en/hcp/products/heart-failure/cardiomems-hf-system.html

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

Presented by Dr Stephen Pavia, Cardiologist and Cardiac Electrophysiologist at The Wesley Hopsital.

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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

The opioid crisis "a unique American problem". This piece uncovers the origin of some of the misinformation about opioids, the consequences of calling pain a "fifth vital sign" and the absurd practice of waking patients up in the middle of the night to ask them if they are in any pain.

As these factors combined fatalities started to spiral into the crisis we see today. Recent statistics make for grim reading, in 2017 it was estimated over 47,000 Americans died from an opioid overdose. However action is now being taken; learn how The American Association of Nurse Anesthetists (AANA) has pushed forward with a sensible, responsible, pain management strategy which tackles the crisis head on.

Opioids are a last resort, many cases do not need them at all and a 30 day prescription to a highly addictive substance is something practitioners should never take lightly. Furthermore ensure patients are well informed, not 'opioid naive' and ideally do not have a family history of opioid dependence.

If you enjoyed this piece we have more on the topic here: https://www.topmedtalk.com/periop-coach-3-06-is-pain-the-fifth-vital-sign/

Also, if you've not yet heard Paul Wishmeyer's powerful take on this topic we highly reccomend you go here: https://www.topmedtalk.com/treating-patients-properly-ebpom-usa/

The Center For Disease Control's guidelines, mentioned in this piece, are here: https://www.cdc.gov/drugoverdose/prescribing/guideline.html

The PDF our guest mentions "The PAIN MANAGEMENT BEST PRACTICES INTER-AGENCY TASK FORCE REPORT" is here: https://www.hhs.gov/sites/default/files/pain-mgmt-best-practices-draft-final-report-05062019.pdf

This piece was part of our coverage of The AANA 2019 Annual Congress in Chicago, Illinois.

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

Presented by Monty Mythen and Desiree Chappell with their guest, Bruce Schoneboom, PhD, CRNA, FAAN, Associate Dean for Practice, Innovation and Leadership at Johns Hopkins School of Nursing.

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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 takes some time to reflect on where we're at in the UK - and wider Western World - with regard to civil liberties, human rights and the essentials of a functioning 'first world' country.

How important is social justice and human rights in a world where a global pandemic puts all that we hold dear at risk?

The Liberty website is here: https://www.libertyhumanrights.org.uk/

For more information on the UK Government's plan to track and trace British subjects via a mobile phone app The Guardian covers the piece here: https://www.theguardian.com/world/2020/may/27/government-unveils-covid-19-test-and-trace-strategy-for-england

The UK Government website - at the time of publication - has this to offer: https://www.gov.uk/guidance/nhs-test-and-trace-how-it-works#the-nhs-coronavirus-app

If you'd like to hear Martin's talk, about the Grenfell Inquiry, it was recorded exclusively on TopMedTalk last year, please go here: https://www.topmedtalk.com/topmedtalk-the-grenfell-inquiry/

Presented by Desiree Chappell with Nick Margerrison and Martin Howe of Howe and Co, a human rights law firm. He is a recipient of the Ross McWhirter Award for his campaigning work and twice has been a runner up for the Human Rights Practitioner of the Year Award. Furthermore, as a member of the Gurkha Justice Campaign, Martin won the prestigious Human Rights Award from Justice and Liberty in 2009.

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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 wide ranging talk asks where and how we should focus on the needs of postoperative care patients. "Brain care has an impact way beyond the acute surgical episode"; how do we minimise the risks of a poor outcome when it comes to postoperative care?

"Advanced recovery from anaesthesia and surgery" is 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.

Presented by Professor Jacqueline Close, Principal Research Fellow, NeuRA Conjoint Professor, UNSW Consultant Geriatrician, Prince of Wales Hospital.