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Geriatric care and the value of teamwork | The RoundTable Mar 05, 2019

Show notes

How do we best negotiate working in a multidisciplinary team? Generalisations regarding surgeons and anaesthetists only ever work generally, the specifics of each practitioner and their priorities inevitably contrast. How do we keep sight of these broad differences without falling foul of stereotypes?

The conversation evolves; how does the surgical journey fully utilise the team based perioperative approach? With specific focus on geriatric care there is further discussion regarding shared decision making, something which has been part of that discipline for many years.

The debate regarding when a patient becomes geriatric is explored. Is it age which defines that or do symptoms and comorbidities qualify the term?

Recorded on the first day of the Royal College of Anaesthetists' annual conference at The British Museum.

Desiree Chappell and Monty Mythen interview their guests Professor Jenifer Weller, Head of the Centre for Medical and Health Sciences Education, University of Auckland and Dr Jugdeep Dhesi, Clinical Lead, POPS and Consultant Geriatrician, Guys and St Thomas' NHS Trust.

Assessing the risk of delirium | Perioperative Coach Mar 04, 2019

Show notes

What can practitioners do to preoperatively screen for signs that their patients may have issues with post operative delirium? How do we get patients fit for surgery, particularly as regards delirium? Can you build up mental resilience in the run up to an operation, do suggestions that puzzles and mental activity such as sudoku and a good crossword help have any evidence behind them? This piece features Monty Mythen and Desiree Chappell in conversation with Dan Cole, professor of clinical anesthesiology at the David Geffen School of Medicine, University of California, Los Angeles and former president of the American Society of Anesthesiologists (ASA).

Nasogastric feeding | Sunday Special Mar 03, 2019

Show notes

How is it the case that some people can lose significant muscle mass while they are being cared for on the Intensive Care Unit (ICU)? What can practitioners do to help avoid this? How do we integrate a dynamic stimulus and react to new research relating to nasogastric feeding? In this piece you will hear about a randomised controlled pilot study investigating the effect of intermittent versus continuous nasogastric feeding on muscle mass and function in intensive care unit survivors. Hugh Montgomery presents with his guest, Dr Angela McNelly, clinical researcher at the ISEH and the UCL Centre for Human Health and Performance.

Mike Swart | TopMedTalks to... Mar 02, 2019

Show notes

How do you become well known in the NHS for being innovative, particularly in the perioperative area regarding evaluation and communication of risk? How can cardiopulmonary exercise testing lead to shared decision making? Hear how aortic aneurysms are dealt with by a world class professional perioperative physician. Learn how that process and its success then spread out into other areas of healthcare within his institution. Do you need to develop a broad knowledge of all surgery and medicine so that you understand what is going on within the different surgical specialities? Following this discussion is had about the GIRFT (Getting It Right First Time) project. The stated aim is 'to help improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes'. This piece gives you the detail from one of the joint clinical leads. Presented by Monty Mythen, Joff Lacey and Desiree Chappell with their guest Dr Michael Swart, Consultant in Anaesthesia and Critical Care Medicine at Torbay Hospital and advisor to the UK Department of Health for the Enhanced Recovery Programme.

POET 2.02 | Overcoming the behaviour gap Mar 01, 2019

Show notes

The gap between ambition and action is familiar to us all but when it's potentially a matter of life and death how do we overcome it? This piece gives you a sense of both the research which illustrates the 'behaviour gap' in patients who are attempting to make good on their promise to regularly exercise. Presented by Chloe Grimmett, behavioural scientist from Southampton University. She works closely alongside the 'Fit for Surgery Team', providing the behavioural intervention which is part of the on-going WesFit prehabilitation trial. Originally streamed live on www.topmedtalk.com from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 the fuller version of this talk is here: "POETTS 2018 | Psychological Behavioural Change Interventions in Cancer Patients" https://www.topmedtalk.com/poetts-2018-psychological-behavioural-change-interventions-in-cancer-patients/

Various Journals: ACE, ARBs and Asprin | Journal Club Feb 28, 2019

Show notes

Interesting thoughts on the use of ACE inhibitors and ARBs, alongside considerations regarding asprin. We look at the following papers: Anesthesia and Analgesia: A Systematic Review of Outcomes Associated With Withholding or Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers Before Noncardiac Surgery. https://www.ncbi.nlm.nih.gov/pubmed/29381513 Anesthesia and Analgesia: A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury After Noncardiac Surgery: Results of the VISION Study

https://journals.lww.com/anesthesia-analgesia/FullText/2018/06000/A_Prospective_International_Multicentre_Cohort.25.aspx

Gynecologic Oncology: Use of paracetamol, low-dose aspirin, or non-aspirin non-steroidal anti-inflammatory drugs and risk of ovarian borderline tumors in Denmark.

https://www.ncbi.nlm.nih.gov/pubmed/30249529

JAMA Surgery: Association of Aspirin With Prevention of Venous Thromboembolism in Patients After Total Knee Arthroplasty Compared With Other Anticoagulants: A Noninferiority Analysis.

https://www.ncbi.nlm.nih.gov/pubmed/30347089

Presented by Desiree Chappell with Monty Mythen and their guests Barbara Slawski, Professor of Medicine and Orthopaedic Surgery; Chief, Section of Perioperative and Consultative Medicine; Froedtert and Medical College of Wisconsin and Steven L. Cohn, Professor Emeritus, Director – Medical Consultation Service, Jackson Memorial Hospital University of Miami Miller School of Medicine.

Do you have your ticket to the Dallas Master's Course being organised in March by EBPOM USA yet?

Find out more here: https://www.ebpom.org/EBPOM-USA-2019

As a TopMedTalk subscriber you can get a 20% discount for 1 person, or a 50% discount for a team. Just use the promo code "DAL 20" if you're solo or "EDAL 50" if you're coming as a group.

EBPOM Highlight 1.12 | Perioperative nutrition should be a key part of Enhanced Recovery Feb 27, 2019

Show notes

"Perioperative nutrition should be a key part of Enhanced Recovery" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 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: contact@topmedtalk.com

Presented by Paul Wischmeyer, Professor of the Department of Anesthesiology, Duke University.

Treating anemia in the perioperative process | The RoundTable Feb 26, 2019

Show notes

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.

ERAS what's the 'secret sauce'? | Perioperative Coach Feb 25, 2019

Show notes

This piece starts with the question: Is there a hierarchy amongst the various elements of an enhanced recovery pathway? The conversation that follows tackles some of the essential elements of perioperative care.

This conversation is taken from a longer piece to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-2/

For further expert discussion regarding the Drink, Eat, Mobilise, Sleep (DrEaMS) concept there is another short piece you can find here: https://www.topmedtalk.com/standardised-outcomes-from-surgery-drink-eat-mobilise-dream/

This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum.

The conversation features questioner Dr Vishal Patil, Consultant Anaesthetist at Cambridge University Hospitals NHS Foundation Trust, alongside Professor Monty Mythen and his two guests; Dr Simeon West, consultant anaethetist at (University College London Hospitals) UCLH who sits on the board at Regional Anaesthesia UK (RAUK) and Mark Harper Consultant Anaesthetist at Brighton and Sussex University Hospitals, with a research interest in the prevention of perioperative hypothermia and the use of cold water adaptation for thearaputic purposes.

Do you have your ticket to the Dallas Master's Course being organised in March by EBPOM USA yet?

Find out more here: https://www.ebpom.org/EBPOM-USA-2019

As a TopMedTalk subscriber you can get a 20% discount for 1 person, or a 50% discount for a team. Just use the promo code "DAL 20" if you're solo or "EDAL 50" if you're coming as a group.

Part 2 of TRIPOM USA | Sunday Special Feb 24, 2019

Show notes

Trainees with an interest in perioperative medicine (TRIPOM) is an ever growing organisation set to continue the global push for perioperative care. This high energy podcast gives you a taste of the enthusiasm people pick up as they learn more about the value of these ideas. Moving more obviously into the perioperative period this piece continues on from last week's talk regarding mitochondrial health where 'healthy ageing' was the focus. The panel now draw the conversation into areas such as nutrition, the impact of frailty on outcomes regarding surgery and patient assessment. How does this gripping research impact upon our work during the perioperative period? Presented by John Whittle, assistant Professor at Duke University Medical Centre and one of the founders of TRIPOM, with a panel including, Mike Grocott, Professor of Anaesthesia and critical care at the University of Southampton, Dr Brant Inman, Urologist at Duke University Medical Center, Dr Amy Pastva, immunologist, physiologist and researcher at Duke University School of Medicine, Dr Paul Wishmeyer, Professor of the Department of Anesthesiology, Duke University. -- Do you have your ticket to the Dallas Master's Course being organised in March by EBPOM USA yet? Find out more here: https://www.ebpom.org/EBPOM-USA-2019 As a TopMedTalk subscriber you can get a 20% discount for 1 person, or a 50% discount for a team. Just use the promo code "DAL 20" if you're solo or "EDAL 50" if you're coming as a group.

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