TopMedTalk

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Why are you short of breath? Apr 21, 2018

Show notes

When it comes to breathlessness how do we better diagnose and apply treatment earlier? How do we overcome the fact that referring to a specialist can sometimes take a patient 'down the wrong route' with a condition that might not be just heart or lung related?

Ronan Astin, clinical consultant in respiratory medicine at UCL Hospital, explains his more holistic approach to treatment and diagnosis.

"Nick the patient" asks a few questions and demonstrates the misunderstanding that many sufferers might have; breathlessness is not of course always connected to your lungs.

"Johnny the patient" then speaks about his Mother, 84, who has recently experienced breathlessness, she didn't want to complain about it, how can we pick these issues up earlier?

Dan Martin, anaesthetist at The Royal Free Hospital, speaks about his processes including the cardiopulmonary exercise testing they use. Testing patients, during a session on an exercise bike, reveals physiological and pathological causes but furthermore it can reveal the psychological issues which may be behind the problem.

This podcast is presented by Professor Monty Mythen and features contributions from; Ronan Astin, clinical consultant in respiratory medicine at UCL Hospital; Dan Martin, anaesthetist at the Royal Free Hospital and finally 'the patients' Nick Margerrison and Johnny Themans.

Journal Club Express - Postoperative delirium in total knee and hip arthroplasty patients Apr 20, 2018

Show notes

Professor Monty Mythen presents Journal Club Express.

Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors

DOI: 10.1016/j.bja.2017.12.046

S. M. Weinstein et al. Br J Anaesth 2018; 120(5): 999-1008

This is an American single center retrospective study with 41,766 patients undergoing hip and knee arthroplasties over a seven year period. They showed that 22.1% patients developed post operative delirium according to the ICD 9 definition of delirium. Delirium occurs more in patients with multiple co-morbidities, older age, higher baseline creatinine, lower haemoglobins and longer patients stays.

They looked at the type of anaesthetic as well as the use of opioids, ketamine and benzodiazepines. They found the rates of delirium were higher in the knee arthroplasty group compared with the hip arthroplasty group.

Those that received a neuroaxial block had a lower rate of delirium; Spinal: OR 0.55 (CI 0.37-0.83), Epidural: OR 0.59 (CI 0.38-0.93), CSE: OR0.56 (CI 0.40-0.80). There was a high risk with the use of postoperative benzodiazepines (OR 2.47 CI 2.04-2.97) and ketamine infusion ()R 10.59 CI 5.26-19.91) as well as intraoperative ketamine (OR 1.27 CI 1.01-1.59) and opioids (OR 10.59 CI 5.26-19.91).

Sleep disorders in surgical patients, EBPOM USA Apr 20, 2018

Show notes

This podcast concerns sleep apnea as part of pre-operative patient optimisation. How important is it to evaluate patients for sleep disorders before surgery? Are patients with sleep apnea aware of their condition and are they using some form of treatment? What are the health problems associated with sleep disorders? How do you build a financial case for including this in your practice?

A piece originally streamed live from Atlanta Georgia during TopMedTalk's coverage of "EBPOM-USA Masters Course, A Perioperative Care Practicum".

Featuring hosts Desiree Chappell and Vicki Morton interviewing Dr Andrew R. Spector, Neurologist, Sleep Medicine Specialist at Duke Health.

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Psychological optimisation, EBPOM USA Apr 20, 2018

Show notes

Originally streamed live from Atlanta Georgia during TopMedTalk's coverage of "EBPOM-USA Masters Course, A Perioperative Care Practicum" this podcast includes discussion about psychological optimisation for surgery; who should have it, what does it mean and how does it work? Further conversation moves into weaning patients off opioids in advance of surgery and cutting their dependency afterwards. Also, the question of consent to opioids during and after surgery comes up - should we be educating patients more and is it time to look more deeply at the issue of consent?

Hosted by Desiree Chappell and Vicki Morton featuring Dr. Padma Gulur, anesthesiologist and a Pain Medicine Specialist who sees patients at Davis Ambulatory Surgical Center, Duke Pain Medicine and Duke Perioperative Pain Care.

Join us on www.topmedtalk.com sign up for our email updates and never miss a live streamed conference again.

The importance of what you eat and what you do, EBPOM USA Apr 18, 2018

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The importance of exercise, weight and perioperative nutrition. Which is worse, being fat or not being fit? Malnutrition, a silent epidemic? How useful are protein shakes? Are supervised exercise sessions cost effective?

Finally the team discuss the importance of starting these conversations with children, optimising nutrition and exercise for them will enhance their lives forever.

Hosted by Monty Mythen and Mike Grocott with their guests; Dr Denny Levett, consultant in Perioperative Medicine and Critical Care at Southampton University Hospital NHS Foundation trust, and Dr Paul Wischmeyer Professor of Anaesthesiology and Surgery at Duke Anesthesiology.

Journal Club The FEDORA trial Apr 15, 2018

Show notes

Professor Monty Mythen's full presentation regarding 'the FEDORA trial'.

This piece was originally presented during the Third Annual Quality Improvement Leadership Forum, 2018, at the Union League Club in Philidelphia.

The trial looked at the effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial).

Randomised Controlled Multicentre trial; n=420; GDHT vs Control

Conclusions:

"Oesophageal Doppler monitor-guided GDHT reduced postoperative complications and hospital length of stay in low–moderate risk patients undergoing intermediate risk surgery, with no difference in mortality at 180 days."

Click here for full text.

http://bjanaesthesia.org/article/S0007-0912(17)54207-5/fulltext

If you are using this article to earn your CPD points please now, having listened, click here:

http://pmp.ocbmedia.com/podcasts/journal-club-the-fedora-trial/

Day 3 EBPOM USA with Monty Mythen and Desiree Chappell Apr 15, 2018

Show notes

Join Desiree and Monty as they reflect on the EBPOM USA weekend so far and look ahead to what remains.

Also - a reminder that you still have chance to hear the conference presentations live from the www.topmedtalk.com website. Go there now to get details, it's free and has proven to be incredibly popular around the world!

Dealing with policy and value based care, The Roundtable Blog Apr 14, 2018

Show notes

A fascinating discussion and debate regarding the central dichotomy inherent in periperative medicine. No stone is left unturned as the team get their teeth into the subject tackling the always tricky subject of profit and patient optimisation.

Recorded on the first day of the conference this piece is a real stand out moment for TopMedTalk, make sure you both listen in and provide us with your thoughts contact@topmedtalk.com

Featuring Desiree Chappell, Monty Mythen, Dr Lee A. Fleisher Chair of Anesthesiology and Critical Care (University of Pennsylvania) and Vicki Morton DNP and Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates University of South Carolina.

Remember, TopMedTalk are live streaming the conference for free, exclusively for listeners to the podcast. Go now to www.topmedtalk.com

TopMed talk live from EBPOM USA Apr 14, 2018

Show notes

Originally streamed live from the EBPOM USA conference. Desiree Chappell, Monty Mythen, Dr Tim Miller (anaestheseologist at Duke University) and Dr Angela Edwards (head of perioperative medicine at Wake Forest University School of Medicine) discuss some of the presentations and their personal highlights.

Join in the conversation, email us at contact@topmedtalk.com

The Roundtable blog live from EBPOM USA Apr 14, 2018

Show notes

A fascinating conversation, streamed live from EBPOM-USA on the second day of the conference.

Reflections on the conference alongside insightful discussions about how the contributors have each been attracted to perioperative medicine. Also, the perennial debate about patient care and profits, are the two factors in conflict?

Featuring Desiree Chappell host of The Roundtable Blog, Dr Brian Woods anesthesiologist and Vice President at NorthStar Anesthesia, Irving Ye Regional Chief medical officer for NorthStar Anesthesia and Elena Koepke Perioperative Medicine Fellow at Duke University.

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