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Science & Medicine
**TopMedTalk**

TopMedTalk for the latest medical news surrounding Anaesthesia, Perioperative Care and Enhanced Recovery. Live updates from conferences; Journal Club; Techno Talk and Hot-Topic podcasts. Continuing Medical Education (CME) on the go

Latest Episodes:

EBPOM London 2020 | Functional Assesment Feb 21, 2021

Show notes

"Perhaps assessing functional performance is something that we've overlooked in medicine"

This piece is about the role of functional assessment and status in perioperative medicine.

The Duke Activity Status Index (DASI) can be found here: https://www.mdcalc.com/duke-activity-status-index-dasi

The Mini Cog assessment is here: http://mini-cog.com/wp-content/uploads/2015/12/Mini-Cog-Form-010816.pdf

The video resources mentioned in the piece are here: https://www.youtube.com/channel/UCvOamR8Sb4RXENr56fvRehA/featured

Presented by Daniel Conway, Consultant in Anaesthesia and Critical Care, Group Lead for Perioperative Medicine, Manchester Royal Infirmary, UK and Chair of the Manchester Perioperative Medicine Society.

Essential COVID knowledge: Dr. Manuel Ignacio Monge García | COVID 19 Feb 20, 2021

Show notes

This piece digs deep into the realities of coping with COVID 19 patients who have had their care escalated to the Intensive Care Unit (ICU); "we don't seem to be looking at our typical sepsis patients who get multiple organ failure in the classical way" and "you're surprised at how young some of the patients are...".

Our guest provides us further insight; a 'household name' in the haemodynamic monitoring space; he is treating patients in a medium sized hospital (500 beds) with mostly COVID patients in Spain. How are things going there, how does it compare to Italy? How are the patients being dealt with, what can we learn about the basics here, airway, breathing, ventilation (ABC)?

There is also a gripping discussion regarding dynamic arterial elastance. If you'd like to know more about that do check out our discussion here: https://www.topmedtalk.com/periop-coach-2-09-haemodynamic-monitoring/

The webinar mentioned in this piece can be found here: https://www.esicm.org/education/webinars/

Presented by Desiree Chappell and Monty Mythen with their guest Dr. Manuel Ignacio Monge García who works in an ICU in the South of Spain.

New treatments for Post Operative Nausea and Vomiting | TopMedTalk Feb 19, 2021

Show notes

This piece gives us a look at some of the latest thinking on Post Operative Nausea and Vomiting (PONV). It includes a discussion about Amisulpride and discusses new, yet to be published, consensus guidelines for PONV.

The original guidelines are here: https://www.ncbi.nlm.nih.gov/pubmed/24356162

Also, you may like to check out the details of this paper here: Amisulpride: A New Dopamine Antagonist for Treatment of Postoperative Nausea and Vomiting https://www.ncbi.nlm.nih.gov/pubmed/31094771

Presented by Desiree Chappell and Monty Mythen with their guest Tong Joo (TJ) Gan, Professor and Chairman at Stoney Brook in New York.

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Like this, want more?

Check out TJ Gan's masterful presentation "EBPOM USA Part 5| Practical realities; How and why multimodal Analgesia matters" here: https://www.topmedtalk.com/ebpom-usa-part-5-a-perioperative-practicum-with-tj-gan/

Practical tips for preoperative risk assessment | EBPOM Ireland 2020 Feb 18, 2021

Show notes

"Some practical tips you can take away and implement in your hospital..."

In the UK there is a legal imperative to minimalise and individualise risk now but it's widely understood to be helpful if you want to provide better value and patient outcomes. How can risks be identified and minimised? How can these risks then help to provide better quality shared decision making? How can plan a perioperative pathway tailored to these needs?

Presented by Ramani Moonsinghe, Professor of Perioperative Medicine at University College London (UCL).

IMPORTANT NOTE: We discuss "The Montgomery Case" in more detail here; this piece is very relevant to you and your patients, legally speaking, if you work in the UK: https://www.topmedtalk.com/sunday-special-being-on-the-right-side-of-the-law-2

Critical care for the very elderly patient | EBPOM Ireland Highlight Feb 17, 2021

Show notes

"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 Dr Brian Marsh, Anaesthesia, Critical Care Medicine, Extracorporeal Life Support, The Mater Hospital, Dublin.

Brain Health: Frailty, Delirium and Post-operative cognitive dysfunction Part 2 | Chicago 2020 Feb 16, 2021

Show notes

This piece gets deep into a much needed discussion regarding frailty, delirium, post-operative cognitive dysfunction and brain health. Noted as one of the highlights of the year in our recent holiday specials and previously only available to attendees to the incredibly successful EBPOM Chicago 2020; go to www.ebpom.org now for more details on forthcoming events and special offers now. This piece is part two of two.

This piece gets a mention "End of life decision planning in the perioperative setting: the elephant in the room?" https://academic.oup.com/bja/article/115/5/648/230412?login=true

The Global Council on Brain Health is here on the American Association of Retired People's website: https://www.aarp.org/health/brain-health/global-council-on-brain-health/

This is part one of a two part piece, part two features questions from the online conference audience.

Presented by Monty Mythen with Angela Bader, Professor of Anesthesia at Harvard Medical School and Vice Chair for Perioperative Medicine in the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women's Hospital, founding Director of the Weiner Center for Preoperative Evaluation, Sarah Lenz Lock, Senior Vice President for Policy and Brain Health in the American Association of Retired People's (AARP) Policy, Research and International Affairs (PRI), Executive Director of the Global Council on Brain Health, Jeanna Blitz associate professor of Anesthesiology at Duke University School of Medicine, Director of the Preoperative Anesthesia Surgical Screening (PASS) Clinic. There's also a surprise appearance from the EBPOM Chicago 2020 host, Sol Aronson, tenured Professor at Duke University.

Brain Health: Frailty, Delirium and Post-operative cognitive dysfunction Part 1 | EBPOM USA - Chicago 2020 Feb 15, 2021

Show notes

This piece gets a mention "End of life decision planning in the perioperative setting: the elephant in the room?" https://academic.oup.com/bja/article/115/5/648/230412?login=true

The Global Council on Brain Health is here on the American Association of Retired People's website: https://www.aarp.org/health/brain-health/global-council-on-brain-health/

This is part one of a two part piece, part two features questions from the online conference audience.

Perioperative Quality Initiative P.O.Q.I. news | ASA 2019 Feb 14, 2021

Show notes

"It might just be 'boring old blood pressure ... (but) ... 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/

Somnia Anesthesia Services | TopMedTalk Feb 13, 2021

Show notes

"We're so invested in outcomes and data that it really gives us an objective view on how to approach things"

This wide ranging conversation looks at how a data driven approach to change can produce better results in terms of patient outcomes. How do you highlight those opportunities with tact and clarity? How do we start to reward and recognise the best care that the evidence supports?

We also hear more about Evidence Based Perioperative Medicine (EBPOM) in 2021; for more on the opportunities mentioned in this piece please go to www.ebpom.org

Also, if you're aligned with the great nation of Wales or you love perioperative medicine, you'll be delighted to hear about the Welsh Perioperative Medicine Society:

Their Twitter is here: https://twitter.com/pomswelsh

Their Facebook page is here: https://www.facebook.com /PomsWelsh/

And their excellent website is here: https://www.welshpoms.com/

Presented by Desiree Chappell and Monty Mythen with Marc Koch, President and CEO of Somnia Anesthesia and Shelley Sharma, Acute Pain service line Director for Somni Anesthesia.

Can medicine be cured? | EBPOM Ireland Highlight Feb 12, 2021

Show notes

Warning; this piece may make for uncomfortable listening. It is a fascinating look at the recent history of medicine and how our profession may in fact be sick. Contained within the story is a message of hope; evidence may contain the cure.

In our recent history we seem to have enjoyed something of a "Golden Age" of medicine which, by raising quality of life so dramatically, has transformed our understanding of concepts such as "public health" and even "standard of living". However, running alongside that is an industry and society that is primarily interested in business and profit above evidence and health. Has the industry which built up around our profession during the 'Golden Age' now become a parasite which weakens its host to the point of near exhaustion?

After a concise critique of the current culture of research this talk asks why we are wasting time on research that is not reliable, not useful and does not impact care. Could it be that market forces have strangely made us less efficient? Evidence based medicine is the way forward but can we overcome the inherent bias behind the fact that often big business funds the evidence gathering and its publication?

Some assumed the period of rapid development, which included discovering the DNA helix, successful organ transplant and vaccinations, would soon inevitably be followed by equally epoch transforming breakthroughs, others are less optimistic. Are genomics and big data more often 'science' than medicine? Is "digital health" "simply one part of what has now been called surveillance capitalism"?

This challenging but ultimately hopeful and inspirational talk was given at the EBPOM Dingle conference 2019, please share it to as wide an audience of your peers as you can to help make this important and healing conversation happen.

Presented by Seamus O'Mahony, Consultant Gastroenterologist at Cork University Hospital, associate editor for medical humanities of the Journal of the Royal College of Physicians of Edinburgh and is a regular contributor to the Dublin Review of Books.

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