TopMedTalk

Journal Club Express

2 articles in March 1st NEJM of circa 30,000 patients studied at Vanderbilt Medical Centre, USA One in non-critically ill patients. Click here: http://www.nejm.org/doi/full/10.1056/NEJMoa1711586?query=featured_home The other in critically ill adult patients: http://www.nejm.org/doi/full/10.1056/NEJMoa1711584?query=featured_home Accompanied by a very balanced Editorial by Professor John Myburgh. Click here: http://www.nejm.org/doi/full/10.1056/NEJMe1800449?query=recirc_curatedRela...

Are you screening surgical patients adequately for malnutrition?

Monty Mythen talks to Professor Paul Wischmeyer from the Department of Anesthesiology, Duke University, USA about the recently e.published American Society of Enhanced Recovery (ASER)  and Perioperative Quality Initiative (POQI) joint consensus statement on Nutrition and Screening Therapy within an Surgical Enhanced Program. --   Click on this link to access the full paper: https://journals.lww.com/anesthesia-analgesia/Abstract/publishahead/American_Society_for_Enhanced_Recovery_and...

The beauty of shared decision making?

A short digest of the longer chat from Desiree Chappell's "Round Table Blog", hosted at the American College of Perioperative Medicine's Interdisciplinary Conference on Orthopedic Value-Based Care.  Here Kevin Bozic, Chair of Surgery & Perioperative Care at the Dell Medical School and Professor Monty Mythen, London, UK discuss aspects of perioperative care with insightful additional comments from Eric Schneidewind, President of the AARP. -- The fuller version of this is here: https://w...

Lifesaving news; big data delivers shocking information regarding intraoperative blood pressure - Dan Sessler at the ASA 2017

A stunning moment from last year's conference, captured exclusively on TopMedTalk; Monty Mythen and Mike Grocott are joined by Dr Dan Sessler (Cleveland Clinic) and Dr Tim Miller (Duke University Medical Centre) exciting results from the first multicentre, randomised controlled trial into targeted intraoperative blood pressure management. Don't forget: 15th - 17th March 2018 ASER/EBPOM 2018 Annual Congress of Enhanced Recovery and Perioperative Medicine, register here: http://aserhq.org/20...

"A seminal moment in anaesthesia" - Julian Gore-Booth ASA 2017

Julian Gore-Booth, Chief Executive Officer at The World Federation of Societies of Anaesthesiologists, in an exclusive interview for TopMedTalk at last year's ASA. Here he reveals why we are at 'a seminal moment in anaesthesiology'. For the fuller interview look for "Live from Boston ASA 2017 - Anaesthesia and Global Health - an expert view" direct link here: http://topmedtalk.libsyn.com/monty-boston-pod-12

The singularity university and exponential change

The first round table discussion hosted by Desiree Chappell and featuring Monty Mythen, recorded on February the 9th, the first night of the Interdisciplinary Conference on Orthopedic Value-Based Care. This is the first segment of a fascinating 'round table discussion' between Desiree, Monty and their two guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in Irvine, California). Firstly ...

Pre-operative and post-operative rehabilitation

The first round table discussion hosted by Desiree Chappell and featuring Monty Mythen, recorded on February the 9th, the first night of the Interdisciplinary Conference on Orthopedic Value-Based Care.   This is the second segment of a fascinating 'round table discussion' between Desiree, Monty and their two guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in Irvine, California).   H...

Using new technology with elderly patients

The first round table discussion hosted by Desiree Chappell and featuring Monty Mythen; recorded on February the 9th, the opening night of the Interdisciplinary Conference on Orthopedic Value-Based Care.   Desiree, Monty and their two guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in Irvine, California) continue a discussion about using new technology with elderly patients. -- Don't...

Knowing your outcomes

The first round table discussion hosted by Desiree Chappell and featuring Monty Mythen, recorded on February the 9th, the first night of the Interdisciplinary Conference on Orthopedic Value-Based Care. This is the fourth segment of the conversation between Desiree, Monty and their two guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in Irvine, California). Here Monty speaks, from a t...

The magic of value based care

The first round table discussion hosted by Desiree Chappell and featuring Monty Mythen; recorded on February the 9th, the opening night of the Interdisciplinary Conference on Orthopedic Value-Based Care. This is the fifth segment of a fascinating 'round table discussion' between Desiree, Monty and their two guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in Irvine, California). Here Jen...

Patients are the experts in being patients

The penultimate part of the first round table discussion hosted by Desiree Chappell and featuring Monty Mythen; recorded on February the 9th, the opening night of the Interdisciplinary Conference on Orthopedic Value-Based Care. This is the final segment of a fascinating 'round table discussion' between Desiree, Monty and their two guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in Irvine,...

Perioperative care and the multidisciplinary approach

The final part of the first round table discussion hosted by Desiree Chappell and featuring Monty Mythen; recorded on February the 9th, the opening night of the Interdisciplinary Conference on Orthopedic Value-Based Care. Join Desiree, Monty and their two guests; Shawna Butler (RN, NBA who works with Singularity University in Exponential Medicine) and Jennifer Brandon (PT, MPT, Hoag Orthopedic Institute in Irvine, California) as they discuss perioperative care and the multi-disciplinary ap...

Zeev Kain, organiser of the American college of perioperative medicine interdisciplinary conference on orthopaedic value based care.

Desiree Chappell speaks with Zeev Kain, organiser of the American college of perioperative medicine interdisciplinary conference on orthopaedic value based care. Find his podcast here: http://drzeevkain.health/podcast/

The future of value based care.

Monty Mythen and Desiree Chappell of The Roundtable blog speak with Jan Vest, C.E.O of Signature Medical Group and Josh Luke, America's leading health-care futurist and writer of "EX-Acute, a former hospital CEO tells all on what's wrong with American healthcare".

Barriers and successes in value based care

Desiree Chappell from The Round Table blog speaks with Dr. Jay Pond and Allan Beck Chief Executive Officer of the Baylor Orthopedic and Spine Hospital at Arlington.

Value based care at the Baylor Orthopedic and Spine Hospital, Arlington.

Desiree Chappell catches up with John Boudreaux and Phillip Gallegos from the Baylor Orthopedic and Spine Hospital, Arlington. They discuss improving patient outcomes and their approach to value based care.

Utilization of pre-op management and pre-habilitation.

Desiree Chappelle of The Round Table perioperative care blog and our very own Monty Mythen are joined by Linda Russell. Linda is a national expert in the area of perioperative Management of Orthopedic Patients. Over the past 5 years she created a division responsible for the preoperative assessment and postoperative care of approximately 16,000 patients who have Orthopedic surgery and are admitted to the famed HSS.

Rehabilitation: exercise is real medicine

Steve Flanagan, Brian Stewart and Colleen Walsh join Desiree Chappelle and Monty Mythen on TopMedTalk in association with The Round Table Perioperative Care Blog. The team discuss physical medicine and rehabilitation, applying a team approach in care and 'pre and post-habilitation'.

Don't ask patients 'what is the matter' ask them what matters?

Desiree Chappell of The Roundtable blog, with Monty Mythen of TopMedTalk discuss outcomes and patient care, what matters the most? They are joined by two of the guest speakers from the American College of Perioperative Medicine's 2018 conference; Eric J Schneidewind and Kevin Bozic.

Should you have to lose weight before you get a new knee?

Should you have to lose weight before you get a new knee. A short sampler from Desiree's round table discussion with TopMedTalk.

Today at value based orthopedic care 2018

Professor Monty Mythen and the TopMedTalk team have just arrived in Southern California to join Desiree Chappell for the American College of Perioperative Medicine's Interdisciplinary Conference on Orthopedic Value-Based Care (visit here: https://www.transcend.health). TopMedTalk partners with The Round Table (visit here: http://www.enhancedrecoveryblog.org) to deliver quality guest interviews and discussions between researchers and practicioners of perioperative medicine with a focus on E...

Should more surgery be postponed the USA to better prepare patients?

Bowel prep for ERAS? President of ASER live from Washington DC meeting 2017.

Bowel prep has moved on and become “less harmful”, patient satisfaction is now part of the process, it wasn’t always previously. How is surgical site infection balanced with patient comfort?   Sponsored by EBPOM and EDWARDS life sciences.   This is a piece from the first ever pilot episode of TopMedTalk; Monty couldn’t make it to ASER that year so worked with some friends to pick up on the big stories, Dr Joff Lacey here speaks with their guest Dr Julie Thacker, the then president...

Post-operative Frailty. Fay Gilder Live from American Society of Anesthesiology, Boston 2017 (1min 24 sec)

Presidential visit to the Ether Dome at Massachusett's General Hospital in Boston

Joff Lacey joins Dr Liam Brennan (President, Royal College of Anaesthestists) and Dr Andy Bailey (Addenbrooke's Hospital, Cambridge) on a trip to the birthplace of anaesthesia - the Ether Dome.

Live from Boston ASA 2017 - The RELIEF Trial

The REstrictive Versus LIbEral Fluid Therapy in Major Abdominal Surgery: RELIEF Study (RELIEF) is discussed. How much IV fluid should be used? Will a more restrictive approach be useful? The trial design is discussed, pre-trial surveying, how they went about setting it up and what protocols they followed. Will this trial put to bed the questions about liberal restricted fluid therapy? Can a trial ever be truly definitive? Presented by Monty Mythen, Mike Grocott and Joff Lacey, joined b...

Live from Boston ASA 2017 - Life at The Extremes - trials on Everest & adapting to hypoxia

A discussion about oxygen and the Xtreme Everest research studies into human adaptation to hypoxia. How does the human body adapt to extreme conditions, we assume it will inevitably cause damage but this is not always the case. How do people who have inherited a tolerance for low levels of oxygen manage? Monty Mythen, Mike Grocott and Joff Lacey are joined by special guest Dr Dan Martin OBE Consultant in Intensive Care and Everest summiteer.

Live from Boston ASA 2017 - Anaesthesia and Global Health - an expert view

Podcast 12: Guest presenter Dr Liam Brennan (President of the Royal College of Anaesthetists) is joined by Dr Gonzalo Barreiro (President of the World Federation of Societies of Anaesthesiologists, WFSA), Julian Gore-Booth (CEO of WFSA) and Dr Paul Clyburn (President of the Association of Anaesthetists of Great Britain and Ireland) to discuss the unmet global need for safe and accessible anaesthesia.

Live from Boston ASA 2017 - Perioperative Delirium

A discussion about the importance of screening and risk mitigation regarding cognitive dysfunction and delirium in the perioperative period. Monty Mythen and Mike Grocott are joined by their guests Dr Liam Brennan, President of the Royal College of Anaesthetists, and Dr Fay Gilder, Addenbrooke’s, Cambridge. Join the debate: [email protected]

Live from Boston ASA 2017 - Goal Directed Fluid Therapy - Increased Risk of Kidney Injury?

Podcast 10: Monty Mythen, Mike Grocott and Joff Lacey talk to Dr Tim Miller (Duke University Medical Centre) about a recent study investigating the impact of GDFT on postoperative acute kidney injury in the colorectal patient.

Live from Boston ASA 2017 - Physiological Principles of Goal Directed Fluid Therapy - fluid responsiveness, the stressed system and the glycocalyx

Joff Lacey talks to Dr Randall Dull (University of Illinois) to pick apart the physiological principles of intraoperative fluid resuscitation and the need to rethink our approach.

Live from Boston ASA 2017 - Enhanced Recovery and Protocolised Care in Cardiac Surgery

Podcast 8: Joff Lacey is joined by Dr Davinder Ramsingh (Loma Linda University) to discuss the application of ERAS in the cardiac surgical patient.

Live from Boston ASA 2017 - The Elephant In The Room - intraoperative hypotension

A discussion regarding the exciting results from the first multicentre, randomised controlled trial into targeted intraoperative blood pressure management. Monty Mythen and Mike Grocott are joined by their guests Dr Dan Sessler, Cleveland Clinic, and Dr Tim Miller, Duke University Medical Centre.

Live from Boston ASA 2017 - Intraoperative Goal Directed Fluid Therapy - where do we stand?

This podcast focuses on the changing role of goal directed fluid therapy in enhanced recovery programmes. There is discussion around the Perioperative Quality Initiative guidelines, assessment of risk and how this relates specifically to laparoscopic surgery. Updates on relevant trials and the importance of risk stratifying patients to ensure goal directed fluid therapy is used on those that stand to really benefit. Presented by Monty Mythen, Mike Grocott and Joff Lacey, who are joined b...

Live from Boston ASA 2017 - The Bigger Picture of Perioperative Medicine - the UK and USA perspective

This conversation explores the extended role of the anaesthetist, brought about partly by perioperative care but more widely because of societal changes. Practitioners face a dilemma; how do you best impact value based care, as a specialist, when multidisciplinary approaches are becoming essential? In the UK, The Royal College of Anaesthetists, are working on this very issue; find out how they are becoming part of conversations regarding public health and modifiable risk factors, as relate...

Live from Boston ASA 2017 - Perioperative Medicine in USA

Anaesthesiology has reached a moment of great change, the discipline is evolving rapidly. With change comes opportunity, this conversation explores the transitional situation experts, practitioners and students find themselves in, how can you best fit into the new world? Renumeration is one changing factor but so is the idea that prevention is a clear goal for people who would like to avoid being seen as patients. The transatlantic side of this debate is useful as a paradigm to think about...

Podcast 3: Live from Boston ASA 2017 – Perioperative Medicine and the Perioperative Surgical Home – are we talking the same language?

Discussion about the challenge of delivering patient-centred, value-driven healthcare. Value based care is discussed, value for the patient is emphasised and discussion is had about how much people trust hospitals and doctors. The difference between the perception of healthcare institutions and practitioners in UK and the US is debated.  Perioperative medicine, perioperative surgical home, enhanced recovery after surgery (ERAS); the terms differ but are they all really the same thing? ...

Podcast 2: Live from Boston ASA 2017 - The big challenge of big trials

The challenges facing the anaesthesia community as the need for big trials looms large. Why does it take so long for the anaesthesia community to adopt new techniques? Goal directed fluid therapy, as an example, seems to work but involves a cultural change and huge trials before it can be adopted. The Optimisation of Peri-operative Cardiovascular Management to Improve Surgical Outcome II (OPTIMISE II) trial is discussed in detail, as is the FLO-ELA (FLuid Optimisation in Emergency LAparoto...

Podcast 1: Live from Boston ASA 2017 - Anaesthesia and the Perioperative Medicine movement

The largest gathering of anaesthesiologists in the world; feel as if you're there with the TopMedTalk team at ASA 2017. This discussion covers the birth of anaesthesia, in Boston, and its adoption around the world. The contrast between demonstration and adoption in the 1800's and in the modern world is questioned, are we too cautious in adopting new ideas these days? Also - what has been the impact upon surgery, do patients now have unrealistic expectations as regards pain management as a ...

Anesthesiology 2017 intro

TopMedTalk ASA 2017 mission statement. The start of our live coverage from Boston.

Urine output

Should we still measure urine output? How useful is permissive oliguria? Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh.   Join in the debate: [email protected] This taken from a longer conversation on the subject of perioperative nephrology to be found here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-fro...

Renal Injury Biomarkers

How do cell cycle arrest biomarkers offer hope? Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh and Dr Tim Miller from Duke University Medical Centre.   Join in the debate: [email protected]   This piece taken from a longer conversation to be found here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/

Perioperative Nephrology Fluids and the Kidney

Professor John Kellum gives a thumbnail sketch summary of the fluid debate. Presented by Professor Monty Mythen and Dr Joff Lacey with guest John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh.   Join in the debate: [email protected]   This conversation taken from a longer piece here: http://www.topmedtalk.com/ebpom-2017-pod-one-live-from-london/

Intraoperative Hypotension

Reactions to one of the big take away points of EBPOM 2017, intraoperative hypotension lower than 65 mmHg appears to show a close correlation to terrible, sometimes fatal, outcomes. Presented by Professor Monty Mythen and Dr Joff Lacey featuring guests Dr Tim Miller from Duke University Medical Centre and John A. Kellum, Tenured Professor, Critical Care Medicine from The University of Pittsburgh.   Join in the debate: [email protected]   This piece taken from a longer conversa...

Risk of Surgery

What is a 'micromort'? Even more of a worry, what does ten of them mean? How do we measure and communicate risk to patients? Everyday activities all carry inherent risks, how do we put surgery into a context 'everyday people' can more easily understand? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and Dr Mike Irwin, Professor and ...

Refusing Surgery

Should we refuse surgery to those who won't change? What about pathological issues, such as smoking, should practitioners become more didactic in their approach? How do we effectively communicate risk, both to the patient and the institution you work for? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with Dr Joff Lacey and guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology, and Dr Mike I...

Fitness for surgery

Fitness for surgery and an understanding of the realities of risk. How important is it for surgery to take place when balanced against the specific health of the patient? How do we encourage patients to alter pathological aspects of their lives in order to minimise the chances of a negative outcome? Recorded on day two of EBPOM 2017; Professor Monty Mythen presents with Dr Joff Lacey and guests, Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in th...

Perioperative Enhancement Teams

ASER 2017 and the POET acronym - a truly multidisciplinary Perioperative Enhancement Team; responsible for project managing optimisation programmes. Monty Mythen speaks with Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology. This piece is taken from a longer conversation to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-three-live-from-london/ Join the debate: [email protected]

Pain Management for ESR "optimal analgesia"

Pain Relief in Enhanced Surgical Recovery. Monty Mythen asks Dr Joff Lacey and Professor Mike Grocott to reflect on the pain management discussions from day 1 of the American Society of Enhanced Recovery 2017. For further reading see the articles in Perioperative Medicine Journal: https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-017-0064-5 This conversation taken from a longer piece to be found here: http://www.topmedtalk.com/aser-ebpom-2017-recap-pod-t...

Standardised Outcomes from Surgery. Drink, Eat, Mobilise (DrEaM)

Dr Ramani Moonesinghe on Standardised Outcomes from Major Surgery. Dr Joff Lacey and Professor Monty Mythen talk to Dr Ramani Moonesinghe, Director of the Heath Services Research Centre at the Royal College of Anaesthetists and a lead author of the Perioperative Quality Initiative (POQI http://www.poqi.org) guidelines on outcomes from surgery. Simple objective measures such as Drinking, Eating and Mobilising (DrEaM). For further reading see this article in Perioperative Medicine: https...