TopMedTalk

2020 was a big year for prehabilitation, the advent of a global pandemic has only increased the importance of this exciting field of medicine. Various questions from EBPOM 2020 attendees were tackled by the panel: Can you use "Timed Up and Go" (TUG) and The Duke Activity Status Index (DASI) to screen out unnecessary cardio-pulminary exercise testing (CPET)? What exactly is prehabilitation and what...

"My first thought was - why can't we do this here?" What is ketamine, what sort of drug is it and how is it used? How was it first synthesized? Was it intentionally found or another of science's happy accidents? This piece is a fascinating look into the history and future of ketamine with a focus on outpatient infusion centers. Could this unusual and "dirty" drug - meaning it acts on many parts of...

How do we manage our operating room capacity and restore elective surgery in a post-COVID19 world? A world where conditions change week by week, sometimes day by day. Managing capacity was always a challenge but now we need to think differently in order to stay resilient and agile. How has COVID19 changed the landscape now? What are the tools that exist to handle it? What are the systems and best...

"Oxygen is the commonest drug that we give to our patients today during surgery and the general anaesthetic" but what do we really know and understand about it from a perioperative perspective? This talk illustrates why, even with some of the evidence and background physiology that we have at our fingertips today, the following questions are still perplexing: How much is too little oxygen? How muc...

This talk aims to answer four major questions: How much fluid should you give perioperatively? Does hypotension matter? Should you use advanced hemodynamic monitoring, and do colloids have any advances over crystalloids? Using high quality studies and a data based approach in all four categories, a lot of which has come from conversations that have had happened at Evidence Based Perioperative Medi...

"As Anaesthetists the ultimate goal of almost all of our interventions and monitoring is to support cell energy production to provide mitochondria with the oxygen and the fuel they need to produce enough adenosine triphosphate (ATP) to power cell function and integrity". How human cells produce energy, how this changes in response to stress and how this may influence survival; this piece focuses w...

This piece covers the PREP-WELL project which is a community based prehabilitation program in South Tees, in the North of England: "We established the following guiding principles; we wanted to provide patient centered care under one roof with facilitated self management; we wanted to work as a cross sector collaborative, by that I mean primary care, secondary care and public health; all working t...

"We have to create the culture of learning; the culture of having a safe space, the culture of wanting to do better and learning those conditions in which we do do better" This powerful talk looks directly at how a clear approach to patient safety really can improve the standard of care where you work. What is the culture of quality and safety that you're trying to embed, can you actually do bette...

Pain is a subjective experience that affects all segments of the population. However, there are inter-individual differences in pain. The biopsychosocial model proposes that the intersection of biological, psychological, and social factors create a pain experience and pain outcomes that differ by sex, race, and socioeconomic status. "The minority stress theory ... the idea that for racial minoriti...

This piece was recorded at the start of the year, to celebrate the launch of Tom Woodcock's book Fluid Physiology, A Handbook for Anaesthesia and Critical Care Practice: https://books.google.co.uk/books?id=F-m4DwAAQBAJ&printsec=copyright&redir_esc=y#v=onepage&q&f=false The editorial team here at TopMedTalk recently (08/12/2020) reflected upon the fact that Tom's 'big areas to watch in 2020' have p...

This piece considers the need to understand the patient having surgery and the complexity with which they present so we can match our skills to them. Developing these skills requires new approaches; to education and training at undergraduate and postgraduate level; to challenge the old ways of delivering perioperative care. This requires new ways of working, the breaking down of silos, a rethink o...

This piece looks at some of the advantages to having a perioperative interdisciplinary team reducing complications, understanding and discussing risk, facilitating better shared decision making and increased patient satisfaction, even among those who - as part of this process - decide not to go ahead with an operation. It also incorporates evidence regarding what we know about COVID-19; "The risks...

"We did not have a concensus view on the very basic subject of fluid physiology and I needed to write a book". Recorded at the start of the year this piece builds on our previous look at Fluid Physiology, which you can find here: https://www.topmedtalk.com/topmedtalk-tom-woodcock/ We also make reference to the book "Fluid Physiology" which is available now, check out the website here: http://fluid...

"We, who physically will be elsewhere in the world, for example, in London and in Southampton, are going to - within what we're allowed to do - get together in a bubble probably at work, and set aside the time to watch the meeting together, and to share some food and maybe share some diet coke and talk about what we've been looking at what we've been learning. So that's the start of the hybrid eve...

The team enjoy reflecting on 2020 as we appreciate the fact that there were the green shoots of hope during the middle part of the year. The patient facing Macmillan Cancer Care podcasts are here: https://www.topmedtalk.com/?s=topmedtalk+%26+macmillan The POCAPALOOZA is here: https://www.topmedtalk.com/?s=pocapalooza Find out more about the African Surgical Outcomes Study (ASOS) and the African Pe...

The annual TopMedTalk Holiday Special series this year takes a look back at COVID19 and the first year we had to live with it. Listen to the full conversations used in this piece: TopMedTalk | Henrik Kehlet and Nick Scott https://www.topmedtalk.com/topmedtalk-henrik-kehlet-and-nick-scott/ TopMedTalk | Silent pandemic of surgical complications https://www.topmedtalk.com/topmedtalk-silent-pandemic-o...

"I cannot sleep. It's like, I wake up at 1am and my mind's going crazy ... if you had someone come to you and say; 'I'm really struggling right now, I'm having a lot of anxiety, with work with family, with kids with whatever'; what are some of the top things that you want to share with them?" How can a regular yoga practice bring you into a deeper union with what you do and help improve your perfo...

This remarkably prescient conversation was recorded at an Australian National Summit in Adelaide regarding the 'hidden pandemic of postoperative complications'. The dangers presented by them certainly suggest this area needs to be taken more seriously. Although staged in Australia this conversation is of global concern, particularly at a time when the world is realising the benefits of proper peri...

"I think you're now famous in the CRNA community for being one of the first people in Fargo to receive the the COVID vaccine" This piece sees us catching up with Certified Registered Nurse Anesthetists (CRNA's) who have just been vaccinated for COVID-19. Their story reminds us that even now some practitioners are facing their first real wave of the pandemic in their area: "We had a kind of trickle...

What happens when cutting edge computer game creators, fresh from working on top titles in their industry such as 'Hunger Games' and 'Mission Impossible', use their skills to simulate high stress moments from the real world of anesthesia and surgery? Using "the neuro-science of game design" to help accelerate learning within the profession: "The motivation for starting Level Ex, what if we actuall...

"You've given us all a lot to think about" - a randomized controlled trial regarding intravenous iron does not go 'as expected'. "I mean, look, I've built my entire career on thinking this was the best thing since sliced bread, the silver bullet, the magic wand ..." A great scientist follows accurate data to wherever it may lead, what now? More trials, more time, more questions? How common is anem...

How can we align personalised care with prehabilitation? "Personalised care is where people have more choice and control over how their health and care needs are met" where we recognise "people themselves can sometimes be the best integrators of health and care". In this context our role is to support them to "live as independently as they wish". With shared decision making and personal choice at...

After working at a Veterans Affair Medical Center, hear how our guests moved into the field of emergence delirium: "upon emergence our patients were swinging and very aggressive ... there must be some way to prevent this". This fascinating piece enjoys an engaging discussion about an important topic for both patients and practitioners; how important is it for you to know a patient may suffer from...

"It's useful to reflect on what SNAP-2 EPICCS might offer us in the brave new world that we find ourselves in with Coronavirus" The 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care after Surgery (SNAP-2 - EPICCS) study launched in March 2017 around the UK. More than 2,200 investigators at more than 250 sites across the UK were signed up to take part. The observational study c...

"Critical Care has a moment in time, a moment where we can make some big changes, a moment of opportunity" This uncompromising and informative talk from the technical lead for critical care in the Getting It Right First Time (GIRFT) project takes us through how services can improve and work alongside perioperative care to improve standards and outcomes for patients. Sharing best practice between t...