TopMedTalk

With questions from the online audience, this piece looks at the "not too much and not too litte" sweet spot regarding fuel, fluid and oxygen; where is it and how do we get there, according to our distinguished panel? This podcast works well as a companion piece to the following talks which have already been released here on TopMedTalk: Helen McKenna, "Fuel, can you have too much?" https://www.top...

This piece is a continued deep dive into the subject, of 'fitness, function, or frailty' and, perhaps, "fixing". It's essential listening for anyone interested in the latest thinking on this crucial topic and was a highlight of the London conference. How can we integrate frailty and cognitive scores in risk assessment tools to facilitate inclusion in shared decision making? How can we improve a su...

Fitness, function and, or, frailty are important determinants of the quality of the life that we live. In the context of major surgery it's very important we recognize and work with individual patients improving and optimizing them and their ability to handle an operation. This piece is an essential deep dive into the subject, essential listening for anyone interested in the latest thinking on thi...

"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...

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 remember that patients have a team" How do we involve patients in the increasingly complex conversations we have in the perioperative space? This piece is a detailed case study which shows how shared decision making works in the perioperative setting. We know this improves patient experience yet in the last 10 or so years, consistently only 50 to 60% of patients say they were involved...

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 is a story that starts with some of the challenges faced in our world outside the operating theatre and it's about how we might address some of these problems systematically. Healthcare organizations have to deliver high quality, competitive and sustainable results and costs. Good quality perioperative surgery is absolutely critical to maintain the health and well being of our population goin...

"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...

"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...

"Perioperative medicine ... I always think of a Venn diagram where there's truly an intersection between surgery anesthesia and medicine, and perhaps even a subset of medicine called geriatrics, that really create this convergence of what we're now creating as a novel science ... Perioperative medicine, I would say is a new clinical science that really incorporates all that" This piece is a fascin...

This piece is essential listening for any medical practitioner. The pathophysiology of COVID 19 is now being understood, although there are still a number of outstanding questions. This piece attempts to answer those questions; where does it come from, what do we know about it now, what would we like to know about it in the future? Why is the disease more pronounced in men, how come obesity seems...

This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being questions from the online audience: What is your opinion about spinals and hip fractures for patients on clopidogrel? Do you use any near patient tests to confirm residual anticoagulation? Where are the best guidelines to be found? We suggest you listen to this piece alongside part...

The conversation begins with "a day in the life" with respect to managing the anti coagulation questions that come up commonly. The contributors swap stories from their time in practice. The conversation moves to protocols, guidelines and also, when where and how to begin bridging. This piece is divided into two parts, the first being discussion between the panelists and the second, part 2, being...

How can enhanced recovery after surgery (ERAS) be applied to cardiac and what exciting opportunities are there for those who have made this their mission? This detail driven address contains more information on The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac), more information can be found on their website: https://www.erascardiac.org/ Since this address was given at Evidenc...

This piece looks at some of the latest research from a perioperative perspective regarding an essential question, when and how is surgery possible after a COVID-19 infection? How do we balance that ideal with the other pressures coming to bare on patients, practitioners and public health as a whole? The paper "Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort st...

This piece focuses on iDelirium; The International Federation of Delirium Societies on world delirium day. As well as considering this difficult condition the conversation asks what the latest research shows us and how things could improve both for patients and practitioners. For more detail check out their website here: http://www.idelirium.org/ Presented by Desiree Chappell and Monty Mythen with...

"You have to take the viewpoint that if the Nurses and the Physical Therapists and the Pharmacists are resisting the idea that you're putting forward, then there's probably something wrong with it, it doesn't work for them, for some reason, and you got to find out what that is..." This long form conversation is a highlight for TopMedTalk's coverage of The Society for Enhanced Recovery After Cardia...

"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...

From a UK perspective this piece covers variation in access to critical care, behaviors and decisions regarding its use. With reference to how, over the last 20 years, efforts have been made in Torbay to improve access to critical care we look at what can be done and what works. Finally there's a summary of where we are on this issue today. Getting it right first time (GIRFT) is here: https://www....

This piece provides an update on the Perioperative Exercise, Testing and Training Society (POETTS); "established back in 2017, in the context, in the United Kingdom, of cardiopulmonary exercise testing becoming much more common in the preoperative period". Now, more than half of acute hospital trusts in the United Kingdom have a cardiopulmonary exercise testing service to evaluate their patient's...

This piece gives you the evidence base required to deliver an even higher standard of perioperative medicine where you work. Hear about the "Fit 4 surgery" studies; the "fit 4 surgery consortium", the ongoing e-studies, key findings, recent studies and the set up in Southampton. Physical fitness is greatly affected by chemotherapy; poor outcomes are significantly linked to physical fitness; learn...

"The goal of ERAS® Cardiac is when you leave one of our meetings, you're going to be chock full of tips and tricks that you can take back and implement, if not the next day, then in the next week or next month." TopMedTalk's coverage of The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac) conference continues with a conversation that covers the nuggets and insights that a confer...

"You didn't have to think about it, the compliance continued, because it was so standardized. We had a well oiled machine that just kept on working through COVID". The Society for Enhanced Recovery After Cardiac Surgery (ERAS® Cardiac)'s conference has gotten off to a great start; this exclusive chat gets into some of the stand out moments so far; nutrition, data collection, the essentials of ERAS...