TopMedTalk

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...

This piece focuses on the question of looking after yourself as a practitioner and interlinking into your team. How important is it to listen to your team? What is "burn out"? How does it express itself in people? What signs should we look for in our friends and colleagues? Presented by Desiree Chappell , Sol Aronson and Monty Mythen with their guest Sasha Shillcutt , Vice Chair of Strategy and In...

This piece is about the application of data, how do we use it and when should we gather it? How important is it to "just get started and find out what the problem is"? Further reading is available here: https://bjanaesthesia.org/article/S0007-0912(17)33828-X/fulltext If you're interested in hearing more about the Enhanced Peri-Operative Care for High-risk patients (EPOCH) trial go here: https://ww...

As a general rule, should ward monitoring be increased? Should continuous blood pressure monitoring be more frequent? This short piece follows on from Tim Miller's talk "Perioperative Blood Pressure (PeriOperative Quality Initiative: POQI 3) how low can you safely go?". Presented by Desiree Chappell and Monty Mythen with Tim Miller , Associate Professor of Anesthesiology from Duke University Medic...

This panel discussion and extended question and answer session focuses upon troponin screening. Where is the latest evidence as regards this debate? Is MINS ( Myocardial injury after noncardiac surgery) the most common postoperative complication associated with death and if so why is there a transatlantic divide as regards the evidence? Is there a place for troponin screening preoperatively for ri...

"Pain strategies" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings Presented by Dr. Ryan Hanson , Anesthesiologist in Boston, Massachusetts, affiliated with Brigham and Women'...

What are some of the major issues regarding billing? What are the most common mistakes when it comes to documentation? How do we keep the focus on great healthcare, as well as good book keeping? How does "the false claims act" impact on billing? If you find a mistake or an issue in your note keeping the advice here is clear; deal with it the moment it is discovered. Also, under recording is an obv...

"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 perioperat...

Discussion begins with thoughts about University College London (UCL)'s Masters Course in Perioperative Medicine, moving further to the various ways in which people can learn more about the specialty The wider conversation reaches out into the field of anaesthesia and the constant shortage of practitioners that there is in the UK and more widely around the world. Also, if you're intrigued, here's...

"Delirium: The brain and the older surgical patient Part 2" was a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: "Updates in Perioperative Medicine 360" which took place between November 7th-9th 2019. This piece is a look at some of the new technology which is becoming more widely used. A leadless pacemaker is a small implant...

The Silver Tsunami is coming, are you prepared to assess the elderly patient? Mature patients present unique and interesting opportunities to perioperative practitioners. New ways of thinking and different approaches are always necessary. The British Geriatric Society's "Fit For Frailty" is here: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty Presented by Desiree Chappell and Mon...

Originally broadcast live from Anesthesiology 2019, this piece focuses on the mission to advocate and apply prehabilitation, pre-optimisation and enhanced recovery. Defined here as "good public health [...] with the crucible of surgery". How do we do that in a way that both patients and front line providers understand the value of it? Can this message help to allow for delays in surgery? Also, how...

"Exercise capacity and sarcopenia" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedt...

"I know how to manage pain medication [...] addiction was the absolute last thing that would happen to me". This podcast helps tackle the difficult subject of Substance Use Disorder in healthcare practitioners. How do we, from a caring and helpful perspective, address this issue either within ourselves or others? This piece was part of our coverage of The American Association of Nurse Anesthetists...

TopMedTalk has recently engaged with a large number of new listeners, we are delighted to have you join our family of perioptimists! This piece works as a primer, it explains what lies at the core of the world's favorite perioperative medicine podcast; enhanced recovery. What is it? How do you implement it? And, what are its core principles? If you've never heard TopMedTalk before but you are a me...

"Excellent teamwork"; the key to good outcomes. This piece features an in depth discussion of post operative acute kidney injury (AKI), are there fresh approaches we can take? Could more data help us? The conversation then moves to myocardial injury after noncardiac surgery (MINS). What should our thoughts be as regards postoperative troponin levels? Presented by Desiree Chappell and Monty Mythen...

"Delirium: The brain and the older surgical patient Part 1" was a presentation originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: "Updates in Perioperative Medicine 360" which took place between November 7th-9th 2019. "Acute brain failure is really the concept we're talking about", this piece covers delirium and dives into why this co...

This piece focuses upon goal directed fluid therapy, with an automated system, for decision support; "a step between a simple monitor and a fully automated system". The "proof of concept" paper we highlight towards the end of the podcast, "Feasibility of closed-loop titration of norepinephrine infusion in patients undergoing moderate - and high-risk surgery" has now been published and can be found...

Away from the world of politics there is a sensible debate to be had about payment methods for healthcare. Here you will find evidence, shared goals and specific payment models from the US being looked at in detail. It's a debate about total cost of care and a two sided risk model that could potentially be cheaper and better for both patients and providers. Bundle payments provoke debate, "the int...

"Pain Strategies" - was originally streamed live from the Charles Sammons Cancer Center, Dallas, during EBPOM-USA 2019 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented...

In the military Forward Surgical Teams (FSTs) are deployed into challenging environments to deliver "damage control surgery". They help people who have been injured, relieve the pain, stop the bleeding, 'patch the holes' and move them to a safer environment. It's from this background that our two contributors come, learn how they have been forced to innovate and what insights they can give to prac...

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 alongside a message that 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 dramaticall...

"Hypotension probability in practice" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you'd like to attend an event like this ensure your next click is here: www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: con...

"We've had the opportunity to catch up with some friends from Africa to tell us more about what is happening in their neck of the woods with perioperative medicine..." We reference this piece in The Lancet here: https://www.thelancet.com/journals/lancet/issue/vol396no10243/PIIS0140-6736(20)X0027-4 The African Surgical Outcomes Study (ASOS) is discussed in more detail here: https://www.topmedtalk.c...

This piece focuses upon the unique 'Collaborative Clinical Trials in Anaesthesia biennial conference', of which this was the fifth, organised in Prato, Italy, by Monash University. TopMedTalk was given the chance to listen in on this cutting edge gathering of trialists, academics and practitioners as it happened. We take a deeper dive on the history behind this very special meeting, how it works a...