TopMedTalk

"So in all these ERAS programs, you need a physician champion, a nurse champion, a coordinator; then we brought our pharmacist in - I will not start rounds without a pharmacist. I refuse. I won't start because the pharmacist is integral ... it's just you need that multidisciplinary team" This piece is a question and answer session prompted by the address our guest gave during EBPOM Chicago. Both t...

This piece is a question and answer session with questions from the online audience. What do we think is the clinical care difference that having an elevated level of monitoring and more people around of all all sorts? Why is it good for our patients? As regards admissions to your campus care area; what criteria do you use? Do we need rapid critical care expansion in countries with very few beds?...

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 is the second part of a conversation about leadership in medicine, during times of change. It follows on from the first part where our speaker outlines his thoughts in a short talk. Now questions from the audience are considered and the conversation develops. What have we learned after the recent huge changes we've seen in our profession? Presented by Desiree Chappell and Monty Mythen w...

"I believe most people can be leaders or better leaders. You can create or participate in change and a better future. You can make a difference in your own lives, the lives of others and the life of your organization. If you believe you can." This piece contains a powerful, inspirational and prescient talk about leadership. Part 1 contains some conversation and the talk, to be followed by question...

This piece presents an invaluable wealth of first hand experience in setting up various business cases in relation to perioperative medicine in the UK. At University College London (UCL) cardiopulmonary exercise testing (CPET) was set up as a research tool "but then clinicians came, became interested in the results of the tests and started to ask for tests to be done on their patients for clinical...

"Just having more staff doesn't always equate to better care, especially when the staff do not have the skills required." Perioperative medicine has the opportunity to lead the way in advanced practice; the extended role of the practitioner within the perioperative pathway can be done with nurses, allied health professionals or physician associates. As we evolve these roles, we must be mindful and...

"46% pretty much means every other patient who was getting IV opioids was having some sort of a respiratory depression event" After a quick round up of COVID news in the contributor's respective areas this piece gets involved in a much needed discussion about the "PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY)" trial. PRODIGY trial is here: https...

Armed with a background in biomedical engineering, doubled with an EMBA in Finance, our guest has spent the past 20 years within the medical device industry. In 2010 he was instrumental in setting up MDoloris Medical Systems, with the mission to provide technologies that allow clinicians a reliable, continuous and non-invasive evaluation of autonomic nervous system (ANS) activity. Based on 23 year...

This piece looks at the most recent guidance regarding prehabilitation for cancer, developed and published in 2009 by Macmillan Cancer Care. Extremely well received across the UK, and internationally, here we look at the details and some context in terms of UK national policy. From an NHS England point of view the desire is to ensure that all patients and participants have personalized care embedd...

"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 piece is a listener generated question and answer session from EBPOM 2020. Although it works as a stand alone piece it relates directly to this talk here: https://www.topmedtalk.com/ebpom-2020-london-prediction-of-opioid-induced-respiratory-depression-on-the-general-care-floor-does-surveillance-monitoring-help/ Some of the questions considered include: How much do you think partial / inadequa...

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...