TopMedTalk

The POCAPALOOZA, a celebration of perioperative care that went around the world in the wake of EBPOM 2020. "Early intervention and people taking it seriously is a big thing" The conversation evolves as our guest speaks to the realities of moving internationally to pursue your career in medicine. Can a truly global perspective better position the medical community when it comes to international co-...

"4-10% of opioid naïve patients will continue to use opioids more than 90 days after surgery" Opioids are good for pain control but there's another issue, they also numb emotional pain. How do we responsibly deal with this? It's important to remember: "When you give patients high doses, you're putting them at risk". Long term listeners will recall TopMedTalk spent the best part of our launch year...

"It was successful early on within the National Health Service.. [because] you could eliminate the cost of some unhelpful, unnecessary tests... referrals to other "-ologists"... in our system that works, because more work is just more work. It's not more money." Is the business case for prehabilitation a "slam dunk", as some enthusiasts claim? If so how do you measure value versus volume, is value...

This piece focuses on intensive care, the use of data and the future of fluid therapy research and its related physiological outcomes. The article mentioned in this podcast is here: "Perioperative haemodynamic therapy for major gastrointestinal surgery: the effect of a Bayesian approach to interpreting the findings of a randomised controlled trial" https://bmjopen.bmj.com/content/9/3/e024256 Prese...

"Cognitive testing has been in the news ... there are recommendations for keeping pets mentally sound by implementing nutritional modifications, regular exercise and mental stimulation, we should certainly think about providing the same support to our geriatric patients." What does the latest research say about this vital issue? How is frailty defined? What's the clinical impact of preoperative co...

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 collected data on all patients undergoing inpatient surgery during a one-week period (21 March to 27 March) in UK NHS hospitals....

"Studies suggest that even three fourths of patients may be anemic when they present for surgery and many of these patients are previously undiagnosed" This common problem is known to cause issues both within the perioperative period and beyond. How can we manage this condition and where does the latest data lead us? Following a presentation there is a panel discussion featuring questions from the...

This talk examines the rationale for using methadone in our surgical patient population, reviews clinical trials that assess the effect of intraoperative methadone on post operative outcomes and discusses some unanswered questions related to the administration of this long acting opioid in the perioperative period. Presented by Glenn Murphy , Jeffery S. Vender Chair of Anesthesiology Research and...

This piece is a much needed contribution to a conversation about how we should be caring for the transgender patient within the scope of perioperative care. Our guest's excellent article, "Anesthesia Inclusive Practices Amidst Adversity: Caring for the Transgender Patient", is here: https://cms.aana.com/docs/default-source/pr-aana-com-web-documents-(all)/anesthesia-inclusive-practices-amidst-adver...

How does an experienced physician, health service changer, improver and researcher see the process of re-engineering perioperative care pathways? What are the challenges we face when we try to rework or improve the culture of an institution? How do we tackle common issues, which nowadays seem less acceptable, such as delirium? This piece is part of a series of talks regarding "re-engineering perio...

Smoking is bad for you, there's little debate about that, even among users of the drug. However, further to the widely known consequences, the bottom line in the perioperative period is that smokers are 40% more likely to die after major surgery. Do patients also know this? Tissue healing, increased risk of infection and increased possiblities of complications with the anaesthetic; with these risk...

"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...

This piece focuses on the work of our guest and her impact upon the crucial area of gender and racial diversity in the US Anesthesia and Critical Care Workforce. How can we advocate for diversity within this field? What do we make of the Athena SWAN (Scientific Women's Academic Network) charter? Can social media help to raise awareness and build communities that can tackle these issues? Also in th...

"When you start to think about how we can protect ourselves; we have some reasonably robust literature for a few interventions [..] that do seem to associate with the prevention of viral infections…"; maintain a normal vitamin D level, probiotics, vitamin C. This piece is an edited highlight of a fascinating conversation with a TopMedTalk favorite. How can we optimise ourselves for an oncoming vir...

How do we convince patients that prehabilitation is safe? What forms of certification are available for the accreditation of a balanced multidisciplinary team? How do you monitor home based patients? How do we tap into the wider 'exercise industry' on behalf of perioperative prehabilitation? Panel discussion, featuring; Daniel Santa Mina , Assistant Professor at University of Toronto & Scientist i...

"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...

The Perioperative Quality Initiative (POQI) is a vital part of the process needed to more widely implement sensible practice which, using a clear evidence base, provides better value care with more positive outcomes for the patient. POQI continues to provide its work in an attempt to clarify fundamental concepts in perioperative care. The fact this one focuses upon fluid management makes it partic...

We begin with a conversation about The UK Perioperative Medicine Clinical Trials Network, their website is here: https://www.pomctn.org.uk/ This piece focuses on the Optimising Shared decision-makIng for high-RIsk major Surgery (OSIRIS) programme. Shared decision making can be very challenging when we're not sure what the risks are and older patients with chronic diseases often make very different...

How have we adapted in our views on the use of video laryngoscopy during the Covid-19 pandemic? Who is best suited to intubate? Are we seeing "a poorly managed first wave"? How are practitioners changing their approach in light of the possibility of infections? What lessons are being learned by practitioners in the midst of the COVID crisis? This piece was generously supported by Medtronic.com Pre...

Why has 'prehabilitation' suddenly picked up pace in terms of both practice and interest? This piece takes a serious look at the widening interest in an idea familiar to many sportsmen. Learn how the marginal gains we get through the application of science to optimise the moment of surgery as a real opportunity to apply everything we know. Also; what are ketones and how can they be used to promote...

This piece focuses in upon the important work being done by The Enhanced Recovery After Cardiac Surgery Society, specifically the new guidelines which were published in May 2019. Furthermore, how is the society going to move forward, will it continue to push for a sensible combination of both care providers and academics and what areas of focus are most impactful when it comes to improving care an...

In the UK community based prehabilitation is being spearheaded by the Prepwell Initiative, supported by a grant from Sports England. Their pioneering work is a great example of the way in which prehabilitation is gathering pace at the moment. The "PREP: Preoperative Risk Education Package" website is here: https://www.prepwell.co.uk/ What are the economics of such a programme? Why did the project...

"The more I learn about this, the more my eyes are opened to how much opportunity we have to improve in this area" This piece covers the "perennial topic" of whether paralysis is bad for breathing, here with a focus upon outcome criteria associated with residual neuromuscular blockade. It's a piece based in part upon a recent talk at the American Association of Nurse Anesthetists annual conference...

Burn out and stress management have been an important theme on TopMedTalk recently, here we have a top medical professional sharing their story in relation to the topic. How do we describe "burn out", are certain words a barrier to discussion? How do we cut through to people who are most likely to suffer from this incredibly dangerous condition? Is the medical profession finally making progress he...

This panel discussion covers essential ground for any institution that is trying to make real and lasting change. What do we need to know? What do our patients need to know? Who is responsible for questions of safety? How important are checklists? What about "patient advocates"? This piece was generously supported by Massimo.com it follows on from this piece here: https://www.topmedtalk.com/ebpom-...