TopMedTalk

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...

The electronic cigarette market is a $14 billion industry worldwide. As of August 2019, 215 cases of severe pulmonary illness related to e-cigarette use are being investigated in the United States. The known hazards of e-cigarette use are rapidly coming to light with the sudden onset of serious bronchiolitis-related pulmonary disease in otherwise healthy people who were known to use e-cigarettes....

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 invaluable piece is a chance to attend a workshop which looks at the latest thinking on "perioperative cognition" and 'post-operative cognitive dysfuntion'. We advise you use this link here to find the PDF of the paper being discussed: https://bjanaesthesia.org/article/S0007-0912(17)54082-9/fulltext Presented by David Scott , Professor, University of Melbourne, Director, Anaesthesia and Acute...

"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...

"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...

"Our job is to tell them; there is another solution ... there's another way to solve this problem and I can help you" This piece takes a bold and honest look at suicide in anesthesia, although it has a US set of contributors the issues here are to do with everyone in healthcare. TopMedTalk is keen to promote the fact help is available, please seek it out if you are concerned you might be affected...

How do you become well known in the NHS for being innovative, particularly in the perioperative area regarding evaluation and communication of risk? How can cardiopulmonary exercise testing lead to shared decision making? Hear how aortic aneurysms are dealt with by a world class professional perioperative physician. Learn how that process and its success then spread out into other areas of healthc...

This piece looks at innovations in our field, through the lens of the Hypotension Prediction Index (HPI). Innovations in medicine are always exciting, "neuro-monitoring" is discussed "if you told me two years ago that I was going to be able to understand an EG waveform I would have laughed at you". "Data is what drives any change", how can new insights regarding hypotension potentially revolutioni...

"Perioperative nutrition should be a key part of Enhanced Recovery" - 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...

"Thank you for taking this meeting beyond these walls" - this piece was the final part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. We begin with the global audience in mind and break down what it is to be a Nurse Anesthetist. It's a role which is expanding in scope, our guest walks us through how and why that's the case. This...

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...