TopMedTalk

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...

Originally broadcast live from Anesthesiology 2019, this piece is a chance to hear from a couple of Temple University residents who presented on two different cases: The first being a critical care case in the ICU involving acute respiratory distress; the second involving a case of surgery for a pheochromocytoma in a patient with neurofibromatosis type 1 and severe pulmonary hypertension and right...

After a quick chat about the immediate aftermath of the incredibly successful EBPOM LIVE from London and its accompanying online Perioperative Care Festival, The POCAPALOOZA , this piece is a conversation with friends of ours at Medtronic. Now is an interesting and resource scarce time for everyone in medicine; Medtronic made huge waves here with their support of the Ventilator Training App, today...

This panel discussion is an honest and challenging look at blood pressure management. Questions include but are not limited to: How should practitioners maintain blood pressure in patients and where is the threshold? How much precaution is inspired by eminence rather than actual evidence? What is the best and safest way to attenuate sympathetic responses intraoperatively? If harmful hypotension oc...

How can a multidisciplinary group collectively define and maintain what they do while maintaining a patient centred approach? How focused can prehabilitation become? Should personal trainers be more widely involved in perioperative medicine? What is the correct terminology when it comes to expertise in the various areas of your team? Should practitioners be expected to apply lifestyle behaviour ch...

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...

"Surgery and anaesthesia; you very much recognise right away that that is considered a luxury in many place of the world" Do you work in a low-resource setting or support partners and organizations that do? The Lifebox pulse oximeter is specifically designed for high-use, low-resource environments. Hear about how Lifebox came into existence and discover how you can help. The World Health Organisat...

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...

When it comes to blood pressure, hypotension is associated with poor outcomes for patients, how do we react to this? How do we manage and avoid hypotension where possible? How has technology caught up with this challenge? Could automated closed loop systems be helpful here? The bottom line is simple; "If we measure blood pressure properly, we can predict it". Presented by Dr Simon Davies , Consult...

This piece outlines some of the topics related to the third Perioperative Quality Initiative (POQI). What is 'perioperative blood pressure'? What have been the major developments in this area? Also, should we be looking at increasing monitoring of patients, particularly regarding their blood pressure, in hospital? The Perioperative Quality Initiative (POQI) is discussed here: https://www.topmedtal...

This piece argues that troponin screening might be overused, "it's not all about the heart". Myocardial injury after noncardiac surgery (MINS) is seen as a relatively common issue driving post-operative harm. This piece gets into the detail and asks some important questions as to how focused practitioners should be upon troponin screening. It's part 2 of 3 from The EBPOM 2019 TopMedTalk session wh...

"I did a study back in 2002 where I was able to count a grand total of forty patients above the age of eighty in our (Intensive Care Unit) ICU and our (High Dependency Unit) HDU, nowadays I'd count close enough to a hundred and sixty" How do we refine our diagnostic tools? How can teaching in this area help to save lives? Should you consider a 'geriatric intensive care unit'? Is this an area where...

"Perioperative medicine is an opportunity; it's multidisciplinary and its developing around a culture of trust between anaesthetists, surgeons and perioperative physicians" The future of perioperative medicine embraces the full scope of medical advancement and is therefore difficult to predict, as a result truly informed shared decision making is both crucial and more complex. Variability of pract...

This piece argues that troponin screening is useful, if used appropriately. Is it the case that this test has been 'over sold' and as a result has provoked unhelpful pushback from practitioners? It's part 1 of 3 from The EBPOM 2019 TopMedTalk session which debated the issue. Presented by Duminda Wijeysundera , Professor in the Department of Anaesthesia and the Institute of Health Policy Management...

This is an Edwards Lifesciences Sponsored Lecture which was originally streamed live on TopMedTalk from the hugely successful EBPOM USA 2019 in Dallas. In this piece we hear about the ongoing need for institutions and healthcare professionals to recognise the damaging consequences of intraoperative hypotension. Evidence has been mounting here on TopMedTalk over the last couple of years; there's no...