TopMedTalk

"We are getting super excited about EBPOM Live from London at the end of June..." - thousands of you already have your tickets, this podcast is your essential primer; a fascinating rundown of what attendees to the virtual conference "EBPOM Live From London!" can expect. As a listener to TopMedTalk you are part of a movement which aims to help save lives every year around the world. The practice of...

"Data is destiny"; this piece looks at way we can unlock it for Anesthetists. The Open-Source Anesthesia Electronic Medical Record (OSAEMR) was developed specifically for Nurse Anesthetists. Its focus is on solo or small-practice nurse anesthetists operating in environments with limited or no network and computing resources other than an iPad. One patient, one nurse anesthetist, and one iPad. It c...

"We believe these results are applicable to a very broad population" Focusing on a study of over 6,000 patients, this hugely important piece attempts to finally move forward discussion regarding the long term consequences of deep anaesthesia? There is no difference in the survival rate of patients who have had a "deep level" of anaesthesia, which is still strictly within the bounds of normal clini...

"The NHS is composed by about 20% of non-white individuals" This piece takes a data driven look at a controversial area, how well informed are we about the risks associated with the coronavirus behind this unprecedented global pandemic? "The background issues of gender and ethnicity may out weigh the issues related to comorbidities" but, in terms of data, "it's a moving target". There have been th...

How can we learn more by seeing more? This fascinating piece looks at how learning and the zone of proximal development (ZPD) of a student can be used to help the process. We are learning about learning, thanks partly to the use of algorithms that monitor our progress and performance. This talk asks challenging questions; "In terms of performance, just think technical procedures at the moment, is...

Evidence Based Perioperative Medicine (EBPOM) is the reason TopMedTalk exists; the vast majority of the content we love everyday comes from conferences organised by this important global initiative designed to promote high value perioperative practice around the world. Here on TopMedTalk, as you have heard, we immediately reacted as firmly as we could to the news of the novel coronavirus COVID 19....

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...

Everything you ever wanted to know about CPET (Cardio Pulmonary Exercise Testing) but were too afraid to ask; this conversation is a fascinating deep dive into the topic with two experts in the field. Discover how widely practiced this technique is across the UK, hear about the advantages people who use it have in terms of outcomes and patient safety. Also, what do institutions then do with the da...

How does the treatment of anemia fit into the perioperative process? How far should patient optimisation extend to treatment of this condition? Live from the hugely successful EBPOM USA conference, directly after their presentation Desiree Chappell talks with her guests; Dr Lori Heller , Cardiac Anesthesiologist, Swedish Medical Center, through US anaesthesia partners and acting instructor at the...

Desiree and Monty catch up with Dan Martin, OBE, and speak with him about treating infectious diseases and in particular patients with ebola. Presented by Desiree Chappell and Monty Mythen with their guest Dan Martin , OBE anaesthetist and intensivist at the Royal Free Hospital and Reader at University College London (UCL).

This piece presents the prehabilitation 'business case'; why it's important to care about costs, how outcomes and value based care can help and why money has to be important in healthcare. How do we convert health benefits and risk management into something which explains the financial bottom line? Can we really argue that a process which appears, at the point of practice, to take more time, resou...

Discussion begins with a hugely successful Enhanced Recovery program at a large community hospital, continued improvements and service line expansion. Learn about both the advantages and the challenges of a perioperative practice here. Presented by Desiree Chappell and Monty Mythen with their guests Kim Duggan , Perioperative Surgical Home (PSH) - Enhanced Recovery After Surgery (ERAS) Manager, Ne...

"Updates in cardiac devices, 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 focused upon transcatheter aortic valve implantation (TAVI) devices. "A balloon valvular plasti in comparison to a TAVI is 90% of the r...

"Updates in cardiac devices, Part 1" 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 looks set to become more widely used. A leadless pacemaker is a small implantable "bullet li...

The opioid crisis "a unique American problem". This piece uncovers the origin of some of the misinformation about opioids, the consequences of calling pain a "fifth vital sign" and the absurd practice of waking patients up in the middle of the night to ask them if they are in any pain. As these factors combined fatalities started to spiral into the crisis we see today. Recent statistics make for g...

This piece takes some time to reflect on where we're at in the UK - and wider Western World - with regard to civil liberties, human rights and the essentials of a functioning 'first world' country. How important is social justice and human rights in a world where a global pandemic puts all that we hold dear at risk? The Liberty website is here: https://www.libertyhumanrights.org.uk/ For more infor...

This wide ranging talk asks where and how we should focus on the needs of postoperative care patients. "Brain care has an impact way beyond the acute surgical episode"; how do we minimise the risks of a poor outcome when it comes to postoperative care? "Advanced recovery from anaesthesia and surgery" is a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medici...

"Shared decision making and risk prediction in the emergency setting: Can we achieve it?" is 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 talk discusses survival after admission to intensive care. How do we incorporate concepts li...

This piece is a fascinating discussion regarding research and safety in anaesthesia management; "in the past five or six years there's been a shift from high risk patients to all types of patients". How are we improving methods, evaluation and monitoring? What are some of the more essential elements of the process? Where is the latest research? What is a sensible policy when it comes to opioids? P...

This piece dives into the latest thinking behind opioid-free anaesthesia; how can we improve? Is the challenge of the opioid crisis being met head on by perioperative medicine? Is it realistic to expect to reach a point where opioids are removed from the equation entirely? Presented by Michael Manning , MD, PhD, Assistant Professor at Duke University Medical Center, Director of research for the Pe...

This piece tells the story of two different innovators in the field of an anesthesia. The first is, The Pediatric Device for Induction of Anesthesia (PeDIA), a mask-free anesthesia delivery system designed for kids. The second is the Error Recovery and Mitigation Aide (ERMA), a reworking of the traditional needle box whereby a clear reservoir is inserted between the re-entry proof top and opaque t...

Doesn't the decision to delay surgery depend upon the type of cancer? Can you measure complications as an outcome? What's the cause of non cardiac complications that are related to lack of exercise? Can we change the mindset of prehabilitation by explaining that prehabilitation is the start of treatment? How do we convince patients and decision makers that delaying surgery is a good idea? How invo...

"We wanted to know if goal directed therpy using a (Hypotension Prediction Index) HPI monitor can prevent hypotension". This piece looks in detail at the HPI monitor in practice- what is the benefit of this piece of technology in relation to hypotensive episodes? Furthermore how else is it to be tested and when will these tests be carried out? Presented by Desiree Chappell and Monty Mythen with th...

Some practitioners habitually prescribe opioids, the consequences in America are now described as a national crisis. Essentially the focus here is "better opioid stewardship" and a "move away from the traditional fundamental principle of opioids first". Presented by Michael Manning , MD, PhD, Assistant Professor at Duke University Medical Center, Director of Research for the Perioperative Medicine...

After a short overview of the history of the Society of Cardiovascular Anesthesiologists (SCA) this conversation zones in on some of the hot topics that are being discussed in the field; devices and extracorporeal membrane oxygenation (ECMO) machines, as well as trans-esophageal echocardiography and how the practice has evolved. The conversation ends with a discussion about pre-habilitation in a r...