TopMedTalk

This hugely important talk was the centerpiece of EBPOM 2019 and, appropriately enough, it focuses on a big topic for us here at TopMedTalk; the future of fluid therapy. Originally given as the EBPOM 2019 Ernest Henry Starling plenary lecture the talk is complimented by this piece which was recorded on the same day: https://www.topmedtalk.com/desirees-roundtable-fluids-in-the-2020s/ Where is the l...

This piece focuses upon the African Surgical Outcomes Study (ASOS-2). More than a thousand people across Africa have combined forces to make this research into perioperative medicine in a resource limited environment happen. We know patients in Africa are twice as likely to die following surgery when compared to the global average, why is this? How does "failure to rescue" play into this? The webs...

This piece is a reliable first hand account of COVID 19, directly from a patient, our Editor in Chief Monty Mythen. "This kind of reassurance that seemed to go with it, to seem to say to people: 'nah, nah, nah, it's ok; you've just got a bit of a sore throat and a bit of a dribbly nose, crack on!' Was not supported by the available evidence at all" How is Monty feeling? What are the actual symptom...

"We're not a big teaching hospital [...] and I think there is a slightly different perspective..." This piece focuses on the realities of preparing for and dealing with COVID 19 patients in the town of Bath in the UK. Innovation with staff training, cautionary tales regarding our advance warning of the current situation and fluctuating guidelines are the opening points of discussion before a fasci...

The team aspect of perioperative care is an essential element, this piece gets into the details as thought leaders and key opinion makers engage with the debate regarding how that actually works in practice. Moderated by Ross Kerridge , John Hunter Hospital, Newcastle, Australia, often cited as 'the father of Modern Perioperative Medicine'; the panel consists of, Charlie Corke , Associate Professo...

This piece dives into "The new www revolution?: Wireless Wearables on the Ward". Improving the monitoring of patients on the wards is an exciting prospect for any modern practitioner and as personal health monitoring technology becomes mainstream for the public it's surely an inevitable part of the future of medicine. The website mentioned in the podcast is here: https://www.michardconsulting.com/...

This piece takes a look at the frontline fight against COVID 19 at Penn Medicine Princeton Medical Center in New Jersey, USA. Details of airway, ventilation and hemodynamic management are discussed with the director of Critical care and Anesthesiology. Resource management is a clear front runner as the virus creates a public health emergency for medics to try to battle. Additional beds and treatme...

Extended periods of intraoperative hypotension are firmly associated with harm. This piece looks into the detail behind concerns regarding hypotension. Are we now in a position where we can eliminate it entirely? The paper mentioned in this piece, "Ability of an Arterial Waveform Analysis–Derived Hypotension Prediction Index to Predict Future Hypotensive Events in Surgical Patients", is here: http...

In this piece we look at how Australia is dealing with the COVID 19 crisis. What restrictions are being placed upon people and how strict are they? How does "the father of perioperative medicine" see the world which is now being asked to face one of its most urgent medical emergencies? Has the time come to honour 'the whole team' in the institutions where we work? How can medics help to rebuild ou...

Preoperative risk stratification; what is are the risks and controversies behind preoperative exercise testing and the six minute walk test? This piece looks at the evidence behind both and some practical guidance for informing clinical care. Does the six minute walk test predict complications? What is the true value for cardiopulminary exercise testing (CPET)? For more on the METS study go here:...

This piece takes a look at the San Diego front line of the global fight against COVID 19. What unique pressures are there here; the large homeless population is a particular challenge, how do psychiatric patients further the conundrum. Also, what about the assumption that patients are likely to be carrying the virus so should all be treated as if that is the case, does that apply here? There is al...

"We keep being told we're one to two weeks away from the peak..." This piece takes a look at how Monty is getting on with his diagnosis, COVID 19 symptoms infamously vary in severity throughout the infection. Now he has been diagnosed how, if at all, will his behaviour change? What is the UK's policy on practitioners who are COVID 19 positive? Further discussion includes the news that 'rapid tests...

Australia has an interesting history both generally and with perioperative medicine specifically. Here the story is told and their current progress is revealed. How do comparisons between various countries help us to understand where improvements can be made? How do the differences between the way in which healthcare is funded impact patients and providers? Moderated by Dr Mark Edwards , Universit...

"About a year ago our chief CRNA sent me a podcast from TopMedTalk about fluid management" - this podcast is a fascinating insight into how Enhanced Recovery continues to reach out across the world to the bedside of patients. How do you take your institution from where you're at now to where you need to be tomorrow? What are the essential ingredients? How do you work, through education, towards re...

This piece focuses on the SuperNO2VA mask, which delivers positive airway pressure to stent open the upper airway, allowing for the preoperative delivery of positive pressure ventilation and oxygen for patients with a decreased level of consciousness. The website mentioned in the piece is here: https://www.vyaire.com/ Presented by Desiree Chappell with Monty Mythen and Michael Pedro , VP, Medical...

"It is interesting how well you can feel, compared to the night time [...] it gives you this real false sense of wellness for a period of time and then it hits you, man it hits you hard, when it hits you." The UK Prime Minister has tested positive for COVID 19 as has The UK's Health Secretary, Matt Hancock, MP. Yesterday we revealed there were concerns our Editor in Chief Monty Mythen had some of...

"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 a fascinating conversation with a TopMedTalk favorite. How are preparations going at Duke University? How can we optimise our...

The historical focus in prehabilitation has been on exercise, how can the insights of psychology and behaviour change techniques be applied to the field? Should psychosocial outcomes and behaviour change be factored into your practice? There's consistent evidence that anxiety around the time of diagnosis is predictive of post operative pain; depression increases the risk of chronic pain; psycholog...

The UK's fight back is now underway; the 'lockdown' is being largely adhered to and the efforts to support the National Health Service (NHS) from the public, medical students and retired professionals is inspiring to many. This piece takes a look at the realities of students being given the chance to graduate and practice their skills a little earlier than previously planned. Presented by Desiree...

"There seems to be a little extra buzz in the cardiac community". This conversation focuses upon the psychology of change, specifically regarding the leadership role presented within perioperative medicine to anaesthesiologists. How can perfectionism, as a barrier to change, be overcome? How do practitioners build the confidence to make a difference? Furthermore, how do we engage in 'internal mark...

"I work in a houshold where my wife was working at a school and my student children have come home so, it's highly likely that I would get COVID 19"; the conversation begins with a discussion about the fact our Editor in Chief Monty Mythen has had some of the symptoms over the last few days. "For us as healthcare workers what we need to do is filter out the true head colds from the COVID 19s"; the...

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...

"The guidelines, in fact, I found most useful were the Royal College's guidelines, all those info graphics and all those protocols" This piece is an emotional conversation with a TopMedTalk favourite; how are things going in New Jersey? Has elective surgery come to a halt yet? What innovations are being deployed by medics are they face a global pandemic? What are the unique pressures which medics...

"'The disease is not complicated, the biology is not complicated, the treatment is not that complicated; our behavior patterns and our understanding of what it is truly like to be in a pandemic is the complicated bit' ... 'Yeah, this is not a drill'": the firm message in this piece is clear, use the internet and stop your face to face departmental meetings now. More broadly we ask; how are things...

"The first case of COVID in China was the 8th of December…" this piece looks at the outbreak of the disease from the perspective of healthcare workers in Italy. Focusing on the community health approach to controlling this pandemic, our guest emphasizes the importance of understanding the epidemiology of COVID- 19. Mirco Nacoti, Department of Anesthesia and Intensive Care, Pediatric Intensive Care...