TopMedTalk

Back in London for EBPOM 2018! This piece features a quick rundown of some of the things you can expect to hear from www. TopMedTalk.com on our live streaming page. As always highlights of that will feature in the main podcast but, while the conference is on, we're streaming it live. TO LISTEN CLICK ON THIS LINK HERE: https://playall.sharp-stream.com/topmedtalk.mp3?autoplay=true This edition of To...

This is the third presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from Dr Lee A. Fleisher Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania. If you like the sound of this and think you and your practice would benefit from attendi...

This is the second presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from our Editor In Chief, Professor Monty Mythen, Smiths Medical Professor of Anaesthesia and Critical Care at University College London. If you like the sound of this and think you and your pract...

This is the opening address and first presentation - originally streamed live on www.topmedtalk.com - taken from the hugely successful "EBPOM-USA: Masters Course, A Perioperative Care Practicum". Hear the full presentation from Professor Sol Aronson, a tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology. If you like the sound of this and think you a...

How and where do you measure a patient's temperature? This is a detailed answer to a frequently asked question, various methods are discussed. This piece is taken from a longer conversation to be found here:  https://www.topmedtalk.com/live-from-the-iseh-part-1/ This edition of TopMedTalk was recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery...

This is another excerpt from "Controversies in perioperative medicine"; "The Great Fluid Debate". A fascinating piece containing Dr Tim Miller's enthusiastic advocation of goal directed fluid therapy and then the subsequent debate that follows. It ends up moving into the subject of 'enhanced recovery after cardiothoracic surgery' and what lessons we can learn from excessive hemofiltration during o...

Effect of intraoperative hyperoxia on the incidence of surgical site infections: a meta-analysis B. Cohen, Y.N. Schacham, K. Ruetzler, S. Ahuja, D. Yang, E.J. Mascha, A.B. Barclay, M.H. Hung, D.I. BACKGROUND Whether supplemental intraoperative oxygen reduces surgical site infections remains unclear. Recent recommendations from the World Health Organization and Center for Disease Control to routine...

Fluid Matters - the 'nil by mouth' or 'NPO' debate This piece is taken from "The Great Fluid Debate", it's about changes in practice that have been implimented both in the UK and at various medical centres in the US. Hear how and why the old 'nil by mouth' or 'NPO' policy has changed in many instances. From water to carbohydrate drinks, to black coffee, the thinking has changed in many institution...

How do we develop a way to teach perioperative medicine and once that's in place, how should it be overseen? What sort of official endorsement might it need? Developing a broad knowledge of the process is distinct from being a specialist, how do we develop that further - without developing a schism? This complicated topic is discussed alongside more detail regarding the future for this area. Prese...

This piece starts with the question: Is there a hierarchy amongst the various elements of an enhanced recovery pathway? The conversation that follows tackles some of the essential elements of perioperative care. This conversation is taken from a longer piece to be found here:  https://www.topmedtalk.com/live-from-the-iseh-part-2/ For further expert discussion regarding the Drink, Eat, Mobilise, Sl...

This is an excerpt from 'The Great American Fluid Debate' which was hosted at Duke University Medical Centre's "Controversies in Perioperative Medicine" conference of this year. The debate is framed as "restrictive versus liberal" but, as you'll hear, those terms are questioned by panel members. How do the results of 'The Relief Trial' figure in this debate? Is the pendulum of progress swinging to...

  What is 'the morpheus consortium'? What's the current thinking on pain management and the 'opioid crisis'? On reflection were people wrong to emphasise the message that 'pain is the fifth vital sign'? How did 'pain management' instead become 'opioid management'? The UK has had a slightly different ride to the US in this respect, although not without its problems, could that be due to this 'fifth...

Monty sits down with one of the co-organisers of this year's meeting in Orlando and discusses this year's annual conference, "Controversies in perioperative medicine". The discussion encompasses pain relief, opioids, the increased use of ultrasound and the use of particular blocks during abdominal surgery. As ultrasound improves how is perioperative medicine changing? What are the challenges prese...

This conversation reflects a discussion had at the Perioperative Quality Inititative (POQI). It originally ran under the title, "Intervascular volume and fluid responsiveness" but, as this conversation explains, it was renamed "Fluid Responsiveness and venous capacitance". With a genuinely multidisciplinary approach on display here this piece gives you a glimpse at the inner workings of the POQI p...

This discussion focuses on the perioperative quality initiative's intense focus this year on total body water and electrolights. How often should we weigh patients to monitor water balance? What can we learn from a real understanding of the circulation of interstitial fluid and lymphatics? What is the role of diuretics for the perioperative practitioner? Also, haemodilution, what should you do if...

How does perioperative care relate to obstetrics? Who does it benefit, the patient, the hospital or both? How does it help to engage pregnant patients through the perioperative process? Furthermore, does the issue of addiction arise in this area? Coming from this summer's Peroperative Quality Initiative (POQI), hosted at Washington Duke University in Durham, this podcast features Monty Mythen and...

Names, titles and definitions were sliced, diced and discussed at the Perioperative Quality Initiative (POQI). This conversation, recorded on the morning of the second day of the meeting and featuring some of the participants, reflects that. "Stress volumes" and "Pre-load" are a couple of examples given in this piece. Everyone involved knew what these words described but once discussions got into...

We begin with a question from the audience; 'how do we drive change in our institutions towards enhanced recovery after surgery?' The GIRFT (Getting It Right First Time) project is explained. The Health Foundation is also mentioned. This conversation is taken from a longer piece to be found here: https://www.topmedtalk.com/live-from-the-iseh-part-2/ This edition of TopMedTalk was recorded at The I...

Association of Multimodal Pain Management Strategies with Perioperative Outcomes and Resource Utilization: A Population-based Study. Memtsoudis SG1, Poeran J, Zubizarreta N, Cozowicz C, Mörwald EE, Mariano ER, Mazumdar M. BACKGROUND: Multimodal analgesia is increasingly considered routine practice in joint arthroplasties, but supportive large-scale data are scarce. The authors aimed to determine h...

The debate ' Direct laryngoscopes should be consigned to history ' was hosted by The Royal College Of Anaesthetists and carried out by the two guests on this piece. The conversation explores the fact that this skill is a key part of the job of practitioners, are we "de-skilling" the profession in an overly enthusiastic race toward new technology, or are some resisting it simply because it's not wh...

The patient experience can be quite passive and, as a result, people can lose temperature quickly. The consequences can be very negative, this conversation revolves around how you can keep your patients warm. This piece is taken from a longer conversation to be found here:  https://www.topmedtalk.com/live-from-the-iseh-part-1/ This edition of TopMedTalk was recorded at The Institute of Sport Exerc...

This piece focuses on the latest print issue of 'Anesthesia and Analgesia' which is saturated with coverage of the Perioperative Quality Initiative (POQI), the most recent meeting of which was sponsored by the American Society of Enhanced Recovery (ASER). This conversation acts as an update on where some of the latest thinking is as regards perioperative medicine. It includes a deep dive into gast...

Most people are familiar with ultrasound these days, next to the stethoscope and thanks largely to baby photographs, it's one of the most frequent public facing technologies in medicine. New developments in transesophageal echocardiography have brought about huge advancements in its use as a technology; not to mention the incredible images now available from three dimensional echocardiography. As...

What is TopMedTalk and how did it come about? Why is perioperative medicine such an inspiration to us? Why is our Editor in Chief such an advocate? What is the opioid crisis? Broadcaster Nick Margerrison speaks with our Editor in Chief about TopMedTalk and perioperative medicine. We regularly enjoy reading your feedback: contact@topmedtalk.com

The GIRFT (Getting It Right First Time) project. The stated aim is 'to help improve the quality of care within the NHS by reducing unwarranted variations, bringing efficiencies and improving patient outcomes'. This piece gives you the detail from one of the joint clinical leads.   This piece is taken from a longer piece to be found here:  https://www.topmedtalk.com/rcoa-13-the-girft-getting-it-rig...