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 gastrointestinal tract dysfunction and allows you to find out the best "whey" to an enhanced recovery al...
Jun 12, 2018•22 min
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 ultrasound becomes more available and more portable this conversation gives you an idea of where, wh...
Jun 11, 2018•21 min
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
Jun 10, 2018•14 min
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-right-first-time-project/ Also, if you'd like to hear more about The GIRFT (Getting It Right First Time) p...
Jun 09, 2018•7 min
A Randomized Trial of a Family-Support Intervention in Intensive Care Units Douglas B. White et al. for the PARTNER Investigators Surrogate decision makers (e.g. family and friends) for incapacitated, critically ill patients can understandably find it very difficult to make decisions related to goals of care. Having to make such decisions can cause them psychological distress and may lead to treatment that is not exactly what the patient might have chosen if they could speak for themselves. In t...
Jun 08, 2018•3 min
Geriatricians naturally fit into the perioperative sphere. Shared decision making is an obvious aspect of this, as is preoperative assessment and the consideration of the risks and benefits of surgery. Also in this piece; when do you become geriatric? This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/rcoa-06-geriatric-care-and-the-value-of-teamwork/ Desiree Chappell and Monty Mythen interview their guest Dr Jugdeep Dhesi, Clinical Lead, POPS and Consulta...
Jun 07, 2018•7 min
How can perioperative medicine be part of helping less developed healthcare systems? The considerations are different but the principles remain the same. The birth of the NHS gave parity of esteem to anaesthetists, the benefits of this are felt by us all in the Western world, could it be argued that this visionary decision might actually help other healthcare systems to evolve more rapidly? This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/rcoa-04-the-ro...
Jun 06, 2018•8 min
Big data is a complicated topic and here you will find a discussion about the need to balance the rights of the individual against an obligation to explore and unlock the treasures it offers for wider society. How do we hammer home the fact that responsibly recording data is part of a practitioner's duty of care? Taken from day two of our coverage of the Royal College of Anaesthetists' annual conference at The British Museum in London. Presented by Desiree Chappell and Joff Lacey, with their gue...
Jun 05, 2018•5 min
The pressures of being an anaesthetist are difficult to discuss for some, this conversation might be the start of that for you or a colleague. The message is clear; practitioners are human and they must ask for help if they need it. This piece is taken from a longer piece to be found here: https://www.topmedtalk.com/rcoa-05-if-youre-struggling-seek-help/ Presented by Desiree Chappell and Monty Mythen with their guest Dr Clare Gerada, Medical Director, Physician Health, Practitioner Health Servic...
Jun 04, 2018•4 min
NAP (National Audit Project) 6 is the largest ever prospective study of anaphylaxis related to anaesthesia and surgery. This conversation deals with the question; when is the best time to administer antibiotics? This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/rcoa-8-nap6-perioperative-anaphylaxis/ Joff Lacey presents with his guest Professor Tim Cook, Consultant in Anaesthesia and ICM, Royal United Hospitals, Bath. Join in the conversation: contact@top...
Jun 03, 2018•4 min
TopMedTalk set itself a target of over 10,000 downloads in the first year. Much to everyone's delight and surprise, we've smashed that target already! This piece is a chance to hear how you can become a bigger part of what we are doing here; it could be as simple as you connecting with us online, sharing some of our content on your social media feed, emailing us your feedback ( contact@topmedtalk.com ), or even coming to one of the many meetings we're scheduled to attend: www.ebpom.org/meetings ...
Jun 02, 2018•11 min
The NHS has helped to put the UK into a leading position in perioperative medicine, elsewhere there have been pioneers and innovators pushing it forward. How has this leadership in perioperative medicine become a force for change and improvement worldwide and what are the common themes that emerge as we take a global perspective on the discipline? This piece is taken from a longer conversation to be found here: https://www.topmedtalk.com/rcoa-04-the-royal-college-of-anaesthetists-world-leading-h...
Jun 02, 2018•4 min
In this piece Monty Mythen speaks to Professor Paul Wischmeyer from the Department of Anesthesiology, Duke University, about the recently published American Society of Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on Nutrition and Screening Therapy within an Surgical Enhanced Program, which has just been print published. The link to it is here: https://journals.lww.com/anesthesia-analgesia/pages/currenttoc.aspx Join the debate: contact@topmedtalk....
Jun 01, 2018•20 min
A highlights RCoA’s Anaesthesia 2018 A fascinating conversation about the anti-inflammatory effects of exercise. The theory is floated that this could be part of the reason why exercise as a form a prehabilitation might be so effective as part of an enhanced recovery pathway. This is part of a longer piece which you can enjoy in full here: https://www.topmedtalk.com/rcoa-03-adverse-outcomes-and-patient-optimisation/ Featuring Joff Lacey speaking to Dr Mark Edwards, Consultant in Anaesthesia and ...
May 31, 2018•6 min
Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation Brian E. Driver, MD1; Matthew E. Prekker, MD1,2; Lauren R. Klein, MD1; et al Key Points Question In patients admitted to the emergency department with difficult airway characteristics undergoing orotracheal intubation with a Macintosh laryngoscope blade, does a bougie facilitate higher first-attempt intubation success than an endotrac...
May 30, 2018•3 min
How do we develop an agreed curriculum that speaks to what perioperative medicine should be? Once that's in place, how should it be overseen? What sort of official endorsements would it need? Running in parallel to this are the MOOCs - Massive Online Open Courses - that are being developed. Developing a broad knowledge of the process is distinct from being a perioperative specialist, how do we develop that even further - without developing a schism? These complicated topics are discussed alongsi...
May 29, 2018•20 min
A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum. 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. The piece also includes patient communication and the question of 'how much is too much?', when administe...
May 28, 2018•24 min
A special edition of TopMedTalk recorded at The Institute of Sport Exercise and Health (ISEH) live from an Enhanced Recovery After Surgery (ERAS) leadership forum. How can cold water adaption help people deal with medical issues? There's evidence to suggest that cold water adaption reduces inflamation, can open water swimming help with issues such as chrohn's disease? On the other hand how important is it to ensure patients do not become cold while in our care? Hypothermia is never good, how imp...
May 27, 2018•24 min
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 healthcare within his institution. Do you need to develop a broad knowledge of all surgery and medicine so ...
May 26, 2018•18 min
The debate ' Direct laryngoscopes should be consigned to history ', hosted by The Royal College Of Anaesthetists and carried out by our two guests on this piece. Here we get into the advantages and challenges behind the two techniques; video laryngoscopy and direct laryngoscopy. The conversation explores the fact that these skills are 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 be...
May 25, 2018•18 min
The RELIEF (Restrictive versus liberal fluid therapy in major abdominal surgery) trial has been a huge story for us here at TopMedTalk, recorded on the second day of The Royal Collage of Anaesthetists' annual conference at the British Museum this is the moment the team get to pick over the results in detail. One of the biggest trials ever, it has both raised questions and provided answers. Inevitably there has been a huge debate, this piece puts all the major questions and concerns to the organi...
May 24, 2018•28 min
How does The Royal College of Anaesthetists' move forward from here? A stunning conference with internationally renowned speakers from all around the world, the perioperative process continues to grow and the NHS is leading the world in healthcare. This conversation gets into some of the issues this momentum can now be focused on. How has the conversation moved forward, how has the RCoA contributed to this and where should we be looking to now? Recorded towards the end of the first day of the Ro...
May 23, 2018•11 min
The Royal College of Anaesthetists' Lifelong Learning platform will replace the e-Portfolio and include a logbook functionality. It's expected to go live in August 2018. Find out the details here. This piece was recorded as part of TopMedTalk's coverage of the RCoA's annual conference at The British Museum in 2018. Joff Lacey presents, with his guests Esma Doganguzel and Lina Fazlanie, from the Royal College of Anaesthetists' Lifelong Learning team. Email us your feedback: contact@topmedtalk.com...
May 23, 2018•10 min
NAP (National Audit Project) 6 is the largest ever prospective study of anaphylaxis related to anaesthesia and surgery. Find out the details behind this intriguing study, how long did it take, how does the data impact upon our day to day practice? There follows a deep dive into the results and recomendations that NAP 6 has produced. Packed with useful information this podcast is one of the stand out pieces of our coverage of the Royal College of Anaesthetists' annual conference in London. Joff L...
May 23, 2018•27 min
Can artificial intelligence drive new changes in care and the value of big data? We're already comfortable with using tools that help us to do our job better, what are the opportunities and pitfalls related to this new technology? Are we ready yet for big data? The changes it may cause are staggering but equally; nuance is the friend of truth, do we have enough 'data literacy' to handle it all? Also - can the way you pronounce 'scone' give you an idea of your life expectancy? How do we balance p...
May 23, 2018•17 min
How do we best negotiate working in a multidisciplinary team? Generalisations regarding surgeons and anaesthetists only ever work generally, the specifics of each practitioner and their priorities inevitably contrast. How do we keep sight of these broad differences without falling foul of stereotypes? The conversation evolves; how does the surgical journey fully utilise the team based perioperative approach? With specific focus on geriatric care there is further discussion regarding shared decis...
May 23, 2018•13 min
Why do anaesthetists suffer from mental health problems, what help is there available for them? Learn here about The Practitioner Health Programme and hear why anaesthetists are uniquely placed to deal with the inevitable pressures related to healthcare and how they can become leaders, helping to destigmatise and tackle mental health issues. Presented by Desiree Chappell and Monty Mythen with their guest Dr Clare Gerada, Medical Director, Physician Health, Practitioner Health Service. Share your...
May 23, 2018•5 min
How has the Royal College of Anaethestists (RCoA) evolved over the years and why is perioperative medicine so crucial to its agenda? How has this leadership in perioperative medicine become a force for change and improvement worldwide and what are the common themes that emerge as we take a global perspective on the discipline? The RCoA's global partnership programme is explained, how can perioperative medicine be part of helping less developed healthcare systems? The considerations are different...
May 22, 2018•19 min
Adverse outcomes, we all know they happen but how do we handle them, record them and avoid them in the first place? The discussion then moves to (Patient Recorded Outcome Measures) PROMS. Patient optimisation is then discussed. Exercise, could it be so effective because it works as an anti inflammatory? A deep dive into the research on that is contained in this conversation. The RELIEF trial is discussed as the team get into a discussion about what a patient sees as a good outcome. How do we com...
May 22, 2018•22 min
Recorded live at The British Museum in London this piece contains a lot of discussion about the NHS; how does it rank in terms of outcomes? What does the offer of universal healthcare mean in terms of that? How does it compare to the way things are done in America and around the world? The team then discuss the shared goals and huge crossoever which exists between perioperative practitioners and The Royal College of Anaesthetists. Particular focus is given to the challenge of public health overa...
May 22, 2018•12 min
