"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' are being introduced in the battle against the global pandemic as well as 'drive through' testing....
Mar 30, 2020•10 min•Season 1Ep. 15
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, University College London Hospital, with his guests Ross Kerridge, John Hunter Hospital, Newcastle, Australia,...
Mar 30, 2020•22 min
"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 real patient engagement and empowerment? How do you manage a sensible quality improvement programme? P...
Mar 29, 2020•23 min•Season 1Ep. 5
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 Director at Vyaire Medical.
Mar 28, 2020•14 min
"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 the symptoms, only days before he was set to return to active duty in Critical Care. Acting responsi...
Mar 27, 2020•22 min•Season 1Ep. 14
"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 ourselves for an oncoming viral attack? How can we make sure our patients get the best possible care an...
Mar 27, 2020•32 min•Season 1Ep. 13
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; psychological factors also impact on wound healing and functional recovery. Meanwhile low confidence and depr...
Mar 27, 2020•17 min
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 Chappell with her guest, Henry Howe, a medical student at Bristol University, a frequent contributor...
Mar 26, 2020•9 min•Season 1Ep. 12
"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 marketing' where we promote success within our own institutions? More information on The Morpheus Consor...
Mar 26, 2020•23 min
"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 symptoms could be caused by a number of factors but until a clear test result is available he is ta...
Mar 25, 2020•18 min•Season 1Ep. 11
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 and helping implementation? The article discussed in this piece "Guidelines for Perioperative Care in ...
Mar 25, 2020•13 min
"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 are being called upon to deal with in this crisis? The collaborative resource from the UK https://ic...
Mar 24, 2020•11 min•Season 1Ep. 10
"'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 going in North Carolina, Louisville and London? Has elective surgery been cancelled yet? How are peo...
Mar 23, 2020•24 min•Season 1Ep. 9
“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 Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy, was subsequently featured in the New England Jo...
Mar 23, 2020•30 min•Season 1Ep. 9
This conversation sets the scene for the UK. London now having some hospitals which are overwhelmed, other parts of the UK still in the anticipation period. The conversation moves to the importance of enhanced recovery after surgery and its immediate relevance to the COVID 19 crisis. Then the topic of Personal Protection Equipment (PPE) is raised, possible shortages are discussed. The debate about non invasive ventilation, continuous positive airwave pressure (CPAP) and optiflow techniques. Oxyg...
Mar 22, 2020•23 min•Season 1Ep. 8
This remarkably prescient conversation was recorded at an Australian National Summit in Adelaide regarding the 'hidden pandemic of postoperative complications'. The dangers presented by them certainly suggest this area needs to be taken more seriously. Although staged in Australia this conversation is of global concern, particularly at a time when the world is realising the benefits of proper perioperative care. For more about the National Emergency Laparotomy Audit go here: https://www.topmedta...
Mar 22, 2020•32 min
What are the benefits of Cardio Pulmonary Exercise Testing (CPET) in cancer patients? What is the evidence that suggests prehabilitation changes outcomes? Furthermore, what is the National Emergency Laparotomy Audit (NELA) and what are its benefits? Presented by Joff Lacey and Desiree Chappell with their guests; Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and Improvement lead for the National Emergency Laparotomy Network ( NELA.org.uk ) and Malcolm West, National I...
Mar 22, 2020•22 min•Season 1Ep. 4
"Enhanced Recovery After Cardiac Surgery" - 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 Daniel Engelman is the Medical Director of the Heart, Vascular and Critical Care Unit...
Mar 21, 2020•11 min
This piece is a detailed and reassuring look at how preparations are being made in North Carolina by our occasional host and regular contributor Vicki Morton. "I was told a few weeks ago [that] my focus was shifting to Covid preparedness"; hear how a taskforce was put together to prepare for the global pandemic. "Various different countries have been in denial" but now the fight back has begun in ernest. Will testing kits be made more widely available soon? Questions for our listeners: Could a '...
Mar 21, 2020•26 min•Season 1Ep. 7
Our guest is an intensivist and specialist in dangerous transmissible diseases as well as being one of the scientists who took part in the Xtreme Everest expedition which investigated the effects of human tolerance of hypoxia. What about continuous positive airway pressure (CPAP)? Information suggests this may be more useful as we head into the pandemic stage "based on the experience the Italians are describing to us". This piece looks at how the UK is preparing to tackle the global pandemic bef...
Mar 20, 2020•19 min•Season 1Ep. 6
Can delirium, the most frequent complication in an elderly patient, be tackled with multimodal prehabilitation? This piece explains how that challenge is being investigated at the moment. A link to the paper is here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564537/ Presented by Ties Lukas Janssen, General Surgery Resident at Amphia Ziekenhuis.
Mar 20, 2020•13 min
Desiree and Monty update each other on how it's going as both the US and UK healthcare services prepare for, and begin battle with, COVID 19. School closures in both the UK and the US; how do the practicalities of cancelling school attendance impact upon frontline providers? What do comparisons with other countries tell us about the oncoming tsunami? Presented by Monty Mythen and Desiree Chappell. Link to Hugh Montgomery's piece: https://www.topmedtalk.com/covid-19-hugh-montgomery-north-london-u...
Mar 19, 2020•26 min•Season 1Ep. 5
A large part of the journey towards enhanced recovery, better outcomes and fewer complications, is to do with educating patients. How do we explain to patients that an operation is something which is ideally a collaboration between both practitioner and patient? The "Fitter, Better, Sooner" toolkit, which this piece focuses on, can be found here: https://www.rcoa.ac.uk/fitterbettersooner The excellent video we mention is here: https://www.youtube.com/watch?v=0NMHMX-nFgY Presented by Nick Margerr...
Mar 19, 2020•17 min
"Thank you for taking this meeting beyond these walls" - this piece was the final part of our coverage of The American Association of Nurse Anesthetists (AANA) 2019 Annual Congress in Chicago, Illinois. We begin with the global audience in mind and break down what it is to be a Nurse Anesthetist. It's a role which is expanding in scope, our guest walks us through how and why that's the case. This wide ranging conversation then moves to the future of enhanced recovery and the AANA's future develo...
Mar 18, 2020•33 min
"The parade here in Dingle is usually the first in Ireland..." but this year it is postponed. We speak to a Councillor in Dingle, a place much loved by many TopMedTalk listeners who attend the annual Evidence Based Perioperative Medicine (EBPOM) conference there. Monty Mythen is joined by Cllr. Breandán Fitzgerald, County Councillor on Kerry County Council. Thank you to our sponsor Edwards Lifesciences. Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation...
Mar 17, 2020•15 min•Season 1Ep. 4
"Maintaining your staffing is key"; this piece is a conversation recorded immediately after a deeply concerning report regarding the situation in Bergamo, Italy. The risk of overwhelm at our institutions is present as the understanding sinks in regarding the fact this is a massive population health issue. Presented by Desiree Chappell and Monty Mythen with their guests Dr Michael Scott, Professor of Anesthesiology at Virginia Commonwealth University, Maurizio Cereda, Associate Professor at Hospi...
Mar 17, 2020•13 min•Season 1Ep. 3
Preparations in London and the US are discussed before a frontline report regarding Italy and the consequences of the pandemic there. Presented by Desiree Chappell and Monty Mythen with, Dr Michael Scott, Professor of Anesthesiology at Virginia Commonwealth University, Maurizio Cereda, Associate Professor at Hospital of the University of Pennsylvania and Andrea Ciocca from Naples. This conversation preceeded the one in this piece here: https://www.topmedtalk.com/covid-19-you-must-learn-the-epide...
Mar 17, 2020•32 min•Season 1Ep. 2
This piece focuses upon the increasing development of artificial intelligence and automation within the medical profession. Can automated monitoring actually allow practitioners to live more "in the moment" while in the operating theater? How do we use algorithms to avoid information overload? The book "Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again", your "anxiety antidote" to the AI discussion, is here: https://www.amazon.co.uk/Deep-Medicine-Artificial-Intelligence-...
Mar 17, 2020•17 min
"There hasn't been any griping, there hasn't been any ill temper and people are coming in to help out in any way..." this piece gives us an idea of how things are going in the UK, in this instance in Whittington, North London. A sense of preparation is in the air. Looking at other countries and the epidemiology "we're about to reach the inflection point when a little trickle of cases [become] a flood". How can lessons from other nations help our preparation process? Should 'social isolation' be ...
Mar 16, 2020•35 min
"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 both Hong Kong and Italy. It starts with a summary of a conversation with Professor Mike Irwin, University of Hong Kong. We then move to a conversation with Mirco Nacoti, specialist intensivist at Bergamo, Italy. Presented by Monty Mythen and Desiree Chappell. This piece is part of a longer conversation, which will be available in full soon. ...
Mar 16, 2020•37 min•Season 1Ep. 1
