This piece was recorded at the start of the year, to celebrate the launch of Tom Woodcock's book Fluid Physiology, A Handbook for Anaesthesia and Critical Care Practice: https://books.google.co.uk/books?id=F-m4DwAAQBAJ&printsec=copyright&redir_esc=y#v=onepage&q&f=false The editorial team here at TopMedTalk recently (08/12/2020) reflected upon the fact that Tom's 'big areas to watch in 2020' have proven to be remarkably prescient. The 13 Minutes To The Moon podcast is here: https:...
Dec 30, 2020•34 min
This piece considers the need to understand the patient having surgery and the complexity with which they present so we can match our skills to them. Developing these skills requires new approaches; to education and training at undergraduate and postgraduate level; to challenge the old ways of delivering perioperative care. This requires new ways of working, the breaking down of silos, a rethink of the financial support that is required and that we share good practice rather than 'reinventing th...
Dec 29, 2020•17 min
This piece looks at some of the advantages to having a perioperative interdisciplinary team reducing complications, understanding and discussing risk, facilitating better shared decision making and increased patient satisfaction, even among those who - as part of this process - decide not to go ahead with an operation. It also incorporates evidence regarding what we know about COVID-19; "The risks ... of the COVID-19 virus is that if people contract it during or after their surgery, they have a ...
Dec 28, 2020•28 min
"We did not have a concensus view on the very basic subject of fluid physiology and I needed to write a book". Recorded at the start of the year this piece builds on our previous look at Fluid Physiology, which you can find here: https://www.topmedtalk.com/topmedtalk-tom-woodcock/ We also make reference to the book "Fluid Physiology" which is available now, check out the website here: http://fluidphysiology.org/ Tom's always entertaining twitter feed is here: https://twitter.com/thomaswoodcock P...
Dec 27, 2020•9 min
"We, who physically will be elsewhere in the world, for example, in London and in Southampton, are going to - within what we're allowed to do - get together in a bubble probably at work, and set aside the time to watch the meeting together, and to share some food and maybe share some diet coke and talk about what we've been looking at what we've been learning. So that's the start of the hybrid events - and we hope that by the time we get to the World Congress of Perioperative Care, which used to...
Dec 26, 2020•19 min
The team enjoy reflecting on 2020 as we appreciate the fact that there were the green shoots of hope during the middle part of the year. The patient facing Macmillan Cancer Care podcasts are here: https://www.topmedtalk.com/?s=topmedtalk+%26+macmillan The POCAPALOOZA is here: https://www.topmedtalk.com/?s=pocapalooza Find out more about the African Surgical Outcomes Study (ASOS) and the African Perioperative Research Group (APORG) here: https://www.topmedtalk.com/pocapalooza-cape-town/ Guy Ludbr...
Dec 25, 2020•19 min
The annual TopMedTalk Holiday Special series this year takes a look back at COVID19 and the first year we had to live with it. Listen to the full conversations used in this piece: TopMedTalk | Henrik Kehlet and Nick Scott https://www.topmedtalk.com/topmedtalk-henrik-kehlet-and-nick-scott/ TopMedTalk | Silent pandemic of surgical complications https://www.topmedtalk.com/topmedtalk-silent-pandemic-of-surgical-complications/ COVID 19 | An update on patient, Professor Monty Mythen https://www.topmed...
Dec 24, 2020•39 min
"I cannot sleep. It's like, I wake up at 1am and my mind's going crazy ... if you had someone come to you and say; 'I'm really struggling right now, I'm having a lot of anxiety, with work with family, with kids with whatever'; what are some of the top things that you want to share with them?" How can a regular yoga practice bring you into a deeper union with what you do and help improve your performance? Why is it that people in the caring profession sometimes leave self care at the bottom of th...
Dec 23, 2020•24 min
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...
Dec 22, 2020•31 min
"I think you're now famous in the CRNA community for being one of the first people in Fargo to receive the the COVID vaccine" This piece sees us catching up with Certified Registered Nurse Anesthetists (CRNA's) who have just been vaccinated for COVID-19. Their story reminds us that even now some practitioners are facing their first real wave of the pandemic in their area: "We had a kind of trickle in, so to say, of COVID patients, and then this in this fall, the middle of November was really whe...
Dec 21, 2020•24 min•Season 1Ep. 61
What happens when cutting edge computer game creators, fresh from working on top titles in their industry such as 'Hunger Games' and 'Mission Impossible', use their skills to simulate high stress moments from the real world of anesthesia and surgery? Using "the neuro-science of game design" to help accelerate learning within the profession: "The motivation for starting Level Ex, what if we actually took the top game designers and developers in the industry? We're talking the executive producer o...
Dec 20, 2020•41 min
"You've given us all a lot to think about" - a randomized controlled trial regarding intravenous iron does not go 'as expected'. "I mean, look, I've built my entire career on thinking this was the best thing since sliced bread, the silver bullet, the magic wand ..." A great scientist follows accurate data to wherever it may lead, what now? More trials, more time, more questions? How common is anemia? Are there any nuggets of hope buried within these data? What have we learned? Evidence Based Per...
Dec 19, 2020•46 min
How can we align personalised care with prehabilitation? "Personalised care is where people have more choice and control over how their health and care needs are met" where we recognise "people themselves can sometimes be the best integrators of health and care". In this context our role is to support them to "live as independently as they wish". With shared decision making and personal choice at the heart of this we allow patients to be "experts in their own lives, health and care". The increas...
Dec 18, 2020•20 min
After working at a Veterans Affair Medical Center, hear how our guests moved into the field of emergence delirium: "upon emergence our patients were swinging and very aggressive ... there must be some way to prevent this". This fascinating piece enjoys an engaging discussion about an important topic for both patients and practitioners; how important is it for you to know a patient may suffer from post traumatic stress disorder? Do different anesthetics promote or avoid emergence delirium? Can em...
Dec 17, 2020•23 min
"It's useful to reflect on what SNAP-2 EPICCS might offer us in the brave new world that we find ourselves in with Coronavirus" The 2nd Sprint National Anaesthesia Project: Epidemiology of Critical Care after Surgery (SNAP-2 - EPICCS) study launched in March 2017 around the UK. More than 2,200 investigators at more than 250 sites across the UK were signed up to take part. The observational study collected data on all patients undergoing inpatient surgery during a one-week period (21 March to 27 ...
Dec 16, 2020•30 min
"Critical Care has a moment in time, a moment where we can make some big changes, a moment of opportunity" This uncompromising and informative talk from the technical lead for critical care in the Getting It Right First Time (GIRFT) project takes us through how services can improve and work alongside perioperative care to improve standards and outcomes for patients. Sharing best practice between trusts GIRFT identifies changes that help improve and change an institution’s procedures and cost sav...
Dec 15, 2020•20 min
From a UK perspective this piece covers variation in access to critical care, behaviors and decisions regarding its use. With reference to how, over the last 20 years, efforts have been made in Torbay to improve access to critical care we look at what can be done and what works. Finally there's a summary of where we are on this issue today. Getting it right first time (GIRFT) is here: https://www.gettingitrightfirsttime.co.uk/ Presented by Mike Swart, Consultant in Anaesthesia and Critical Care ...
Dec 14, 2020•20 min
This piece provides an update on the Perioperative Exercise, Testing and Training Society (POETTS); "established back in 2017, in the context, in the United Kingdom, of cardiopulmonary exercise testing becoming much more common in the preoperative period". Now, more than half of acute hospital trusts in the United Kingdom have a cardiopulmonary exercise testing service to evaluate their patient's functional capacity prior to surgery. Furthermore exercise interventions to optimise a patient's fit...
Dec 13, 2020•13 min
"Obstetric anaesthesia" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 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: https://www.ebpom.org/meetings If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented by Carolyn Johnston, consultant Anaesthetist in St Georges hospital in London and...
Dec 12, 2020•18 min
This piece presents an invaluable wealth of first hand experience in setting up various business cases in relation to perioperative medicine in the UK. At University College London (UCL) cardiopulmonary exercise testing (CPET) was set up as a research tool "but then clinicians came, became interested in the results of the tests and started to ask for tests to be done on their patients for clinical evaluation". An external contractor model, using a charitable organisation, enabled them to charge ...
Dec 11, 2020•10 min
The electronic cigarette market is a $14 billion industry worldwide. As of August 2019, 215 cases of severe pulmonary illness related to e-cigarette use are being investigated in the United States. The known hazards of e-cigarette use are rapidly coming to light with the sudden onset of serious bronchiolitis-related pulmonary disease in otherwise healthy people who were known to use e-cigarettes. Learn also how COVID 19 has increased these dangers. Presented by Desiree Chappell with Monty Mythen...
Dec 10, 2020•32 min
"In the elective surgical domain 20% of people who are scheduled to have surgery are not ready for surgery" The road towards economic reality is paved with data; this talk, confidently assertive in tone, provides you with a number of useful facts and reassurances which can be transformed into reasons why you and your patients can enjoy the benefits of prehabilitation; a better value of care and a higher standard of good quality outcomes. This piece works well in tandem with this debate here: htt...
Dec 09, 2020•34 min
What is a "Respect Officer"? Why is respect so important in perioperative care? How does improving 'the culture of safety' also help to improve outcomes? Should we be overly concerned about high cancellation rates for surgery? And what are the advantages of a preoperative risk assessment clinic (PRAC)? Presented by Desiree Chappell and Monty Mythen with their guest Amir Jaffer, Chief Medical Officer, New York Presbyterian / Queens.
Dec 08, 2020•20 min
What are the aims of The International Prehabilitation Society? Its vision is about "bringing together international multidisciplinary expertise, across healthcare and beyond, creating a platform of shared learning, research and education for the benefit of patients". This piece updates you on the current board members, the roles of committee members, conferences that the society has previously supported alongside those being planned for the future. Also there's an update on some exciting new sp...
Dec 07, 2020•10 min
This piece gives you the evidence base required to deliver an even higher standard of perioperative medicine where you work. Hear about the "Fit 4 surgery" studies; the "fit 4 surgery consortium", the ongoing e-studies, key findings, recent studies and the set up in Southampton. Physical fitness is greatly affected by chemotherapy; poor outcomes are significantly linked to physical fitness; learn how preoperative cardio-pulmonary exercise testing and training can monitor and track this potential...
Dec 06, 2020•32 min
"The people of Wales are particularly unfit", there is a high incidence of smoking, physical inactivity, and alcohol intake. Grim news from one angle but on the other hand it's a huge opportunity to make a massive difference in the prehabilitation stage of the perioperative process. Hear how cancer outcomes are being dramatically improved as a clear pathway of optimisation is rolled out. Presented by Rachael Barlow, National Lead, Enhanced Recovery, Prehabilitation and Optimisation, at Cardiff a...
Dec 05, 2020•13 min
This piece looks at the most recent guidance regarding prehabilitation for cancer, developed and published in 2009 by Macmillan Cancer Care. Extremely well received across the UK, and internationally, here we look at the details and some context in terms of UK national policy. From an NHS England point of view the desire is to ensure that all patients and participants have personalized care embedded into everyday NHS services. Work around streamlining multidisciplinary team meetings for cancer i...
Dec 04, 2020•17 min
Pediatric patients can present quite a challenge when emerging from anesthesia. Here we discuss ways to “ACE” your transition to PACU! “A”void Emergence Agitation, and discover the latest evidence about “C"riteria for “E”xtubation in this challenging population. How do the protocols and standard of care compare between the UK and US. What does the evidence tell us? Also, how is Enhanced Recovery After Surgery progressing in pediatrics? Presented by Desiree Chappell and Monty Mythen with their gu...
Dec 03, 2020•31 min
It's widely understood that high value care during, before and immediately after surgery is optimal whereas poor quality care in the perioperative period produces long term difficulties which are compounded by the acute stresses produced during and immediately after a procedure. This talk covers three main areas; surgical care for patients in Greater Manchester, "ERAS+"; prehabilitation for cancer, for the population of Greater Manchester; how Manchester has supported patients during the time of...
Dec 02, 2020•29 min
What do we mean by "nutritionally fit" and why does it matter? How do we identify those most at risk in terms of screening and assessment and what's the difference between these two processes? How can we use screening and assessment to triage patients into care? Also, in the time of COVID19, are there ways we can perform some tasks related to these processes remotely? Presented by Steve Wooton, Senior Lecturer in Human Nutrition within Medicine at the University of Southampton.
Dec 01, 2020•32 min
