The Perioperative Quality Initiative (POQI) is a vital part of the process needed to more widely implement sensible practice which, using a clear evidence base, provides better value care with more positive outcomes for the patient. POQI continues to provide its work in an attempt to clarify fundamental concepts in perioperative care. The fact this one focuses upon fluid management makes it particularly appropriate in these times. Link to the paper: https://perioperativemedicinejournal.biomedcen...
Apr 30, 2020•21 min•Season 1Ep. 53
"There's no advertisements popping up, non of that nonsense, this is just the data you need on the front lines to help save time and save lives" This piece focuses on the Ventilator Training Alliance APP, developed to meet the need practitioners have to use and understand ventilation equipment which may be new or unfamiliar to them. Download the APP now and share it with all friends and colleagues who may find themselves in this situation. The app is here: https://www.allego.com/ventilator-train...
Apr 30, 2020•26 min•Season 1Ep. 52
"If you have major surgery and you are COVID positive at the time your outcomes are severely reduced" This piece takes a look at how we try to move back to some semblance of "normal" as the peak appears in many parts of the Western world to have reacted to social distancing measures. How have thought leaders and anesthesiologists tried to come together to produce guidance for each other? What should that guidance be? What specific areas of practice have been changed by the pandemic? Also - more ...
Apr 29, 2020•22 min•Season 1Ep. 51
In the UK community based prehabilitation is being spearheaded by the Prepwell Initiative, supported by a grant from Sports England. Their pioneering work is a great example of the way in which prehabilitation is gathering pace at the moment. The “PREP: Preoperative Risk Education Package” website is here: https://www.prepwell.co.uk/ What are the economics of such a programme? Why did the project start to get referrals from initially sceptical surgeons? How did the programme impact the lives and...
Apr 29, 2020•22 min
Mixed in with conversation about EBPOM's plans to push forward with online conferencing and other ideas this piece asks how Ireland has and is faring in the battle against COVID. Decisive and brave action began with cancelling the world famous St Patrick's Day celebrations. How have things progressed from there? Presented by Desiree Chappell with Monty Mythen and Jan Brohan, Consultant in Anaesthesia and Intensive Care Medicine in Cork University Hospital. Thank you to our sponsor Edwards Lifesc...
Apr 28, 2020•26 min•Season 1Ep. 50
The war against COVID 19 is ongoing but some relief has reached the frontlines in New York. Hear how a rapid response military team, United States Air Force Reserves, deployed into the "war zone" built and supported the first wave of our battle against this terrible virus. How has this effort been received and implemented? What is the significance for this unprecedented move in the US? What lessons are being learned and could the end result improve healthcare for all? Presented by Desiree Chappe...
Apr 28, 2020•33 min•Season 1Ep. 49
“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 an edited highlight of a fascinating conversation with a TopMedTalk favorite. How can we optimise ourselves for an oncoming viral attack? How can we make sure our patients get the best possible care and are as informed as they ...
Apr 27, 2020•17 min•Season 1Ep. 48
The debate 'Direct laryngoscopes should be consigned to history', was 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 ...
Apr 27, 2020•19 min
ACE inhibitors (angiotensin converting enzyme inhibitors) have been mentioned frequently in this series over the last month. This piece sees the long promised focus on ACE and the effects of estrogen as a way of dealing with some of the potentially fatal symptoms caused by COVID 19. It's still early days in the battle against this terrible virus, this piece presents some speculation as to where the conflict may head to. TopMedTalk provides evidence based discussions, here we ask how more evidenc...
Apr 26, 2020•35 min•Season 1Ep. 47
The healthcare profession has a mixed history when it comes to messaging around alcohol. Nowadays, from a public health perspective, it is clear that overall it is not helpful for our physiology and well being. How often do you have alcohol? How many units do you drink? How often do you have a binge? What are the age groups where drinking problems are most apparent? Where is the latest research regarding a perioperative approach to alcohol consumption? How effective is intervention for risky dri...
Apr 26, 2020•19 min
"You're a bit further down the line with managing these patients. Any particular advice?" Italy, the situation is difficult but there are now clear lessons to be learned as the first chapter in the front line battle against the consequences of a global pandemic is written. Hear how the story regarding treatment for this disease evolved in Italy and consequently around the world. Has the debate regarding acute respiratory distress syndrome (ARDS) been a red herring? What is the effectiveness of c...
Apr 25, 2020•38 min•Season 1Ep. 46
"Moving as medicine; is it the most underused but proven health promotion and healthcare practice?" Prehabilitation and population health naturally walk alongside each other. Learn here how Sport England's ambitious strategy to reduce inactivity and improve the nation’s physical and mental health is connected to prehabilitation and Enhanced Recovery After Surgery. Should patients be seeking expert condition specific advice before becoming active? How do we improve the quality of conversations be...
Apr 25, 2020•19 min
This piece is something of a ray of hope, here we learn how New Zealand appears to have managed the crisis remarkably well, a low level of infections overall. What lessons can be learned from the political leadership and tactic deployed here? Is there a downside to this, as regards to 'herd immunity', or is the reality that all of us must wait for a vaccine? Presented by Desiree Chappell and Monty Mythen with Julian Fuller, Anaesthetist in Auckland, New Zealand. Thank you to our sponsor Edwards ...
Apr 24, 2020•24 min•Season 1Ep. 45
This piece is a catch up with a popular contributor on TopMedTalk, Ross Kerridge, John Hunter Hospital, Newcastle, Australia, (often cited as 'the father of Modern Perioperative Medicine), for an update on how Australia appears to have managed to broadly keep a lid on this crisis. Social distancing, quick action and border controls appear to have worked to forestall the impending crisis. Our guest writes regularly and is a very popular opinionator, find some of his work here: Newcastle's 'quiet ...
Apr 24, 2020•25 min•Season 1Ep. 44
"It's really important just to talk about the situation and not keep it bottled up“ Psychological stress is inevitable at this time for medical practitioners, that's why we here at TopMedTalk are keen to both raise money for the Intensive Care Society (ICS) charity and to remind our listeners of the importance of mental health and self care. There's a wealth of resources on this topic in the TopMedTalk archive. Here's a good piece to start with: https://www.topmedtalk.com/topmedtalks-to-sasha-sh...
Apr 24, 2020•15 min•Season 1Ep. 43
"Our mission is to make sure everybody in intensive care can learn [ultrasound]". How important and how possible is it to use ultrasound in your practice? Hear how it can transform the way you diagnose issues with pocket sized point of care ultrasound. Lung ultrasound is discussed as is its use with eyeballs. Hear how one of the pioneers in this area, Professor Sol Aronson, reacts to an enthusiast in the field. "Wherever you are, however novice or new, it just makes you smarter". Recorded live a...
Apr 24, 2020•25 min
"It's heartbreaking - we have to recognise the fact, and continue to think; 'we've all got it, we can all get it and we can all give it!'" This urgent release from TopMedTalk will force the many leaders in our profession to tackle a very serious and important subject, what does the data reveal regarding COVID deaths among staff members and healthcare workers? Stark questions need to be asked; why is there a disproportionate number of fatalities from black and minority ethnic groups (BAMEs)? The ...
Apr 23, 2020•14 min•Season 1Ep. 42
The Intubate Covid project is an essential contribution to an evidence based answer to the issue posed by dangers of health care workers contracting and spreading the virus. By both collecting and sharing data the project gives you both a track record of where you are, in relation to your own safety, as well as the knowledge you are contributing to vital research. Find out more about the project by joining now: www.intubatecovid.org Presented by Joff Lacey with his guest Kariem El-Boghdadly, Con...
Apr 23, 2020•25 min•Season 1Ep. 41
"The concept of 'disruptive innovation' in healthcare and that's what this has been; a major challenge to healthcare has forced us to do something very differently, very quickly." This piece starts with a quick update on the current situation from Monty and Desiree regarding where they are, London and Louisville Kentucky, in both the US and UK respectively. We then move to the fascinating and inevitably - rapidly expanding - area of 'tele-medicine'. Hear how our guest has helped to pioneer this ...
Apr 22, 2020•21 min•Season 1Ep. 40
This is the second and concluding part of our real life case study of a COVID 19 patient. In this instance our Editor in Chief Monty Mythen has - during the course of presenting this series - contracted COVID 19. Fortunately for us, it was a comparatively mild case. This short documentary takes the story up right after Monty's decision to take a test to see if his symptoms were as we feared. Presented by Nick Margerrison, part 1 is available of download here: https://www.topmedtalk.com/covid-19-...
Apr 22, 2020•20 min•Season 1Ep. 39
This piece looks at our recent archive and pieces together the story of our Editor in Chief, Monty Mythen's bout of COVID 19. From the start TopMedTalk was keen to reflect the global battle against this terrible virus and - as you will hear - concerns for our friends and contributors in the medical world was never far from our minds. In retrospect it is particularly interesting listening to how evidence and best practice were in this instance vital to the health of our team and the people they c...
Apr 21, 2020•20 min•Season 1Ep. 38
A quick surprising poll of perioperative practitioners sets the tone for a robust advocation of the responsibility of surgeons and practitioners to do surgery right; as opposed to being inclined to feeling it must be done "right now!". A data driven approach combined with a patient focused attitude are at the centre of the argument. How do these factors combine to produce a business case which all institutions, practitioners and patients can understand? In terms of time spent, what do we mean wh...
Apr 21, 2020•21 min
The UK has accelerated the graduation of medical students to help fight COVID 19. We speak to some of Britain's newest doctors to hear what it's like getting ready for - and going into - action against one of the most dramatic health crisis in living memory. Discussions about palliative care, end of life decisions and rapid patient decline are just some of the experiences they are learning to cope with, fresh out of medical school. Presented by Desiree Chappell and Dr Henry Howe with Dr Dolcie P...
Apr 20, 2020•31 min•Season 1Ep. 37
All treatments have unintended consequences, "locking down" most of The Western World is certainly no exception. In the medical world we're faced with a familiar set of problems which has been intensified thanks to the sidelining and postponement of treatment for people who do not have the corona virus. It's a complicated debate, with many strands, here we focus upon how prehabilitation, specifically regarding anemia, is actually now more important than it ever has been. There is an opportunity ...
Apr 19, 2020•26 min•Season 1Ep. 36
This piece digs deep into the realities of coping with COVID 19 patients who have had their care escalated to the Intensive Care Unit (ICU); "we don't seem to be looking at our typical sepsis patients who get multiple organ failure in the classical way" and "you're surprised at how young some of the patients are...". Our guest provides us further insight; a 'household name' in the haemodynamic monitoring space; he is treating patients in a medium sized hospital (500 beds) with mostly COVID patie...
Apr 18, 2020•21 min•Season 1Ep. 35
"It was taken pretty seriously, right from the start" After a quick update with both Monty, UK, and Desiree, US, we join one of our friends and colleagues at the University of Hong Kong; what's the situation there? What useful comparisons can be drawn from speculation about the differences between Hong Kong's response in contrast to ours? How can it be that in spite of such proximity to the epicenter of the global pandemic they appear to be managing a situation we are having such problems with? ...
Apr 18, 2020•27 min•Season 1Ep. 34
"It's airway, breathing, circulation" This piece focuses upon treating patients outside of Philidelphia at an "all COVID unit"; what can we learn from someone who stands at the cutting edge of fighting this terrible virus? How are staffing concerns being dealt with? What about on the job training and upskilling? How do we maximise human resources during this crisis? There is also a detailed conversation about the care of COVID patients, the changing thoughts on ventilation and continuous positiv...
Apr 17, 2020•26 min•Season 1Ep. 33
Why does the US have the highest maternal mortality rate of any developed country? This piece tackles a very controversial issue in healthcare head on, could the problem be due to racism? The chances of a serious issue is "substantially higher if you come from a minority group, in particular if you are African-American". We also cover the issue of postpartum hemorrhage, what are the key signs that a patient is at risk? Furthermore, how are quality care initiatives and standardization of care hel...
Apr 17, 2020•20 min
This piece sees the welcome return of our favorite live musician, Jeremy Sassoon, intended as a chance for listeners to TopMedTalk to both raise money for the effort to tackle COVID 19 and fight the 'burnout blues' while doing so. If you enjoyed this piece please check out this live video (which features on the podcast) here: https://www.youtube.com/watch?v=HbdJAFpRz34 And find Jeremy Sassoon here: https://www.facebook.com/jeremysassoon Presented by Monty Mythen with Desiree Chappell and their g...
Apr 16, 2020•14 min•Season 1Ep. 32
"The peak keeps getting pushed..." What's the difference between a strategy of rationing as compared with one where the aim is concordence? As the crisis rumbles on, how do we decide who should have surgery, as well as the pressing question of how and where? The principles of perioperative medicine kick in here, pre-optimisation and enhanced recovery are uniquely suited within the profession to assist in the worldwide battle against this pandemic. What about the need for end of life conversation...
Apr 16, 2020•27 min•Season 1Ep. 31
