The NHS, a national institution beloved by the people of the United Kingdom is over 70 years old. EBPOM celebrated this fact with a talk that gets right to the heart of why this institution is so special and also how it can move forward in the brave new world we find ourselves in now. This piece was streamed live, from the IET at EBPOM, on www.topmedtalk.com Sir Bruce Keogh KBE, FRCS, FRCP, is a giant in the world of UK healthcare. A British surgeon and physician who specialises in cardiac surge...
Jun 26, 2020•42 min
What are the two prime components of any good nutrition programme? How is avoiding malnutrition different from supporting anabolism? What's the best way to screen patients for malnutrition risk? How can a patient's anthropomitry be assesed alongside their stated needs and preferred outcomes? How important are protein supplements? What are the wider benefits of a good diet? How do we devise nutrition care plans for malnurished patients who need a more aggressive approach? Is it fair to say that e...
Jun 25, 2020•19 min
This question and answer session is a valuable insight into where the latest thinking is as regards tackling the opioid crisis. How do we get to an understanding where the entire continuum of care is on the same page as regards pain relief? What's the level of adoption for opioid free anaesthesia? Can re-languaging pain or "re-writing the narrative" help, for example is it better to speak of 'comfort levels' as opposed to pain? What's the latest thinking as regards caffeine as an aid to comfort?...
Jun 24, 2020•15 min
"Rehabilitation post critical care" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 on www.topmedtalk.com Hear this excellent talk, for free, on this podcast. If you have any comments or questions you'd like to send to the team email: contact@topmedtalk.com Presented by Linda Denehy, Head of the Melbourne School of Health Sciences and Professor of Physiotherapy at The University of Melbourne, Australia. -- Have you heard? EBPOM 2020 –...
Jun 23, 2020•23 min
The Cleveland Clinic London Hospital opens to inpatients in early 2021. Here you can hear what it is about, how it is going to work and how it intends to improve healthcare in the UK. Presented by Nick Fletcher, Chair of the Institute of Anaesthesia and Critical Care at the Cleveland Clinic London, Consultant in Anaesthesia and Critical Care, St Georges University Hospital NHS Foundation Trust.
Jun 22, 2020•17 min
This piece focuses on The Balanced Anesthesia Study, 'A Prospective Randomized Clinical Trial of Two Levels of Anesthetic Depth on Patient Outcome After Major Surgery'. How can delerium be measured and standardised in a multi-centre trial? More on the study here: https://journals.lww.com/anesthesia-analgesia/FullText/2015/08000/Rationale_and_Design_of_the_Balanced_Anesthesia.14.aspx More on the Confusion Assesment Method here: https://www.guysandstthomas.nhs.uk/resources/our-services/acute-medic...
Jun 21, 2020•18 min
"Every fourth operation there is evidence of a modifiable risk factor". The Perioperative Quality Initiative (POQI) is our starting point for this conversation, seven concensus conferences focusing on various topics of interest to the perioperative practitioner. Check out their extensive open source resources here: www.poqi.org Hypotension and Mean Arterial Pressure (MAP) are discussed in detail; how are patients now being managed? How can a 'hazard index' help? "25% of our patients experience h...
Jun 20, 2020•36 min
This piece discusses The Brain Health Initiative and the sixth Peri-Operative Quality Initiative which focused upon delirium. How can progress in these areas be built upon and encouraged? Where is the data in regards to detecting and dealing with delirium? Beers Criteria Medication List; Potentially Inappropriate Medications for the Elderly According to the Revised Beers Criteria is here: https://dcri.org/beers-criteria-medication-list/ The website for the AARP is here: https://www.aarp.org/ Pre...
Jun 19, 2020•28 min
This piece focuses on the great work done by The Anesthesia Patient Safety Foundation. We turn to their specific focus on COVID 19 and then look at the wider benefits of a network dedicated to patient safety in our field. Their section on COVID 19 is here: https://www.apsf.org/news-updates/perioperative-considerations-for-the-2019-novel-coronavirus-covid-19/ Furthermore there is a remarkably prescient article by Mike Grocott and Monty Mythen on there in which we discuss, Perioperative Fluid Mana...
Jun 18, 2020•30 min
"We are getting super excited about EBPOM Live from London at the end of June..." - thousands of you already have your tickets, this podcast is your essential primer; a fascinating rundown of what attendees to the virtual conference "EBPOM Live From London!" can expect. As a listener to TopMedTalk you are part of a movement which aims to help save lives every year around the world. The practice of evidence based perioperative medicine guarantees healthcare as a whole, and surgery in particular, ...
Jun 17, 2020•13 min
"Data is destiny"; this piece looks at way we can unlock it for Anesthetists. The Open-Source Anesthesia Electronic Medical Record (OSAEMR) was developed specifically for Nurse Anesthetists. Its focus is on solo or small-practice nurse anesthetists operating in environments with limited or no network and computing resources other than an iPad. One patient, one nurse anesthetist, and one iPad. It can now be scaled to larger multi-provider practices outside of CRNAs. Hear how this innovation came ...
Jun 16, 2020•26 min
"We believe these results are applicable to a very broad population" Focusing on a study of over 6,000 patients, this hugely important piece attempts to finally move forward discussion regarding the long term consequences of deep anaesthesia? There is no difference in the survival rate of patients who have had a "deep level" of anaesthesia, which is still strictly within the bounds of normal clinical practice. Could this research lead to us using less anaesthesia overall and improving our enviro...
Jun 15, 2020•22 min
"The NHS is composed by about 20% of non-white individuals" This piece takes a data driven look at a controversial area, how well informed are we about the risks associated with the coronavirus behind this unprecedented global pandemic? "The background issues of gender and ethnicity may out weigh the issues related to comorbidities" but, in terms of data, "it's a moving target". There have been theories regarding vitamin D absorption, genetics and other hypotheses but in this piece we also ask i...
Jun 14, 2020•38 min•Season 1Ep. 59
How can we learn more by seeing more? This fascinating piece looks at how learning and the zone of proximal development (ZPD) of a student can be used to help the process. We are learning about learning, thanks partly to the use of algorithms that monitor our progress and performance. This talk asks challenging questions; "In terms of performance, just think technical procedures at the moment, is there such a thing as an 'expert performance' of any of the techniques we do daily"? How do we get t...
Jun 13, 2020•25 min
Evidence Based Perioperative Medicine (EBPOM) is the reason TopMedTalk exists; the vast majority of the content we love everyday comes from conferences organised by this important global initiative designed to promote high value perioperative practice around the world. Here on TopMedTalk, as you have heard, we immediately reacted as firmly as we could to the news of the novel coronavirus COVID 19. However we realised our dreams of a conference that truely moves the debate forward on perioperativ...
Jun 12, 2020•19 min
How does an experienced physician, health service changer, improver and researcher see the process of re-engineering perioperative care pathways? What are the challenges we face when we try to rework or improve the culture of an institution? How do we tackle common issues, which nowadays seem less acceptable, such as delirium? This piece is part of a series of talks regarding "re-engineering perioperative care pathways" which were given during the 8th Australian and New Zealand Symposium of Peri...
Jun 11, 2020•21 min
Everything you ever wanted to know about CPET (Cardio Pulmonary Exercise Testing) but were too afraid to ask; this conversation is a fascinating deep dive into the topic with two experts in the field. Discover how widely practiced this technique is across the UK, hear about the advantages people who use it have in terms of outcomes and patient safety. Also, what do institutions then do with the data and how does that increase our understanding of the human body? Some of the UCL podcasts mentione...
Jun 10, 2020•36 min
How does the treatment of anemia fit into the perioperative process? How far should patient optimisation extend to treatment of this condition? Live from the hugely successful EBPOM USA conference, directly after their presentation Desiree Chappell talks with her guests; Dr Lori Heller, Cardiac Anesthesiologist, Swedish Medical Center, through US anaesthesia partners and acting instructor at the University of Washington, Seattle and Dr Bobbie Jean Sweitzer, Associate Professor and Director of pr...
Jun 09, 2020•25 min•Season 3Ep. 8
Desiree and Monty catch up with Dan Martin, OBE, and speak with him about treating infectious diseases and in particular patients with ebola. Presented by Desiree Chappell and Monty Mythen with their guest Dan Martin, OBE anaesthetist and intensivist at the Royal Free Hospital and Reader at University College London (UCL).
Jun 08, 2020•14 min
This piece presents the prehabilitation 'business case'; why it's important to care about costs, how outcomes and value based care can help and why money has to be important in healthcare. How do we convert health benefits and risk management into something which explains the financial bottom line? Can we really argue that a process which appears, at the point of practice, to take more time, resources and involve a shorter length of stay for patients, is actually cheaper for institutions in the ...
Jun 07, 2020•21 min
Discussion begins with a hugely successful Enhanced Recovery program at a large community hospital, continued improvements and service line expansion. Learn about both the advantages and the challenges of a perioperative practice here. Presented by Desiree Chappell and Monty Mythen with their guests Kim Duggan, Perioperative Surgical Home (PSH) - Enhanced Recovery After Surgery (ERAS) Manager, New Hanover Medical Centre and Robin Davis, Clinical Education Specialist II at New Hanover Regional Me...
Jun 06, 2020•10 min•Season 3Ep. 7
"Updates in cardiac devices, Part 2" was a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: “Updates in Perioperative Medicine 360” which took place between November 7th-9th 2019. This piece is focused upon transcatheter aortic valve implantation (TAVI) devices. "A balloon valvular plasti in comparison to a TAVI is 90% of the risk, 10% of the gain" you're trading one problem with another, argues our speaker. Find out more abo...
Jun 05, 2020•35 min
"Updates in cardiac devices, Part 1" was a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: “Updates in Perioperative Medicine 360” which took place between November 7th-9th 2019. This piece is a look at some of the new technology which looks set to become more widely used. A leadless pacemaker is a small implantable "bullet like" device that sends electrical pulses to the heart whenever it senses that the heartbeat is too sl...
Jun 04, 2020•24 min
The opioid crisis "a unique American problem". This piece uncovers the origin of some of the misinformation about opioids, the consequences of calling pain a "fifth vital sign" and the absurd practice of waking patients up in the middle of the night to ask them if they are in any pain. As these factors combined fatalities started to spiral into the crisis we see today. Recent statistics make for grim reading, in 2017 it was estimated over 47,000 Americans died from an opioid overdose. However ac...
Jun 03, 2020•30 min
This piece takes some time to reflect on where we're at in the UK - and wider Western World - with regard to civil liberties, human rights and the essentials of a functioning 'first world' country. How important is social justice and human rights in a world where a global pandemic puts all that we hold dear at risk? The Liberty website is here: https://www.libertyhumanrights.org.uk/ For more information on the UK Government's plan to track and trace British subjects via a mobile phone app The Gu...
Jun 02, 2020•43 min•Season 1Ep. 58
This wide ranging talk asks where and how we should focus on the needs of postoperative care patients. "Brain care has an impact way beyond the acute surgical episode"; how do we minimise the risks of a poor outcome when it comes to postoperative care? "Advanced recovery from anaesthesia and surgery" is a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: “Updates in Perioperative Medicine 360” which took place between November...
Jun 01, 2020•25 min
"Shared decision making and risk prediction in the emergency setting: Can we achieve it?" is a talk originally given at the 8th Australian and New Zealand Symposium of Perioperative Medicine Special Interest Group: “Updates in Perioperative Medicine 360” which took place between November 7th-9th 2019. This talk discusses survival after admission to intensive care. How do we incorporate concepts like shared decision making and value based care into this high stress, time limited environment? Pres...
May 31, 2020•20 min
This piece is a fascinating discussion regarding research and safety in anaesthesia management; "in the past five or six years there's been a shift from high risk patients to all types of patients". How are we improving methods, evaluation and monitoring? What are some of the more essential elements of the process? Where is the latest research? What is a sensible policy when it comes to opioids? Presented by Desiree Chappell and Monty Mythen with their guest Dan Longrois, Professor of Anaesthesi...
May 30, 2020•21 min
This piece dives into the latest thinking behind opioid-free anaesthesia; how can we improve? Is the challenge of the opioid crisis being met head on by perioperative medicine? Is it realistic to expect to reach a point where opioids are removed from the equation entirely? Presented by Michael Manning, MD, PhD, Assistant Professor at Duke University Medical Center, Director of research for the Perioperative Medicine Fellowship at Duke. -- EBPOM 2020 - Live from London - is on! For those who have...
May 29, 2020•14 min
This piece tells the story of two different innovators in the field of an anesthesia. The first is, The Pediatric Device for Induction of Anesthesia (PeDIA), a mask-free anesthesia delivery system designed for kids. The second is the Error Recovery and Mitigation Aide (ERMA), a reworking of the traditional needle box whereby a clear reservoir is inserted between the re-entry proof top and opaque terminal disposal portion, allowing practitioners to have visualization of all the syringes and vials...
May 28, 2020•32 min
