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-...
Jan 29, 2021•16 min
This piece takes a look at the frontline fight against COVID 19 at Penn Medicine Princeton Medical Center in New Jersey, USA. Details of airway, ventilation and hemodynamic management are discussed with the director of Critical care and Anesthesiology. Resource management is a clear front runner as the virus creates a public health emergency for medics to try to battle. Additional beds and treatment facilities are being prepared, what other innovations are being brought to the fore. Presented by...
Jan 28, 2021•33 min•Season 2Ep. 2
"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...
Jan 27, 2021•18 min
"46% pretty much means every other patient who was getting IV opioids was having some sort of a respiratory depression event" After a quick round up of COVID news in the contributor's respective areas this piece gets involved in a much needed discussion about the “PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY)” trial. PRODIGY trial is here: https://clinicaltrials.gov/ct2/show/NCT02811302 Presented by Desiree Chappell and Monty Mythen with Mike ...
Jan 26, 2021•37 min
Armed with a background in biomedical engineering, doubled with an EMBA in Finance, our guest has spent the past 20 years within the medical device industry. In 2010 he was instrumental in setting up MDoloris Medical Systems, with the mission to provide technologies that allow clinicians a reliable, continuous and non-invasive evaluation of autonomic nervous system (ANS) activity. Based on 23 years of academic research, performed by a French research lab, the technology allows anaesthetists and ...
Jan 25, 2021•38 min
This piece highlights four papers published in the May 2019 edition of the (British Journal of Anaesthesia) BJA. Find them on www.poqi.org Furthermore, there's an interesting piece about the Perioperative Quality Initiative (POQI) here: https://www.topmedtalk.com/anesthesia-and-analgesia-go-big-on-poqi/ Presented by Desiree Chappell with Monty Mythen and Sol Aronson, tenured professor at Duke University and Executive Vice Chairman in the Department of Anesthesiology....
Jan 24, 2021•15 min
"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...
Jan 23, 2021•26 min•Season 2Ep. 1
This piece gives you clear practical suggestions which you might want to include in your practice and institution. How do we improve the physiological reserve of patients? Is there a way to do enhanced recovery with an extra edge? Specifically, how do we reduce pulmonary complications? What is 'surgery school'? How does 'icough' fit into this? How can practitioners and admin staff help to reduce anxiety as surgery comes closer? Visit the I COUGH UK website here: https://mft.nhs.uk/mri/services/i...
Jan 22, 2021•17 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...
Jan 21, 2021•29 min
"Patients undergo surgery for important reasons, we need to improve surgical outcomes to the point where anyone can have surgery - and I believe that is do-able; we need to implement what we know, we need to avoid missed opportunities and we need to conduct more research. We should learn from the history of anesthesiology and how intraoperative care so dramatically improved outcomes" This powerful data based talk sets a bold standard for the year, a highlight from the momentous (Evidence Based P...
Jan 20, 2021•31 min
This piece is a chance to hear more about the work of our guest, who made a big impact as a guest on a recent edition of TopMedTalk: https://www.topmedtalk.com/topmedtalk-computer-gamer-to-life-saver/ The Perioperative Quality Initiative (POQI) is here: www.poqi.org This piece covers cerebral oximetry with near-infrared spectroscopy (NIRS), often used during the perioperative period of cardiovascular operations. Article here: "American Society for Enhanced Recovery and Perioperative Quality Init...
Jan 19, 2021•36 min
This piece explores the current thinking on hemodynamics, get ready for a deep dive into the conversation and controversies. Originally streamed live from www.topmedtalk.com as part of our coverage of The EBPOM USA Dallas Master's Course 2019. This panel discussion is chaired by Desiree Chappell, CRNA from Louisville Kentucky and Board Member of ASER. It features Monty Mythen, TopMedTalk Editor In Chief, Smiths Medical Professor of Anaesthesia and Critical Care at University College London, Tim ...
Jan 18, 2021•47 min
This piece ploughs into some of the academic papers that have provoked discussion in the perioperative community. We discuss the following papers: Risk factors for opioid-induced respiratory depression in surgical patients: a systematic review and meta-analyses. https://www.ncbi.nlm.nih.gov/pubmed/30552274 Increased Postoperative Glucose Variability Is Associated with Adverse Outcomes Following Total Joint Arthroplasty. https://www.ncbi.nlm.nih.gov/pubmed/29975266 Effect of A1C and Glucose on Po...
Jan 17, 2021•13 min
This piece took a look at the San Diego front line of the global fight against COVID 19 on March the 30th at the start of the crisis. What unique pressures were there; the large homeless population is a particular challenge, how do psychiatric patients further the conundrum. Also, what about the assumption that patients are likely to be carrying the virus so should all be treated as if that is the case, does that apply here? Presented by Desiree Chappell with Roneet Lev, MD FACEP, Chief Medical ...
Jan 16, 2021•15 min
This piece is a conversation with friends of ours at Medtronic. Now is an interesting and resource-scarce time for everyone in medicine; Medtronic made huge waves here with their support of the Ventilator Training App, today we ask them about where it's at and how things are changing in the world of medical technology. How does product development actually work these days? How important have standards of proof become? Should we celebrate the fact hardware appears to be being pushed toward a simi...
Jan 15, 2021•25 min
"The more I learn about this, the more my eyes are opened to how much opportunity we have to improve in this area" This piece covers the "perennial topic" of whether paralysis is bad for breathing, here with a focus upon outcome criteria associated with residual neuromuscular blockade. It's a piece based in part upon a recent talk at the American Association of Nurse Anesthetists annual conference which was this year held virtually. Presented by Desiree Chappell with her guest Brent Dunsworth, C...
Jan 14, 2021•30 min
"Just having more staff doesn't always equate to better care, especially when the staff do not have the skills required." Perioperative medicine has the opportunity to lead the way in advanced practice; the extended role of the practitioner within the perioperative pathway can be done with nurses, allied health professionals or physician associates. As we evolve these roles, we must be mindful and recognise not all services will be the same. How can you tailor your service to your specific needs...
Jan 13, 2021•20 min
This vital piece deals with a variety of issues related to COVID-19; what we know and what we know we do not know: - Similarities and differences between COIVD-19 and Aqute Respiratory Distress Syndrome (ARDS) - The most useful information observed by practitioners at the bedside, conscious of the lack of Randomised Controlled Trials (RCTs) in this area - The controversy regrading early invasive ventilation versus non-invasive ventilation - What are the aerosolization risks? - Pragmatic patient ...
Jan 12, 2021•37 min
"It's all about safety and recovery, it's not about speed"; this conversation focuses on enhanced recovery, are we getting it right and where are people getting it wrong? How reliable and well understood is the data behind it? Also, what are the current thoughts on perioperative steroids? How do we refocus and move back to enhanced recovery after surgery rather than "enhanced discharge" after surgery. Presented by Monty Mythen and Desiree Chappell with Sol Aronson, tenured Professor at Duke Univ...
Jan 11, 2021•33 min
TopMedTalk has recently engaged with a large number of new listeners, we are delighted to have you join our family of perioptimists! This piece works as a primer, it explains what lies at the core of the world's favorite perioperative medicine podcast; enhanced recovery. What is it? How do you implement it? What are its core principles? If you've never heard TopMedTalk before but you are a medical practitioner this piece is a great place to start; if you're already onboard it will be a welcome r...
Jan 10, 2021•27 min
This piece explores perioperative shared decision making from a variety of angles. Where is the latest research? Is it something we can reasonably out source? Does it always play in the favour of the patient or do we as practitioner benefit from this process also? How do we implement it without 'bulldozing' through years of experience? Link to video featuring patient "Doug": http://www.petermac.org/sdm Presented by Desiree Chappell and Ross Kerridge, "The Father of Perioperative Medicine", Debra...
Jan 09, 2021•48 min
2020 was a big year for prehabilitation, the advent of a global pandemic has only increased the importance of this exciting field of medicine. Various questions from EBPOM 2020 attendees were tackled by the panel: Can you use "Timed Up and Go" (TUG) and The Duke Activity Status Index (DASI) to screen out unnecessary cardio-pulminary exercise testing (CPET)? What exactly is prehabilitation and what's its natural scope? How important is nutrition? Is it possible to standardise these areas more? Wh...
Jan 08, 2021•46 min
"My first thought was - why can't we do this here?" What is ketamine, what sort of drug is it and how is it used? How was it first synthesized? Was it intentionally found or another of science's happy accidents? This piece is a fascinating look into the history and future of ketamine with a focus on outpatient infusion centers. Could this unusual and "dirty" drug - meaning it acts on many parts of the body and is not fully understood - have incredibly useful consequences for people who face the ...
Jan 07, 2021•31 min
How do we manage our operating room capacity and restore elective surgery in a post-COVID19 world? A world where conditions change week by week, sometimes day by day. Managing capacity was always a challenge but now we need to think differently in order to stay resilient and agile. How has COVID19 changed the landscape now? What are the tools that exist to handle it? What are the systems and best practice guidelines that are helping institutions cope? How do we look at supply and demand within t...
Jan 06, 2021•42 min
"Oxygen is the commonest drug that we give to our patients today during surgery and the general anaesthetic" but what do we really know and understand about it from a perioperative perspective? This talk illustrates why, even with some of the evidence and background physiology that we have at our fingertips today, the following questions are still perplexing: How much is too little oxygen? How much is too much oxygen? And how much is just the right amount of oxygen? Presented by Daniel Martin, O...
Jan 05, 2021•29 min
This talk aims to answer four major questions: How much fluid should you give perioperatively? Does hypotension matter? Should you use advanced hemodynamic monitoring, and do colloids have any advances over crystalloids? Using high quality studies and a data based approach in all four categories, a lot of which has come from conversations that have had happened at Evidence Based Perioperative Medicine (EBPOM) meetings, this talk draws some interesting conclusions. The American Society of Enhance...
Jan 04, 2021•24 min
"As Anaesthetists the ultimate goal of almost all of our interventions and monitoring is to support cell energy production to provide mitochondria with the oxygen and the fuel they need to produce enough adenosine triphosphate (ATP) to power cell function and integrity". How human cells produce energy, how this changes in response to stress and how this may influence survival; this piece focuses what we know about how our bodies get the fuel they need to survive surgery and thrive as a result, p...
Jan 03, 2021•20 min
This piece covers the PREP-WELL project which is a community based prehabilitation program in South Tees, in the North of England: "We established the following guiding principles; we wanted to provide patient centered care under one roof with facilitated self management; we wanted to work as a cross sector collaborative, by that I mean primary care, secondary care and public health; all working together to try and improve on the fragmented service provision and sign work that we often see in ou...
Jan 02, 2021•35 min
"We have to create the culture of learning; the culture of having a safe space, the culture of wanting to do better and learning those conditions in which we do do better" This powerful talk looks directly at how a clear approach to patient safety really can improve the standard of care where you work. What is the culture of quality and safety that you're trying to embed, can you actually do better? Learn why it's important to focus on psychological safety; "if people start being scared, everyon...
Jan 01, 2021•16 min
Pain is a subjective experience that affects all segments of the population. However, there are inter-individual differences in pain. The biopsychosocial model proposes that the intersection of biological, psychological, and social factors create a pain experience and pain outcomes that differ by sex, race, and socioeconomic status. "The minority stress theory ... the idea that for racial minorities, especially blacks, they are exposed to chronic stress; the stress of daily racism" Could epigene...
Dec 31, 2020•33 min
