TopMedTalk

"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 detail, contained within, is surprising.

Are we doing enough to mitigate these dangers? Why, beyond the obvious, is it so vital to look after the health of our staff? Are there lessons we can learn going forward.

We implore you to spread this story as far as you can, this debate is vital to our personal health and the wider battle against this virus.

Much of the source material for this podcast can be found here: "Exclusive: deaths of NHS staff from covid-19 analysed" Health Service Journal HSJ - https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article

Presented by Desiree Chappell and Monty Mythen.

We interview Tim Cook here: https://www.topmedtalk.com/8316-2/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

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, Consultant Anaesthetist at Guy's & St Thomas' NHS Foundation Trust, London and Scientific Officer for UK's Difficult Airways Society (DAS).

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"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 and managed to increase value, achieving things which were simply not possible 'the old fashioned way'.

The global COVID crisis brings this subject into sharp relief however; "this isn't just about, what's happening now. How do we use these technologies better going forward?": How can you include relatives in difficult ICU bedside conversations without these technologies? How can you use this technology in your practice? Finally, how can the new parameters of this domain be defined?

Presented by Desiree Chappell with Monty Mythen and their guest Carol Peden, Professor of Anesthesiology and Exec. Director of the Center for Health System Innovation, University of Southern California.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

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-case-study-professor-monty-mythen-01/

The longer conversations which these clips were part of can be found here:

COVID 19 | Professor Monty Mythen has tested positive: https://www.topmedtalk.com/covid-19-professor-monty-mythen-has-tested-positive/

COVID 19 | Dr Joff Lacey: https://www.topmedtalk.com/covid-19-dr-joff-lacey/

COVID 19 | Special Charity Concert with Jeremy Sassoon 5pm UK time: https://www.topmedtalk.com/covid-19-special-charity-concert-with-jeremy-sassoon-5pm-uk-time/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

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 care about.

Presented by Nick Margerrison, this is part one of a two part series.

The clips used in this piece are taken from fuller conversations which you can hear here:

COVID 19 | Desiree and Monty: https://www.topmedtalk.com/covid-19-desiree-and-monty/

COVID 19 | Hugh Montgomery – North London UK: https://www.topmedtalk.com/covid-19-hugh-montgomery-north-london-uk/

COVID 19 | From the front line; Desiree and Monty: https://www.topmedtalk.com/covid-19-from-the-front-line-desiree-and-monty/

COVID 19 | UK, Southampton and London: Mike Grocott and Monty: https://www.topmedtalk.com/covid-19-uk-southampton-and-london-mike-grocott-and-monty/

COVID 19 | Does one of our team have COVID 19? https://www.topmedtalk.com/covid-19-does-one-of-our-team-have-covid-19/

COVID 19 | Critical Care Update; optimizing care for patient and provider: https://www.topmedtalk.com/covid-19-critical-care-update-optimizing-care-for-patient-and-provider/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

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 when we say "delay"? How do we overcome a patient's attitudes towards healthcare professionals, if they feel there has already been a delay in 'getting treatment'? How can the pathways from diagnosis to recovery be shortened or made more flexible? Can a case manager help this process? Is eight weeks an acceptable waiting time, can we reasonably expect it to be less than that?

Presented by Gerrit Slooter, MD, PhD, Surgical Oncologist, Maxima Medical Centre, The Netherlands.

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 Paxton, Dr Chloe Hall, Dr Beth Robinson, Dr Jessica Hatrick of Southmead Hospital in Bristol.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

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 for perioperative practitioners, specifically you, the TopMedTalk listener, to advocate these ideas now as loudly as possible in order to secure long term benefits for the healthcare profession and population health a whole.

Learn how iron infusions are helping countless people to prepare for a better outcome after their delayed surgery, are there innovations you can take at your practice which will similarly be an obvious help to your patients? Furthermore, hear how online networking is being used to assess patients, could you more widely use these technologies at your practice?

The paper being discussed in parts of this piece is here: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2763405

Presented by Desiree Chappell with Monty Mythen and their guest, Professor Bobbi Jean Sweitzer, The Associate Chair for Clinical Perioperative Practice, Northwestern University in Chicago, Illinois.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

This piece is also co-featuring as part of the "Women in Anaesthesia" series this year. Check out the last in the series here: https://www.topmedtalk.com/women-in-anaesthesia-part-6-carol-peden/

The British Journal of Anaesthesia article, which inspired the "Women in Anaesthesia" series, is here: https://bjanaesthesia.org/article/S0007-0912(20)30003-9/fulltext

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 patients in Spain. How are things going there, how does it compare to Italy? How are the patients being dealt with, what can we learn about the basics here, airway, breathing, ventilation (ABC)?

There is also a gripping discussion regarding dynamic arterial elastance. If you'd like to know more about that do check out our discussion here: https://www.topmedtalk.com/periop-coach-2-09-haemodynamic-monitoring/

The webinar mentioned in this piece can be found here: https://www.esicm.org/education/webinars/

Presented by Desiree Chappell and Monty Mythen with their guest Dr. Manuel Ignacio Monge García who works in an ICU in the South of Spain.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation

"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? As well as the possible hygiene benefits is there a symbolic power to the use of masks, by members of the public, that actually helps? What role can fear, not panic, but genuine healthy "respect", play in preparation for things of this nature?

How sensible is the track and trace method, in comparison to the 'herd immunity' approach mooted in the UK?

We also revisit the concept of a "micromort" and see how it applies to a global pandemic.

Mike sent us this fascinating article here: https://medium.com/wintoncentre/how-much-normal-risk-does-covid-represent-4539118e1196

Presented by Desiree Chappell and Monty Mythen with Mike Irwin,

If you enjoyed Mike's take on things, check out his previous appearance here: https://www.topmedtalk.com/measuring-risk-in-surgery-what-is-a-micromort/

If you'd like to hear our summary of the last time we spoke to him, and the conversation which prompted us to discuss fear as a motivator to sensibly prepare for pandemics go here: https://www.topmedtalk.com/covid-19-you-must-learn-the-epidemiology/

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation