TopMedTalk

Smoking is bad for you, there's little debate about that, even among users of the drug. However, further to the widely known consequences, the bottom line in the perioperative period is that smokers are 40% more likely to die after major surgery. Do patients also know this?

Tissue healing, increased risk of infection and increased possiblities of complications with the anaesthetic; with these risks in mind how do we cut through the ubiquitous, but often ignored, government health risk messaging and get patients to understand the increased risk for those undergoing surgery? How do we use smoking cessation techniques in the perioperative setting? How do we manage to start, ideally, six weeks before surgery? What is the latest thinking on the neuro psychiatric consequences of smoking cessation? How useful is the Fagerstrom test of nicotine dependence? What about "vaping", is it better than smoking from a perioperative perspective?

Presented by David Yates, Consultant in Anaesthesia and Critical Care Medicine at York Teaching Hospital, set up one of the UK's first Perioperative Medicine Services in York, Anaesthesia, Perioperative Medicine and Pain Clinical Lead for the Yorkshire & Humber Comprehensive Research Network.

TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis.

It's vital you remain active after a cancer diagnosis, why is this? Hear the fascinating story behind the discovery that activity not only reduces your overall levels of fatigue but also improves your chances of recuperation. "You have to pace yourself [...] listen to your body"; but any physical activity will help fight feelings of tiredness. In short, if you get active you feel good.

Also in this podcast, with direct reference to medical trials and studies, our guests give you the mechanism behind incredibly helpful changes caused by moderate exercise in cancer patients, evidence which has led medics to conclude that "exercise is real medicine".

"When we're talking about being active during cancer it's at any stage of the cancer journey: from prehabilitation through recovery". Prehabilitation is the process by which people prepare their bodies for a major obstacle such as an operation or chemotherapy. It's like rehabilitation but it takes place before the event.

Just as when you start your recovery after treatment you would expect to get your body back to full health, here you try to achieve the best possible physical health before you start. The key point is that the medicine of exercise can be useful from diagnosis right through to full recovery and beyond.

Again, with direct reference to the evidence, find out how incredible research into prehabilitation is changing the way we think about cancer and recovery.

Recorded specifically at the height of the COVID 19 crisis hear how this research is being applied in the context of a global pandemic. Group forms of exercise are not an option while social distancing restrictions are in place, can exercising with other people bring us special benefits? If so, can those benefits be matched if we use the internet to continue the social side of going to a gym or a class?

The YouTube link mentioned in this piece is here: https://www.youtube.com/playlist?list=PL4YhGgVzlQXjhq6UYbX7idSDYcPX5PRy9

Presented by Nick Margerrison with the Professor of Clinical Exercise Science, Anna Campbell, MBE, of Edinburgh Napier University and the director of CAN Rehab and the Professor of Prehabilitation Medicine, Sandy Jack, a consultant clinician scientist from The University of Southampton and University of Southampton NHS Foundation Trust .

For more information, in the UK, phone: 0808 808 00 00

email: [email protected]

Twitter: @macmillancancersupport

TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis.

We know food gives us energy "but it also provides so much more". This podcast looks at the raw materials you'll need, when facing a cancer diagnosis, to get a better outcome; the vitamins, minerals and proteins, as well as the energy sources you're best using.

What is a balanced diet when you have cancer? "We're talking about eating well to stay well [...] we're not really looking for people to lose weight"; it's often important for people to try to maintain their weight during a cancer diagnosis, should you track your weight throughout your cancer journey?

Recorded at the height of the COVID 19 crisis this podcast also reflects upon how this information is applied in the context of a global pandemic. What foods can we store which also contain the vital building blocks of our body's natural defenses?

Presented by Nick Margerrison with his guest Clare Shaw, consultant Dietician at The Royal Marsden NHS Foundation Trust.

For more information, in the UK, phone: 0808 808 00 00

email: [email protected]

Twitter: @macmillancancersupport

TopMedTalk in Collaboration with MacMillan Cancer Support in the UK developed this podcast series to support patients during their cancer journey amidst the COVID 19 crisis.

"It's very normal to sit with some difficult thoughts and feelings" after a cancer diagnosis. Broadly there are two types of mindsets; anxiety, which can be helpful, an element of wanting to 'do something' and, on the other hand, low mood, a feeling of not wanting to do anything, this can be unhelpful if not addressed at a certain level. We should expect both of these mindsets the question is 'how does the latest scientific research show can we control them'? Your body and mind are not separate, one effects the other, this is why it is so important we look at mental health as part of an overall approach.

"You can do quite a lot of things [...] that put you into a better mood"; exercise, meditation, even simple breathing exercises. Spending time communicating with friends and family is another suggestion.

Recorded at the height of the COVID 19 crisis this podcast also reflects upon how this is applied in the context of a global pandemic; how important is it that people engage with online facilities and opportunities to maintain relationships? "In an odd way the relationships seem to intensify".

It's not about ignoring negative feelings though, anxiety and low mood are very common for people with a cancer diagnosis. Hear how it is important to allow yourself to reflect, part of understanding your mental health is about regaining control, we are allowed to let ourselves feel difficult thoughts as part of the process of monitoring and working with them.

This podcast also contains a reminder about the importance of goal setting in allowing people to regain control over their lives. Small, realistic and specific, short term goals are useful at this particular stage of life; "start with the thing you are most confident you are able to change [...] make a day and a time that you'll stick to".

Presented by Nick Margerrison with his guests Judit Varkonyi-Sepp psychologist, psychology lead for the Wesfit prehabilitation programme and Chloe Grimmett, behavioural scientist and lead for Wesfit prehabilitation.

For more information, in the UK, phone: 0808 808 00 00

Email: [email protected]

Twitter: @macmillancancersupport

After a quick update from Desiree and Monty this piece focuses on Philadelphia Pennsylvania and gets into specifics regarding caring for COVID 19 positive patients.

As regards The Jefferson Hospital; where has the ICU "take over" expanded to? Have critical care ventilators been deployed to all new ICU beds or have acceptable compromises been made? "Staffing is tougher than the equipment" but how has a "critical care pool" system, prepared over a year ago, helped? What does the typical COVID 19 critical care patient look like? Enormous quantities of oxygen are being used by institutions to care for them, have there been issues with supply? What about aerosolisation issues regarding the virus? How many of these patients can be proned?

Crucially we get into the important differences between this - and the way it is treated - and acute respiratory distress syndrome (ARDS) patients. How do COVID 19 patients differ from 'usual' cases where ventilation or breathing assistance is used?

"What the renal teams are saying I respect, they've never seen anything like this" we're told, "the climb of creatinine, had a trajectory that is inconsistent with a cardio renal syndrome".

"This is a climb that is pushing us into almost round the clock use of the dialysis nurses to handle these patients [...] because they're encephalopathic, their BUN's [blood urea nitrogen] are very, very high - and because the creatinine trajectory has gone from '1' on Monday, to '3' on Tuesday, to '9' on Wednesday! This is astonishing."

Also, hear how a comprehensive approach to planning and innovative ideas about nurse training, upskilling and basic critical care education have helped.

Presented by Monty Mythen and Desiree Chappell with their guest, Herbert Patrick, Pulmonologist and Critical care physician, Jefferson Hospital, Philadelphia, Pennsylvania.

Thank you to our sponsor Edwards Lifesciences.

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

Why has 'prehabilitation' suddenly picked up pace in terms of both practice and interest? This piece takes a serious look at the widening interest in an idea familiar to many sportsmen.

Learn how the marginal gains we get through the application of science to optimise the moment of surgery as a real opportunity to apply everything we know.

Also; what are ketones and how can they be used to promote health?

Presented By Desire Chappell and Monty Mythen with their guests Gerard Danjoux, consultant in Anaesthesia and Sleep Medicine at South Tees Hospitals NHS Trust and Ken Van Someren, Director KvS Performance Ltd.

What are the latest developments in quality improvement programs that help operative teams around the world take what they do to the next level? When does the surgical journey begin? How has a focus upon patients prior to surgery improved outcomes? What are "the five phases of care"? How has data collection and management helped us to continually improve a patient's surgical journey?

This piece is a talk which was given during 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

Presented by Clifford Ko, Professor of Surgery at UCLA, Director of the Division of Research and Optimal Patient Care at the American College of Surgeons.

We get a quick update from Monty, how is his return to work going after quarantining at home with COVID 19

Further conversation takes a look at the care being given to COVID 19 patients and their providers. What is PPE fatigue? Where is the debate regarding COVID 19 positive patients and fluid management? A lot of it boils down to the mantra "keep it simple", do the job as correctly and properly as possible and know what you are capable of.

Please listen to the end of this piece for a vitally important discussion regarding temperature variation in COVID 19 patients.

Link to Nicole Cupchick her: https://nicolekupchikconsulting.com/media-resources/

Barbra McClean can be found here: http://barbaramclean.com/

The story mentioned by our guest "Coronavirus: Tiger at Bronx Zoo tests positive for Covid-19" is reported by The BBC here: https://www.bbc.co.uk/news/world-us-canada-52177586

Presented by Desiree Chappell and Monty Mythen with their guest Barbara McLean, Critical Care Clinical Specialist, Grady Memorial, Atlanta, GA.

Thank you to our sponsor Edwards Lifesciences.

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

This piece sees us catch up with a the TopMedTalk team favorite; Joff Lacey. A popular presenter here on TopMedTalk, Joff tells us of his first hand experiences in the ongoing battle against COVID 19 in South London.

We also get an update on Monty's condition.

Presented by Desiree Chappell with Dr Joff Lacey, Consultant Anaesthetist at St George's Hospital in South West London.

Thank you to our sponsor Edwards Lifesciences.

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

Emotional intelligence is the ability to perceive, integrate, understand and utilize emotions in an effective and meaningful way in order to cope and adapt to the situation. It's a hot topic at the moment, here we speak with the first CRNA to be certified in emotional intelligence. Stress and burn out is a common problem in the CRNA community, handling that could have a real impact on performance and outcomes.

Our guest mentions the Mayer-Salovey-Caruso Emotional Intelligence Test™ which can be found here: https://www.mhs.com/

She also advocates "The Student EQ Edge: Emotional Intelligence and Your Academic and Personal Success: Student Workbook" which can be found on Amazon here: https://www.amazon.co.uk/Student-EQ-Edge-Emotional-Intelligence/dp/1118094603

Our guest kindly allowed us to share her email with you: [email protected]

Presented by Desiree Chappell and Monty Mythen with their guest, Andrea Bittinger, CRNA at William Beaumont Hospital.