TopMedTalk

Warning; this piece may make for uncomfortable listening. It is a fascinating look at the recent history of medicine and how our profession may in fact be sick. Contained within the story is a message of hope; evidence may contain the cure.

In our recent history we seem to have enjoyed something of a "Golden Age" of medicine which, by raising quality of life so dramatically, has transformed our understanding of concepts such as "public health" and even "standard of living". However, running alongside that is an industry and society that is primarily interested in business and profit above evidence and health. Has the industry which built up around our profession during the 'Golden Age' now become a parasite which weakens its host to the point of near exhaustion?

After a concise critique of the current culture of research this talk asks why we are wasting time on research that is not reliable, not useful and does not impact care. Could it be that market forces have strangely made us less efficient? Evidence based medicine is the way forward but can we overcome the inherent bias behind the fact that often big business funds the evidence gathering and its publication?

Some assumed the period of rapid development, which included discovering the DNA helix, successful organ transplant and vaccinations, would soon inevitably be followed by equally epoch transforming breakthroughs, others are less optimistic. Are genomics and big data more often 'science' than medicine? Is "digital health" "simply one part of what has now been called surveillance capitalism"?

This challenging but ultimately hopeful and inspirational talk was given at the EBPOM Dingle conference 2019, please share it to as wide an audience of your peers as you can to help make this important and healing conversation happen.

Presented by Seamus O'Mahony, Consultant Gastroenterologist at Cork University Hospital, associate editor for medical humanities of the Journal of the Royal College of Physicians of Edinburgh and is a regular contributor to the Dublin Review of Books.

"We wanted to know if goal directed therpy using a (Hypotension Prediction Index) HPI monitor can prevent hypotension". This piece looks in detail at the HPI monitor in practice- what is the benefit of this piece of technology in relation to hypotensive episodes? Furthermore how else is it to be tested and when will these tests be carried out?

Presented by Desiree Chappell and Monty Mythen with their guest Marit Habicher, Specialist, Department of Anesthesia and Critical Care at UKGM Giessen.

"We have to remember that patients have a team"

How do we involve patients in the increasingly complex conversations we have in the perioperative space? This piece is a detailed case study which shows how shared decision making works in the perioperative setting. We know this improves patient experience yet in the last 10 or so years, consistently only 50 to 60% of patients say they were involved in decision making.

How can shifting towards a value based care model help? What is "moral injury" and how do we avoid it? Can a data driven analysis actually show shared decision making reduces costs?

Perioperative medicine for older people undergoing surgery (POPS) is an award winning geriatrician led service and the first of its kind in the UK - find out more here: https://www.guysandstthomas.nhs.uk/our-services/ageing-and-health/specialties/pops/overview.aspx

The Centre for Perioperative Care is here: https://cpoc.org.uk/

Presented by Ramai Santhirapala, Consultant Anaesthetist and Perioperative Medicine Lead at Guy's and St Thomas' NHS Foundation Trust, fellow of the Royal College of Anaesthetists, Faculty of Intensive Care Medicine and Higher Education Academy, Honorary Associate Professor at University College London, Clinical Lead for the UK arm of an international programme in shared decision making, "Choosing Wisely", which is led by the Academy of Medical Royal Colleges, Shared Decision Making Lead at the Centre for Perioperative Care and sits on the Choosing Wisely International Roundtable.

"In this session, we're going to talk about the importance of fitness, frailty, function and perioperative medicine."

Fitness, frailty and function are overlapping concepts. In the UK, about quarter of patients will be over the age of 65 by 2034. As patients age they may develop comorbidities. These factors combine to present a unique opportunity for the perioperative physician; fitness increases the chances of a positive outcome, time to ensure every patient is "fit for surgery".

The Making Every Contact Count (MECC) campaign is here: https://www.makingeverycontactcount.co.uk/

Presented by Denny Levett, Professor in Perioperative Medicine and Critical Care at Southampton University Hospital NHS Foundation trust and Honorary Associate Professor at the University of Southampton.

"If I were to develop a simple uncomplicated urinary tract infection, I may well be able to continue to go to work as I was being treated for that illness but if an older frail patient develops a similar uncomplicated urinary tract infection, that can be a very significant illness, that patient may well be unable to walk or transfer as they could"

Frailty in the perioperative period - what is it, what is it not and how do we work with and manage it before, during and after an operation so as to increase the value of care to our patients?

The opening article refered to in this piece is here: https://journals.sagepub.com/doi/full/10.1177/1756287220916614

The British Geriatrics Society "Fit for Frailty" document is here: https://www.bgs.org.uk/resources/resource-series/fit-for-frailty

More information on Perioperative medicine for older people undergoing surgery (POPS), an award winning geriatrician led service and the first of its kind in the UK, go here: https://www.guysandstthomas.nhs.uk/our-services/ageing-and-health/specialties/pops/overview.aspx

Presented by Jude Partridge, consultant geriatrician POPS, honorary senior lecturer, King's College London, Chairs the British Geriatrics Society POPS SIG.

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 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?

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.

"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

"Accelerated surgery for hip fracture is safe and feasable, with troponin elevation before randomization, there was a mortality advantage with accelerated surgery. The logistics and resources required for accelerated surgery need to be balanced with the demonstrated benefits and patient's desires for accelerated surgery"

This exciting piece from EBPOM 2020 provides a data download that further illucidates the perennial debate surrounding hip fractures and their management and treatment. What is the correct perioperative approach to this nasty injury?

For more on the Hip Attack Trial go here: https://clinicaltrials.gov/ct2/show/NCT02027896

Presented by P.J. Devereaux, cardiologist, clinical epidemiologist, and perioperative care physician, Professor in the Departments of Health Research Methods, Evidence, and Impact (HEI) and Medicine, Director of the Division of Perioperative Care, McMaster University, Associate Deputy Director of the Population Health Research Institute, President of the Society of Perioperative Research and Care.

This is an Edwards Lifesciences Sponsored Lecture which was originally streamed live on TopMedTalk from the hugely successful EBPOM USA 2019 in Dallas.

In this piece we hear about the ongoing need for institutions and healthcare professionals to recognise the damaging consequences of intraoperative hypotension.

Evidence has been mounting here on TopMedTalk over the last couple of years; there's no doubt hypotension is an area of concern for many of our experts and contributors. Listen to more on this here via our large selection of podcasts on the topic: https://www.topmedtalk.com/?s=hypotension

For those who are already across the data the next question is, how do we detect it and prevent it, ideally before it even occurs? Here the HPI monitor comes into play, a cutting edge piece of technology which uses artificial intelligence to analyse the data and make predictions which could save your patient from a problematic outcome.

Presented by Dr Simon Davies, Consultant Anaesthetist, York Teaching Hospitals, NHS Foundation Trust.