What insights does a history of working in military healthcare bring? How do we cut back on readmissions to hospital after time spent in the intensive care unit? How serious an issue is 'burn out' within healthcare? How did standardisation help when designing an award winning patient transfer bag? What's the best way to transfer a patient from ward to ward or from institution to institution? How do we handle data during this period? What do we think about remote supervision and monitoring? Could a dedicated transfer team be useful? Could a new anaesthesia drug be on the way for the NHS soon? How can training in ultrasound be improved? And lastly, will improvements in artificial intelligence ultimately cost us our jobs?

Recorded live at the Association of Anaesthetists' Winter Scientific Meeting 2020, from The Queen Elizabeth II Centre, London, UK.

This piece follows on from part one, which you can find here: https://www.topmedtalk.com/topmedtalk-matt-wiles-and-marcus-peck-live-from-london/

Presented by Monty Mythen featuring guests, Gezz Van Zwanenberg, Nurse and Project Lead North West London Critical Care Network, Matt Wiles, Consultant Anaesthetist & Senior Clinical Lecturer at Sheffield Teaching Hospitals NHS Trust and University of Sheffield and Marcus Peck, NHS Consultant in Anaesthesia and Intensive Care Medicine at Frimley Park Hospital and Chair of Focused Intensive Care Society's (FICE) Committee.

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EBPOM | Dingle - the hottest tickets in anaesthesia and perioperative medicine - go now to the website: https://www.ebpom.org/

Recorded live at the Association of Anaesthetists' Winter Scientific Meeting 2020 in the centre of London from The Queen Elizabeth II Centre. Hear the conversation and questions asked by our online audience.

In our online world is there still a place for a paper based journal? What are the big stories and hot topics of 2020 going to be? What about hyperoxia? How does what we do effect the environment? What are the latest thoughts about 'depth of anaesthesia'?

The podcast mentioned in this piece is here: https://www.topmedtalk.com/anes19-timothy-short-and-kate-leslie/

This link takes you to the trial: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32315-3/fulltext

Is there a future for volatile anaesthesia? What's the future for pediatric intensive care units? How can we use ultrasound technologies to enhance patient care? Will the iconic stethoscope end up with dust on it? What's the future for ultrasound in the intensive care unit?

Presented by Monty Mythen with his guests Matt Wiles, Consultant Anaesthetist & Senior Clinical Lecturer at Sheffield Teaching Hospitals NHS Trust and University of Sheffield and Marcus Peck, NHS Consultant in Anaesthesia and Intensive Care Medicine at Frimley Park Hospital and Chair of Focused Intensive Care Society's (FICE) Committee.

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 training to produce clinically meaningful performances?

The articles mentioned in this piece are here:

"Looking and seeing" by Roger Kneebone: https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(19)30507-0.pdf

"Machine Learning Identification of Surgical and Operative Factors Associated With Surgical Expertise in Virtual Reality Simulation", published by The Journal of the American Medical Association (JAMA) is here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2740782

And, "Proficiency-based progression training: an 'end to end' model for decreasing error applied to achievement of effective epidural analgesia during labour: a randomised control study" is here: https://bmjopen.bmj.com/content/8/10/e020099

This talk, originally titled "Recent research articles in medical education", presented by George Shorten, Professor, Anaesthesiology and Intensive Care Medicine and Consultant Anaesthesiologist at Cork University Hospital, at last year's "21st Current Controversies in Anaesthesia & Peri-Operative Medicine and SIAA Autumn Congress" at the Dingle Skellig Hotel, Ireland.

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EBPOM | Dingle - the hottest tickets in anaesthesia and perioperative medicine - go now to the website: https://www.ebpom.org/

What happens when cutting edge computer game creators, fresh from working on top titles in their industry such as 'Hunger Games' and 'Mission Impossible', use their skills to simulate high stress moments from the real world of anesthesia and surgery? Using "the neuro-science of game design" to help accelerate learning within the profession:

"The motivation for starting Level Ex, what if we actually took the top game designers and developers in the industry? We're talking the executive producer of "Mortal Kombat", the creative director of "Call of Duty", the marketing director of "Words with Friends"; put them with top physicians from multiple specialties, to capture the challenges of the practice of medicine using video game mechanics".

"This doesn't recreate the mannequin, what this does replace is the five hundred live patients you need to train on in order to encounter those five to ten rare scenarios because we can recreate the rare and the difficult and then we can help you train your visualization skills, your recognition skills, your deductive reasoning skills, on those cases."

The key point here is not that motor function is being copied by a screen interactive experience but instead the aim is to "optimise cognitive load" and recreate the thought process alongside an emotional experience.

"We're not introducing you to how to do a fiber optic intubation, we're going to present dozens of rare difficult challenging once in a lifetime cases". Here computer games can currently excel in their teaching ability, "it's a cognitive skill, it's a decision making algorithm". As time ticks by in the simulation "you do get to a point where there's no return and you have like three minutes to do this successfully and so your algorithm and decision making is absolutely crucial". It's about taking in data and making decisions in a way that is not possible on a mannequin or ethical on a live patient.

"Everything that goes into the app is peer reviewed" and, with any computer game you can earn points as you go along; this game though gives you (Continuing Medical Education) CME points.

Google Play: https://play.google.com/store/apps/details?id=com.levelex.airwayex&hl=en_GB

Apple: https://apps.apple.com/us/app/airway-ex/id1154656060

Open Anesthesia is here: https://www.openanesthesia.org/

Presented by Desiree Chappell and Monty Mythen with their guests. Sam Glassenberg, CEO and Founder of Level Ex, before which he was CEO of the leading independent game publisher in Hollywood, releasing games based on popular films, including The Hunger Games and Mission: Impossible, he also led the DirectX graphics team at Microsoft, where he accepted a Technical Emmy on behalf of his team for advancing the visual realism of video games across the industry. His career began at LucasArts, creating Star Wars games for PlayStation and Xbox. Sam serves on numerous industry advisory boards and speaks internationally on video games in medicine. Robert H. Thiele, Associate Professor, Departments of Anesthesiology and Biomedical Engineering, Division Chief, Critical Care Anesthesiology, Board of Directors, University Physicians Group, University of Virginia School of Medicine. He has a background in engineering and has been using technology to improve education since his residency in 2008. He is co-founder of www.OpenAnesthesia.org which lead to the development of Self-Study, and also authored one of the first iBooks focused on cardiac and critical care ultrasound.

EBPOM Chicago is now underway - go to www.EBPOM.org now and discover all the latest conversation in the global perioperative sphere.

"You've given us all a lot to think about" - a randomized controlled trial regarding intravenous iron does not go 'as expected'.

"I mean, look, I've built my entire career on thinking this was the best thing since sliced bread, the silver bullet, the magic wand ..."

A great scientist follows accurate data to wherever it may lead, what now? More trials, more time, more questions? How common is anemia? Are there any nuggets of hope buried within these data? What have we learned?

Evidence Based Perioperative Medicine sticks to the facts and there's nothing more important than data; make sure you listen to the end, there are interesting details that give many a sense of optimism.

Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial is here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31539-7/fulltext

Toby is a popular contributor to TopMedTalk - check out his earlier piece here: https://www.topmedtalk.com/prato-2019-toby-richards/

Presented by Monty Mythen and Mike Grocott with their guest Toby Richards, Professor, Anaesthesia Teaching & Research Faculty of Medicine, Nursing and Health Sciences Central Clinical School, Monash University.

"We take care of the world but we don't take care of ourselves"

This piece is focused on suicide and emotional stress, the latter has been a theme on TopMedTalk for some time now. Here you'll find out how to tackle this significant health concern, how to identify it, what the warning signs are, how to develop emotional intelligence and information regarding drug free novel therapies including the arts and music.

It features conversations from the following pieces:

AANA 2020 | Suicide Prevention in Anesthesia: CRNAs and SRNAs

https://www.topmedtalk.com/aana-2020-suicide-prevention-in-anesthesia-crnas-and-srnas/

This piece featuring Catherine Horvath DNP, CRNA, Assistant Professor and Program Director of the Doctor of Nursing Practice Nurse Anesthesiology Track at Johns Hopkins School Of Nursing, Baltimore MD, Chuck Griffiths, PhD, CRNA, USC, Assistant Clinical Professor at the UCLA School of Nursing, Faculty, USC Doctor of Nurse Anesthesia Practice Program and Fara Lekhnych, MSN, CRNA, The Johns Hopkins Hospital, Baltimore.

AANA 2019 | Emotional Intelligence and Occupational Stress: https://www.topmedtalk.com/aana-2019-emotional-intelligence-and-occupational-stress/

This piece features Andrea Bittinger, CRNA from William Beaumont Hospital.

TopMedTalk | WHO is looking at the arts and health?

https://www.topmedtalk.com/topmedtalk-who-is-looking-at-the-arts-and-health/

This features Katherine Taylor, Clinical psychologist, Arts & Mental Health Innovation Programme Manager at GMiTHRIVE.

World Suicide Prevention Day is covered in more detail here:

https://www.iasp.info/wspd2020

There's also an interesting resource on the World Health Organisation website here:

https://www.who.int/mental_health/prevention/suicide/wspd/en/

The AANA has a page with more information about Jan Stewart here:

https://www.aana.com/practice/health-and-wellness-peer-assistance/about-health-wellness/wellness-and-substance-use-disorder-education/jan-stewart-memorial-wellness-lecture-series/jan-stewart-in-memoriam

The Social Prescribing Network is here: https://www.socialprescribingnetwork.com/

AANA Peer Assistance Helpline: 1 800 654 5167 US National Suicide Hotline: 1-800-273-talk (8255)

Depression and Suicidal Ideation is tackled further on the AANA website here:

https://www.aana.com/practice/health-and-wellness-peer-assistance/about-health-wellness/emotional-and-mental-well-being/depression-and-suicidal-ideation

Presented by Nick Margerrison with interviews also conducted by Desiree Chappell and Monty Mythen.

The Patient Safety Movement Foundation (PSMF) has ambitious targets to limit preventable deaths in healthcare, this piece explains how they intend to reduce them down to zero. They need your help, this is a global movement with an action plan to improve the world in an important but achievable way. Their website is here: https://patientsafetymovement.org/

Monty Mythen and Desiree Chappell speak with their guest Michael Ramsay, Chairman, Department of Anesthesiology and Pain Management, Baylor University Medical Center, and President of Baylor Scott & White Research Institute.

"Coming out of this pandemic, and this crisis, I think the future for perioperative medicine is very bright and we should definitely take the opportunity and really build on that now..."

The two co-vice presidents of The International Board of Perioperative Medicine join Desiree's POCAPALOOZA; this conversation is global in its context, with perceptive reflections upon the US healthcare market specifically.

"Towards high‐quality peri‐operative care: a global perspective" - the paper we begin by discussing - is here: https://onlinelibrary.wiley.com/doi/full/10.1111/anae.14921

As anesthesiologists "we are part of teams" how can innovations like tele-medicine help us to do better? Are we right to be optimistic about our specialty in this difficult time? What are "the four M's"?

The International Board for Perioperative Medicine is here: https://www.internationalboardpom.org/

The Global Health Data @ Work team - which both our guests contribute to - are an invaluable resource; visit them here: https://ghdatwork.com/team

The Hartford Foundation is here: https://www.hfpg.org/

"Perioperative medicine journal" is here: https://perioperativemedicinejournal.biomedcentral.com/

Listeners will also doubtless enjoy this paper - highlighted in the conversation - here: "The Brain-Heart Connection: GCBH Recommendations to Manage Cardiovascular Risks to Brain Health" - https://www.aarp.org/content/dam/aarp/health/brain_health/2020/02/gcbh-heart-health-report-english.doi.10.26419-2Fpia.00099.001.pdf

Presented by Desiree Chappell with Lee Fleisher, Professor and Chair of Anesthesiology and Critical Care, University of Pennsylvania and Carol Peden, Professor of Anesthesiology and Exec. Director of the Center for Health System Innovation, University of Southern California, University of Bath and the Institute for Healthcare Improvement (IHI).

If you loved this piece please enjoy another episode of TopMedTalk featuring Lee Fleisher here: https://www.topmedtalk.com/ebpom-2019-brain-health-peri-operative-quality-initiative-poqi-6-what-can-we-do-tomorrow-2/

Or check out some more of Carol Peden's work here: https://www.topmedtalk.com/women-in-anaesthesia-part-6-carol-peden/

Attentive listeners will also recall that we mention the impressive work of Maurizio Cecconi; we profile him here: https://www.topmedtalk.com/topmedtalks-to-maurizio-cecconi/

And finally we mention change management, a theme on TopMedtalk. Check out this classic piece here: ERAS Team Working and managing change - https://www.topmedtalk.com/eras-team-working-and-managing-change/

"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 Perioperative Medicine) EBPOM 2020 - Live From London, it featured as this year's Ernest Henry Starling Plenary Lecture, entitled: "Perioperative Care: A new paradigm for the next decade".

Introduced by Mike Grocott and presented by P.J. Devereaux, MD, PhD, FRCP(C), McMaster University, cardiologist, clinical epidemiologist, and perioperative care physician. Director of the Division of Perioperative Care at McMaster University he is the Associate Deputy Director of the Population Health Research Institute. He is also the Scientific Leader of the Anesthesiology, Perioperative Medicine, and Surgical Research Group at the Population Health Research Institute. A full Professor in the Departments of Health Research Methods, Evidence, and Impact (HEI) and Medicine at McMaster University. He has published over 330 peer reviewed papers and over 80 book chapters, editorials, and commentaries. He has given over 900 lectures and research presentations in 40 countries. He is supported by the McMaster University/ Hamilton Health Sciences Chair in Perioperative Care and a Tier 1 Canadian Research Chair in Perioperative Medicine. He's also the President of the Society of Perioperative Research and Care.