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 alongside a message that 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 last year, 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.

"Hypotension probability in practice" - originally streamed live from The Institute of Engineering and Technology (IET) in London during EBPOM 2018 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: www.ebpom.org/meetings

If you have any comments or questions you'd like to send to the team email: [email protected]

Presented by Mike Spiro, anaesthetic consultant at the Royal Free Hospital and Jez Fabes, Speciality Registrar and Academic Clinical Fellow of Anaesthesia at University College London (UCL) Hospitals.

"We've had the opportunity to catch up with some friends from Africa to tell us more about what is happening in their neck of the woods with perioperative medicine..."

We reference this piece in The Lancet here: https://www.thelancet.com/journals/lancet/issue/vol396no10243/PIIS0140-6736(20)X0027-4

The African Surgical Outcomes Study (ASOS) is discussed in more detail here: https://www.topmedtalk.com/topmedtalk-african-surgical-outcomes-study-asos-2/

The above piece inspired the Evidence Based Perioperative Medicine (EBPOM) team to take action and organise a ground breaking night of live music and conversation about cutting edge scientific research; the now famous "POCAPALOOZA" - POC, perioperative care and "APALOOZA" meaning some form of festival.

In spite of the global pandemic, one of the world's leading medical communites, decided to organise an online international academic conference followed by a massive fundraising effort for perioperative research, in Africa.

For more about the African Perioperative Research Group (APORG) start here: https://onlinelibrary.wiley.com/doi/epdf/10.1111/anae.14934

"People in Africa are twice as likely to die from surgical complications.."

If you want to help, donations welcome at: https://www.justgiving.com/crowdfunding/protea-live?utm_id=1&utm_term=ZKW35J94X

Current total at the time of press: £7,581 - Thank you!

Presented by Desiree Chappell with her guests Bruce Biccard, consultant anaesthetist at the University of Kwazulu-Natal, Director, Perioperative Research Unit, Department of Anaesthetics, Nelson R Mandela School of Medicine and Salome Maswime, Obstetrician and Gynaecologist and Professor of Global Surgery at the University of Cape Town.

Press media inquiries: [email protected]

This piece focuses upon the unique 'Collaborative Clinical Trials in Anaesthesia biennial conference', of which this was the fifth, organised in Prato, Italy, by Monash University.

TopMedTalk was given the chance to listen in on this cutting edge gathering of trialists, academics and practitioners as it happened. We take a deeper dive on the history behind this very special meeting, how it works and special moments from the meeting.

Learn how some of the big trials gather pace and how major studies get established.

The ANZCA Clinical Trials Network is here: http://www.anzca.edu.au/ctn

More detail on the African Surgical Outcomes Study - 2 (ASOS-2) here: https://www.asos.org.za/index.php/about-the-study

Presented by Desiree Chappell with Monty Mythen and their guest Paul Myles, Director, Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University.

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Like this, want more?

Bruce Biccard is interviewed here: https://www.topmedtalk.com/prato-2019-bruce-biccard/

Also, check out EBPOM Chicago now for exclusive ticket offers: www.ebpom.org

Originally broadcast live from Anesthesiology 2019, this piece is a chance to hear from a couple of Temple University residents who presented on two different cases: The first being a critical care case in the ICU involving acute respiratory distress; the second involving a case of surgery for a pheochromocytoma in a patient with neurofibromatosis type 1 and severe pulmonary hypertension and right ventricular failure.

What challenges do the residents describe in these cases and how were they overcome?

Presented by Desiree Chappell with Mike Grocott and their guests Dane Grenda and Noreen Tiangco, Residents at Temple University Hospital.

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We reference this podcast here: https://www.topmedtalk.com/sca-poster-presenters/

After a quick chat about the immediate aftermath of the incredibly successful EBPOM LIVE from London and its accompanying online Perioperative Care Festival, The POCAPALOOZA , 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 similar evidence standard needed to take a new drug to market? How are research and development administered? How can we make a clinical and economic argument that makes sense to everyone?

Also, how has the Covid Crisis galvanized the medical industry and shown them that things can be achieved at speed in our profession?

The Ventilator Training App episode we reference is here: https://www.topmedtalk.com/covid-19-the-ventilator-training-alliance-app/

Presented by Desiree Chappell and Monty Mythen with their guests, Vafa Jamali, Senior Vice President and President of Respiratory, Gastrointestinal & Informatics (RGI) within Medtronic's Minimally Invasive Therapies Group (MITG) and Jennifer Doyle, Global Vice President, Medical Affairs - Respiratory, Gastrointestinal & Informatics and MITG at Medtronic.

This panel discussion is an honest and challenging look at blood pressure management. Questions include but are not limited to: How should practitioners maintain blood pressure in patients and where is the threshold? How much precaution is inspired by eminence rather than actual evidence? What is the best and safest way to attenuate sympathetic responses intraoperatively? If harmful hypotension occurs between induction and incision should we refuse to induce anaesthesia until the surgeon is scrubbed and ready? If we had better, more specific or sensitive ways to monitor tissue perfusion rather than blood pressure and now - almost discounted - urine output, would this lead to better care? Is it the case that minimally invasive cardiac output technology may be of much greater value in the ward than in theatre?

Presented by Desiree Chappell with Monty Mythen and Dr Simon Davies, Consultant Anaesthetist at York Teaching Hospital NHS Foundation Trust with Timothy Miller, Associate Professor of Anaesthesiology from Duke University Medical Centre.

How can a multidisciplinary group collectively define and maintain what they do while maintaining a patient centred approach? How focused can prehabilitation become? Should personal trainers be more widely involved in perioperative medicine? What is the correct terminology when it comes to expertise in the various areas of your team? Should practitioners be expected to apply lifestyle behaviour changes which other members of our team advocate to patients?

Why is a collaborative approach so important to perioperative medicine?

The ELLICSR Kitchen is here: https://www.ellicsr.ca/en/clinics_programs/ellicsr_kitchen

Presented by Daniel Santa Mina, Assistant Professor at University of Toronto & Scientist in ELLICSR at the Princess Margaret Cancer Centre.

This piece focuses on the work of our guest and her impact upon the crucial area of gender and racial diversity in the US Anesthesia and Critical Care Workforce. How can we advocate for diversity within this field? What do we make of the Athena SWAN (Scientific Women's Academic Network) charter? Can social media help to raise awareness and build communities that can tackle these issues?

Also in this piece we discuss Implementation Science, the study of methods to promote the adoption and integration of evidence-based practices, interventions and policies into routine health care and public health settings.

More about Athena SWAN (Scientific Women's Academic Network) here: https://www.ecu.ac.uk/equality-charters/athena-swan/

Presented by Desiree Chappell with Monty Mythen and their guest Meghan Fall-Lane, Assistant Professor of Anesthesiology and Critical Care at the Perelman School of Medicine; Co-Director of the Penn Center for Perioperative Outcomes Research and Transformation; and Senior Fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania.

"Surgery and anaesthesia; you very much recognise right away that that is considered a luxury in many place of the world"

Do you work in a low-resource setting or support partners and organizations that do?

The Lifebox pulse oximeter is specifically designed for high-use, low-resource environments.

Hear about how Lifebox came into existence and discover how you can help.

The World Health Organisation's Surgical Safety Checklist is here: https://www.who.int/patientsafety/safesurgery/checklist/en/

Recorded live at Anesthesiology 2019, Orange County Convention Center, Orlando and presented by Desiree Chappell, with Sol Aronson, and their guests Alexander Hannenberg, M.D. Senior Research Scientist, Ariadne Labs; Principal Consultant, ORDx&Rx Surgical Safety Solutions, 2010 president of the American Society of Anesthesiologists (recently served as its Chief Quality Officer) and by Kris Torgeson, Global CEO, Lifebox Foundation.

Find out more here: https://www.lifebox.org