Iain Moppett OBE @iainmoppett.bsky.social · 09/10/2026Congratulations, Prof Leslie. Thoroughly well deserved. @bjajournals.bsky.social is in good hands.static.klipy.comMan Clapping EnthusiasticallyAlt: Man Clapping Enthusiastically 000
Reposted by Iain Moppett OBEANZCA @anzca.bsky.social · 09/10/2026Professor Kate Leslie AO FAHMS, a past president of ANZCA, has been appointed editor-in-chief of the British Journal of Anaesthesia (BJA), making her the first Australian in the role. Read more about Professor Leslie’s appointment here: bit.ly/4yf4LZQ 174
Reposted by Iain Moppett OBEAnaesthesia @anaesjournal.bsky.social · 08/10/2026Beyond survival: understanding postoperative disability in peri-operative care "...disability has emerged as an important outcome that may better reflect the lived experience of patients after surgery compared with conventional endpoints alone." #AnSky #MedSky #SurgSky doi.org/10.1111/anae... 075
Reposted by Iain Moppett OBEBritish Geriatrics Society @gerisoc.bsky.social · 07/10/2026We are pleased to endorse Clinical Guideline for Perioperative Care of People with Parkinson’s Disease, a multidisciplinary pathway guideline developed by the Centre for Perioperative Care with people living with Parkinson’s, carers and multidisciplinary clinical experts. buff.ly/fGIqpbx 033
Reposted by Iain Moppett OBEAlasdair MacLullich @amaclullich.bsky.social · 05/10/2026Constipation is an unglamorous cause of delirium, and a common one. On many wards the bowel chart has a six day gap in it. Check the simple causes first. 053
Reposted by Iain Moppett OBEAdmirable Women @admirablewomen.bsky.social · 04/10/2026English physician & epidemiologist Dr. Alice Stewart is best-known for her pioneering research in the 1950s that established a strong link between prenatal X-ray exposure and childhood leukemia. Her work influenced radiation protection standards. She was born #OTD in 1906. #WomenInSTEM #MedSky 111334423
Reposted by Iain Moppett OBEAlasdair MacLullich @amaclullich.bsky.social · 03/10/2026Post-operative delirium often begins in recovery, not on the ward. The first frightened hours after anaesthesia pass unwitnessed if we only screen at the next routine ward checks. It's good practice to screen in the recovery room (PACU). #periop #delirium 033
Reposted by Iain Moppett OBEAnaesthesia @anaesjournal.bsky.social · 01/10/2026Outcomes and complications of the pericapsular nerve group block with phenol for non-operative hip fracture management in patients living with frailty #AnSky #RASky #frailty doi.org/10.1111/anae... 001
Reposted by Iain Moppett OBEAnaesthesia @anaesjournal.bsky.social · 30/09/2026Pericapsular nerve group block + phenol 6% • for non-operative hip fracture management • in patients living with frailty ⚠️ "is an effective, minimally invasive procedure for pain management in addition to opioid-based pain relief" #AnSky #RASky doi.org/10.1111/anae... 011
Iain Moppett OBE @iainmoppett.bsky.social · 25/09/2026Thanks for sharing @liangrhea.bsky.social Good that this critique is coming from surgeons themselves. I suspect similar issues apply within my world (anaesthesia) and more broadly. Shout out to UK NICE who try to ensure that stuff we do has a clinical and cost-effectiveness base. #AnSky 051
Reposted by Iain Moppett OBERhea Liang @liangrhea.bsky.social · 25/09/2026I don't know any surgeons who wake in the morning thinking 'yep, I'm going to do an operation today that carries no benefit'. 🤔 www.economist.com/science-and-...economist.comMany surgical interventions are little better than placeboA succession of clinical trials is upending the field 5288
Iain Moppett OBE @iainmoppett.bsky.social · 25/09/2026Want to see some cool applied science? My @uniofnottingham.bsky.social neurosurgical colleague, Stuart Smith, has been leading some work on ultra-rapid genetic diagnosis of brain tumours. www.bbc.co.uk/news/article... @braintumourrsch.bsky.social @nanoporetech.combbc.co.ukBrain tumour diagnosis cut from weeks to hours with rapid new NHS testThe test means patients can start treatment sooner and are spared weeks of uncertainty. 030
Reposted by Iain Moppett OBEChristos Chamos @hamos1977.bsky.social · 23/09/2026Here I am this afternoon, returning to the dog-eared, detached pages of a disintegrating old textbook to reread V/Q mismatch under anaesthesia, simply because I was annoyed with myself for having forgotten parts of it. It happens to other people too (the forgetting, I mean)? #ansky 3175
Iain Moppett OBE @iainmoppett.bsky.social · 22/09/2026I know a lot of medics (me included) and others can find statistics a bit opaque and frequently (😉) misinterpret reported findings. Really nice article from a colleague using stories to explore these issues. onlinelibrary.wiley.com/doi/10.1002/... #AnSky #Statsonlinelibrary.wiley.comTeaching Thoughtful Statistical Inference: Stories for the World Beyond <fc><fi>p</fi></fc> < 0.05Statistical hypothesis tests and p values are poorly understood by many students of statistics. Poor application and misinterpretation of statistical inference procedures are common in published rese... 030
Reposted by Iain Moppett OBEJohn Watson @dr-lungs.bsky.social · 19/09/2026Ok. A change for me. This is not about politics. Or a silly joke. This is about chronic respiratory disease. Mine 184
Reposted by Iain Moppett OBEAlasdair MacLullich @amaclullich.bsky.social · 17/09/2026If memory or thinking remains different after delirium, arrange clinical review. Recovery and longer-term cognitive change need to be considered separately. 021
Reposted by Iain Moppett OBEAlasdair MacLullich @amaclullich.bsky.social · 14/09/2026For delirium researchers: Publishing delirium research should not require a four-figure fee. Delirium is open access: €20 to submit and a €280 publishing charge (APC) on acceptance. Peer review normally takes an estimated 4 to 6 weeks. deliriumjournal.com/for-aut... #Deliriumdeliriumjournal.comFor Authors | DeliriumThe open-access home for delirium research, quality improvement, reviews, protocols, and case reports. 011
Reposted by Iain Moppett OBEAlasdair MacLullich @amaclullich.bsky.social · 14/09/2026As people become older and more frail, sometimes the doses of drugs that they are on become toxic. This can also happen acutely. Especially in the presence of acute injury. This is why medication review as part of delirium care is so important. #delirium 022
Reposted by Iain Moppett OBERoyal College of Anaesthetists @rcoanews.bsky.social · 07/09/2026NAP8 update 🙌 The baseline surveys are done! The activity survey is done! We're 3 months into the NAP8 case registry, and almost 90 cases have been logged. Remember to discuss any potential complications below with your local co-ordinator. Learn more 👉 ow.ly/xURr50ZBRP3 #Medsky 165
Reposted by Iain Moppett OBEIain Moppett OBE @iainmoppett.bsky.social · 01/09/2026New consensus guidelines on non-operative (or conservative) management of hip fracture published, led by @healthdataprof.bsky.social. A quick thread on why these are needed and what they say. As always, interested in people’s opinions. www.injuryjournal.com/article/S002... 1/N 🧵 #AnSky #GeriSkyinjuryjournal.comOperative and non-operative management of people with hip fracture: A modified-Delphi study to develop an international consensusTo develop a series of consensus statements regarding the operative and non-operative management of hip fracture patients. 144
Reposted by Iain Moppett OBEElle Cordova @ellecordova.bsky.social · 08/09/2026I am the very model of a modern day typographer A font take on the tune “Modern Major General” by Gilbert & Sullivan #typography #fonts #graphicdesign 24550451568
Reposted by Iain Moppett OBEAltmetric @altmetric.com · 24/08/2026🧵 (Part 1) Science is Not Just for Scientists In a few short years we have seen the rise of scammers, quacks, unlettered politicians assuming critical health infrastructure roles (with predictably devastating results) and more. Should "Science" just be for scientists? 1/25 42114
Reposted by Iain Moppett OBECentre for Perioperative Care (CPOC) @cpoc.bsky.social · 07/09/2026CPOC is delighted to congratulate former Deputy Directors, @scarlettmcnally.bsky.social and @jkdhesi.bsky.social, on being awarded Honorary Fellowships of the @rcoanews.bsky.social (RCoA) at the Diplomates Ceremony on Friday 4 September - cpoc.org.uk/former-cpoc-... 032
Reposted by Iain Moppett OBEProf Scarlett McNally @scarlettmcnally.bsky.social · 05/09/2026It was surreal being awarded Honorary Fellowship of the Royal College of Anaesthetists! Thank you @rcoanews.bsky.social and @cpoc.bsky.social. @collegeofsurgeons.bsky.social @medicalwomenuk.bsky.social 2113
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Conflict: I am an editor for Anaesthesia where some of the referenced work is published, and I sit on the National Hip Fracture Database advisory group. Opinions are all mine - no-one else's. END 000
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Caveat: These are my own reflections on work I was glad to be part of, alongside @healthdataprof.bsky.social, @antonyjohansen.bsky.social, Hanna Willems, Irewin Tabu and Hannah Seymour. Not everyone will agree with every statement - that’s fine, let’s discuss. 31/Nstatic.klipy.comBoss Love Questions: Ask Me Questions CatAlt: Cat wearing glasses leaning on computer: Can says 'Ask Me Questions' 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Limitations worth being upfront about: Our panel was thin on LMIC representation, and there’s a real lack of research comparing operative vs non-operative outcomes across differently-resourced settings. Generalisability has real limits. 30/Nstatic.klipy.comGeorge Costanza: Why Must There Always Be a Problem?Alt: George Costanza: Why Must There Always Be a Problem? 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Methods (cont.): The Delphi was convened by an FFN (Fragility Fracture Network) working group, and the panel spanned anaesthetists, orthopaedic/trauma surgeons and geriatricians. Relevant to members of @assocanaes.bsky.social, @gerisoc.bsky.social and @britorthopaedic.bsky.social alike. 29/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Methods: We ran a 2-round modified-Delphi with an international panel - 67 respondents round 1, 55 round 2, across 17 countries - rating statements on their importance in guiding operative vs non-operative decisions. Reported using the ACCORD framework. pubmed.ncbi.nlm.nih.gov/38709851/ 28/Npubmed.ncbi.nlm.nih.govACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration: Guidance and examples to support reporting consensus methods - PubMedThe ACCORD materials - including the reporting guideline and this explanation and elaboration document - can be used by anyone reporting a consensus exercise used in the context of health research. As a reporting guideline, ACCORD helps researchers to be transparent about the materials, resources (b … 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Bottom line: These are statements of principle, not rules - deliberately ‘should’ and ‘offer’ not ‘must’. For the vast majority of people with a hip fracture, surgery remains the right plan. Non-op options deserve the same rigour, decision-making and governance. 27/N 110
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 13/14 (cont.): currently we don’t know enough about why patients receive non-operative management and what happens to them afterwards. We hope that FFN and individual national registries will pick this up so we get a much better picture to help inform our patients. 26/Nstatic.klipy.comCommander Data's Sarcastic LookAlt: Commander Data smiling. 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statements 13/14: National hip fracture registries are useful for informing shared decision-making on operative care - and should also record why patients choose non-op management, and their outcomes, using standardised classification. 25/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 12 (cont.): advanced care planning. There are no perfect tools for predicting mortality, but even a fairly crude split of the Nottingham Hip Fracture Score can identify a fairly high-risk group. pubmed.ncbi.nlm.nih.gov/21278153/ 24/Npubmed.ncbi.nlm.nih.govNottingham Hip Fracture Score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur - PubMedNHFS can be used to stratify the risk of 1 yr mortality after hip fracture surgery. 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 12: Advance care planning should happen for patients at high risk of death within 12 months of a hip fracture. This is about planning ahead, not just responding to imminent dying. 23/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 11 (cont.): I suspect some places do this really well – after all most geriatricians are experts in palliative care – but sometimes it’s more of a mindset. Has anyone actually written (and explained to the patient / family) that the surgical intent is focussed on palliation? 22/Nstatic.klipy.comMaximus from Tangled: ExplainAlt: Maximus from Tangled: Explain 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 11: Hip fracture can be the precipitant of terminal decline, and either operative or non-operative management can form part of an agreed palliative care approach. Surgery and palliative care aren’t mutually exclusive. 21/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 10 (cont.): The number of people having non-operative / conservative management is always likely to be small, but that doesn’t mean that units (or national organisations) can’t think ahead of time as to what best care looks like. 20/Nstatic.klipy.comPooh Think GifAlt: Pooh Bear: Saying 'think, think, think' 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 10: If non-op management is chosen, there should be clear, patient-centred policies to optimise comfort and dignity. Only 24% of our panellists’ facilities had any protocol for this - it seems the exception, not the rule. 19/Nstatic.klipy.comSkipper: Follow The RulesAlt: Skipper: Follow The Rules 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 9 (cont.): International data (which aren’t great) suggest that currently non-op management is associated with high, but not 100% early mortality. bsky.app/profile/iain... Hence, the importance of the word ‘consider’ – what does / would the patient want? See statement 8! 👆 18/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 9 (cont.): writing ‘at high risk of death’ is pretty straightforward, but as yet, there aren’t any very reliable tools to identify precisely who these people are. Expert clinical judgement is important but not perfect either. pubmed.ncbi.nlm.nih.gov/28585391/ 17/Npubmed.ncbi.nlm.nih.govUnderstanding mortality rates after hip fracture repair using ASA physical status in the National Hip Fracture Database - PubMedHip fracture is the most common reason for older patients to need emergency anaesthesia and surgery. Up to one-third of patients die in the year after hip fracture, but this view of outcome may encourage therapeutic nihilism in peri-operative decisions and discussions. We used a multicentre national … 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statements 9a/9b: Non-op management should be considered for palliation in patients at high risk of dying within the next week (9a), or the next month (9b). 16/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 8 is an important addition to no 7 ☝️: Shared decision making should prioritise the patient’s own wishes, or - if they can’t participate - the priorities reported by people who know them best. Not the clinician’s preference, and not necessarily the family’s either. 15/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 7: Shared decision-making between clinicians, the patient and (where appropriate) their family should inform whether surgery goes ahead. I hope this isn’t controversial - but worth a formal statement given how often this doesn’t happen well. 14/Nstatic.klipy.comMan Says AgreedAlt: Man Says Agreed 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 6 (cont.): Registry data suggest around half of non-op management in high-income countries is for fracture-pattern reasons, not comorbidity / end-of-life reasons. www.nhfd.co.uk/reportopen/N... Lumping them together obscures two very different patient groups and decision making. 13/Nnhfd.co.uk 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 6 is different - about fracture pattern, not frailty: Some hip fractures are mechanically stable or already healing and don’t need surgery. We kept this separate from the frailty / end-of-life statements deliberately. 12/N 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 5 (cont.): the ‘costs’ (financial, familial, social etc) of operating and not operating are very context dependent. Clinicians need to be mindful of the overall impact of the options being discussed. 11/Nstatic.klipy.comCrash Out: Imbalanced ScaleAlt: A Scale tilting from side to side. Representing decision making weighing everything in the balance. 200
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 5: Longer-term health and social care costs should be part of the conversation too, not just immediate surgical risk. Cost-utility work in frail institutionalised patients shows this isn’t just an academic point. pmc.ncbi.nlm.nih.gov/articles/PMC... 10/Npmc.ncbi.nlm.nih.govNonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort studyHip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term ... 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 4: Being older, having delirium or dementia, are not in themselves a reason to withhold surgery. Age or cognitive impairment are important context but not deciding factors - outcomes for people with dementia are more nuanced than that. pmc.ncbi.nlm.nih.gov/articles/PMC... 9/Npmc.ncbi.nlm.nih.govAssociation of Clinical Outcomes With Surgical Repair of Hip Fracture vs Nonsurgical Management in Nursing Home Residents With Advanced DementiaThe decision whether to surgically repair a hip fracture in nursing home (NH) residents with advanced dementia can be challenging. To compare outcomes, including survival, among NH residents with adva... 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 3: Early death within a month of surgery can still happen even with good, shared decision-making. That doesn’t mean the decision to operate was wrong. Open, honest communication with families beforehand is vital. pubmed.ncbi.nlm.nih.gov/32907702/ 8/Npubmed.ncbi.nlm.nih.govPrognosis of nonoperative treatment in elderly patients with a hip fracture: A systematic review and meta-analysis - PubMedNonoperative management of frail elderly patients with a hip fracture is associated with a poor prognosis. Heterogenous study cohorts and limited outcomes were reported. Current literature shows a lack of evidence of the true prognosis of nonoperative management of frail elderly patient with a hip f … 100
Iain Moppett OBE @iainmoppett.bsky.social · 01/09/2026Statement 2 (cont.): This is really important context setting about non-operative management of hip fracture. As with other aspects of palliative / end of life care, we shouldn’t equate non-surgical pathways with doing nothing. 7/N 100