TopMedTalk

This month's TopMedTalk Classic was originally aired in 2019 but remains very relevant today.

Presented by Dr Jugdeep Dhesi, Clinical Lead, POPS and Consultant Geriatrician, Guys and St Thomas' NHS Trust, and an expert on frailty. This talk explores how our understanding and discussion has improved regarding a condition that is still yet to have a clear, universally accepted, definition. How do we build a patient's physical reserve? What is the best way to conceptualise frailty? Are there any universal treatments available?

TopMedTalk's back catalogue contains over 2000 episodes covering all aspects of perioperative medicine. We'd love you to go back and listen to some of our other classic episodes.

Recording from TopMedTalk at EBPOM in Dingle, Ireland, Kate Leslie and Imogen Fecher-Jones interview Oliver Pratt, Consultant Anaesthetist at Salford Royal Hospital, Chair of the Primary FRCA Structured Oral Examinations for the Royal College of Anaesthetists, and a Medical Officer for the Kinder Mountain Rescue Team and Joe Cosgrove, a Consultant in Anaesthesia and Intensive Care Medicine at the Newcastle upon Tyne Hospitals NHS Foundation Trust, a Primary FRCA Examiner for the Royal College of Anaesthetists, and the Critical Care Outreach Lead specializing in advance care planning. He is also Events Medicine Doctor for Durham County Cricket Club and Newcastle United FC plus adviser to the England and Wales Cricket Board on medical contingency and major incident planning for international cricket matches.

The discussion is about contributing to pre-hospital care in mountain rescue and event healthcare.

Oliver describes joining Kinder Mountain Rescue as a volunteer; emphasising that organisational, teaching, and communication skills are often more useful than advanced procedures. He also notes increasing call-outs for poorly prepared walkers alongside serious cases such as major haemorrhage from a femoral artery laceration.

Joe discusses stadium medicine at Newcastle United, where cardiac arrests occur about once per season, including a 19-year-old with Wolff-Parkinson White (WPW) syndrome and cocaine who survived after prolonged CPR amid derby-day security.

Both outline structured debriefing practices, and Cosgrove mentions new mandatory event healthcare requirements and forthcoming government guidance, while Pratt directs listeners to Mountain Rescue England and Wales for involvement or donations. More on that here: https://www.mountain.rescue.org.uk/support-us/

This month's Perioperative Profile features Duminda Wijeysundera, Professor in the Department of Anesthesiology and Pain Medicine and IHPME at the University of Toronto, and a Staff Physician at St. Michael's Hospital, who holds the Endowed Chair in Translational Anesthesiology Research, serves as Head of Science at SPHERE, acts as a Senior Adjunct Scientist at ICES, and is a Trustee for the International Anesthesia Research Society (IARS).

He describes growing up across Sri Lanka, the US, Singapore, and Canada, and how adaptability and cultural sensitivity shaped him; he entered medicine for scientific interest and stability, switched from internal medicine to anesthesiology, and pursued research training using Ontario administrative data, including work on epidural outcomes. He explains the METS study comparing clinicians' judgment, CPET, the Duke Activity Status Index, and NT-proBNP, and discusses follow-on FAST WALK and FIT After Surgery findings on postoperative disability, frailty, and the impact of poor social supports.

Recorded at the Evidence Based Perioperative Medicine (EPBOM) World Congress in London, this TopMedTalk episode, presented by Andy Cumpstey, features Guy Ludbrook, Professor of Anaesthesia and Head of Acute Care Medicine at the University of Adelaide and resident Georgia Cadzow, discussing the Perioperative Quality Initiative (POQI)

POQI is a not-for-profit that uses a formal Delphi process to distill evidence and expert consensus into publishable clinical recommendations on topics such as perioperative hypotension, acute kidney injury, delirium, health economics, and fluid therapy.

Georgia describes the iterative POQI meeting format, including pre-reading, small-group drafting, plenary workshopping, and final voting requiring 85% agreement. The conversation focuses on recent POQI work on Enhanced Postoperative Care (EPOC) units—protocolized, short-stay (24–48 hour) care for medium-risk postoperative patients—covering benefits and harms, economic impacts, and quality indicators, alongside plans for shared core datasets, the EPOC Network, and a 2027 second EPOC World Congress.

Today's TopMedTalk AI podcast was recorded at the Association of Anaesthetists of Great Britain and Ireland in London. It features Andy Cumpstey and Desiree Chappell and their guests, John Whittle, honorary associate professor of Perioperative medicine at University College London and Duncan McPherson, Head of the clinical team at QMD Services and Anesthesiologist and Honorary Professor at University College London.

We discuss how early AI research shares core requirements with other research—especially data safety and governance—while medical device regulation applies the same legal principles to AI as to other devices: safety and performance, alongside separate data protection laws.

Patient concerns focus on data use, trust, and whether AI use in care should require consent. The panel addresses "black box" models, evolving software, bias and generalisability. The conversation contrasts regulated medical devices with unregulated scientific publishing, noting risks from AI-generated fraudulent papers and limits of relying on peer-reviewed literature, while emphasizing critical appraisal and appropriate clinical implementation.

At the 58th Society for Obstetric Anesthesia and Perinatology (SOAP) meeting in Montreal, TopMedTalk hosts Mike Grocott and Desiree Chappell interview Heather Nixon, SOAP immediate past president and Section Chief for Obstetric Anesthesiology; Section Chief for Simulation, Education, and Training Department of Anesthesiology University of Illinois, about SOAP's educational mission, governance, outreach, and special interest groups.

Nixon describes her focus on intraoperative pain during caesarean delivery after a sentinel event and how listening to patient narratives, including The Retrievals (Season 2), highlighted issues such as dismissal of pain, communication failures, and cultural bias. She outlines SOAP's toolkit response and UIC system changes: intraoperative pain scoring every 15 minutes in Epic, empowerment to speak up, workflow education, and quicker conversion to general anesthesia to prevent prolonged severe pain, and notes SOAP's patient-facing Painless Push website.

Link to the The Retrievals: https://podcasts.apple.com/gb/podcast/the-retrievals/id1691599042

Recorded at ANZCA and the Faculty of Pain Medicine's Annual Scientific Meeting in Auckland, TopMedTalk hosts Andy Cumstey and Kate Leslie interview visiting pain research leaders, Professor Irene Tracey, the Vice-Chancellor of the University of Oxford and Professor Lesley Colvin, the Chair of Pain Medicine at the University of Dundee and an Honorary Consultant in Anaesthesia and Pain Medicine at NHS Tayside.

They discuss how thinking has shifted from chronic pain as a simple transition from acute pain, to a distinct disease with separate mechanisms and early "pre-vulnerability" factors including stress-axis disruption and reduced endogenous inhibition. Colvin outlines epidemiological and neuroimaging evidence linking adverse childhood experiences, including repeated medical procedures, to higher risks of chronic pain and other long-term conditions, with reward-system blunting also seen in depression and more severe pain. Tracey explains the "Bayesian brain," where dominant priors can sustain pain, influencing treatment and trial design, while both highlight brain plasticity, emerging neurotech such as VR-based training, and behavior-change approaches to increase physical activity.

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The 2026 International Practicum on Cardiopulmonary Exercise Testing will be held at the Balmer Lawn Hotel in Brockenhurst, UK, from September 16th to 18th this year. It is organised by iPOETTS , the international perioperative testing and training society.

Come and join us at this premier educational event designed for clinicians, scientists, and healthcare professionals interested in sport, exercise, and perioperative medicine.

This is an International Perioperative Testing and Training Society accredited event so when you attend you can get your iPOETTS accreditation, showing that you are a practitioner who has reached a high, standardized level of competence in performing and interpreting Cardiopulmonary Exercise Testing (CPET) for patients preparing for major surgery.

Go now to http://www.ebpom.org

At EBPOM 2026 live from the British Library in London, Joff Lacy and Imogen Fecher-Jones speak with Malcolm West and Tim Baker, clinical co-leads for the National Clinical Audit of Perioperative Care (NCAPC), an NHS England mandated and HQIP-funded initiative managed by the Royal College of Anaesthetists to audit major elective surgery in England and publicly funded Jersey.

They outline the audit's denominator (major surgery with anaesthetist involvement and >24-hour stay), year-one focus cohorts (thoracic, major gynaecology, major hip/knee orthopaedics, and lower GI/colorectal surgery), and aims to improve data quality and reduce unwarranted variation. The team describes a rapid modified Delphi process involving 200+ professionals and 70+ patients to define core metrics, highlights plans to automate data collection via hospital electronic records, and explains local roles, an organisational survey, and the goal of ongoing expansion and long-term delivery.

FOR MORE ON EBPOM IRELAND GO HERE: www.ebpom.org

This month's TopMedTalk Classic has been digitally remastered for you and we've added the Q&A which wasn't part of the original podcast.

We're featuring a talk first broadcast in 2018, featuring BobbieJean Sweitzer, Systems Director, Preoperative Medicine, Inova Health, Falls Church, Virginia, and Professor of Medical Education, University of Virginia.

BobbieJean discusses whether perioperative risk in frail patients can be managed, emphasizing that current risk tools underweight frailty and functional outcomes. Using cases and data from U.S. nursing home residents, she highlights high postoperative mortality and functional decline after procedures such as colectomy and breast surgery, arguing for multidisciplinary, patient-inclusive decision-making that considers nonoperative and palliative options.

Sweitzer describes Northwestern's implementation of quick frailty and cognitive screening, plus interventions including anemia treatment, nutritional optimization, and elements of prehabilitation, noting evidence that screening can trigger goal clarification and more palliative care consults.

In the Q&A, speakers debate frailty-tool consensus, motivating patient engagement, funding prehab services, interpretation of mortality reductions after screening, and strategies to influence surgeons' decision-making.

Original podcasts:

https://topmedtalk.libsyn.com/periop-medicine-sig18-can-perioperative-risk-in-the-frail-be-managed

TopMedTalk: Periop SIG18 | Perioperative frailty - panel discussion

At the Collaborative Clinical Trials meeting in Prato, Italy, Mike Grocott and co-host Mark Priestley speak with Sachin Kheterpal, University of Michigan Medical School's Associate Dean for Research Information Technology and the Robert B Sweet Professor and Kelley M. Kidwell, Chair of the Department of Anesthesiology and Professor of Biostatistics at the University of Michigan School of Public Health and Senior Associate Dean for Faculty Affairs .

Kidwell explains sequential multiple assignment randomized trials (SMART) as multi-stage designs that randomize at key decision points to evaluate treatment sequences, distinguishing them from adaptive trials and addressing misconceptions about sample size. Kheterpal describes the University of Michigan–led Multi-Center Perioperative Outcomes Group (MPOG), contrasting EHR-based automated extraction and individual provider feedback with manually collected programs like NSQIP, and discussing alignment with AQI/NACOR and inspiration from UK National Audit Projects to improve documentation for future inference. They note emerging use of large language models to extract outcomes from free-text notes, discuss pragmatic trial designs including THRIVE, and emphasize the value of close statistician–clinician collaboration and scientific humility, highlighting a BMJ talk on countering misinformation.

For more information on EBPOM Dingle, go here now: www.ebpom.org