A5091191993- Acute Myocardial Infarction Research
- Cardiac Imaging and Diagnostics
- Trauma Management and Diagnosis
- Atrial Fibrillation Management and Outcomes
- Emergency and Acute Care Studies
- Coronary Interventions and Diagnostics
- Healthcare professionals’ stress and burnout
- Pleural and Pulmonary Diseases
- Trauma and Emergency Care Studies
- COVID-19 and Mental Health
- Posttraumatic Stress Disorder Research
- Cardiac Arrest and Resuscitation
- Health and Medical Studies
- Heart Failure Treatment and Management
- Cardiac, Anesthesia and Surgical Outcomes
- Cardiac Valve Diseases and Treatments
- ECG Monitoring and Analysis
- Ultrasound in Clinical Applications
- Disaster Response and Management
- Airway Management and Intubation Techniques
- Global Health Workforce Issues
- Health Promotion and Cardiovascular Prevention
- Sepsis Diagnosis and Treatment
- Venous Thromboembolism Diagnosis and Management
- Spinal Fractures and Fixation Techniques
University of Bristol
2021-2025
At Bristol
2025
North Bristol NHS Trust
2015-2024
Southmead Hospital
2015-2024
Northwestern Memorial Hospital
2024
University of the West of England
2021-2023
Royal College of Emergency Medicine
2020-2022
Bournemouth University
2014-2018
Poole Hospital NHS Foundation Trust
2013-2018
Poole Hospital
2012-2017
Importance Critical bleeding is associated with a high mortality rate in patients trauma. Hemorrhage exacerbated by complex derangement of coagulation, including an acute fibrinogen deficiency. Management replacement cryoprecipitate transfusions or concentrate, usually administered relatively late during hemorrhage. Objective To assess whether survival could be improved administering early and empirical dose to all trauma that required activation major hemorrhage protocol. Design, Setting,...
Background The original Manchester Acute Coronary Syndromes model (MACS) ‘rules in’ and out’ acute coronary syndromes (ACS) using high sensitivity cardiac troponin T (hs-cTnT) heart-type fatty acid binding protein (H-FABP) measured at admission. latter is not always available. We aimed to refine validate MACS as Troponin-only (T-MACS), cutting down the biomarkers just hs-cTnT. Methods present secondary analyses from four prospective diagnostic cohort studies including patients presenting ED...
Background Staff retention in Emergency Medicine (EM) is at crisis level and could be attributed some part to adverse working conditions. This study aimed better understand current concerns relating conditions practices Departments (EDs). Methods A qualitative approach was taken, using focus groups with ED staff (doctors, nurses, advanced care practitioners) of all grades, seniority professional backgrounds from across the UK. Snowball recruitment undertaken social media Royal College...
<h3>Objective</h3> To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable discharge after single high-sensitivity troponin T (hs-cTnT) taken at presentation to the emergency department. We also compared accuracy of this ADP with strategies using initial undetectable hs-cTnT. <h3>Methods</h3> This prospective observational study evaluated ability Triage Rule-out Using...
Low concentrations of high-sensitivity cardiac troponin I determined on presentation to the emergency department (ED) have been shown an excellent negative predictive value (NPV) for identification acute myocardial infarction. The sensitivity, and therefore clinical applicability, such testing strategies is unknown.To determine diagnostic performance low in patients with suspected chest pain electrocardiogram showing no ischemia as indicator infarction.A pooled analysis 5 international...
<h3>Objective</h3> To evaluate the incidence of major adverse cardiac events (MACE) at 1 year in emergency department (ED) patients with possible acute coronary syndromes, stratified by high sensitivity troponin (hs-cTnI) concentrations using sex-specific cut points compared overall points. <h3>Methods</h3> In a multicentre observational study 2841 patients, presentation hs-cTnI were categorised (women 16 ng/L; men 34 ng/L) and (26 The primary outcome was MACE occurring within presentation....
Introduction The clinical effectiveness of a ‘rule-out’ acute coronary syndrome (ACS) strategy for emergency department patients with chest pain, incorporating single undetectable high-sensitivity cardiac troponin (hs-cTn) taken at presentation, together non-ischaemic ECG, remains unknown. Methods A randomised controlled trial, across eight hospitals in the UK, aimed to establish an hs-cTn and ECG (limit detection discharge (LoDED)) strategy. Eligible adult presented pain; treating clinician...
Objectives The growth in ultrasound usage necessitates concurrent the number of sonographers. Despite increasing importance ultrasound, there is a shortage sonographers United States that has never been specifically quantified. This study examines recent trends exams, sonography graduates, open sonographer positions, and wages. Methods retrospective uses public databases surveys including Medical Expenditure Panel Survey (MEPS), Bureau Labor Statistics (BLS), Integrated Postsecondary...
The psychological impact of the COVID-19 pandemic on doctors is a significant concern. Due to emergence multiple waves, longitudinal data are vital ensure an adequate care response. primary aim was assess prevalence and degree distress trauma in frontline during acceleration, peak deceleration first wave. Personal professional factors associated with also reported.A prospective online three-part survey.Acute hospitals UK Ireland.Frontline working emergency medicine, anaesthetics intensive...
BackgroundOlder people are at the greatest risk of poor outcomes after serious injury. Evidence is limited for benefit assessment by a geriatrician in trauma care. We aimed to determine effect on clinical older admitted hospital with injury.MethodsIn this multicentre observational study (FiTR 2), we extracted prospectively collected data (aged ≥65 years) 23 major centres England over 2·5 year period from Trauma Audit and Research Network (TARN) database. examined within 72 h admission...
To quantify psychological distress experienced by emergency, anaesthetic and intensive care doctors during the acceleration phase of COVID-19 in UK Ireland.Initial cross-sectional electronic survey distributed first pandemic wave Ireland (UK: 18 March 2020-26 2020 Ireland: 25 2020-2 April 2020). Surveys were via established specialty research networks, within a three-part longitudinal study. Participants working medicine acute hospitals across Ireland. Primary outcome measures General Health...
Background Lidocaine patches, applied over rib fractures, may reduce pulmonary complications in older patients. Known barriers to recruiting patients emergency settings necessitate a feasibility trial. We aimed establish whether definitive randomised controlled trial (RCT) evaluating lidocaine patches with fracture(s) was feasible. Methods This multicentre, parallel-group, open-label, RCT seven hospitals England and Scotland. Patients aged ≥65 years, presenting ED traumatic requiring...
Introduction The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. psychological impact frontline doctors of dealing with the currently unknown. This longitudinal professional survey aims to understand evolving and cumulative effects working during outbreak well-being in emergency departments (ED), intensive care units (ICU) anaesthetics pandemic. Methods analysis study a questionnaire-based three predefined time points spanning acceleration, peak...
Introduction Traumatic pneumothoraces are present in one of five victims severe trauma. Current guidelines advise chest drain insertion for most traumatic pneumothoraces, although very small can be managed with observation at the treating clinician’s discretion. There remains a large proportion patients whom there is clinical uncertainty as to whether an immediate required, no robust evidence inform practice. Chest drains carry high risk complications such bleeding and infection. The default...
Introduction Within the UK, chest pain is one of most common reasons for emergency (999) ambulance calls and reason hospital admission. Diagnosing acute coronary syndromes (ACS) in a patient with prehospital setting by paramedic challenging. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision rule validated tool used department (ED) to stratify patients suspected ACS following single blood test. We are seeking evaluate diagnostic accuracy T-MACS aid algorithm ‘rule out’...
Trauma in the elderly (>65 years) is an increasingly common presentation to ED. A fall from standing height most mechanism after which such patients present, and rib fracture non-spinal fracture. Thoracic injury aged over 65 associated with significant morbidity mortality. There are currently no universally applied guidelines for assessment, investigation management of patients. In this expert practice review, we discuss evidence base options clinical vulnerable patient group.