Alasdair Gray
A5004488025- Acute Myocardial Infarction Research
- Cardiac Imaging and Diagnostics
- Coronary Interventions and Diagnostics
- Cardiac Arrest and Resuscitation
- Trauma and Emergency Care Studies
- Emergency and Acute Care Studies
- Sepsis Diagnosis and Treatment
- Cardiovascular Syncope and Autonomic Disorders
- Intensive Care Unit Cognitive Disorders
- Respiratory Support and Mechanisms
- Heart Failure Treatment and Management
- Drug-Induced Hepatotoxicity and Protection
- Atrial Fibrillation Management and Outcomes
- Anesthesia and Sedative Agents
- Cardiac, Anesthesia and Surgical Outcomes
- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Hemodynamic Monitoring and Therapy
- Cardiac Arrhythmias and Treatments
- Mechanical Circulatory Support Devices
- Abdominal Trauma and Injuries
- Asthma and respiratory diseases
- Poisoning and overdose treatments
- Clinical Reasoning and Diagnostic Skills
- Ultrasound in Clinical Applications
- Airway Management and Intubation Techniques
Edinburgh Royal Infirmary
2015-2024
University of Edinburgh
2015-2024
Heriot-Watt University
2022-2024
NHS Lothian
2011-2024
Mater Misericordiae University Hospital
2020-2024
Emerge
2023
Institute of Population and Public Health
2023
Christchurch Hospital
2022
British Heart Foundation
2015-2022
Medical Research Council
2022
Noninvasive ventilation (continuous positive airway pressure [CPAP] or noninvasive intermittent positive-pressure [NIPPV]) appears to be of benefit in the immediate treatment patients with acute cardiogenic pulmonary edema and may reduce mortality. We conducted a study determine whether reduces mortality there are important differences outcome associated method (CPAP NIPPV).In multicenter, open, prospective, randomized, controlled trial, were assigned standard oxygen therapy, CPAP (5 15 cm...
Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and a large burden on health-care resources. Strategies identify low-risk patients suitable immediate discharge would have major benefits.We did prospective cohort study of 6304 consecutively enrolled with suspected presenting four secondary tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using high-sensitivity cardiac I assay. In derivation validation...
<b>Objective</b> To evaluate the diagnosis of myocardial infarction using a high sensitivity troponin I assay and sex specific diagnostic thresholds in men women with suspected acute coronary syndrome. <b>Design</b> Prospective cohort study. <b>Setting</b> Regional cardiac centre, United Kingdom. <b>Participants</b> Consecutive patients syndrome (n=1126, 46% women). Two cardiologists independently adjudicated by (men 34 ng/L, 16 ng/L) compared current practice where contemporary (50 single...
Acetaminophen overdose is a common reason for hospital admission and the most frequent cause of hepatotoxicity in Western world. Early identification would facilitate patient-individualized treatment strategies. We investigated potential panel novel biomarkers (with enhanced liver expression or linked to mechanisms toxicity) identify patients with acetaminophen-induced acute injury (ALI) at first presentation when currently used markers are within normal range. In plasma sample from (n =...
High-sensitivity cardiac troponin assays permit use of lower thresholds for the diagnosis myocardial infarction, but whether this improves clinical outcomes is unknown. We aimed to determine introduction a high-sensitivity I (hs-cTnI) assay with sex-specific 99th centile diagnostic threshold would reduce subsequent infarction or cardiovascular death in patients suspected acute coronary syndrome.In stepped-wedge, cluster-randomised controlled trial across ten secondary tertiary care hospitals...
Paracetamol poisoning is common worldwide. It treated with intravenous acetylcysteine, but the standard regimen complex and associated frequent adverse effects related to concentration, which can cause treatment interruption. We aimed ascertain whether could be reduced either a shorter modified acetylcysteine schedule, antiemetic pretreatment, or both.We undertook double-blind, randomised factorial study at three UK hospitals, between Sept 6, 2010, Dec 31, 2012. randomly allocated patients...
Background: High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the optimal approach is uncertain. We compared European Society of Cardiology rule-out pathway with a that incorporates lower concentrations risk stratify patients. Methods: Patients suspected acute coronary syndrome (n=1218) underwent high-sensitivity I measurement at presentation and 3 6 or 12 hours. (<99th centile hours if symptoms <6 hours) developed in High-STEACS study...
Background: The introduction of more sensitive cardiac troponin assays has led to increased recognition myocardial injury in acute illnesses other than coronary syndrome. Universal Definition Myocardial Infarction recommends high-sensitivity testing and classification patients with based on pathogenesis, but the clinical implications implementing this guideline are not well understood. Methods: In a stepped-wedge cluster randomized, controlled trial, we implemented assay recommendations 48...
Delirium affects > 15% of hospitalised patients but is grossly underdetected, contributing to poor care. The 4 'A's Test (4AT, www.the4AT.com ) a short delirium assessment tool designed for routine use without special training. primary objective was assess the accuracy 4AT detection. secondary compare with another commonly used tool, Confusion Assessment Method (CAM).This prospective diagnostic test study set in emergency departments or acute medical wards involving aged ≥ 70. All those...
High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the safety and efficacy of this approach is uncertain. We investigated whether an early rule-out pathway safe effective for patients with suspected acute coronary syndrome.
Abstract Although guidelines recommend fixed cardiac troponin thresholds for the diagnosis of myocardial infarction, concentrations are influenced by age, sex, comorbidities and time from symptom onset. To improve diagnosis, we developed machine learning models that integrate at presentation or on serial testing with clinical features compute Collaboration Diagnosis Evaluation Acute Coronary Syndrome (CoDE-ACS) score (0–100) corresponds to an individual’s probability infarction. The were...
Objectives To determine whether self-monitoring of blood glucose (SMBG), either alone or with additional instruction in incorporating the results into self-care, is more effective than usual care improving glycaemic control non-insulin-treated diabetes. Design An open, parallel group randomised controlled trial. Setting 24 general practices Oxfordshire and South Yorkshire, UK. Participants Patients type 2 diabetes, aged ≥ 25 years glycosylated haemoglobin (HbA1c) 6.2%. Interventions A total...
<h3>Aim</h3> To describe procedural aspects and clinical outcomes in a consecutive series of patients whom manual aspiration thrombectomy (MAT) was performed as the first treatment modality with other techniques used only case MAT did not yield recanalization. <h3>Methods</h3> A retrospective review prospectively acquired acute stroke intervention database performed. Primary carried out preference for largest catheter considered to be trackable into target occlusive lesion. The wedged...
In September 2012 the UK's Commission on Human Medicines (CHM) recommended changes in management of paracetamol poisoning: use a single '100 mg l(-1) ' nomogram treatment line, ceasing risk assessment, treating all staggered/uncertain ingestions and increasing duration initial acetylcysteine (NAC) infusion from 15 to 60 min. We evaluated effect this presentation, admission, treatment, adverse reactions costs poisoning.Data were prospectively collected adult patients presenting three large UK...
Delirium is a common and serious neuropsychiatric syndrome, usually triggered by illness or drugs. It remains underdetected. One reason for this lack of brief, pragmatic assessment tools. The 4 'A's test (Arousal, Attention, Abbreviated Mental Test - 4, Acute change) (4AT) screening tool designed routine use. This project evaluated its usability, diagnostic accuracy cost.Phase 1 the usability 4AT in practice was measured with two surveys qualitative studies health-care professionals, review...
High-sensitivity cardiac troponin assays can help to identify patients who are at low risk of myocardial infarction in the emergency department. We aimed determine whether addition clinical scores would improve safety early rule-out pathways for infarction.In 1935 with suspected acute coronary syndrome, we evaluated and efficacy 2 alone or conjunction low-risk TIMI (Thrombolysis In Myocardial Infarction) (0 1), GRACE (Global Registry Acute Coronary Events) (≤108), EDACS (Emergency Department...
Major disparities between women and men in the diagnosis, management, outcomes of acute coronary syndrome are well recognized.The aim this study was to evaluate impact implementing a high-sensitivity cardiac troponin I assay with sex-specific diagnostic thresholds for myocardial infarction suspected syndrome.Consecutive patients were enrolled stepped-wedge, cluster-randomized controlled trial across 10 hospitals. Myocardial injury defined as concentration >99th centile 16 ng/l 34 men. The...
Objective To evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis myocardial infarction across different healthcare settings.Design Prospective study three independent consecutive patient populations presenting to emergency departments.Setting Secondary and tertiary care hospitals in United Kingdom States.Participants High I concentrations were measured 8500 departments: unselected UK (n=1054) two selected whom was requested by attending...
Abstract Objectives To establish if the use of early computed tomography (CT) coronary angiography improves one year clinical outcomes in patients presenting to emergency department with acute chest pain and at intermediate risk syndrome subsequent events. Design Randomised controlled trial. Setting 37 hospitals UK. Participants Adults suspected or a provisional diagnosis more previous heart disease, raised levels cardiac troponin, abnormal electrocardiogram. Interventions Early CT standard...
Abstract Despite progress in the development of standards for describing and exchanging scientific information, lack easy-to-use mapping between different representations same or similar objects databases poses a major impediment to data integration interoperability. Mappings often metadata needed be correctly interpreted applied. For example, are two terms equivalent merely related? Are they narrow broad matches? Or associated some other way? Such relationships mapped not documented, which...
Collaboration for the Diagnosis and Evaluation of Acute Coronary Syndrome (CoDE-ACS) is a validated clinical decision support tool that uses machine learning with or without serial cardiac troponin measurements at flexible time point to calculate probability myocardial infarction (MI). How CoDE-ACS performs different points measurement compares guideline-recommended diagnostic pathways rely on fixed thresholds uncertain.
Background Supporting people to quit smoking is one of the most powerful interventions improve health. The Emergency Department (ED) represents a potentially valuable opportunity deliver cessation intervention if it sufficiently resourced. objective this trial was determine whether an opportunistic ED-based can help smoking. Methods In multicentre, parallel-group, randomised controlled superiority conducted between January and August 2022, adults who smoked daily attended six UK EDs were...